Welcome to Dr.Bill! We're happy you're here.
Now, you're on your way to fast and easy medical billing and this article is a great place to start with how to manage your claim issues on our platform.
When you join Dr.Bill, there are two service level options: Essentials and Comprehensive.
Comprehensive:
If you're a Comprehensive user, we manage your rejections and refusals for you. We will only reach out if we need additional information to fix and resubmit your claims. It's important to check-in using the web application (app.dr-bill.ca) on a regular basis to ensure that the messages from our team are reviewed as soon as possible.
You can review notifications for billing issues by checking the bell icon in the top right hand corner of your dashboard:
Here, you will see an overview of the claim and patient issues that require your attention.
Select "View Claim" to leave a message for our agents on the timeline:
Once complete, you can "Mark as Resolved" to remove the notification from your account.
Our team aims to review your claims within 30 days of each remittance. You can help by making modifications to your claims on your own, or providing us with additional information in advance of our review.
If you feel that the claim cannot be recovered, write it off. This tells that it does not need to be pursued.
If you know how to resolve the issue with your claim, you can make the appropriate changes and re-submit the claim yourself. Click the Edit button, make the necessary changes, and click Save. Then, click the Re-submit button.
If you aren't sure what to do, or if you have questions or comments that will help us resolve the issue, send us a message.
Messages on your claims are reviewed in about 7-10 business days. If you're looking for a faster response, send us a message through our in-app messaging system (click the speech bubble icon in the bottom-right of the screen).
Essentials:
When you are an Essentials user... you're in charge of your own claims. Our team will not be monitoring any patient or claim issues, so you'll need to check on this frequently to ensure that nothing is missed.
Refusals:
For Alberta Billing, some refusals are returned from Alberta Health daily (such as 05BB) and the rest within 24-48 hours of submission. You'll notice updated claim status after Friday submission on the weekend.
Once a claim is refused, you can edit the claim and resubmit the changes, the claim will then be sent with a new claim number automatically by our system. If the claim is past 90 days from the DOS, the claim will require text stating the previous claim numbers.
In order to monitor incoming refusals, you'll need to navigate to the "Claims" tab on the web, and select "Submission Error" tab:
Here you will see any claims that came back from the ministry with issues that require your attention.
In order to review the reason for refusal and make necessary changes, select "View" next to a claim:
Here you will see the claim overview and applicable actions at the top right hand side of the screen:
If you scroll to the Timeline, you can review the reason for Refusal:
To make changes to the claim, scroll back up and select "Edit":
This will re-open the original claim and allow you to edit the items that require correction. Once the changes have been made, select "Save".
This brings you back to the claim overview where you need to select "Re-Submit" to submit the claim back to Alberta Health.
If you need to make edits to the patient and not the claim, select the "Edit" pencil next to the patient name at the top of the claim, make the changes, "Save" and "Re-Submit".
Rejections/ Paid with Adjustment/Paid Claims:
Rejected, paid with adjustment and paid claims can be edited and the changes can be resubmitted. For claims with these statuses, the resubmitted claim will be resubmitted as a change action code with the same claim number. Previous claim numbers do not need to be listed in the text field.
These claims (Rejected, Paid and Paid with Adjustment) can be reviewed in two ways.
Navigating to the "Rejections" or "Paid with Adjustments" tab on the "Claims" page of your account:
Or, you can review rejections, paid claims or adjustments on your Remittance in "Reports" > "Payments":
When dealing with claim rejections, you'll follow similar steps as outlined above to locate the reason for rejection. On the claims tab, select "View":
Or, in your remittance, select the blue box to the left of the billing item and PHN:
Once you are in the claim, you can scroll to the timeline to review the reason for rejection:
Depending on the reason for rejection, you can cancel the claim (and submit a new one if needed), reverse the claim, write the claim off or accept and close the claim.
Important to note:
- Rejections and refusals can not be managed from the mobile application at this time. Only on the web.
- AB Physicians have 90 days from the DOS to submit claims to Alberta for payment
We hope this helps you manage your rejections and refusals, but if you need more support, please reach out to us at hello@dr-bill.ca.
Happy Billing!