Claim Management

Summary

The Claim Management module is designed to be the one area a user can manage the claim lifecycle, modify a claim, add notes, change status and assign ownership. This window will be a comprehensive overlook of all unpaid claims for any given filtered range.   

Access

Go to Billing > Claim Management.

Parameters

1. Claim ID- Search for a specific claim by claim ID
2. Patient- Filter claim search results by patient name
3. Provider- Filter claim search results by Provider
4. Current Payer- Filter claim search results by Current Payer the claim is against
5. Diagnosis- Filter claim search results by Diagnosis that is on the claim(s)
6. Procedure- Filter claim search results by Procedure code that is on the claim
7. Program- Filter claim search results by Program
8. Place of Service- Filter claim search results by Place of Service on the claim 
9. Date of Service- Filter claim search results by Date of Service range of the claim
10. Current Bill Date- Filter claim search results by Current Bill Date range
11. Follow Up (Days)- Filter claim search results by the remaining days set on the Activity Items that can be placed on a claim
    • From- Define the minimum number of follow up days
    • To- Define the maximum number of follow up days
12. Adjustment- Flag to indicate if you intend to Void the claim or mark it as a Replacement for submission back to the payer
    • Void- Flag a claim ‘Void’ to tell the payer that the claim was sent/paid in error
    • Replacement- Flag to send a claim as a correction from original submission
13. Claim Age (Days)- Filter claim search results by age (in days) of the claim(s)
    • From- Define the minimum age (days) of the claim
    • To- Define the maximum age (days) of the claim
14. Total Charge- Filter claim search results by the total value of the claim(s)
    • From- Define the minimum charge amount ($)
    • To- Define the maximum charge amount ($)
15. Last Activity- Filter the claim search results by the last Activity Item recorded on the charge
    • Code- Filter by Activity Item Code
    • From- Define the beginning activity date
    • To- Define the end activity date
16. Claim Owner- Filter claim search results by the current owner of the claim
    • Include Inactive- Includes inactive claim owners in the search results
17. Claim Status- Filter claim search results by the current Claim Status
18. Sort Order By- Define how the search will be sorted and in what order
    • Drop Down 1- Define what the search results will be sorted by
    • Drop Down 2- Define whether the list will be in ascending or descending order
19. Hide Parameters- Hides the parameters to show more claims
20. Clear Parameters- Clears all search parameters

    ---

Searching For Claims

1. Search- Runs your parameters through the system to find claims
   • After you run the search you will see a message saying, “Search complete”
2. Check Box- Used to select every claim listed to assign/unassign those claims
3. Claim ID- Displays the claim IDs per claim
4. Attachments- Displays if any documents are attached per claim
5. Date of Service- Displays the date of service per claim
6. Patient Name- Displays the patient name per claim
7. MRN- Displays the Medical Record Number of the patient per claim
8. Total Charge- Displays the total charge per claim
9. Status- Displays the status per claim
10. Symbols- Allow the user to expand/collapse claim details and assign/unassign claims
    • ‰¡ - Allows the user to assign/unassign selected or all searched claims to/from different users
    • + - Expands the details of the claim
    • €“ - Collapses the details of the claim
11. Records per Page- Allows the user to choose how many claims are displayed on each page
12. Page _ of x- Displays the current page the user is on and allows the user to quickly change pages
13. X Total Records- Displays the total number of claims searched

[Back To Top]