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Determining the eClaims option

When you click Save after capturing an invoice Panacea (after saving the invoice) must decide between one of the following courses of action:

  • Send the invoice immediately as a realtime eClaim, or
  • Place the invoice in the Pending eClaims queue so that it can be sent later, or
  • Do not send the invoice as an eClaim

Panacea makes this decision as follows:

If eClaims have been disabled on the settings tab  of the patient's account  - either on the Disable eClaims field or the Disable eClaims Until field - then Panacea will not send the invoice as an eClaim.

If there is no funder  specified on the patient's account, then Panacea will not send the invoice as an eClaim.

If there is a funder  specified on the patient's account then Panacea will check if the funder  has a valid eClaims Destination .  If not then Panacea will not send the invoice as an eClaim.  If the funder  does have a valid eClaims Destination  then Panacea checks the funder's eClaims Option .  If the funder's eClaims Option  is set (i.e. it is not Default) then Panacea will act according to this setting.

If the funder's eClaim option is set to Default then Panacea looks at the setting on the practice eClaims settings .  Note that there are two possible settings depending on whether the eClaims Destination is realtime-enabled or not.

 
 
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