ADDING CLAIMS:
From the Left Navigational Menu select ‘Patients’ and doubleclick on the
patient’s record to open the ‘Edit Patient Data’ window, and then select
the ‘Add Claim’ button to begin entering information in the opened ‘Edit
New Claims Data’ screen:
TOP PORTION:
a) Facility: From the drop down menu, select the facility where the
services were rendered.
b) Hospitalized From/To: Enter the patient’s hospitalization dates.
c) Unable to Work From/To: Enter the appropriate from/to dates.
d) Condition Related To, State, Date: (HCFA 1500 Claim Form Box
10). Enter as appropriate.
e) Date of Current Illness, First Date if Illness is Same or Similar,
Date Last Seen: (HCFA 1500 Claim Form Box 14, 15, and 16).
Enter as appropriate.
f) Medicaid Resubmission Code/Original Reference #: Provided by
Medicaid. Enter as applicable.
g) Outside Lab: If lab work was sent to an outside lab to process, but
your office is billing for the service, select the ‘Yes’ button, and
enter
the charge(s) in the field(s) provided.
BOTTOM PORTION:
a) Click the ‘Add’ button under the word ‘Procedures’ to open the ‘Edit
New Transaction Data’ form.
b) Dates of Service (From/To): Enter the date (or date range) that the
services were rendered.
c) Place of Service: Select the correct code from the drop down menu.
d) Type of Service: Select the correct code from the drop down menu.
e) Diagnosis: Enter (or select) the diagnosis code(s) to be billed.
f) Procedure (1-6): Enter (or select) the procedure code(s) to be
billed.
If more than one diagnosis is used, but not applicable to each
procedure code billed, uncheck the box(es) next to the number(s) of
the diagnosis pointer(s) that do/do(es) not apply.
Note: If the ‘Procedure Code’ set up was done correctly (refer to
section ‘II)
Program Setup/Procedure Codes’, the ‘Units’ and ‘Dollars’ fields will
fill in
with the appropriate amounts. You may override them by highlighting the
amount(s) shown and typing in the corrected amount(s).
g) Prior Authorization: If previously entered, (refer to section ‘III)
PATIENTS F) PATIENTS /Default Tab’), select it from here. You
may also enter it by selecting ‘Edit’ from the drop down menu, then
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selecting ‘Add’ in the ‘Prior Authorization For’ box that appears in
the ‘Edit New Prior Authorization Code’ window. In the fields
provided, enter the number, select the amount of visits from the drop
down menu, and enter the expiration date. Click ‘Save’ when done
and close the ‘Prior Authorization For’ box.
If you have additional services to bill for this patient, click the
‘Save and Add’
button on the bottom left side of this screen to open a new ‘Edit New
Transaction
Data’ screen to enter more charges.
If there are no additional services, click the ‘Save’ button on the
bottom right
side of this screen to return to the ‘Edit New Claims Data’ screen.
Click the
‘Save’ button to exit out of this screen and return to the ‘Edit Patient
Data’
screen, then ‘Save’ to exit and return to the ‘Patient Data’ screen.