Chapter 10

 

The S.I. Manager (Student Instructor Manager; SIM) *** is the software center in which you will need to access to:
            
            1. Register your Access Key Code (for new students).
            2. View your assignment status.
            3. Toggle between your active assignments with the green ball.
            4. Score your claims.

Log in to S.I. Manager ***

If you are a new student and need to register your Access Key Code, this is how you will access S.I. Manager . 

1. Open ClaimGear ***, on the Welcome tab, click on Click here to access S.I. Manager.*

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2. The S.I. Manager *** login screen will display. Enter your student username and password that you wrote on the inside cover of
the workbook ***, and then click the Go button.

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*The website is http://sim.collaboratemd.com.

Log in to S.I. Manager *** While Logged in to ClaimGear ***

While connected in ClaimGear ***, go to the menu bar tab Tools and select S.I. Manager.

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The S.I. Manager *** opens into your student account automatically.


Understand The Assignment Details Provider

When you log in to S.I. Manager ***, your account immediately displays all assignments you have been assigned with the
AssignDate, Assignment, Account #, Status, Grade %, last Score Date, # Checks, Class, and Instructor.

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Assign Date: Displayed is the date on which your instructor created the assignment.

Assignment: Displayed is the name of your assignment section in the workbook ***. See the main Table of Contents for the page
number of your assignment.

Account: This number is for official ClaimGear support.

Status: The status is Active, Canceled, or Completed. Active means you can still access this assignment; Canceled means the
assignment was created but then canceled and cannot be accessed; and Completed means this assignment was assigned and
finalized, a grade has been recorded, and the assignment cannot be accessed.

Grade: The grade provided is a percentage (%).

Score Date: Displayed is the last date someone has scored your work. Only three people have access to score your work: you, the
instructor, and ClaimGear Support (administrator).

Checks: Displayed is the number of times your ClaimGear assignment has been scored. You can click the number (e.g. 50), and
specific information displays (who scored the assignment, the date it was scored, and the assignment total score).

Class: Displayed is the name of the class as provided by the instructor.
Instructor: Displayed is the name of the instructor who created this assignment.


Understand the following icons:

 ***            View Score: Click to view the assignment scores.

 ***            Current Active Assignment: The green ball indicates the student is active in this class assignment.
    
 ***            No Current Assignment: The clear ball indicates the student is not active in this class assignment.


CONTROL ASSIGNMENTS WITH THE GREEN BALL ***
A student can be ACTIVE in multiple assignments at one time, but can work only on the selected assignment that is indicated by the
green ball. Students have control over which assignment they can log in to, and need to make sure the green ball is selected on the
correct assignment. To begin working on an assignment, click the clear ball next to the assignment on which you want to work.

After it changes to green, log into ClaimGear ***, and the corresponding assignments database will be retrieved.

For example, notice below that the student is active in 11 assignments, but can currently work only on the Prime Smile assignment
because the green ball indicates it.

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To choose a different assignment, click on that assignment’s clear ball to change it to green. In this new example, we change from
Prime Smile to the Rocky Shore assignment. Note that Prime Smile changes to a clear ball, and Rocky Shore changes to green.

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SCORE YOUR WORK

To score your ClaimGear *** assignment, click the View Score icon.

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The assignment details, including all the patients you are responsible for completing, will display with a grade. The Problem column
is where the patients name and claim date is listed. For each patient/claim, the total Points, Score, and percentage Grade is listed.

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EXPAND TO SEE THE ERRORS
All Problems: To expand and see details for all patients (problems), click the *** on the first row.

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Individual patients: To expand and view details on individual patients, click the *** on the desired patient. It turns into *** when expanded.

Note: The box numbers listed refer to the Specs chapter in this manual (CMS-1500, page 127 or UB-04, page 132 or ADA-J430, page 139) and provide directions on how to access the appropriate field in ClaimGear *** to make the error corrections.

After you see the details of your errors (see the “What Do These Errors Mean?” on page 119), you can toggle back into ClaimGear *** and fix them.

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To score again, click the Rescore Now button at the top of the screen.

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PRINT A SCORING REPORT
You can print your report anytime and as often as you would like, especially be sure to print your report prior to the end of the class.
In the event that something happens with your ClaimGear *** account or Internet connection, having a record of your assignment
and what you have completed gives you a grade with the work thus far.

The easiest way to print your report:

From anywhere on the scoring screen, right-click, and select Print.

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DETAILS AT THE TOP OF THE SCORING REPORT
Understand the information provided on the scoring report.

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WHAT DO THESE ERRORS MEAN?
Is it possible to have multiple errors on the scoring report? Potentially there could be an error or score for almost every field on each
of the three claim forms. Students are scored on hundreds of fields. Whether the error is caused by a typo or blank (when it should
be completed), the scoring logic will produce an error on the report. The scoring report provides details for the student to
make it easier in locating the position of the error in ClaimGear *** so a correction can be made.

Understand the following five columns of error details:

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Box: Refers to the box number on the claim forms. Note: Although UB-04’s boxes are referred to as FL’s (form locators), ClaimGear *** lists it as boxes.

Object: One-word summary of the screen the error is located in.

Field: The specific field name in ClaimGear ***. If the field says “NOT FOUND,” then you must see the “Charge Not Found Error” and “Claim Not Found Error” at the end of this chapter for specific steps to correct this issue.

Value: The exact data the student entered, including the typo or a blank (a blank will say “not found”). If data is in this field (e.g., 22 or Not Found), this is the error that needs to be corrected. Reference the patient’s information in the workbook against this error information and locate the erroneous field in ClaimGear *** to correct the data. There is an exception to this box where the data provided in this value box is the correct information instead of the error entered by the student. This happens only when the Field column states, “…Not Found.” You must see the “Charge Not Found Error” and “Claim Not Found Error” at the end of this chapter for specific steps to correct this issue.

Points: The number of points this box is worth.

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See the Specs chapters (CMS-1500, page 127 or UB-04, page 132 or ADA-J430, page 139) for a visual of the claim forms, a
description of the field and box, and directions on how to locate this field in ClaimGear *** so a correction to the typed error can be
made.

BILLER'S GOAL

The goal of a biller is to receive 100% on all claims. Therefore, continue to score the claims and correct all errors until the due
date and time.

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"CHANGE NOT FOUND" ERROR:

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If your report says, “Charge Not Found,” one or more of four issues is present. You must check all four issues and determine
which of them needs to be fixed prior to rescoring.

    1.     Multiple claims: When only one claim per date of service is assigned (for example, in West Point Clinic), having multiple claims                    entered will cause this error. To delete all extra claims, retrieve in Claim *** the extra claim(s) one at a time, and click the Delete                    Claim button.

    2.     Claim is Complete: In Claim ***, retrieve the patient’s claim. Under the 1 Claim tab, is the box “Claim is complete” checked? If not,             the system cannot score it. Please make sure all claims are saved and checked to indicate “Yes” in the Claim is Complete field. If                the system won’t allow you to save your claim as complete, then you are forced to review all three screens in this claim and                        determine which information is missing/incorrect. Note: It could be several things (provider, facility, charges, or dates of services).

    3.     Date of Service (DOS): In Claim ***, retrieve the patient’s claim. Under the 2 Charges tab, the Date of Service(s) could be incorrect.             Open to the claim in the workbook *** and verify its correct date of service. Remember the correct DOS is listed on the scoring                    report in the Value field (pictured above).

    4.     Charge/Procedure (CPT/HCPCS/CDT) and Modifier/Rev Code/Tooth: In Claim ***, retrieve the patient’s claim. Under the 2                    Charges tab, both the Charge/Procedure codes and the Modifier/Rev Code/Tooth could be incorrect. Open to the claim in the                        workbook *** and verify its correct code(s). Remember the correct code(s) are listed on the scoring report in the Value field (pictured             above).

Now you can rescore your claim.



"CLAIM NOT FOUND" ERROR:

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If your report says “Claim Not Found,” one or more of five issues is present. You must check all five issues and determine which
of them needs to be fixed prior to rescoring.

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    1.     *Duplicate patient: How many patients do you have in the system? Only one patient is allowed; any duplicate patient accounts can             cause this error. To delete this duplicate patient account, in Patient ***, search to retrieve the duplicate account. Under the Patient                tab at the top middle, check the Make this patient inactivate box and click the Save button. This completely removes your duplicate             patient. For details on this, see the Patient Registration chapter, page 30.

    2.     Spelling of patient’s name: In Patient ***, search to retrieve the patient and under the Patient tab, check the spelling of the                        patient’s name, as it could be incorrect. Open to the patient information in the workbook ***and verify its correct spelling and                        position. Remember the correct spelling and position of the patient name is listed on the scoring report in the Value field (pictured                above).

    3.     Date of Birth (DOB): In Patient ***, search to retrieve the patient, and under the Patient tab, review the Date of Birth as it could be                incorrect. Open to the patient information in the workbook ***and verify its correct date of birth. Remember the correct DOB is listed             on the scoring report in the Value field (pictured above).

    4.     Claim Complete: In Claim ***, search to retrieve the patient’s claim. Under the Claim tab, determine whether the box is checked for             “Claim is complete”. If not marked, the system cannot score it. Please make sure all claims are saved as “Yes” by making sure this                box is checked. If the system won’t allow you to save your claim as complete, then you are forced to review all three screens in this             claim and determine which information is missing or incorrect. Note: It could be several things (provider, facility, charges, or dates of             services).

    5.     Date of Service (DOS): In Claim ***, search to retrieve the patient’s claim. Under the Charges tab, the Date of Service(s) could be                incorrect. Open to the Claim in the workbook *** and verify its correct date of service. Remember the correct DOS is listed on the                scoring report in the Value field (pictured above).

Now you can rescore your claim.

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CROSS-REFERENCE THE SCORING REPORT WITH THE "PATIENT LISTING" REPORT
As described previously, there are several reasons this error is present and can easily be identified by cross-referencing this information.

Following are two examples that demonstrate how cross-referencing the “Claim Not Found” error with the “Patient Listing” report in ClaimGear *** will assist you in troubleshooting the specific error, causing the “Claim Not Found” error.

EXAMPLE 1

Below is an example of the patient name being misspelled. Generate both reports and compare them. Notice the student has the patient last name as “Wqarenski” and it should be “Warenski”. Simply clicking in Patient ***, retrieving the record, and editing the last name will fix this error so at least the claim can be found and properly scored.
    
                                                    "Patient Listing"                                                        "Scoring Report"

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EXAMPLE 2

Below is an example of the patient being duplicated in ClaimGear ***. Generate both reports and compare them. Notice on the “Patient Listing” report, the patient Warenski displays twice, which indicates that more than one record has been created. Simply go to Patient ***, search for this patient, choose the incomplete patient record to retrieve (and by the Account # listed on the “Patient Listing” report), and then check to inactivate the record. Once re-scored, the claim can be found and properly scored.

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PRACTICE REVENUE CYCLE ACTIVITIES: PATIENT REGISTRATION, CLAIM                                                                                         MANAGEMENT, COLLECTIONS, AND                                                                                     REPORTING  

The practice revenue cycle activities are a combination of discussion questions and activities using ClaimGear *** and its workbook ***.

It is important to understand that scoring your assignment/claims is simulating the real-world process of submitting claims electronically to the clearinghouse and payers. After you have scored your assignment, complete the following tasks to further enhance your revenue cycle experience as it relates to your current ClaimGear *** assignment.

    1.     How many times did you receive 100% on the claim(s) the first time you scored your assignment?
    2.     How many times did it take you to receive 100% on your entire assignment? Discuss how this relates to an office and                                    the consequences of submitting the claims many times and the time it takes to receive the report and the lost time in between.
            How does this affect the office and provider(s) financially?
    3.     How often did you score your assignment? Discuss how in an office you may choose to submit claims daily or weekly, and discuss                your opinion of when you should submit claims.
    4.     What was your most common error? What section is this in ClaimGear, the Patient, Claim, or Payment?
            a.     How do these errors impact various job functions in an office? Discuss how possibly the error of an inacurate insured date of                        birth relates to the front desk receptionist. Discuss how possibly the error of a missing date of onset relates to the medical                            assistant/biller.  Discuss how possibly the error of the incorrect payer adjustment relates to the billing specialist.
           b.      Discuss the various errors that can occur (visit the Specs chapters to aid in this discussion) and which job                                                    and/or whose responsibility is it in the office setting. How could you improve your performance if you committed this error?
    5.     How does scoring (submitting claims electronically and receiving acceptance or denial results) include the entire revenue cycle                    experience?

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