1) Verify / Delete Pending Eclaims
 |
This screen lets you visually
inspect all of your electronic claims prior to sending them to the clearinghouse
for processing. |
| 2)
Search Last Name |
To jump quickly to someone who's claim
you want to see, type the first couple of letters of their last name here
and click the "Go to" button.
|
| 3)
Client Personal Information |
The client's personal information as it
is being transmitted to the insurance company through the clearinghouse.
This information comes off of the client's Fiscal Face sheet.
|
| 4)
Claim ID |
The unique CLAIM ID that is associated with
this claim. Each person will have a unique Claim ID for each batch of sessions
that are being transmitted. All services that are being sent in the same
batch will have the same Claim ID as all of the others for a specific client,
and you can see what the Claim ID is by looking here, or at the bottom of
the Session Note screen itself. Over time, an individual client will have
many Claim IDs, one for each time one or more services were transmitted.
The claim ID's are automatically generated by CILe.
|
| 5)
Total Charges |
This is the total amount of your fees that
are on all of the services being submitted with this claim.
|
| 6)
Insurance Company |
This is the insurance company to whom the
claim is being sent, and whether it is the Primary or Secondary insurance
company for this client.
|
| 7)
Delete All Services button |
If you want to delete all of the services
for this client from the current transmission, click this button. The services,
as well as the claim itself, will be deleted from the transmission file.
If you decide to go ahead and include them after all, you can go to the
Fiscal menu, and select "Sessions with no claims submitted" item.
The services you just deleted will appear there, and you can click the "Create
Electronic Claims" button and they will be re-created and included
in the transmission. The other way you can re-submit them is by going back
to the session note itself and clicking the "submit claim" (or
re-submit claim) checkbox and the checkbox corresponding to the Primary
or Secondary insurance policy. When you save the note, the claim will be
recreated and will again appear in this listing.
|
| 8)
Delete Service button |
Click this button if you only want to
delete one of the services listed for this client. If there are more than
one services listed, the claim itself will not be affected. If the service
is the only service listed, then it functions exactly the same way as
the "Delete All Service Claims" button above does. The claim
will be deleted also. See the explanation in the box above for how to
recreate the claims if you decide to do so after you've deleted them.
|
| 9)
Line Number |
This is a number the clearinghouse uses
to uniquely identify each service being submitted. They have to be sequential
with no gaps, and they have to start with the number "1". If you
have more than one service being submitted, be sure that this is the case.
The clearinghouse doesn't care if the dates of service are in any particular
order, so don't worry about that. Just make sure that these numbers are
sequential with no gaps, and that they start with "1." There shouldn't
ever be a problem, but if you see it, you can fix it right here. Just type
over the top of the bad numbers.
|
| 10)
Service information |
This is the date, etc., from the Session
Note. If any of these values change on the Session Note, they will automatically
change here, as well, if the data hasn't yet been transmitted to the clearinghouse.
If, however, you change anything on the Session Note but have already transmitted
this data to the clearinghouse, then you need to be aware that there may
be a discrepancy between what was submitted and what is now on the Session
Note.
|
| 11)
Amount Paid |
This number will always be
zero. From the insurance companies perspective, this is the amount of money
the client paid you for their part of the fee. It can be either the copay
or the co-insurance. The reason I submit a zero to them, however, is because
there are occasions when you might be under the impression that your client's
copay/coinsurance is one thing, but when the paperwork comes in, it turns
out to be something else. If your client paid you more than the insurance
company thinks they should have, then they may send them the balance and
deduct it from your payment. I have had that happen, and it makes my accounting
much harder. Since I've been sending them a zero here, I have never had
that happen. If your client pays you too much or too little, that's between
the two of you to sort out, and the insurance company will deduct the allowable
copayco-insurance anyway, so you're not hurting them a bit.
|
| 12) Balance
of Claim |
This is the summation of your fees on all
of the services being submitted with this claim. When you call the insurance
company to find out why you haven't been paid, they will often ask you the
total of the claim. This is the number they're looking for. You will find
the same number on the "Insurance Payment Maintanance" screen
off of the Fiscal menu.
|
| 13)
Claim DX Code |
This is the Diagnostic code that pertains
to the entire claim rather than the individual service. If you will look
at a HCFA 1500 form, you will see a place for four DX codes above where
you put the individual services, and you will also see a place on the individual
service line for a DX code as well. This is the one that is on the first
line of the four above the service lines. This value is populated from the
"Dx 1" code on the client's Fiscal Face Sheet. If you have filled
in "Dx 2" through "Dx 4" on the face sheet, they will
be on the claim that is transmitted, but not show up on this screen. |
| 14)
Claim navigation arrows |
Don't forget the Windows record navigation
arrows. These arrows allow you to go from one record to the next - in this
case one claim to the next. The single arrow takes you one claim, the double
arrow jumps you to the beginning or ending claim. |
