Claim Submission Guide

Choosing How You Submit Claims

Residex offers two ways to submit claims. Use one or the other, not both. If you use Claims Management, you do not use Batch Upload, and vice versa.

Claims Management:

Submit claims straight from Residex with the Claims Integration add-on. This is the more integrated option: claims are sent right in Residex, so you never need to log in to a clearinghouse to submit them. Claims Management is an add-on feature that requires a separate contract with Waystar. Waystar acts as your clearinghouse and allows you to submit claims directly from Residex.

Batch Upload:

Export an X12 file from Residex, then upload it to your clearinghouse. Batch Upload is a secondary feature included with Billing. It is a report you create in Residex and upload to the clearinghouse of your choice.

• • Before You Use Batch Upload

    • Contact your clearinghouse to confirm they accept batch uploads of X12 claims files.
    • If setup is required, work directly with your clearinghouse to complete it.
    • Some clearinghouses charge additional fees for batch upload. These fees are set by the clearinghouse and are outside the scope of Residex.
    • Residex provides the X12 claims file only. Clearinghouse acceptance, setup, and fees are managed between you and your clearinghouse.

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Table of Contents:

1. Campus Billing Setup

2. Payer Information

3. Client Billing and Finance Setup

4. Claims Management-Creating Claims
5. Claims Management-Status Tracking
6. Batch Upload

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Campus Billing Setup

9-digit ZIP code required when submitting claims

Navigate to: Settings>Campus-Edit Campus

The campus location zip needs to be the 9-digit code with no "-" Example: 423424919

If you are unsure of your 9-digit ZIP code you can look it up on the USPS website https://tools.usps.com/zip-code-lookup.htm?byaddress

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Payers Information

1. Under Billing Configuration > click the Payers tab
2. On the list of the payers, click one of the payers

      3.  Add or edit the payer address and press Save

 

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Claims Submission - Client Billing and Finance Setup

Client Billing & Finance Information:

The next step is to enter the client's payer information. This information will be taken directly from the Service Agreement given by the county.

Payers Tab:

1. Navigate to Residents > Residents
2. Select a Resident
3. Under Billing & Finance, click Payers
4. Click Add Payer
5. When a non-private payer is selected, additional fields will appear
6. This information can be entered using the Service Agreement as indicated below

Claims Management-Creating a Claim

1. Navigate to the Billing > Process Billing tab
2. Select the Claims tab
3. Click + Create a batch

Selecting Claims for Submission

1. Choose your payer from the dropdown menu
2. Residex will automatically populate a list of residents associated with that payer
3. Select your submission dates

Pre-Validation Process

Before submitting your claims, Residex performs a critical pre-validation check to ensure accuracy.

What Pre-Validation Does

The pre-validation step reviews all residents (selected) in the batch and checks for discrepancies between:

1. What was charged
2. What will be submitted (accounting for Hold days)

Pre-Validation Results

Success: If no issues are found, you'll see the message "Pre-Validation passed" and can proceed with submission.

Error: If discrepancies exist, you'll receive an error message explaining exactly what needs to be corrected before you can submit.

Claim Management - Status Tracking

Residex provides real-time status updates at every stage of the claims process, saving your billing staff significant time and effort.

Status Messages

🗒️ Each payer may display slightly different messaging about claim status.

Processing/Pending (highlighted yellow)

The payer has received the claims and is processing them.

Accepted (highlighted blue)

Means there are no problems in the batch, but no further updates on payment status

Paid / Paid with Adjustments / Spend downs (highlighted green)

Rejected / Failed (highlighted red)

Means there are errors in the batch

Each payer will display a number to reflect how many claims are in that batch.

Use the drop-down arrow to see the claims in the batch

Click on the resident name to view the status of the claim. It will look similar to this:

You can scroll down to see the history of "responses" for the claim

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Batch Upload to Clearinghouse

Clearinghouse setup

This guide walks you through creating the file you will use to export an X12 claim submission file. Your clearinghouse may require setup before you can upload it, and you will need to work directly with them to complete it. Residex provides the X12 claims file only. Clearinghouse acceptance, setup, and any fees for using their batch upload are managed between you and your clearinghouse.

Test Before Export

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