Description

Screen used to edit claims.



Screen Access

Access this screen by the following forms:

  • New Claims: Creating a new claim in Create New Claims and pressing the button of Create Claim in the Quick Claim / Create Claim Without Encounter or the Create button of Create Claim Queue area.
  • Existing Claims: 
    • Double Click: Press double click over the selected claim in the Billing screen. 
    • Edit: Press the Edit button over the selected claim in the Billing screen.


Configurations

To be automatically displayed:

  • Billing Provider: The Billing Provider will be displayed automatically when you configure in  Billing/ Settings / Configurations in the Provider Mappings area on the Claims Biller.
  • Problem List History: When the provider collects the information from the "Problem List" screen,all the diagnosis of the patient will be automatically displayed.
  • Services Line: For the service line to be displayed automatically, there are two forms:
    • 1st: The provider has to select the procedures codes on the Close Patient Encounter screen by closing the progress note.
    • 2nd: Creating a claim from the Create New Claims screen, one of the two alternatives can be selected Add Service Line:New Visit - 30 Minutes or Add Service Line: Office / Outpatient Visit - 15 Minutes. 
  • Charge: The procedure rate/charge will be displayed depending on the coverage of the patient configured at:
    • Patients WITH coverage: Go to Billing / Settings / Procedures Cash Rates.
    • Patients WITHOUT Coverage: Go to: Billing / Settings / Fee Schedules.
  • Copay: Billing / Settings / Insurance, in the section called CoPays.

Screen Sections

  • Buttons
    • Actions: By pressing this option allows to make actions after the transmission of claims such as:
      • Close Claim: By pressing this buttoncloses claim. 
      • Convert ICD10: By pressing this button displays the ICD10 Diagnosis Code Converter screen in order to change the ICD9 diagnosis code to ICD10 diagnosis codes. 
      • Validate ICD: By pressing this button verifies if the ICD diagnosis codes are billable. If not it will display a message ERROR indicating the non billable diagnosis codes. 
      • Clear All Errors: By pressing this option eliminates the claim errors.
    • Patient History: Displays the Patient Billing History screen. 
    • Cash Payment: Displays the Add Patient Payment to register the patients payment. 
    • Create Secondary: Displays a second tab in same claim in order to edit claim for secondary insurance in cases where patient has two insurances. 
    • Modify Coverage: Allows to edit the patients insurance coverage. Only for claim purposes only. If there is a change in the patients insurance you must edit in the Patient Detail screen. 
    • Print: By pressing this button, the CMS1500/1450 form of the opened claim will be printed.
      • Print and Close: By pressing this button, the CMS1500/1450 form from the opened claim will be printed and will close the screen. 
      • Print All and Close: By pressing this button, the CMS1500/1450 from all opened claims will be printed and will close screen. 
    • Save: Saves all the changes made on this screen. If the claim is saved for the first time, it will automatically create a claim #.
      • Save and Close: Allows to store claim and close screen. 
      • Save All and Close: Allows to store all the displayed claims and closes screen. 
    • Cancel: After saving the information, cancels all the changes made on the screen.
      • Cancel/ Close: By pressing closes the claim edition and closes the screen. 
      • Delete Permanently: By pressing eliminates claim from system. 
    • Previous: Screen closes.
  • Billing Provider: Name of the provider that will receive the claim payment..
  • Flag: Personalized identifier for the claim. They can be identified by the following colors: Clear, Pink, Blue , Yellow, Orange, Red, Green. The color selected will be displayed under the claim number.


Note: Flag: Blue , displayed as: 

  • Name / Coverage: Access the coverage information of the patient.


  • Primary: Primary Insurance information coverage of patient. (If available).
  • Secondary: Secondary Insurance information coverage of patient. (If available).
  • Change: Allows to change the patients name of the edited claim. Apply only for the user that created the claim with errors.
  • Problem List History: In this area will be displayed all the active diagnosis of the patient.
  • Dx: The user can ad, edit and delete diagnosis associated with the claim. If the claim is created form created encounters by the provider,the line will be filled automatically, the user will verify the information and will edit if necessary. The fields will validate only the validated diagnosis. 
  • Services Line : Service line in claim. There can be more than one services line.
    • #: Number that identifies the service line.
    • Provider: Identifies the service provider .
    • Start Date: Start date of service.
    • End Date: End date of service.
    • Qty: Services quantity.
    • Code: Procedure Code.
    • Modifiers: Specific area where modifiers are applicable to code.
    • Description: Code description, it will appear automatically when you fill the Code area.
    • Place: Place of service.
    • Charge: Rate of service. 
      • Note: The service charge rate will be automatically displayed if the office rates or coverage rates are configured in Settings / Fee Schedules or Settings / Procedures Cash Rates.
    • Copay: 
      • Note: The amount that the patient is responsible for will be displayed automatically if its configured  in Settings / Insurance. 
    • Billed: Amount of Insurance payment. This amount is subtract from the copay of patient. 
    • Check to include in 837: Check if you want to include the service in the created file to send automatically the claim
    • Buttons

      •  Add Service: Allows to add a new service line. 

      •  Delete: Deletes the service line.

  • Other 
    • Additional Information: Area to complete relevant information to transmit the claim. For Example, facility information of service date.


  • Notes: Area to document notes related to the claim. For example: Conversation of information made with the Insurance company.
  • Payments: Displays the adjudicated payment of the Insurance company.
  • Transmissions: Displays the times the claim has been transmitted.
  • Change Log: Area where the users information that have edited the claim is documented.
  • Errors: Area where all the transmissions errors when transmitting the claim are documented.