Versions Compared

Old Version 10

changes.mady.by.user Shawna Crawford

Saved on

compared with

New Version 11

changes.mady.by.user Shawna Crawford

Saved on

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.


Overview

Panel
borderColorblack
bgColorgray
titleColorblack
borderWidth2
titleBGColorwhite


Info

The Patient, Guarantor & Insurance tab collects patient, guarantor, and insurance information on the case.

Note
When viewing a case in read-only mode, you can only view information and cannot change any related information on this tab.



Info
titleBGColoraaaaaa
iconfalse
titleHow to Get Here?


From the Home Page:From the Menus:Via Shortcut Keys:
  1. Click Charge Batches from the Manage list.
  2. Double-click the charge batch to review.
  3. Double-click the case to review.
  1. Open the Manage menu and select Charge Batches.
  2. Double-click the charge batch to review.
  3. Double-click the case to review.
  1. Press [Alt] + [M] + [C].
  2. Double-click the charge batch to review.
  3. Double-click the case to review.



 

Image RemovedImage Added


Field Definitions

of the insurance policy

Field

Type

Required

Description

Image Set and Coding Section



Allows you to select an image set and attach it to the case.
Image Set

Drop Down

NoContains the images attached to the case.
Patient Section


Patient

Drop Down Search

YesRecords the person who is the patient on the case.
SSN

Read-only

(Pulled from the Person Information)

YesThe social security number of the patient on the case.
DOB

Read-only

(Pulled from the Person Information)

YesThe date of birth of the patient on the case.
Age

Read-only

(Pulled from the Person Information)

YesThe age of the patient on the case.
Phone

Read-only

(Pulled from the Person Information)

YesThe phone number of the patient on the case.
Gender

Read-only

(Pulled from the Person Information)

YesThe gender of the patient on the case.
Guarantor Section

Records the person or organization financially responsible for the account.
TypeDrop DownYes

The type of person financially responsible for the account. By default, the option is set to Patient. The options include:

  • Patient - If the patient is the person financially responsible for payment
  • Some Other Person - If a person other than the patient is financially responsible for payment, e.g., parent or guardian
  • Organization - If a company or organization is financially responsible for payment, e.g., Worker Compensation carrier
GuarantorDrop Down SearchYesThe name of the person or organization financially responsible for the account.
Account

Read-only

(Pulled from the Accounts Information)

YesThe guarantor account number. It is a link, that when clicked opens the Account / Active AR tab.
SSN

Read-only

(Pulled from the Accounts Information)

YesThe social security number associated with the guarantor account.
DOB

Read-only

(Pulled from the Accounts Information)

YesThe date of birth associated with the guarantor account.
Phone

Read-only

(Pulled from the Accounts Information)

YesThe phone number associated with the guarantor account.
Insurance Section


Order

Read-only

(Pulled from the Person Information)

Yes

The rank designation of the payer as primary, secondary, tertiary, and payer responsible.

ValueDescription
1The payer holds the primary responsibility for reimbursement.
2The payer holds the secondary responsibility for reimbursement.
3The payer holds the first tertiary position responsible for reimbursement.
4The payer holds the fourth position responsible for reimbursement.
5-11The payer holds the fifth through eleventh position responsible for reimbursement.

The rank is assigned according to the position of the payer in the list. A checkmark indicates that the payer is currently active. When a payer is selected, a rank is assigned based on the current position of the payer. As other payers are selected, the ranks are updated according to the position of the payer. For example, if a payer in the second row has a rank of 1, and then the payer in the first row is selected. The payer in the first row will now have a rank of 1 and the payer in the second row will be updated to a rank of 2.

Payer

Read-only

(Pulled from the Person Information)

YesThe name of the company that owns the plan to which the claims are submitted.
Plan

Read-only

(Pulled from the Person Information)

Yes

The name of the plan to which claims are submitted. If the plan has an expiration date, it will not be on the list.

Note

If the plan selected has been designated as a Miscellaneous Plan (via Plan > Claims tab), the Plan Address window opens after tabbing out of the Plan field.

Image Modified

You must enter a name and address for the plan before any new information entered in the Add/Update Insurance window can be saved.


Subscriber

Read-only

(Pulled from the Person Information)

YesThe person who owns the insurance coverage.
Subscriber #

Read-only

(Pulled from the Person Information)

YesThe unique number issued by the payer to the employee who participates in a group plan. This number identifies the employee and can be the same as the Member ID, based on whether the insurance company issues separate numbers to identify its participants. This number comes from the information entered from creating or updating insurance information.
Member #

Read-only

(Pulled from the Person Information)

YesThe unique number issued by the payer to identify the patient who participates in a group plan. Member IDs and Subscriber IDs can be the same or a different number based on whether the insurance company issues separate numbers to identify its participants. The member identification number is used by some payers to differentiate between the employee and the participating dependents, for example, 00 might identify the employee and 01 might identify the spouse of the employee.
Group #

Read-only

(Pulled from the Person Information)

NoThe unique number issued by the payer to the owner of the insurance policy.
Eligibility Status

Read-only

(Pulled from the Eligibility tab)

No

The most recent eligibility check status, or the state of being qualified or entitled to benefits. Three possible values are:

  • Active - patient is currently eligible
  • Inactive - patient is not currently eligible
  • Rejected - the Eligibility Inquiry did return a successful response
Last Checked

Read-only

(Pulled from the Eligibility tab)

NoThe date and time the Eligibility was last checked.
Pre-Auth #Free TextNoThe authorization number issued by the payer for authorization of the treatment or surgery. If you have the pre-authorization number, you can enter it in this column for the payer.
Referral #

Drop Down

NoThe number issued by the primary or referring physician for a specific treatment or treatment series. If a referral number has been entered for the payer on the insurance window, click the applicable referral number from the list.
P&C Claim #Free TextNoThe Property and Casualty insurance claim number associated with the insurance payer line.
Force Self PrintCheckboxNoIf selected, the electronic claim is printed on a pre-printed claim form, for example, the NUCC 1500 form.
Paperwork Attachments Section

Contains a list of the supporting documentation attached to an electronic claim. Paperwork attachments create the additional electronic (PWK) segment in the claim file to indicate:
  • Type of documentation being sent
  • How the documentation will be sent to the payer
Type

Display Only

(Pulled from Attachment)

YesThe type of documentation being sent to the payer, for example, Medicaid Consent for Sterilization form.
Method

Display Only

(Pulled from Attachment)

YesThe method the documentation will be sent to the payer, for example, email, mail, or fax.
Control #

Display Only

(Pulled from Attachment)

YesThe control number the receiving payer can use to link the documentation with the claim.
Code

Display Only

(Pulled from Procedure)

NoA procedure code attached to the case.
ASA

Display Only

(Pulled from Procedure)

NoThe anesthesia code attached to the case.
Related Person Section

Section allows you to designate a person who is related to the patient.
PersonDrop Down SearchNoThe last and first names of the person related to the patient.
DescriptionFree TextNoThe relationship of the patient to the related person, for example, spouse, mother, or father.
Errors and Warning Section

This section reports problems detected through the Error Check validation process. Use the Display options to select the validations to verify.

In addition to errors and warnings, the date and time the last error check occurred is reported. If an error check has never been performed on a charge batch or case, the text displayed will be Last Check: (pending). Each time an error check is completed, this text is updated and displayed in the following format: Last Check: mm/dd/yyyy, hh:mm:ss AM/PM, for example, Last Check:  07/08/2013, 4:35:14 PM.

Display FiltersCheckboxesNo

This filter determines the type of errors or warnings listed in the Error Check list. Errors must be corrected before a case or charge batch can be submitted and claims can be generated. Warnings may or may not cause rejection of a claim and are not required to be corrected. A checkmark next to the display filter indicates that the filter is selected.

The filter options dynamically affect the contents of the error checklist. When you clear a checkbox, the list hides the applicable errors or warnings. When you click the checkbox again, the list refreshes, showing the hidden errors or warnings.

Type

Display Only

(System-generated)

Yes

The classification of the problem detected in a category during the Error Checking process. Cases in the charge batch are validated for certain conditions reported as errors or warnings.

TypeDescription
ErrorsConditions on a case that affect claims generation. Errors must be corrected before cases can be submitted and claims can be created.
WarningsConditions on a case that may cause the claim to be rejected by a payer. Warnings do not have to be corrected before cases can be submitted and claims can be created.


Category

Display Only

(System-generated)

Yes

The component that may contain an error or warning when either condition is detected during error check validation, for example, Concurrency or Data. By default, all categories are selected and all errors and warnings are displayed on the Charge Batch Error Check tab. Errors must be corrected before a claim can be created. Warnings do not have to be corrected before a claim can be created.

The categories listed in the error check table are controlled by the Display filters on the Charge Batch Error Check tab. The following categories are available:

Category
Description
ConcurrencyExceptions reported on anesthesia provider time for violations that occur across multiple cases. In most cases, concurrency exceptions are reported as errors unless concurrency validation is excluded on the case. If concurrency is excluded on the case, exceptions are reported as warnings.
CCIExceptions reported on code auditing for detecting discrepancies between the diagnosis code and the procedure code. CCI edit warnings are not required to be resolved before a claim can be created, but if not correct, the problems may result in claim rejections by the payer.
ICD-9/ICD-10Exceptions reported on diagnosis codes for authenticating that the diagnosis is appropriate for a particular age or gender. ICD-9 edit warnings are not required to be resolved before a claim can be created, but if not correct, the problems may result in claim rejections by the payer.
PayerExceptions reported on payers or plans for evaluating claim filing rules specific to a payer or plan, for example, provider identification numbers, or date of service of procedure occurs after provider effective date.
DataExceptions reported on data for identifying primary data elements (for example, primary diagnosis code) that are missing, are required for all cases, or are required based on specific conditions within a case. Required data must be entered before a claim can be created.


Message

Display Only

(System-generated)

YesThe description of the error or warning.
Related Cases

Display Only

(System-generated)

NoA direct link to cases related to the case that has a warning or error. To go to a related case, click the direct link. If the related case has a warning or error that is corrected, the Error Check validation process will verify the case and remove it from the Charge Batch Error Check tab. 


Button Descriptions

Button

Shortcut Keys

Description

Step-By-Step Guides

Image Set and Coding Section


View[Alt] + [V]To preview the images in the image set.
  1. Open the Image Set drop down arrow and select the image set to view.
  2. Click View. The Image Viewer page opens with the image set displayed.
Coding[Alt] + [O]To review the coding form if the case has been coded from the image set.
  1. Open the Image Set drop down arrow and select the image set to view.
  2. Click Coding. The Coding window opens with the coding information for the case displayed.
    Image Modified
Review Eligibility
To open the Eligibility tab for the patient
  1. Click the Review Eligibility button. The Charge Batches / Eligibility tab opens with the records filtered by the Patient displayed on the Case / Patient, Guarantor & Insurance tab when the button is clicked.
Insurance Section


Create[Alt] + [C]To open the Create Insurance window to record the insurance coverage for the patient.Adding Insurance
Update[Alt] + [U]To open the Update Insurance window to modify the insurance coverage for the patient. You can update the insurance information prior to submitting the charge batch.Editing Insurance
Paperwork Attachments


Create[Alt] + [R]To open the Paperwork Attachment window to record the supporting documentation as a paperwork attachment to an electronic claim.
  1. Click Create in the Paperwork Attachments section. The Paperwork Attachment window opens.
    Image Modified
  2. Open the Attachment Type drop down list and select the type of attachment.
  3. Open the Transmission Method drop down list and select an option.
  4. Enter the Attachment Control #.
  5. (Optional) Select a procedure from the list if the attachment is associated with a procedure.
  6. Click Save.
Update[Alt] + [P]To open the Paperwork Attachment window to modify the record of the supporting documentation.
  1. From the Paper Attachments section, select the attachment to be updated.
  2. Click Update. The Paperwork Attachment window opens.
  3. Update the attachment details as necessary.
  4. Click Save.
Delete[Alt] + [D]To delete the documentation from the Paperwork Attachments table.
  1. From the Paper Attachments section, select the attachment to be removed.
  2. Click Delete. The document is removed from the list.
  3. Click Save to save the changes to the case.
Error and Warnings Section


Error Check[Alt] + [K]To run the Error Check validation for either a charge batch or a case in a charge batch.Running Error Check Validation



 

Panel
titleColorWhite
titleBGColorGray
titleRelated Topics

Charge Batches

Charge Batches / Batches Tab

Charge Batches / Cases Tab

Charge Batches / Case Holds Tab

Charge Batches / EDC Files Tab

Charge Batches / Eligibility Tab

Charge Batch / Charge Batch Information Tab

Check Eligibility Window

Charge Batch / Charge Batch Error Check Tab

Charge Batch / Concurrency Log Tab

Charge Batch / Image Batches Tab

Charge Batch / EDC Files Tab

Case / General Case Information Tab

Case / Procedures & Provider Time Tab

Case / Case & Claim Holds Tab

Case / Additional Case Information Tab

Case / Outcomes Tab

Case / Notes Tab

Add Distribution Window

Creating Charge Batches

Updating Charge Batches

Deleting Charge Batches

Running Error Check Validation

Correcting Errors and Warnings

Copying Charge Batches

Submitting Charge Batches

Generating the Charge Batch Log

Creating Cases

Updating Cases

Deleting Cases

Cloning Cases

Moving Cases

Importing Appointments





Search this documentation

Livesearch
spaceKeyCD