Type of Claim, New or Existing?
It is important to know the difference between creating a new claim versus updating an existing claim.
Review the Tabs
There are nine 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
6. Notes: Not applicable.
7. Alerts: Not applicable.
8. Documents: Not applicable.
9. Review: Not applicable.
Crown Valley Hospital, pg 4 Cherry Hills Hospital, pg 4
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 (see the previous information).
To add a claim into the system, click the Add Claim button. Next, click the Blank Claim or the Add for Patient Name button.
2. If you click the Add for Patient Name option, the active patient that is displayed at the bottom left of the software will populate in 1 Claim tab.
Find an Existing Claim
You can retrieve an existing claim to fix errors. To find a claim, click the Find button or Find for Active Patient button.
Place your cursor in the Search field and type in either part of or the full patient’s first or last name. The results will filter all patients with these specific characters found in the database and display them alphabetically in an organized table. Always search here first to determine whether the patient and claim are already in the system to prevent duplicate claim entry. All saved claims will display here. Click the Search button.
1 Claim Tab
Once a patient is selected, 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 entry. ** Needs to be completed with claim information provided in the workbook .
2. Claim Complete: All claims will be checked as “Claim is complete,” unless when you click to Save the claim, an information screen informs you that this 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 correct information and enter it in the incomplete/incorrect claim, and then check the box to make the claim complete before saving. A claim that is not complete results in a score of 0 (zero).
3. **Type of Bill: With your drop-down arrow, choose 131 (Out-Patient) or 111 (In-Patient) as indicated on your fee ticket.
6. *Select Billing Provider: This field will 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 it here.
2 Charges Tab
Begin this screen by setting the number of rows based on the number of charges on the fee ticket. Then place your cursor in the Service 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:
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.
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.
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.
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 it prints in box (FL) 74a-e.
Also listed on the fee ticket when there is an ICD procedure is the operating physician (box 77). If there is an operating physician listed below the procedure, be sure to select this provider under the 1 Claim tab.
If the value code and amount are provided, be sure to complete these two fields. The code entered must be two digits.
4 Insurance Tab
This screen provides the opportunity to view and edit any insurance information.
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.
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.