Claim entry: Medicare primary

General

• Setup: Professional Claims Menu, Enter Claims, Patient Info & General
• Required: LOB, Billing Provider, Patient Control No, Employment, Accident, Outside Lab, Dental (for 837D claims only)
• Optional: Date/Ind of Current, First Date, UTW/Disability Dates & Types, Hospitalization Dates, Outside Lab Chgs, Facility, Referring Phys Name
• Leave blank: Medicaid Resubmission Code & Ref No, Dental (for 837 claims), COB, Frequency

Insured information

• Setup: Professional Claims Menu, Enter Claims, Insured Information
• Information pulled from Patient database when patient selected on Patient Info & General Tab

Line item details

• Setup: Professional Claims Menu, Enter Claims, Billing Line Items, Line Item Details
• Required: Diagnosis Codes (at least one), Service From/Thru Dates, Charges, PS, Proc, Diagnosis Pointer, Charges, Units, Rendering Phys. (unless billing as a Solo Provider), Total Charge, Dental tab (837D claims only)
• Optional: Additional Diagnosis, EMG, Modifiers, EP, FP, AT, Rendering Physician (unless billing as a group)
• Auto populated: Recalculate, Patient Amount Paid, and Balance due when Recalculate is selected

Line item details: Dental

• Setup: Professional Claims Menu, Enter Claims, Billing Line Items, Line Item Details
• The Dental tab will display when a valid dental HCPCS code is provided along with “A” in the 24h AT field

Tips

• Setup: Professional Claims Menu, Enter Claims, Billing Line Items, Line Item Details
• Tips: Right click or F2: Accesses information from databases or available pull down menus

F4: Field Duplication

F5: Line Duplication

F7: Line deletion

F8: Advance to next line

Edit validation errors list

Once “Save” is selected, the claim will edit for known requirements.

• Error message will indicate the line or field the error is associated with
• Double click on error to jump to corresponding field
• Once error is corrected select “Save” again to re-edit claim
• Red X error must be corrected before transmitting
• Only claims saved as CLN or ERR can be transmitted

Claim entry: Medicare secondary / payment made

General

• Setup: Professional Claims Menu, Enter Claims, Patient Info & General
• Required: LOB, Billing Provider, Patient Control No., Employment, Accident, Outside Lab, COB, Dental (for 837D claims)
• Optional: Date/Ind of Current, First Date, UTW/Disability Dates & Types, Hospitalization Dates, Outside Lab Chgs, Facility, Referring Phys Name
• Leave blank: Medicaid Resubmission Code & Ref No, Dental (for 837 claims), Frequency, Reserved For Local Use

Insured information

• Setup: Professional Claims Menu, Enter Claims, Insured Information
• Information pulled from Patient database when patient selected on Patient Info & General Tab

Line item details: MSP

• Setup: Professional Claims Menu, Enter Claims, Billing Line Items, Line Item Details
• Required: Diagnosis Codes (at least one), Service From/Thru Dates, PS, Proc, Diagnosis Pointer, Units, Rendering Phys (unless billing as a Solo Provider), Recalculate
• Optional: Additional Diagnosis, EMG, Modifiers, EP, FP, AT, Rendering Physician (unless billing as a group)
• Auto populated: Total Charge, Patient Amount Paid, and Balance due when Recalculate is selected

Line item details: MSP/COB line 1

• Setup: Professional Claims Menu, Billing Line Items, MSP/COB Line 1
• Required: Approved, SVD, CAS, Adj/Payment Date
• Leave blank: OTAF, Information on lines 2 and 3 of SVD and CAS, Procedure Code Description, Remaining Owed

Line item details: MSP/COB line 2

• Setup: Professional Claims Menu, Billing Line Items, MSP/COB Line 2
• Required: Approved, SVD, CAS, Adj/Payment Date
• Leave blank: OTAF, Information on lines 2 and 3 of SVD and CAS Procedure Code Description, Remaining Owed

Ext payer insured: Secondary payer

• Setup: Professional Claims Menu, Ext. Payer/Insured, Primary Payer Insured
• Required: Insurance Type (insurance type was left blank for training purposes)
• Auto populates: Payer Address, Payer Source
• Optional: Insured’s Contact, Patient ID
• Leave blank: Payer/ Insured Reference IDs/Types

Ext payer insured: Secondary payer / COB info primary

• Setup: Professional Claims Menu, Enter Claims, Ext. Payer/Insured, COB Info (Primary)
• Required: Zero Payment Made Ind N – to indicate payment was made, COB Code (D – to indicate total claim payer paid amount), MOA Amount
• Leave blank: OTAF, CAS, Medicare Outpatient Adjudication (MOA) Remarks Codes, Claim Adjudication Date

Edit validation errors list

Once “Save” is selected, the claim will edit for known requirements.

• Error message will indicate the line or field the error is associated with
• Double click on error to jump to corresponding field
• Once error is corrected select “Save” again to re-edit claim
• Red X error must be corrected before transmitting