Viewing Claim Form Edits and Claim Billing History Previously In IDX 9.0 the system added a Claim Form Prepared transaction to the invoice when the system captured a claim form for an invoice. When you viewed invoice detail, you could see the transaction and know that the claim was prepared. If the claim had not yet been prepared, you did not know the status of the claim or if the claim was being held by claim form edits. Additionally, there was no central location that displayed information about Demand Claims, Insurance Claims Requests, and Tracers. In This Release In IDX 3.0 claim form edits associated with an invoice can be viewed while viewing invoice detail by using Invoice Inquiry selector. All information related to Demand Claims, Insurance Claims Requests, and Tracers can be viewed. Benefits Lets you quickly determine why a claim form has not been produced and provides a central location from which to view related claim request history.

Areas Affected AreaDescription End User Workflow View Invoice Detail screen The Edits field was added to indicate that an invoice has claim form edits. The L-Claim Info action was added. This action is displayed on the View Invoice Detail Action Screen. This action contains the E-Claim Edits and B-Billing History actions. PCS Processing Workfile screen (for Invoice workfiles only) The Edits field was added to indicate that an invoice has claim form edits. This field is for invoice workfiles only. The following actions are now available in the Actions field: CEL (Claim Edit List) CBH (Claim Billing History)

From Invoice Inquiry Screen From Invoice Inquiry Screen Select D View Detail… Then L Claim Info…

Claim Info Screen Claim Info Screen Two New Action Codes: B – Billing HistoryE – Claim Edits

Claim Billing History Screen Type ValueDescription Edit(s)Edits were found for the claim. You can select the row and then select Claim Edits to view the edits. DemandA Demand Claim was filed. TracerA tracer was placed on the queue. Clm ReqA Claim Status Request was filed. PaperA paper claim was prepared. EDIAn EDI claims transaction was prepared for the claim. Provides historical information about a claim related to Claim Requests, Tracers, and Demand Claims. Actions at the bottom of the screen let you view the claim form edits, attached documents, and EDI claim status results for the selected claim form. Claim Form Displays the Claim form related to the type of transaction that occurred to the claim. Type (see descriptions in below chart) Selector Headings and Descriptions

Date Displays the date on which the request was printed or placed in a queue. If the row is for Edits, this is the date of the run on which the claim first hit an edit. Initials Date on which the request was printed or placed in a queue. If the row is for Edits, this is the date of the run on which the claim first hit an edit. Clm Stat Displays the status of the claim from the payer. A status displays only if you use the EDI Claim Status Request transaction. Claim Billing History Screen Selector Headings and Descriptions – Continued

Claim Billing History Screen

Claim Edit History Screen Claim Displays the claim form or EDI exchange that has an edit for the invoice. The edit could be fatal or non-fatal. Type Displays the type of claim on which the invoice will be prepared (Paper or EDI). Description Displays the name of the claim form edit or paycode description. Edit Date Displays the date of the run on which the invoice's claim first hit the edit. Resolved Displays the date of the run on which the invoice's claim cleared the edit. Lag Displays the number of days the edit has been on the invoice's claim. If the edit has been cleared, this number still displays for historical purposes. Field Descriptions

Del Indicates if the claim was deleted. Y indicates the claim was deleted. No value indicates the claim was not deleted. Deadline Displays the date by which the claim needs to file to the payer to receive reimbursement. Ins Prior Displays the priority of the insurance, either Primary or Secondary. Run Displays the number of the claim run on which the edit was first triggered. Run Clr Displays the number of the claim run on which the invoice's claim cleared the edit. Claim Edit History Screen Field Descriptions – Continued

Claim Edit History Screen