Permissions Required: Clinic Staff must have Administrator, Billing Manager, Billing Assistant, Front Office, or Operations Manager Permissions assigned in order to manage Claim Generation.
Generating Claims
To create new claims, they must first be generated. The drop-down list in the Generation Filter area allows you to select the clinic for which they wish to generate claims. In most circumstances, you will generate claims for all clinics at one time.
When the Generate button is pressed, Clinic Controller will find all claims that are ready to be generated. In other words, the invoice state for these claims will be at Bill Primary, Bill Secondary, Bill Tertiary, etc.
After the claims have been generated, they are displayed in the Output List below. Any claims that generate in error will also show up on the grid marked in red and will contain a reason as to why the claim could not be generated.
The Output List operates like a typical grid-style report. (For more information on Grid Manipulation, see that section in Chapter 2.) Each of the columns can be filtered to show only those claims with which you would like to work.
Only claims of a single format can be Output at the same time. If you have claims of more than one format in your Output List or have claims of multiple formats selected, you will not be able to Output (Output will be grey).
Output List Columns
| Output | Allows you to specify on which claims they are getting ready to act. Double-clicking on the row will select/deselect this box, or the right-click menu can be used to Toggle Selection. |
| Format | Claim format as set in the patient’s policy, i.e., HCFA, CMS1500, 837, EI |
| Case ID | Case ID of the visit represented. |
| Clinic | Clinic where the visit was seen. |
| Ordinal | Primary, Secondary, Tertiary, etc. |
| Carrier | Carrier that will be billed. |
| Carrier Type | Carrier Type of the carrier that will be billed, as set in the Carriers table. |
| Medium | Preferred output method. Paper, Electronic File |
| Visit | Date and time of the visit. |
| Message | Found on rows that have errors. The message will indicate the claim error. (See Claim Errors report in the Reports chapter for a list of common errors.) |
| Patient | Name of the patient on the claim. |
| Therapist | Name of the treating therapist. This may not be the same as the therapist who appears on the claim. |
| Doc Level | Allows you to notate a specific visit that may require documentation to be sent. |
| Ref Doctor | Name of the referring physician assigned to the patient. |
Example:
In this example below, the following columns have been filtered to Claim Format, Ordinal, and Message. Here, we see all claims in the CMS1500 format that are Primary and have no error Message. The list could have been filtered down even further by any or all of the rest of the columns.
When you filter, you are only hiding the claims that don’t meet your filter criteria. Removing the filters will repopulate the Output List with the hidden claims. That status line at the bottom of the screen shows how many claim are currently in the Output List and how many have been selected for output.
A right-click on the Output List brings up the following menu:
Output List Menu
| Mark All | Selects all claims for output and checks the output box. |
| Unmark All | Deselects all claims for output and unchecks the output box. |
| Toggle Selection | Selects or deselects the highlighted row(s). |
| Generate | Generates claims. |
| Output | To Paper | Prints all claims to file that are currently marked for output. |
| Output | To File | Saves all claims to file that are currently marked for output. |
| Output | To Report | Used for outputting EI format claims. |
| Output | Editor | Allows you to bring the claim up in an editor before sending it out. |
| Preview | Allows you to preview a claim. |
| Change Format | Allows you to change the claim format for the selected claims. This will change the format in the policy. You MUST regenerate for this change to take effect. |
| View Provider Info | Takes you to the Providers table at the level where information will be pulled for the selected claim. Aids in troubleshooting Missing provider info error messages. |
| View Case | Opens the case dialog for the selected row. |
| View Transactions | Opens the transaction dialog for the selected row. |
| Additional Info | Case | Opens the additional info window showing case info. This window changes with new patient information as different claims are selected. |
After marking the claims you wish to output, selecting the output type will then output them to the requisite medium.
NOTE: When you output the claim it is output, meaning the system is assuming that you have sent it. This also means that the invoice state for that particular visit has advanced to the next state, which is to wait for payment from the entity you just billed.
When saving to a file, Clinic Controller will use the filename set in the preferences for the given machine. Preferences may be found by going to the File Menu and selecting Preferences.
After generating, you have the option of either just outputting the claims that are available, fixing the errors, and then generating again and then outputting claims or some combination of the two. The actual act of generating claims does not do anything other than present you with a list of claims that are ready to be output.
Claims will be output in the format that is shown. For example, claims that are generated as HCFAs cannot be output as 837s without first going into the policy, changing the claim type, and then regenerating.
Errors may be corrected at any time, but claims that are showing errors may not be output. It is possible to also pull up an error list by running the Claim Errors report in the report module.
Claim Editor
Claims that are Output to the editor allow for editing before they are printed or saved to a file. To edit a claim, select a claim for output, and select Output Editor from the right-click menu. You may right-click any field and select Edit to change the value and then save the claim.
NOTE: You will have to print a HCFA for each date of service.