My Clients Plus Claims Process Overview (My Clients Plus 3.0)

  Permissions: You must have Billing Permissions with the ability to "Submit Claims to Clearinghouse" enabled.

In order to use My Clients Plus to process Claims with Apex, manage your subscriptions to add Claims and then enroll your Payers with Apex. If you have not done that, you will not be able to see all the tabs described below.

There are 5 steps in the Claims Process with  Apex:

The first few steps in the Claim Lifecycle: Create an Invoice, do a basic Claim Scrub, and Submit the Claim to Insurance.

1. 1. Create the Invoice.
   2. Add the Invoice to Awaiting Submission - The Invoice becomes a Claim and sits in the Awaiting Submission queue. 
      • While you Claims are Awaiting Submission, you can perform a general Claim scrub. Claims can be checked for common errors such as Date of Birth, Gender, Address, Diagnostic Code, etc. If a Claim has no errors can be submitted to Apex.
   3. Claim is submitted to Apex. It will be checked again for errors.

Claim Lifecycle: Process Accepted or Rejected Claims, and Process ERA payments.

1. 1. Claim is Accepted or Rejected.
      • If the Claim is Accepted, it will move to the Accepted tab.
      • If the Claim is Rejected, it will move to the Rejected/Denied tab where you can view the rejection codes/reasons and resubmit.
   2. ERA Received. 
      • Process ERAs and update the status updates to paid.
2.