Workfile Build/Prelist

Use the Workfile Build/Prelist routine to build a workfile that contains the appropriate charges to be billed and to print a Prelist that contains any errors and omissions in the patients' records associated with the charges to be billed.  In addition, the Prelist prints a Medicare Secondary Claims List, which lists all of the secondary Medicare claims so that you can check for the EOB records.  You can use the Prelist to correct the errors and omissions before actually submitting the claims.  This will substantially reduce third-party rejections.

 Important:

• While the Workfile Build will bring in all appropriate charges for all form types regardless of the form types selected during the routine, the Prelist only reports errors for charges associated with the form types selected during the routine.

• The Workfile Build/Prelist is the first step in the billing cycle after completing all Daily Work including the Charge Payment Post Initialize.  For more information, see the Billing Overview.

• For information on the criteria that determines which charges are included in the billing workfile, click More.

  • Charges qualify to be included in the billing workfile and to be billed to a third-party insurance if:

  • The charge is assigned an insurance code with Insurance Form Type to Print of 1-9 and

  • The charge has never been billed before (the charge has a Bill Date of zero)

  • The patient's Allowed Insurance Forms is set to Yes

  • Or, the charge is rebilled

  • Charges qualify to be included in the billing workfile and to print on a patient statement if:

  • The patient's Insurance Responsibility is set to Patient and

  • The number of days from the Patient's Date of Last Statement to the current Billing/Statement Date is greater than the Days Between Statements maintained on the Statements Parameter and
    Note:  If during Charge Entry or Payment Entry the ticket's Force Next Statement is set to Yes, the patient will qualify for a statement regardless of their current billing cycle.

  • The Ticket balance is greater than zero

  • Charges are included in the billing workfile and qualify to be billed to a third-party insurance and to print on a patient statement if:

  • The Insurance Form Type to Print is not equal to 0 or -1  and

  • The Insurance Accept Assignment is set to No and

  • The Insurance Force a Statement flag is set to Yes

   

• Since all information that prints on the insurance claim forms and patient statements is derived from the billing workfile, (think of the workfile as a holding bin) charges entered into INSight after the file is rebuilt will not appear unless the workfile is rebuilt.

• For more information about running reports, see Print View.

Directions:

To see directions for...

• Opening the Workfile Build/Prelist Routine, click More.

   

  1.  Click Billing Functions from the Menu Bar.

  2.  Click Workfile Build/Prelist.
  
  Or, use the keyboard shortcut:  [ALT] [b] [w] [ENTER].

   

  Workfile Build/Prelist Window Example:

  

   

• Choosing the Selections, click More.

   

  Workfile Build/Prelist Prompts Tip:  To see more information about a field, click the hyperlink for the field name.
  Billing/Statement Date	To accept the system date as the Billing Statement Date, press [TAB] or enter another date as the Billing Statement Date. (mmddccyy - slashes and century optional) Note:  It is important to make sure the Bill Date is for the correct date!
  Selection	To identify the steps to run during the routine, click to select a choice: Rebuild Workfile Only Rebuild Workfile and Print Prelist Tip:  Generally, you will choose this option first to build the workfile and print the Prelist. Print Prelist Only Tip:  Choose this option if the workfile is already built for the billing cycle and you wish to reprint the Prelist. Note:  All qualifying claims will be pulled into the workfile regardless of the form types that are selected to print.
  Select All Form Types	To specify the form types associated with the tickets to report on the Prelist, click to select the appropriate forms.   Or, to include all Form Types, click to check the Select All Form Types box. Tip:  The Select All Form Types option includes Private for private patient statements.
  Include Open Admission Tickets?	To only include open admission tickets in the workfile, click to select this box. To include all appropriate admission tickets in the workfile, de-select this box. Note:  Select to include open admission tickets if you do hospital billing for charges that have admission dates with no discharge dates and you want to bill them.
  	Displays the default printer number, which can be changed.  For more information, see Printing Options.
  	To run the routine and generate the report, click Print or press [ENTER]. Keyboard shortcut:  [ALT + p]
  	To escape from the routine, click Cancel.  Or, click Close . Keyboard shortcut:  [ALT + c]

   

• Understanding the error messages on the Prelist, click More.

   

  Common Prelist Messages & Corrections Tip:  To see more information about a field, click the hyperlink for the field name.
  Prelist Message	What To Do
  CURR INS DOES NOT VERIFY	This message indicates that the patient account number does not have the specified insurance assigned to their account.  INSight is trying to place the ticket in the billing workfile for the specified insurance.  To correct: Go to the Insurance Window of Patient Entry and add the insurance to the Patient Or, transfer the ticket to a valid insurance for the patient
  CURR INS CERTIFICATE #	This message indicates that INSight cannot find the patient's policy holder certificate number or the certificate number does not have the correct number of characters as specified during Insurance Maintenance, which is a likely error to get in conjunction with the Curr Ins Does Not Verify message.  However, if you get this error alone, go to the Insurance Window of Patient Entry, click on the insurance and add a valid certificate number or verify that certificate number has the correct number of characters. Note:  Also, make sure the patient's Allowed Insurance Form is set to Yes.
  NO INS ALLOWED	This message indicates that the patient's Allowed Insurance Form is set to No.  To allow the patient's charges to be billed, change this setting to Yes. Tip:  Sometimes a patient's Allowed Insurance Form is set to No if the patient address is missing or incorrect and you do not want to bill the claim electronically.
  NO STATEMENT ALLOWED	This message indicates that the patient's Allowed Statement is set to No.  To allow the patient to receive a statement, go to the Allowed window of Patient Entry and change the Allowed Statement setting to Yes.
  ADDITIONAL DOCUMENTATION REQUIRED	This message alerts you to the fact that the insurance company requires additional documentation for the procedure associated with the charge when submitting a claim for reimbursement.  The message displays when the procedure's Additional Doc setting is set to Yes.
  PATIENT DEMOGRAPHICS MISSING	If any of the following patient information is missing, go to Patient Entry and add the missing information: Patient Last Name Patient First Name Patient Address, City, State, Zip Patient Date of Birth

   

• Report Sample(s), click More.

   

  To see an example of the report, click Workfile Build/Prelist Report Sample.