Billing in NikoHealth connects everything that happens before the claim (intake, orders, inventory, scheduling) with everything that happens after (claims, payments, denials, and patient responsibility).
This article gives a high-level overview of how billing works in NikoHealth so you can understand the moving pieces before diving into more detailed workflows.
INVOICE
The Invoice tab will show you ALL the Invoices currently available in your system. It will show all statuses (New, Hold, Submitted, Open, Close, Cancelled). You can filter down what you wish to see by using the search fields at the top, or by using the advanced filter (dark blue circle with 3 lines).
From the blue plus sign on this sub-tab you can choose to:
Print patient statements
Import ERA's
Do a mass write off and close out claims
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PAYMENTS
The payments tab will show ALL of your payments collected in the system and their corresponding status (NEW, Unapplied, Applied, Failed, Completed). From here you can mange all of your payments that are processed manually or auto-posted by the system. From the blue plus sign you can :
Create a New Invoice
Add a payment
Jump to patient statements
Import ERA's
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REFUNDS
You can create and manage your returns, and refund payments to your customers from the Refunds tab. Clicking on the Refunds tab brings you to the Refunds queue where you can see a list of all Refunds. You can also issue a new Refund by clicking on the blue NikoHealth action button from this screen.
For more information on how to create and manage refunds, visit our help article on Creating Returns and Refunds.
DENIALS
The Denials queue will allow you to work all of your Denials by Denial Reason or Payer using the filter options at the top. You will have the following statuses assigned to your denials:
New: a new denial that needs to be worked
Resubmitted: a claim has been resubmitted to be reviewed
Paid: a corrected claim comes back paid
Ignore/Write Off: you will not be working the denial
In the Denial queue, you can also CLAIM a denial to work by checking the box and then using the blue plus sign to mark something "In Progress". This will show the user who is working the Denial and assign the date they began working it.
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EOB/ERA
The EOB/ERA tab in your Billing is the central work queue for ALL remittances. (Note: each individual Invoice also has its own EOB/ERA tab that show only the EOB/ERA records for that specific claim).
When an ERA comes in from the clearinghouse, NikoHealth tries to match it to the correct Payer and remit ID. It then lands in this EOB/ERA queue with a specific status (Failed, Processed, New). Failed ERAs should be worked from this tab.
You can also view/download EOBs, import and export ERAs, and delete (with the correct permissions).
For more information, visit our help article on Understanding the EOB/ERA Billing Tab.
PRESCRIPTIONS
Select the Prescriptions tab to see all Prescriptions that have been entered into NikoHealth. This will help you identify expired prescriptions. Use the advanced filters and search by upcoming prescriptions that are due to expire so you can work them ahead of their expiration date.
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AUTHORIZATIONS
Select the Authorizations tab to see all Authorizations that have been entered into NikoHealth. This will help you identify expired Authorizations. Use the advanced filters and search by upcoming authorizations that are due to expire so you can work them ahead of their expiration date.
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CMNS
This is your CMN expiration report. You can filter this by using the advanced filter and search by upcoming CMNs that are due to expire so you can work them ahead of their expiration date.
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