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Claims Creation

GO TO

BILLING → CLAIMS → CREATE CLAIMS

Claims

STEPS

  1. Choose the filters:
    1. Date of Service
    2. Chart Type – Choose SIGNED CHART
    3. Note Location
    4. Patient – you can search for one patient at a time
    5. Healthcare Provider – you can search for one provider at a time
    6. List All; Billing; Non-Billing (Choose One)
    7. Claim Flag: All; Flagged; Non-Flagged (Choose One)
    8. Show Deleted – checking the box will show the deleted line items

    Create Claims

  2. Select SEARCH
  3. Select the V Button to pull the progress note
    Claims Step 3
  4. Select the S button to pull the superbill
    Claims Step 4
  5. Select the R button to pull the referral note template
    Claims Step 5
  6. Select the TRASH BIN button to delete non-billable line item
    Claims Step 6
  7. Select CREATE CLAIM to pull CMS 1500 / 837P / Claim Form
  8. Box 11C – Primary Insurance; if you need to change the primary insurance or update the member ID, click BOX 11C > Edit Patient’s Insurance Profiles
  9. Box 9D – Secondary Insurance; if you need to change the secondary insurance or update the member ID, click BOX 9D > Edit Patient’s Insurance Profiles

  10. Box 10D – If Medicare is Secondary > click BOX 10D to indicate the reason as to why Medicare is secondary
  11. Box 17 – choose the correct provider qualifier
    DN– Rendering Provider; DK – Ordering Provider; DQ – Supervising Provider
  12. Box 23 – you can enter the REFERRAL; AUTHORIZATION; CLIA# in this box
  13. Box 24 – above the Date of Service; click the dropdown above the DOS for the NDC Code
  14. Box 21 – ICD Code; type “?” to pull the ICD 9/10 Lookup
  15. Box 24D – CPT Code; type “?” to pull the CPT Lookup
  16. Click Verify and Submit Electronically to send the claim to the clearinghouse
  17. Click Verify and Drop to Paper to print a paper claim; send to HOLD Queue to put claim on hold
  18. Box 26 – a unique claim# gets generated in BOX 26 after a claim is created. The claim# used to pull up the claim in WRS
  19. FLAG – Select the flag icon to pull the Flag Note. You can enter your notes here > click Save
  20. You can submit multiple claims. Check the box beside the flag > select Submit Selected Claims

NOTES

  • Review the appointment list. This contains the patients scheduled to specific providers and locations. Front Desk performs the check in and check out workflow
  • When the option MOVE TO EXAM ROOM is clicked the system automatically prepares the EMR NOTE. The CPT, Modifier, ICD Codes entered in the superbill, in the EMR Note, will then automatically populate in the CMS 1500/claim Form
  • Non-Billable line items are prescription notes, phone scripts; notes created for documentation purposes only
  • The system will give you claim submission error warning message when there is something missing from the claim

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