Overview


The Plan: New and Plan: [name] pages are comprised of twelve tabs:

The Electronic Claim Options tab displays a read-only view of the claim options configured for electronic claims. This configuration determines the data sent in a plan's electronic claim clearinghouse file. The claim options are configured with the clearinghouse specifications of the plan provided to Solutions.  You cannot change any information displayed on this tab. Solutions maintains the electronic claim options configuration. If a change is required to this configuration, enter a ticket through Solutions Support Center to  request the change.

Note: This tab is not accessible from the Plan: New page until the General and Claims tabs have been populated and applied.


To open the Electronic Claims Options tab for new plan:

From the Home Page:
From the Menus:
Via Shortcut Keys: 
  1. Click Payers & Plans from the Admin list 
  2. Click Create Plan
  3. Populate the General tab
  4. Click Apply
  5. Click the Claims tab
  6. Populate the Claims tab
  7. Click Apply
  8. Click the Electronic Claim Options tab
  1. Open the Admin menu and select Payers & Plans
  2. Click Create Plan
  3. Populate the General tab
  4. Click Apply
  5. Click the Claims tab
  6. Populate the Claims tab
  7. Click Apply
  8. Click the Electronic Claim Options tab
  1. From the Payers & Plans page, press [Alt] + [P]
  2. Populate the General tab
  3. Click Apply
  4. Click the Claims tab
  5. Populate the Claims tab
  6. Click Apply
  7. Click the Electronic Claim Options tab
 


To open the Electronic Claim Options tab for existing plan:

From the Home Page:
From the Menus:
Via Shortcut Keys: 
  1. Click Payers & Plans from the Admin list 
  2. Select the plan to be modified
  3. Click Update*
  4. Click the Electronic Claim Options tab

*Alternate Navigation: Double-click the plan from the list

  1. Open the Admin menu and select Payers & Plans

  2. Select the plan to be modified

  3. Click Update*

  4. Click the Electronic Claim Options tab

*Alternate Navigation: Double-click the plan from the list

  1. From the Payers & Plans page, select the plan to be modified
  2. Press [Alt] + [U]
  3. Click the Electronic Claim Options tab



 

 



Field Definitions

Field

Type

Required

Description

Field Name

Read-only

Yes

Corresponds to the ANSI loop and segment in the electronic claim file that contains data from the case. The ANSI loops and segments are sorted alphabetically by name.

Group Billing Columns

Columns specific to the practice type of Group, indicating that the practice group bills by provider group.
Primary Claim

Read-only

YesContain the values of the ANSI loop and segment for primary claims.
Secondary Claim

Read-only

YesContain the values of the ANSI loop and segment for secondary claims.
Individual Billing Columns

Columns specific to the practice type of Solo Provider, indicating the practice bills for an individual provider.
Primary Claim

Read-only

YesContain the values of the ANSI loop and segment for primary claims.
Secondary Claim 

Read-only

YesContain the values of the ANSI loop and segment for secondary claims.


 






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