With Custom Claims you can send claims without needing to create, and work, predefined schedules.
Billiyo Custom Claims allow us to prepare bills by selecting a service authorization and billing frequency. After completing this initial set up, all future billing can be handled by pressing a single button.
Jump To:
Navigation
Claim Setup
Generate claim
View Claim
Void Claims
Before creating a custom claim, you will need to enter the Service Agreement that you will be billing. Click here to learn how to enter a service auth.
Navigation
To access the custom claim feature Navigate to Billing > Custom Claim
If you don't see the custom claim option, please reach out to your CSM.
This will take us to the custom claim page where we can create new custom claims, bill the claims we have set up and review/void the custom claims that have been sent.
The Custom Claim page is separated into four tabs
Claim Set Up - Create the set up for the claims that we will be sending
Generate Claim - Send claims based on the set up that was established
View Claims - View and void the custom claims that were sent
Void Claims - Review the custom claims that were voided.
Claim Setup:
To create a custom claim set up, first click into the Claim Setup tab.
This will show us all of the custom claim set ups that have been prepared for your agency. To create a new set up, please click the "Claim Setup" button to the top right of the page:
In the resulting pop up please select the client that we are creating a custom claim for. After choosing a client, some additional fields will appear:
In this expanded window please select the Service Auth that the claim is being prepared for and the frequency that will be billed.
Frequency Options:
Daily -Prepare a unique claim for every day
Monthly - Prepare one claim for the entire month month (Example: 2/1/2025 - 2/28/2025)
Bi-weekly - Send two Custom claims every month (Example: 2/1/2025 - 2/15/2025 and 2/16/20205 - 2/28/2025)
Once - Prepare a claim that will only be sent once
As Needed -Prepare claims that can be sent multiple times whenever you want.
After creating a custom claim set up, it will be added to the table view:
Each custom claim set up will include the dates that the claim is expected to be sent based on the frequency that was provided.
For example, if the custom claim was set up with monthly frequency, and the authorization lasted a year, then there would be 12 entries. One for each month in the auth.
Because claims with the "As Needed" and "Once" frequency do not a set "schedule" they will have not have dates. However, when its time to sent the claim, we will be able to manually enter the dates that we are billing for.
After setting up a custom claim, its time to bill it.
Generate Claim
To send a custom claim, we will click into the "Generate Claim" tab.
This page will show us a list of all the custom claims we can send. In the middle of the table is a Start Date and End Date column.
These date will be auto filled by the frequency we entered when setting up the claim.
For example, if a claim was set up for a "bi-weekly" frequency, the auto filled date range will be for 14 days.
If the frequency was set up as "Once" or "As Needed" then the date range will be blank and you will be asked to enter it yourself.
The Custom Claim page can only show claims with the same frequency. By default, the custom claim tab will showcase all claims with the "Monthly" frequency. However, the frequency can be changed by using the filter at the top of the page:
While generating a claim the service rate is pulled from the agreement and the unit counts defaults to 1. However, you can edit this information directly in the Generate Claim table.
As you change the units and rate, the "Total Charges" column will adjust accordingly.
If you can't see a claim you want to send, please check the date range at the top of the page. Custom claims will only appear in the table if the coincide with the date range.
After reviewing the custom claims, and making any changes that are needed, we can send them by clicking on the check box next to the the claims that we want to send. After selecting these claims we can send them off by hitting the blue "Generate Claim" button to the top right of the page.
After being billed, the claims will leave the "Generate Claim" tab and appear in the "View Claim" tab.
View Claims
To see the claims that you sent, and review their payment status, we can use the "View Claims" tab.
To view a claim in more detail, and review the Service Auth used, we can hit the green plus sign next to the client's name:
In this expanded view we will also see a "Claim Notes" button. This option will generate a pop-up where we can enter internal notes on a claim and provide the claim's ICN number.
The ICN number is also known as the "Control Number" and "Payer Claim Number"
If we are receiving your remittance from your payer, the ICN number will automatically fill in. If you are not receiving remittance in Billiyo, please contact your CSM.
To void a claim that was sent, we will first hit the white check mark to select the claims you want to void. After making your selection you can take back the selected claims by hitting the "Void Claims" button in the top right of the page.
If you don't see the check mark next to a claim, then the you don't have the control number in Billiyo.
Void Claims
To review claims that had been voided, we can click into the Void Claims tab to the top right of the page.
There are filters at the top left of the page that we can use to locate an individual claims. We can search for a voided claim by looking for the client's name and the date the claim was sent back.
After locating a voided claim we can open it up and review the claim in more detail by hitting the green plus sign. 