7 Creating Claims

Learning Outcomes When you finish this chapter, you will be able to: 7.1 Describe the role of claims in the billing process. 7.2 Discuss the information contained in the Claim Management dialog box. 7.3 Demonstrate how to create claims in Medisoft. 7.4 Describe how to locate a claim that has already been submitted. 7.5 Discuss how claims are edited in Medisoft. 7.6 Explain how to change the status of a claim 7-2

Learning Outcomes (Continued) When you finish this chapter, you will be able to: 7.7 List the steps required to submit electronic claims in Medisoft. 7.8 Describe how to add attachments to electronic claims. 7-3

Key Terms filter navigator buttons 7-4

7.1 The Role of Claims in the Billing Process 7-5 Once the services a patient has received from a provider have been entered into the PMP, the next step is to create insurance claims – Most important document for correct reimbursement – Communicate information about a patient’s diagnosis and procedures and the charges to a payer

7.1 The Role of Claims in the Billing Process (Continued) 7-6 The HIPAA standard transaction for electronic claims is the HIPAA X Health Care Claim or Equivalent Encounter Information (837P). The paper format is known as the CMS-1500 claim form.

7.2 Claim Management in Medisoft 7-7 Claims are created in the Claim Management area of Medisoft Claim Management dialog box

7.2 Claim Management in Medisoft (Continued) 7-8 The upper-right hand corner of the Claim Management dialog box contains five navigator buttons Navigator buttons simplify the task of moving from one entry to another Navigator buttons

7.3 Creating Claims 7-9 The Create Claims button in the Claim Management dialog box opens the Create Claims dialog box Create Claims dialog box

7.3 Creating Claims (Continued) 7-10 A filter is a condition that data must meet to be selected The Create Claims dialog box uses these filters: ▪ Transaction dates ▪ Location ▪ Chart numbers ▪ Assigned ▪ Primary insurance ▪ Attending ▪ Billing codes ▪ Enter Amount ▪ Case indicator

7.3 Creating Claims (Continued) 7-11 Once claims are created, they are listed in the Claim Management dialog box, with a status of Ready To Send Exercise 7-1 page 222

7.4 Locating Claims 7-12 Medisoft’s List Only feature selects only those claims that meet specified criteria, such as: – Chart number – Date created – Insurance carrier – EDI receiver – Billing method – Billing date – Batch number – Claims status

7.4 Locating Claims (Continued) 7-13 The List Only Claims That Match dialog box Exercise 7-2 page 226

7.5 Editing Claims 7-14 To edit a claim, first select it in the Claim Management dialog box, then click the Edit button to display the Claim dialog box Edit button

7.5 Editing Claims (Continued) 7-15 Information can be edited on the five tabs of the Claim dialog box Exercise 7-3 page 231 Five tabs