Technical Support
Claim Creation Cycle
A. A charge is marked to become a claim - a charge has been entered on the a Ledger with the proper information in place (ins1, proper procedure codes, insurance information, etc.) a "B" is placed in either "I1", "I2", "I3" or "I4". The "B" indicates that the charge is now billable and a claim will be created.
. The claim is created - Press <Alt+F1> and follow the menus to create a claim. The system looks for a "B" in any charge line field "I1", "I2", "I3", or "I4" and creates a claim for that charge.
The system looks at the "MD" or "MD_ID" field to determine which doctor did the work.
It also looks at the "INS1" (or 2, etc) field to determine which insurance company is involved.
The system now looks at the Practice file to see if the Insurance plan has a listing in the "Ins_Type" field. If it finds one it picks the "Id_Number" field for the provider PIN. This information is placed on the claim file
The system looks at the InsPlan file for the carrier and pulls information from it and places this information in the claim file.
C. The claim is stored and set up for printing/processing - the actual claim is stored in the Insurance Claim File. Some information about the claim is placed in the Printq file (claim number, insurance company involved or electronic processor to be used, patient last name, etc.).
D. Print or process the claim - When asked, the Printq sends the claim information to the printer or to the electronic claim file for transmission. The information is then deleted from the Printq file.
E. To re-process the claim - To send the the claim out again:
Locate it in the Insurance Claim File and press <F8> and put it back in the Printq (or send it to the printer if it is not an electronic claim) or
To re-create it from the Ledger, either:
Put a "B" in the I1 field, Validate, then create the claim normally or
Press <Alt+F1>, select "Insurance Claims", then "Resubmit Transactions", select the insurance plans, enter the lines to appear in the claim, press the <Enter> key to the next several questions, then create the claim normally.
F. To remove a claim - To remove a claim:
Locate it in the Insurance Claim File and press <Alt+R> or
from the Ledger press <Alt+F1>, select "File Maintenance" and then "Delete Old Insurance Claims". This will remove claims that are older than the number of days you select.
G. To re-print a claim - To print a claim not in the printq.
From the "Patient Ledger":
Locate your patient
Press <F8>
Select #4 "Print an Insurance Claim"
The claim will be displayed. If this is not the correct claim (there can be several claims for any one patient) use <F6> and <F5> to locate the correct claim.
Press <P> and the claim will be sent to the printer.
From the "Insurance Claim File":
Locate the claim you want to print.
Press <F8>
Highlight "Print this claim" and press <Enter>. The claim will be sent to the printer
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