Overview

The Case & Claim Holds tab is used to support creation and management of Case Holds on a case.

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

How 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.
  4. Click the Case & Claim Holds tab.
  1. Open the Manage menu and select Charge Batches.
  2. Double-click the charge batch to review.
  3. Double-click the case to review.
  4. Click the Case & Claim Holds tab.
  1. Press [Alt] + [M] + [C].
  2. Double-click the charge batch to review.
  3. Double-click the case to review.
  4. Press [Alt] + 4 to navigate to the Case & Claim Holds tab.

 


Field Definitions

Field

Type

Required

Description

Place case on holdCheckboxNo

If checked, the case is placed on hold indefinitely and cannot be submitted until the hold is removed.

If this field is not selected, the Create button is disabled, preventing the user from creating a Case Hold Reason in the subsequent table.

Case Hold Reason

Display Only

(pulled from created/updated Case Hold)

Yes

Designation or reason for the Case Hold. The drop down list of options are based on Case Hold Reasons created and associated with the Practice on the Case Hold Reasons page.

This field is disabled when updating the Case Hold and cannot be updated after creation.

Status

Display Only

(pulled from created/updated Case Hold)

YesThe current status of the Claim Hold. The options include: Open and Complete.
Assigned User

Display Only

(pulled from created/updated Case Hold)

Yes

Users to which the Case Hold is assigned.

List of options are users associated with the Practice.

Created By

Read-only

(system-generated)

YesUser that created the Case Hold.
Created At

Read-only

(system-generated)

YesTime stamp when the Case Hold was placed.
Notes Section


Note

Display Only

(pulled from created/updated Case Hold Note)

No

Any notes or pertinent information tied to the Case Hold.


Multiple notes can be added to the Case Hold.
Created By

Read-only

(system generated)

YesThe user that created the case hold note.
Created At

Read-only

(system generated)

YesThe date/time when the case hold note was created.
Claim Hold Section


Hold ClaimCheckboxNoIf checked, the claim is placed on hold until the date designated in the Submit claim on field.
Submit claim on

Calendar Date

(mm/dd/yyyy)

NoThe date when the held claim will be submitted. The field is required if Hold Claim field is selected.
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

Read-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

Read-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:

CategoryDescription
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

Read-only

(system-generated)

YesThe description of the error or warning.
Related CasesLinkNoA 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

Create[Alt] + [C]To create a Case Hold.
  1. Click Create. The Create Case Hold Reason window opens.
  2. Open the Case Hold Reason drop down list and select an option.
  3. The Status field defaults to Open and does not need to be changed.
  4. (Optional) Open the Assign To drop own list and select an option. Note: The Case Hold will default to be assigned to you and does not have to be changed.
  5. (Optional) Add a Note. If added, the note displays in the lower Note section.
  6. Click Save.

Click Save & Add Next to save the current record and create another one.

Click Cancel to cancel creation of the new record.

Update[Alt] + [U]To modify a Case Hold Reason or user assignment.
  1. Select a Case Hold Reason line item to update.
  2. Click Update. The Update Case Hold Reason window opens.
  3. (Optional) Enter a Note.
  4. (Optional) Open the Status drop down list and select an option.
  5. (Optional) Open the Assign To drop down list and select a new user.
  6. Click Save.
Reassign[Alt] + [R]To reassign a Case Hold.

  1. Select a Case Hold line item to reassign.

    More than one Case Hold can be selected and reassigned to the same user simultaneously.

  2. Click Reassign. The Reassign Case Holds window opens.

  3. Open the Reassign Case Hold To drop down list and select the new user.

    Users in the drop down list are only those that have been associated with the Practice.

  4. Click Save.
Delete[Alt] + [D]To delete a Case Hold.
  1. Select the Case Hold to remove, or delete.
  2. Click Delete. The Delete Case Hold Reasons confirmation window opens.
  3. Click Yes to confirm and delete the Case Hold line item.
Complete[Alt] + [O]To mark a Case Hold complete.
  1. Select the Case Hold to complete.
  2. Click Complete. The Complete Case Hold Reasons confirmation window opens.
  3. Click Yes to confirm and complete the Case Hold. The Case Hold Status is updated to Complete.
Notes Section


Add[Alt] + [A]To add a note to a Case Hold.
  1. Click Add. The Case Hold Note page opens.
  2. Enter the Note text.
  3. Click Save.
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


 

Related 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 / Patient, Guarantor & Insurance Tab

Case / General Case Information Tab

Case / Procedures & Provider Time 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





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