in either the Billing Provider or Pay-To Provider section and then choose a provider by using the Choose Provider prompt that displays.Every claim form contains the same functionality, regardless of claim type, claim status, and whether you are editing a claim, resolving issues, or entering data for a new claim. Claim forms only differ in layout, as each form appears exactly like the paper version of the corresponding type of claim. This section does not comprehensively detail claim forms, but provides a general summary of functionality in claim forms. The claim form interface is designed so users can directly interact with all fields in order to edit or add necessary data.
While viewing any type of claim, users can scroll through the claim form and interact with the document by using various fields. To enter data in a blank field, or replace existing data in a field, simply click in the desired field and enter the appropriate information. Furthermore, certain fields utilize other functionality, such as drop-down menus or selection prompts.
In addition to simple text or numeric fields, date fields use a pop-up calendar selection prompt, and some data fields utilize a drop-down menu. For instance, users can click the Assignment field and then assign a specific user to the selected claim by selecting the appropriate option listed in the drop-down menu. Other fields may utilize a selection prompt. For example, users can click in either the Billing Provider or Pay-To Provider section and then choose a provider by using the Choose Provider prompt that displays.
As mentioned, each type of claim uses a different layout, but each claim form contains the same type of interactive functionality. Users will encounter several common features throughout claim forms that can be used to edit or add claim data:
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— Add new data to the claim form. Available options will differ for each instance of this icon, depending on the field or section it is associated.
o Institutional Claim examples:
o Professional Claim Examples:
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— Remove data from the claim form. Users may need to confirm the action. For instance, entries in the “BILLING PROVIDER ID” or “REFERRING PROVIDER ID” sections are removed immediately, but users must confirm the removal of service lines included in a claim.
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— View information for the corresponding selection (i.e. Facility, Physician Payer).
o Provider — If located next to a provider section (e.g. "BILLING PROVIDER", "RENDERING PHYSICIAN"), click this to open the Edit Entity screen for the selected provider. This displays all existing information for the corresponding provider.
o Payer — If located next to a payer section (e.g. "Payer Name & Address"), click this to open the Payer Management screen for the selected payer. This displays all existing information for the corresponding payer.
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— Display and/or edit additional data related to the corresponding field, which may include claim data from the EDI file that is not necessarily on the proper claim form. Similar to other claim form controls, the prompt that displays will depend on the field or section where it is located. This field is used to access a range of additional information in each claim, such as accepting assignments, signatures on file, related causes, unlabeled fields, EPSDT, as well as condition codes, additional occurrence span codes, value codes, additional service line information for adjudication, drug codes, physicians, and additional diagnosis codes.
Editing or Adding Claim Codes
Use this control feature to interact with code information in any claim. Click the double-arrow icon in any code section (e.g. “Diagnosis Codes”, “Procedure Codes”, “Occurrence”, “Occurrence Span”, “Value Codes”, etc.) to initiate the corresponding prompt.
Interact with fields in the prompt to search and/or add codes to the claim form. Simply click and then select the desired code using the secondary prompt that displays, as seen in the sample image.
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— Enables several controls in the Services section of the claim form. This button enables a Tools column that allows users to apply an action to any service item that is listed (Destination, Replicate, Remove, Roll). Additionally, users can apply filtering options to all services included in the claim (e.g. Calculate Units, Remove Adjudication, Remove Services Outside Statement Range). Select the desired control options and click Apply Service Tools; or, click Disable Tools to unapply any filtering options that are selected and close the controls section.
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— Create a new service line in the selected claim. Use the Add Service Line(s) prompt that displays to specify the number of blank service lines you want to create.
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— Create a new note for the selected claim and enter any specific details using the Claim Note prompt that displays.
