How to Billing: General Overview

On the Sunwave Dashboard go to Census. You will then put in the date for the week you will be billing for in Go To Date (it will default to the current week) then click Go to the right of the date:

Anything that is in a Green box means the client was in the facility at that time, if the box is outlined with a thick border and followed by Green Boxes that would indicate their admission, if the box is outlined by green and it is followed by white boxes that means the client has discharged. “N/A” means no services have been added and nothing has been selected for generation of services for this client as of yet.

Grey bubbles with levels of care i.e PHP IOP Detox, show that the client has been authorized for that service, a Green Bubble signifies a note that has been signed, a Red Bubble is a note that has not been signed. You can click on these bubbles to view the form. (Please note any note can be a visible on the census. We can include start and end times as well; per request)

To manually bill for the services that are authorized for or notated click on the “N/A”. You will then be given a dropdown of billable services to select. Below you will see two choices Basic and Advanced, in the Basic setting you have your services that you can select and click Add, this will create the service based on your billing rules under Manage Services and will apply to the claim when generated.

Please note: if you are using the automatic inpatient billing or automatic outpatient billing set up in your Managed Services Rules, these services will automatically show up on your census based off either the authorization (inpatient) or signed, completed, and time requirement met (outpatient).

In Advanced you can select the service, change the defaulted units, change the diagnosis, change the rendering provider, add a referring qualifier, and referring provider. This will only change for the individual instance when generating this claim. Once finished click ok.

When placed in the census the service name will appear Red as it has not been submitted yet, once a claim has been generated, the item will turn Green

Once all the services have been selected for the intended clients, click on Billing on the left hand side and Claims Submission:

In here you will click on Generate Claims, you will want to choose the date one day after the last day billed, (example: 10/22 last day billed, generate 10/23) or choose the current date. Should you have more than one entity you can pull the claims for All entities or choose 1 of the entities, you can also click the dropdown option to filter generate claims for a particular patient/ insurance/ or financial class then click Generate:

A pop-up will let you know how many claims were Generate and if any were on Hold or are Ready for submission, click Ok:

To view your Ready claims, change the Status to Ready and click on Year to Date/Last 90 days/ or a specific date range. This will show you all of your claims ready to be submitted. From here you can click the Send Claims in Ready Status in the upper right hand corner.

Should any claims be placed on Hold, you would want to check Status Hold, this will pull up the reason the system did not generate a claim. The most common reason being missing authorizations and subscriber information missing under the Primary Insurance tab in the clients chart under the Menu option.

You can click on the clients MRI# and it will bring you directly to the client’s chart so you can fix the items that are holding these claims:

Once these items are fixed you can generate the claims and they will be released from the hold and be ready for submission. Remember when submitting claims if you have multiple Service facilities to either choose All or the specific facility you are currently billing for only.

Click on send claims in ready status to submit to the clearinghouse.