How to Identify and Process Unbilled Procedures

Unbilled Procedures are billable (claimable) procedures that have been completed and posted to patient ledgers, but not yet billed to insurance. Sensei Cloud provides a consolidated To Do list for you to identify and collect this revenue. 

The Location tab also displays a widget under Claim Stats with a link to this list.
 

To identify and process unbilled procedures:

1. From the Location tab, select To Do > Unbilled Procedures. 
   The software displays a list of patients for whom billable work has been completed, but not billed to their insurance companies.
   
   Note: You can use the filters to refine the list for patients, providers, payers, a service date or
   range, or a specific revenue value range. You can also enable a filter to display procedures that have been set to Never Bill to insurance. See Marking Procedures as Never Bill to Insurance for more information. 
2. Click an item in the list to view summary details and insurance information, and to view the patient’s ledger, or manage claims for the patient.
   
3. Click Create New Claim. The Create Insurance Claim window is displayed with a list of the patient's unbilled procedures.
4. Select the procedures to include in the claim, and then click Create.

Marking Procedures as Never Bill to Insurance 

When needed, you have the ability to flag billable procedures as Never Bill, meaning that they will never be billed to the patient's insurance and thus do not need to be included on a claim. This can be done from either the Unbilled Procedures list or from the Patient Ledger. 

Completed procedures that are marked as Never Bill are hidden from the Unbilled Procedures list. 

This functionality helps you to keep the Unbilled Procedures list tidy and distinguish between procedures that are "on hold" while insurance coverage is confirmed, additional details for the claim are collected, or some related, billable services are awaiting to be completed, etc., from procedures that you never plan to bill to patient insurance. 

Note: 
-- From the Unbilled Procedures list, you can select the Show Never Bill Procedures filter option to view patients with unbilled procedures that have been set to Never Bill. 
-- Click the list item to access the Create New Claim option if for any reason you need to create a claim for the procedures (e.g., if you selected Never Bill by accident). See Returning Never Bill Procedures to the Unbilled Procedures List for more information. 

To mark a procedure to never be billed to insurance from the Unbilled Procedures List:

1. From the Location tab, select To Do > Unbilled Procedures. The Unbilled Procedures list is displayed.
2. Click on the list item for the patient. The list item is expanded.
3. Click Create New Claim. The Create Insurance Claim window is displayed.
4. Select one or more procedures that do not need to be billed to insurance.
5. Click Never Bill. If the patient does not have any other unbilled procedures remaining, the line item is removed from the main Unbilled Procedures list view. 
   

To mark a procedure to never be billed to insurance from the Patient Ledger:

1. Navigate to the Patient Ledger (Patient > Financials > Ledger).
2. From the Actions menu, select Create New Claim ([#] Unbilled). The Create Insurance Claim window is displayed.
3. Select one or more procedures that do not need to be billed to insurance.
4. Click Never Bill. The procedure is removed from the Unbilled procedure count on the patient's ledger and is relocated to the patient's Never Bill Procedures list (which is also accessed from the Create New Claim window). 

Returning Never Bill Procedures to the Unbilled Procedures List

When a patient has procedures that are set to never bill, you can view them from the Create Insurance Claim window. You also have the ability to return the procedures to the unbilled list if you change your mind and need to bill the patient's insurance. 

To set a Never Bill procedure as an unbilled procedure from the Patient Ledger:

1. Navigate to the Patient Ledger (Patient > Financials > Ledger).
2. From the Actions menu, select Create New Claim ([#] Unbilled). The Create Insurance Claim window is displayed.
3. Click View Never Bill Procedures ({#]). The Never Bill Procedures window is displayed.
   
4.  Select the procedures that you want to move back to the Unbilled Procedures list.
5.  Click Mark as Unbilled.

You can also return Never Bill procedures to the Unbilled Procedures list directly from the Unbilled Procedures list:

1. From the Location tab, select To Do > Unbilled Procedures. The Unbilled Procedures list is displayed.
2. Select the Show Never Bill Procedures filter option.
3. Select the list item. The list item is expanded.
4. Click Create New Claim. The Create Insurance Claim window is displayed.
5. Click View Never Bill Procedures ({#]). The Never Bill Procedures window is displayed.
6.  Select the procedures that you want to move back to the Unbilled Procedures list.
7.  Click Mark as Unbilled.