Claim Screen Layout

While viewing either of the claims grids (Institutional or Professional), users can access an individual claim by simply clicking

in the Action column or by clicking anywhere within the row of the claim you want to view.

The Institutional Claim or Professional Claim screen will display, depending on the type of claim selected. The claim screen interface and available features are the same regardless of the type of claim; the primary specific difference is the type of form that displays (e.g. 837I, 837P) and the header label that displays at the top:

● Interface for each claim appears exactly like the paper version of the corresponding claim type.

● Users can correct errors by manually editing fields in the form or by using the guided error message wizard. Learn more about editing claims further on in this part of the guide.

● Claim information banner displays the following: Account number, patient name, total charges in claim, TOB, date range of charges included, payer to be billed, and the status of the claim (i.e. Created, Error, Modified, Validated, Paid, or Released)

● Claim navigation controls allow users to move between other claims or return to the grid.

Claim Status Header

Users can identify the status of any claim (i.e. Error, Released, Validated, On Hold, Modified, Deleted, Denied, Paid, Informational, etc.) they are currently viewing by using the status header that displays above the claim form. As seen in the sample images, each status indicator contains unique verbiage and color schemes.

While viewing an individual claim, users can perform a variety of tasks using several claim control tabs that are available at the top of the screen. Detailed in this section are the five claim control tabs and the actions that are available in each tab.

Transaction tab

The Transaction tab contains a variety of actions used to interact with claims throughout the billing process. Additionally, users can create a new, blank claim or mark selected claims in certain ways to inform other users in the database. The Transaction claim control tab contains the following options:

1 Save & Validate — If no errors are present, click this to save any edits that have been made and also validate the claim.

2 Validate — Validate a claim that contains no errors.

3 Save — Save current information in the claim, including any edits made.

4 Hold / Release Hold — Place a claim on hold. If a claim is already placed on hold, users have the option to release the hold on a claim.

5 Delete / Undelete — Click this to delete a claim. The claim will be placed in a “Deleted” status for a certain amount of time. During this time, users can click Undelete to reverse this action.

6 Mark as Informational — Indicate to other users that this claim is only informational. Claims with an information status will not be processed for payer submission. If selected, a new “Remove Informational Status” will become available in the Transaction tab (under the “Hold” option).

7 Mark as Followup —Indicate that this is a follow-up claim.

8 Mark as Acknowledged — Indicate to other users that this claim has been acknowledged.

9 Mark as Paid — Indicate that a payment has been received for this claim. If selected, users can then indicate the date and amount of payment.

10 Mark as Denied — Indicate to other users that the claim has been manually denied.

11 New Claim — Create a new, blank claim form.

Depending on certain factors about a claim (i.e. current status, if marked already), available options may differ. For example, if a claim has already been put on hold, the menu option will display as "Release Hold" instead of "Hold".

Print tab

12 Claim Summary — Generate a .pdf file with a brief synopsis of information about the selected claim. Click the link in the confirmation prompt to download the .pdf file. This file includes the following:

A Patient Name

B Account Number

C Statement Date

D Total Charge

E Payer Name

F Payer ID

G Claim Type

H Billtype (e.g. 323)

I Event Summary (Date, User, Event)

13 UB-04 / HCFA-1500 — Depending on the type of claim selected, users can print either a UB04 or 1500 claim document. Click this button, then select the print preferences in the Print Claim prompt that displays, and then click Print. Click the link in the confirmation prompt to download the .pdf file.

Copy tab

The Copy tab provides a way for users to perform one of the following two actions using the information contained in the selected claim:

14 Replicate — Create a copy of the selected claim. Once confirmed, the copy will be available in the corresponding claims grid. If desired, users can click Yes to immediately view the replicated claim.

15 Create Institutional Claim / Create Professional Claim — Depending on the type of the claim selected, users can create a different type of claim based on the information contained in the selected claim. For instance, if an institutional claim is selected, users can click Create Professional Claim to create a professional claim based on information included in the selected claim. If desired, users can click Yes to immediately view the new claim that is created.

View tab

The Messages tab (described in "Claim Detail Tabs" drop-down section below) contains any errors present in the claim. By default, this tab displays current errors. To view historical errors related to the claim, hover the cursor over the View tab and click Historical Messages.

Tools tab

While viewing an individual claim, several other control options are available for users under the Tools tab:

16 Add Services From Other Claims — Select services from an existing claim and include them in the claim. Click Add Services From Other Claims and use the Select Claim prompt to find and specify the desired claim(s) to copy service lines from. Any services contained in the corresponding claim(s) can be selected using the Select Service Lines to Add prompt (See sample image).

Check the corresponding box(es) next to service(s) you want to add. Checking the box in the header row will select all services associated with the existing claim. Click Next to confirm the selections.

Lastly, an Add Services prompt will ask the user to confirm this action by clicking Yes. Any services that are added will display in the Services section of the claim form.

17 Move To Test — Move a copy of the selected claim to a test environment. The claim will no longer be in the database you are signed into.

Within each individual claim screen, users have access to three useful tabs that are to work with claims and track the progress of the claim throughout the billing process.

Each tab available in the claim screen is summarized below:

1 Messages — Contains information about errors and overrides for the selected claim, which may require user attention in order for the claim to be approved. Furthermore, the Messages tab provides insight on why a claim was rejected (if applicable). Simply click on an item to view additional details using the error resolution prompt. For more information about the error resolution prompt, refer to the Resolving Errors in Claims topic).

2 Events — Displays all events, changes, modifications, edits, and any other actions that have been performed on a claim, from the time the claim is created to the adjudication of the claim. Details included in the Events tab essentially forms an audit trail for the life cycle of each individual claim.

3 Related — Provides users with a list of all documents and transactions in the firstREV interface that are associated with the claim. This includes source documents, payer acknowledgements, remittances linked to the claim, and more.