Description

Screen where the claim is edited. The user will be able to retransmit and print the claims. It also allows other functions such as: closing the claim, validating diagnosis codes, viewing the patient's billing history, registering patient payment, creating a secondary plan claim and modifying coverage. 


Access


Through Main Menu
  • From the main screen, click on the Billing button. 
  • On the Billing screen, select a claim and double-click twice on the selected claim. 
  • Or select a claim and press the right mouse button and select the Edit option. 
  • For new claims, press the Create button located at the top of the screen. 
Through QuickLinks
  • From the main screen, click on the QuickLinks text located at the top of the screen and select the Billing option. 
  • On the Billing screen, select a claim and double-click on the selected claim. 
  • Or select a claim and press the right mouse button and select the Edit option. 
  • For new claims, press the Create button located at the top of the screen. 
Through Patients
  • On the Patient Details screen, click on the Billing button located at the top of the screen. 
  • On the Billing screen, select a claim and double-click on the selected claim. 
  • Or select a claim and press the right mouse button and select the Edit option. \For new claims, press the Create button located at the top of the screen. 
Through Appointments
  • On the Appointments screen, press the Billing button located at the top of the screen and select the Go To Billing option. 
  • Then, press the Reconcile button, located at the top of the screen. 
  • On the Billing screen, select a claim and double-click on the selected claim. 
  • Or select a claim and press the right mouse button and select the Edit option. 
  • For new claims, press the Create button located at the top of the screen. 


Configurations

To be displayed automatically:

  • Billing Provider: In order for the Billing Provider to be automatically displayed, it must be configured in the Billing/ Settings / Configurations screen, in the Provider Mappings section, in the Claims Biller field.
  • Problem List History: In order for the list of the patient's diagnoses to be automatically displayed, the provider must collect that information in the Problem List screen.
  • Services Line: Para que se despliegue automáticamente, las líneas de servicios, existen dos alternativas:
    • Primera: The provider must select the procedure codes on the Close Patient Encounter screen when closing the progress note.
    • Segunda: When creating a claim, on the Create New Claims screen, select one of the two alternatives Add Service Line: New Visit - 30 Minutes or, Add Service Line: Office / Outpatient Visit - 15 Minutes. 
  • Charge: In order for the procedure fee to be automatically displayed, depending on the patient's coverage, the user must configure the same in: 
  • Copay: In order for the patient's deductible to be automatically displayed, the user must configure it in the Billing / Settings / Insurance screen, in the section called CoPays.


Sections


Buttons

  • Actions: When pressed, it allows subsequent actions to be taken after the transmission of the claim, such as:
    • Close Claim: Allows the claim to be closed.
    • Convert ICD10: Pressing displays the ICD10 Diagnosis Code Converter screen to convert ICD9 diagnosis codes to ICD10.
    • Validate ICD: When pressed, it validates if the ICD's in the claim can be invoiced. If this is not possible, an ERROR message will appear indicating which ICDs cannot be invoiced. 
    • Clear All Errors: When pressed, it removes all errors from the claim. 
  • Patient History: When pressed, displays the patient's billing history screen. 
  • Cash Payment: When pressed, it displays the Add Patient Payment screen, which allows you to register a payment to the patient. 
  • Create Secondary: When pressed, it displays a second tab for editing a claim for the patient's secondary plan, if any. 
  • Modify Coverage: Pressing allows you to edit the patient cover (For claim purposes only.) If you wish to change the patient cover, you must go to the Patient Detail screen. If you wish to change the patient cover, you must go to the Patient Detail screen).
  • Print: When pressed, it prints form CMS1500/1450 of the claim, which is open.
    • Print and Close: When pressed, it prints the open claim form CMS1500/1450 and then closes the screen.
    • Print All and Close: When pressed, it prints all CMS1500/1450 of all open claims and then closes the screen. 
  • Save: Pressing allows you to save all claims, which are open on the screen. When finished, it closes the screen and returns to the main billing screen. 
    • Save and Close: When pressed, saves the claim and closes the screen. 
    • Save All and Close: When pressed, saves all claims and closes the screen. 
  • Cancel: Pressing it allows you to cancel the editing of the claim. 
    • Cancel/ Close: When pressed, it cancels the claim editing and closes the screen. 
    • Delete Permanently: Pressing it allows you to delete the claim from the system. 
  • Previous: Closes the screen.
  • Billing Provider: Provider to whom the claim payment will be sent.
  • Flag: Customized identifier for the claim. These can be identified by the following colors: Blue, Clear, Green, Orange, Pink, Red and Yellow. Depending on the color you select, it will be painted in that color under the tab where the claim number is located.


Note: Blue Flag: will be displayed like this: 


  • Name / Coverage: Area where the patient's cover information will be displayed.


  • Primary: Section where the patient's primary medical plan information is displayed. 
  • Secondary: Section where the patient's secondary plan information is displayed.
  • Change: Allows you to change the name of the patient in the claim being edited. Applies only to errors made by the user when creating the claim.
  • Problem List History: Section where the patient's active diagnoses will be displayed.
  • Dx: Section where the user can add, edit and delete diagnoses associated with the claim. If the claim is created from encounters created by the provider, this section will already be populated, the user will only proceed to verify the information and edit if necessary. The fields validate that they are only valid diagnoses. 
  • Services Line: Service line, which contains the claim. There may be more than one service line.
    • #: Identifying number, the number of the service line.
    • Provider: Identifies the supplier, who provided the service.
    • Start Date: Date on which the service began to be provided.
    • End Date: Date the service was completed.
    • Qty: Amount of service.
    • Code: Procedure code.
    • Modifiers: Section where the modifiers applicable to the code are specified.
    • Description: Description of the code is written automatically, when writing the code, in the Code box.
    • Place: Place where the service was provided.
    • Charge: Amount of service cost.
      • Note: The service charge will be automatically set, if office rates or cover rates are configured, in the Settings / Fee Schedules or Settings / Procedures Cash Rates.
    • Copay: Amount payable by the patient.
      • Note: The amount payable to the patient, if configured, will be automatically placed in the cover under Settings / Insurance.
    • Billed: Amount to be paid by the insurer. This amount is subtracted from the amount to be paid by the patient (Copay).
    • Check to include in 837: Option to be checked if you wish to include the service in the file created to send the electronic claim. 

Buttons

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

  • Delete: When pressed, removes the service line.


Other (Localized options, at the bottom of the screen) 

  • Additional Information: Section where relevant information is completed to process the claim. For example, information about the facility where the service was provided, information about the provider who referred the patient.


  • Notes: Section where notes related to the claim are documented (e.g., information from conversations with insurance companies).


  • Payments: Section where the adjudicated payments from the insurance companies will be displayed.


  • Transmissions: Section where the number of times the claim has been transmitted will be displayed.


  • Change Log: Section where the information of the users, who have edited the claim, is documented.


  • Errors: Section where transmission errors will be documented when transmitting the claim. 


  • Institutional Information: Section where the institution's information is registered.



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