Complete this task to preview a snapshot of the claim form on a CLAIM-E/CLAIM-P line item. The claim form is read-only and cannot be changed.
From the Act: [ID] > Active AR tab of the guarantor account, select the claim (CLAIM-E/CLAIM-P) line item to review.
Use the Filter by DOS option to filter the service fee line items by date of service. You can either type the date in the space provided or use the Calendar Control tool by clicking the arrow and selecting the date on the calendar that appears. To include all service fee lines items, clear the date from the Filter by DOS field.
Click View Tran. An image of the submitted claim form opens in the preview window, for example the CMS 1500 form.
The claim form is read-only and cannot be changed. The electronic claim appears on an image of the paper claim form.
Use the toolbar on the preview window to preview, save, or print the claim.