Step 5 - Claim Entry for Crown Valley (UB-04 Form)

 Training Video

After completing the Patient Registration section, the next step in the patient visit process is Claim Entry.  Post all fee tickets contained in the Claim Entry section of the workbook. 
 
    SEE THE “REMINDERS” and “SAMPLE OF CLAIM ENTRY FORM” IN THE WORKBOOK!
     Following are the page numbers for each Claim Entry section:
 

 Crown Valley pg 419
 Crown Valley A pg 394
 Crown Valley B pg 444

Select the Claim –F1 to enter each fee ticket (claim). 


Review the Buttons
It is important to become familiar with and understand the functionality of the buttons in Claim –F1.  The buttons are:

 

Add: Select this if you want to add this next claim to a patient other than the one listed in the top blue bar.  In other words, you are working on a new patient and need to Select Patient at the beginning of your claim entry.  After you have retrieved your patient, its defaults display.

Add for Active Patient: Select this if you want to add this claim to the patient listed in the top blue bar (which is considered your active patient).

Find for Active Patient: Select this if you want to view or update a claim for the patient listed in the blue bar (active patient).  You can also make changes/updates to this claim and click the Save button.

Find: This enables you to perform a search for an existing claim for any patient.  You can also make changes/updates to this claim and click the Save button.

Import: Not applicable.

 

Review the Tabs
There are eight tabs across the top of each claim.  The first three tabs contain the necessary information to complete your UB-04 form (also known as the CMS-1450 form).

 


 1.     Claim: Contains rendering, billing, operating, and referring provider; facility and insurance information; type of bill; and claim    
        authorization #.

 2.     Charges: Enter all HCPCS.

 3.     Additional Info: Contains statement, admission, and status information.  More tabs under this screen enable you to enter the
        diagnosis, procedures, and value code information.

 4.     Insurance: View the patient’s current payer and update ID numbers.

 5.     Activity: Shows transactions for this claim.

 6.     Internal Notes: Not applicable.

 7.     Documents: Not applicable.

 8.     Review: Not applicable.

 

How Many Claims Per Patient?
It is important to verify the number of claims your assignment requires.  This information is located in the third column on the Patient Listing report in the workbook.

     Following are the page numbers for the Patient Listing report:


 Crown Valley pg 419
 Crown Valley A pg 394
 Crown Valley B pg 444

 
Add a New Claim to a Patient

Before assuming you need to Add a claim, it is important to verify the number of claims your assignment requires. 

To add a claim to a patient, click the Add or Add for Active Patient button.

 


1.    If you click the Add button, you must immediately click the Select Patient button and search for the desired patient.


2.    If you click the Add for Active Patient button, the patient name that is listed in the top blue bar will populate in the 1 Claim tab.
 
                        

 

Find an Existing Claim
You can retrieve an existing claim to fix errors.  To find a claim, click the Find or Find for Active Patient button.


1.    When you click the Find button, the Claim Selection Window displays.  You can search by the partial or full last name in the Patient Last Name field.  Now click the Search button.  If this patient has multiple claims, a selection box displays for you to click on the correct date of service claim.


 1 Claim Tab

Most of the previously entered patient information will default here.  Double check the information that does default, and complete the remaining fields.

 *    Should be defaulted from the initial Patient –F2 entry.

**   Needs to be completed with claim information provided in the workbook .

 
        1.     Claim Complete: All claims will save as Complete, unless when you click the Save button, an information screen informs you that                 your claim is incomplete and asks if you would like to continue to save as “incomplete.”  If you choose to save your claim as
                incomplete, you must remember to get the appropriate information and enter it in the incomplete claim, and then reselect Claim
                Complete - “Yes” and click the Save button.  A claim complete “NO” results in a score of 0 (zero).

        2.     Claim #: Auto-fills.

        3.     **Type of Bill: With your drop-down arrow, choose 131 (Out-Patient) or 111 (In-Patient) as indicated on your fee ticket.

        4.     **Select Patient: When you are adding a claim, you will need to search for your patient here.  Once selected, the defaults from
                the patient registration process will populate.
        5.     *Select Attending Provider: A provider will default if already entered in the Defaults tab found under the Patient -F2, 1 Patient
                tab.  Listed on the fee ticket is the provider who is treating the patient.

        6.     *Select Billing Provider: This should default from the attending provider field.

        7.     **Select Operating Provider: Complete this field with the provider listed under Procedure on the fee ticket. 

        8.     **Select Other Provider: If there is a second referring physician or second operating physician, select here.

        9.     *Select Referring Provider: A provider will default if already entered in the Defaults tab found under the Patient -F2, 1 Patient
                tab.  You can also select it here.
        10.   Select Facility: This will be blank.
        11.   *Select Primary/Secondary Insurance: If the payer information does not default here, then return to Patient –F2 and complete
                the required payer information (primary insurance under the 2 Insured tab; secondary insurance under either 2 Insured tab
                or 3 Other Insured tab).  Then go to 4 Misc. Info tab, check B, and click the Save button.
        12.   **Uncheck “Always auto-calculate totals”: Many units do not divide evenly into the total charge; therefore, un-checking this                       box enables the user to enter in the units and total charge.
        13.   Form Version CMS-1450 UB-04: The version number of the claim.
        14.   **Authorization #: If an authorization number is given on the fee ticket, enter it here. 
                You MUST click the Copy Authorization to Claim button.

 

2  Charges Tab

Place your cursor in the Serv Date field to start entering the claim information.  Press Tab on the keyboard to continue to the next field. 

All the following fields are described and need to be completed:

        1.     Set Rows: Count how many charges you will post and enter the number here.

   2.     Use Description From: Select HCPCS or Rev Code; either is fine.

   3.     Charges: The sum of all Total Charges for this claim.  This amount should match the Total Charges field listed on the fee ticket.

   4.     Serv Date: Enter the Service Date.

   5.     HCPCS: Enter the code as listed on fee ticket.  If no code is listed, use the arrow to display the CPT/HCPCS Code Search 
           screen and select the charge description.

         6.     M1, M2, M3, M4: Means Modifier 1, Modifier 2, etc.  You can enter up to 4 modifiers per charge.

   7.     Rev Code: Auto-fills based on the HCPCS code.

   8.     Description: The description populates for the HCPCS or Rev code, depending on the Use Description From selection.

   9.     Unit Price: Enter the price of the procedure.  Remember to uncheck the “Always auto-calculate totals” box on 1 Claim tab. 

 10.     Units: Enter the number of days or times this HCPCS is performed.

 11.     Total Charges: Auto-calculates to equal unit price multiplied by units (unit price x units = total charge).

 12.     Status: Defaults properly based on whether the insurance payer is electronic or paper.


3 Additional Info Tab

Field requirement usually depends on whether your patient is In-Patient (IP) or Out-Patient (OP).  This has already been specified under the 1 Claim tab.  See your fee ticket for determining if the patient is IP or OP.

Required Fields for In-Patient Claims

1.     Statement Covered (Box 6): The Statement Covers “From” and “To” dates.

      2.     Admission Date (Box 12): Date of admission.

      3.     Admission Hour (Box 13): Time of admission.

      4.     Admission Type (Box 14): This code indicates the priority of admission.

      5.     Admission Source (Box 15): This code indicates the source of patient admission.

      6.     Discharge Hour (Box 16): The time of discharge.

      7.     Patient Status (Box 17): Select the 01-Routine Discharge.

      8.     Accident/Injury Related to and Accident State (Box 29): Mark the method of accident and enter the state abbreviation in
              which the accident occurred.


  Required Fields for Out-Patient Claims

1.     Statement Covered (Box 6): The Statement Covers “From” and “To” dates.

      2.     Admission Type (Box 14): This code indicates the priority of admission.

      3.     Admission Source (Box 15): This code indicates the source of patient registration.

      4.     Patient Status (Box 17): Select the 01-Routine Discharge.




Additional Info Bottom Tabs

You must complete some bottom tabs with the information given on your fee ticket: Diagnosis, Value, and/or Procedure tabs.

 

 

 Diagnosis Tab

 

Enter the code or use the arrow to search for the diagnostic code.   

 

Field requirement usually depends on whether your patient is In-Patient (IP) or Out-Patient (OP).  This has already been specified under the 1 Claim tab.


Procedure Tab

If a procedure is listed on the fee ticket, enter the code and date in the appropriate column. This tab is for in-patient surgical codes only, and prints in box (FL) 74a-e.

 

Also listed on the fee ticket is the operating physician (box 77).  If there is an operating physician listed in the Procedure column, be sure to select this provider under the 1 Claim tab.

 

Value Tab

If the value code and amount is provided, be sure to complete these two fields.  The code entered must be two digits.

 

 

5 Activity Tab

The Activity report lists the activities for all charges on this claim only.  This is a good way to confirm postings (both charges and EOBs) and aging.


Click the List Activity button.  The report will display for you to view, or you can Print this activity report.

 

Save Your Work and Print the Claim

After completing the 1 Claim tab, 2 Charges tab, and 3 Additional Info tab, it is time to save and/or print the claim. 

 Two ways work for the classroom environment:

 
 
 
If you don’t want to Save your work, click the Close button.