Claim Master
Web-Native
Professional - HCFA 1500
December 2004
WebMD Business Services
Table of Contents
CLAIM MASTER INTRODUCTION ... 1
CLAIM MASTER SCREEN DESCRIPTIONS ... 3
CLAIM MASTER MAIN MENU ... 3
837 HEALTH CARE CLAIM: PROFESSIONAL... 4
Claim Screen Layout ... 4
Patient & Subscriber Claim Screen ... 7
Other Insureds Payer Information Screen... 8
Service Lines Screen ... 10
Other Information ... 11
CLAIM DASHBOARD WORK QUEUES ... 12
SEARCH CLAIM SCREEN... 16
Search Results Listing ... 17
CLAIM EDIT SCREEN... 18
CLAIM LOG SCREEN ... 20
Claim Log Screen Description... 21
Claim Audit Screen ... 22
LOGGING INTO CLAIM MASTER... 23
LOGGING INTO CLAIM MASTER WEB-NATIVE... 23
CLAIMS PROCESSING ... 27
CAPTURING CLAIMS ... 27
CLAIM CAPTURE CONFIRMATION ... 29
Batch Upload Report (Claim Capture Report) ... 29
Upload Batch History ... 30
EDITING AND COMPLETING CLAIMS... 30
COPYING CLAIMS ... 34
SPLITTING CLAIMS... 34
VALIDATING CLAIMS ... 36
Validation (Error Checking) ... 36
MAKING NOTES... 37
SETTING THE QUEUE STATUS... 37
SETTING REMINDERS (Followup Marks) ... 37
SAVING CLAIMS ... 38
DELETING CLAIMS ... 38
EXITING CLAIMS... 39
SUBMITTING CLAIMS... 39
CONFIRMING CLAIMS SUBMISSIONS... 40
CLAIM DASHBOARD WORK QUEUES ... 41
VIEWING CLAIMS INVENTORY... 42
Claim Search ... 42
Standard Queries ... 43
View Configuration - General Instructions ... 43
View Configuration - Saving Views... 44
View Configuration - Using Payer Groups... 44
Listing Follow Up Claims ... 45
Summary by Claim Status ... 46
Viewing Work Queue Assignments ... 47
Work Queue Editor (Add or Modify Work Queues) ... 48
Work Queue Field Descriptions ... 50
Auto Assignment Conditions... 51
CLAIM MASTER REPORTS ... 53
Claim File Capture History... 53
Batch Submission History... 56
Management Reports... 57
Claim Summary Report ... 57
Claim Detail Report... 59
Aged Claim Report... 60
Override Claims Report... 61
Downloadable Reports from Filebox... 62
Batch Upload Report (Claim Capture) ... 62
Batch Submission Report ... 65
Attachment Report (EMC Documentation) ... 67
ACCESSING THE HELP DESK... 67
Automated Ticket Generator ... 67
Contacting the Help Desk via E-Mail... 68
APPENDIX B - WEB-NATIVE SYSTEM REQUIREMENTS ... 71
APPENDIX C - LOCATOR DESCRIPTIONS ... 73
APPENDIX D - SCREEN NAVIGATION... 79
Copyright Contents of the WebMD documentation and software is copyrighted as a collective work under the laws of United States and other copyright laws.
Claim Master ™,ERA Master ™,and Eligibility Master ™are trademarks of medi.com. medi.com holds the copyright in the collective work.
Medifax NetDirect™ and Medifax Direct ® are trademarks or registered trademarks of Medifax-EDI SM , Inc.
Microsoft ® , and Windows ® are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.
©2004 All rights are reserved. Only current medi.com/WebMD clients can reproduce these materials for internal use. Any other redistribution, retransmission, or publication of any copyrighted material is strictly prohibited without the express written consent of the copyright owner.
837 Health Care Claim: Professional
Version 3.0
Change Log
Rev # Date Author Page Nature of Change
Draft 05/15/04 J. Elmer Draft
1.0 07/15/04 J. Elmer Initial Release
2.0 Draft
10/14/04 J. Elmer Implemented changes per new Engineering updates and enhancements.
2.1 Draft
11/01/04 J. Elmer Implemented Claim Dashboard, Claim Audit, and Claim Management Reports into the Manual. 3.0 12/15/04 J. Elmer Implemented Reviewer (L.Gilmore) Comments.
Update Claim Dashboard, Claim Log Screen. Copy/Split Functions.
Claim Master Introduction
Overview
Claim Master Web-Native is designed for billing personnel to edit, validate, and send claims electronically to their payers via the clearinghouse. Claims entering Claim Master are scrubbed for errors and completeness. If any claims require correction, they are reworked and revalidated. Once all claims are clean ('New' status assigned to them), they are submitted to the payers via the clearinghouse.NOTES
1) We will refer to 'HCFA 1500' throughout this User Guide as '837
Professional Claims'. This is because the printed HCFA 1500 form format is being replaced with the HIPAA compliant electronic (EDI) format.
2) The word 'error' and 'claim edit' is sometimes used interchangeably. A claim error may be due to an omission rather than a wrong data entry. 3) This User Guide is does not contain Setup and Configuration instruction and information. Please refer to the Web-Native Professional
Administrators Guide for Setup/Configuration information. HI
4) Claim Master Web-Native uses popups to display information pretaining to the claim. If you are running a popup blocker, please disable it while using the software. If you need help, contact your system administrator. COMPLIANT
HIPAA Compliant
This version of Claim Master is based on the new HIPAA compliant EDI ASC X12 837 data set for Professional Healthcare Claims. While the software contains many data elements of the old HCFA 1500 health claim, newer HIPAA compliant data elements have been added.IMPORTANT
For Claim Master to work properly, our clearinghouse must receive healthcare data from your system in the proper HIPAA compliant (1500) file format or in an 'enhanced' non-HIPAA print image file with supplemental data added to the print image. Please contact our Help Desk for additional information (1-800-616-1626).
Upgrading from
Previous Claim Master
Versions
If you are a previous user of Claim Master, you will notice several important differences between Claim Master Web-Native and other previous software versions. Some of the main differences are outlined below:• Function Keys. Previous Claim Master versions used the function keys for important program functions. The function keys are not used in Claim Master Web-Native.
• TAB Key. The TAB key was not used in previous versions of Claim Master. In this version, the TAB key is used to move to the next claim form field.
• F1 - Help. The F1-Help information is now contained in the online user's guide. Click on the 'User Guide' link to access Claim Master help information.
• Claims Capture Terminology. The process of obtaining batch files from your billing system into Claim Master was previously referred to as 'downloading claims'. In Web-Native, we refer to this process as 'capturing claims'.
Claim Master
Process Flow
Claims enter the Claim Master system via a batch file or hand-keyed on aper claim basis. Once claims are entered, or captured as a batch, they are validated for edits (errors). Clean claims have the 'New' status assigned to them. Claims with edits have an 'Incomplete' status assigned to them. Claims are worked by billing personnel until all the edits are corrected and they have the 'New' status assigned to them. After all claims have been corrected, they are submitted to the clearinghouse for submission to the various payers. Claims accepted by the clearinghouse have the 'Submitted' status assigned to them.
General Claim Process Flow
New Incomplete Reworked Claims Yes No Is the claim in the 'new' status?
'Incomplete' claims are worked to correct errors or
complete missing data. Claims are validated and
assigned either a 'new' status (require no edits) or
assigned 'incomplete' status (requires editing) Claims enter Claim Master via a 'Batch' file or manually
by 'Hand-Key' entry.
Claims are formatted and sent to the payers. Claims are chaged to the
'Submitted' Status. Download Report
Submission Report
Accept / Reject Notice Adjudication Report HIS/PMS
WebMD Claim Master
Claims Editing
Claim Master Screen Descriptions
This section describes the Claim Master screens and their usage.
CLAIM MASTER MAIN MENU
The Claim Master Main Menu permits selection all major program functions. The table below summarizes all the major program functions accessed from the Main Menu.
Main Menu Link Description Capture Claim Files From
HMS/PMS
Capture a claim batch into the Claim Master system from your Hospital Management System (HMS) or your Practice Management System (PMS).
Create Professional Claim Create a Professional claim, from scratch, by manually hand-keying billing data.
Claim Dashboard Work Queue
Quickly identify, prioritize, and find claims based on various criteria (i.e. High Dollar Amount and/or Error Code). Setup automated assignment of claims (Work Queues) to billing personnel.
Search Professional Claim Search for claims, by provider, using the following criteria: Claim Status, Status Date, Batch ID, Claims Attachment, Patient Account, or the Patient Last/First Name. Submit Professional Claim Submit complete ('New') status claims to the
clearinghouse.
View Reports View various Claim Master reports. Setup/Configuration
NOT SHOWN ABOVE
Setup and manage claim form look-up tables. Please refer to the Web-Native
837 HEALTH CARE CLAIM: PROFESSIONAL
The Professional field locators and other information are presented on several screens. The various screens are accessed after entering the claim screen or claim edit screen.
Claim Screen Layout
There are four major working areas of the Claim Master form screens: • Provider, Payer, and Patient Information contains
client/claim specific information as well as navigation back to the main menu.
• Error Message and Selection area is displayed after a claim edit is selected. This area contains specific information about the claim edit.
• Claim Form Tool Bar permits easy navigation to all the 837 Professional Claim Form elements as well as major program functions (Save, Exit, Validate, and Print).
• Claim Form (837-HCFA Professional Data Elements)
contains claim specific information. General Screen Layout
The Claim Tool Bar The Claim Tool Bar contains links to all the 837 Professional Claim data elements. The 837 Professional claim data elements are presented on several screens according to similar functions.
The following is a brief description of each of the Claim Tool Bar tabs (functions). The Tool Bar tabs include:
Patient & Subscriber: The Patient & Subscriber tab contains demographic information such as address and other personal data for the current claim.
Service Lines: Service lines contain illness dates, doctor
information, diagnosis codes, authorization information, and other service data.
Other Info: This tab contains Assumed/Relinquished Care dates, Test Results, and Medicare Secondary Payer (MSP) information.
Edit/Log: The Edit Log portion of this screen provides a list of 'edits' to correct or change in order to make the claim ready for submission to the clearinghouse. As the edits are corrected and validated, they are removed. This screen also provides a way to override edits and set a flag for attachments.
CAUTION
Only override a claim after correcting ALL the edits in the claim. Overriding the claim may result in a rejection by the payer.
The Claim Log portion of this screen tracks claim changes made during the editing process.
The Edit/Log screen also contains an area for billing personnel to add notes. These notes are only for internal use and are not submitted to the payer.
Print Overlay: Permits viewing of the claim prior to printing. This function opens an Adobe PDF file that can be viewed but not submitted to the payer.
Print Image: This permits users to print single claims to a local printer loaded with blank HCFA 1500 forms.
Validate: This link is used to check the claim for errors prior to submission to the clearinghouse. If the claim has errors, they are displayed in the Error Log.
Save: Save the current claim anytime during the editing process. Saving the claim during a claims editing process permits editing on another day. If your claim is saved successfully, you will see the following screen.
Exit: Use this link to exit the current open claim. Before leaving the claim, you will be given an opportunity to save your work.
Select OK to save and exit the claim or Cancel to exit without saving the claim.
Edit Message Area This portion of the claims screen displays the edit to correct. Below the edit message are links used to navigate to other claim edits. After correcting the current edit, use the navigation links to move to the next edit.
If you want to display the recommended solution to the edit, place your mouse cursor over the locator number. In the example below, the recommended change to locator 21 is to 'Enter the Primary Diagnosis Code'.
To pass over the current 'error', mark the check box to the far left of the message screen. This edit will now appear in the Claim Edit list as 'touched'.
The Claim Master form screens contain data elements corresponding to the 837 Professional healthcare claim form locators. The
Professional claim elements are found on the following screens:
837-HCFA Data Element Locations
Claim Screen Name
Screen Access Description
Patient and Subscriber Information
Navigation Tab. Contains Patient, Payer, and Insured
account information. If the Insured is 'self' (6) these fields will auto populate.
Other Insured's Payers
Click link on the link
'Other Insureds/Payers'.
Contains 'non-current' payer information for commercial or government entities.
Service Lines Navigation Tab. Displays information about the
nature of the illness, Procedures, Dates of Services, Authorization data, and Doctor Information.
Other Information Navigation Tab. Provides Test Results entries and
Coordination of Benefits (COB) line-level information.
Patient & Subscriber Claim Screen Patient & Subscriber Claim Screen
Data Elements Notes
Provider, Current Payer, Facility (32) Table Driven
Other Insureds Payer Information Screen.
The Other Insureds Payer screen is used for Coordination of Benefits (COB) between payers. Access this screen from the Patient & Subscriber Claim Screen.
Accessing the Other Insureds/Payers screen
NOTE
The Patient and Current Insured Payer screen always displays the current payer regardless of additional payer information on the claim.
Other Insureds Payer (Secondary and Tertiary) Information
Data Element Notes
Service Lines Screen
The Service Lines screen contains data entries for Dates of Illness, Referring/Attending Physicians, Diagnosis Codes, Service Line Information, and required Medicare submission data elements. This screen also has totals for the claim listed at the bottom.
Service Lines Information
Data Elements Notes
Referring & Attending Doctor Table Driven
Doctor (Service Info 24K) Same as Attending Doctor (17) User does not have to fill in if 17 filled in. POS, TOS, HCPCS, and
Diagnosis Codes
Lookup Tables are available from the screen by clicking on the arrow next to the field.
Other Information
This screen has data entries for Date Last Seen, Assumed Care Date, Relinquished Care Date, Test Results, and MSP Line Adjustments and Adjudication.
CLAIM DASHBOARD WORK QUEUES
The Claim Dashboard is a claims management tool permitting quick identification, prioritization, and retrieval of claims based on various criteria (i.e. High Dollar Amount and/or Error Code).
The following section describes each major function of the Claim Master Dashboard main screen.
Claim Search. Search for claims using standard search criteria such as Patient Information, Payer Information and Medical Record Number.
Standard Queries. You may view the distribution of claims in the system by Types of Edits (errors), Assigned Work Queue groups, or preset user views.
• Summary by Edit Number. View claims in the system by their edits. This permits billing personnel to fix all the claims with the same errors at the same time.
• Summary by Work Queue Group.
Setup Work Queues. Assign billing personnel to work on claims based on various criteria (i.e. Patient Name, Claim Age, Claim Status, Provider, Payer Type, and more).
Create Work Queue Groups. Create Work Queue Groups that contain similar individual work queues. For example, you may want to create a Work Queue Group called 'Medicare' and assign the individual work queues 'Medicare A-N' and 'Medicare O-Z' to this group.
Viewing Work Queue Distribution. View claims by Work Queue assignment.
View Configuration. View Configuration controls what information is displayed on the dashboard based on the criteria selected. The View Configuration also controls the scope of how other functions work while in a particular view. For example, if the current view does not have the 'New' Claim Status check box selected, new claims will not be displayed using the Claim Search function.
View Configuration Criteria Descriptions
Criteria Description View
Name
Names of saved 'views'. 'Views' are created using the 'Save View' button on the bottom of this screen area. Work
Queue
Work Queues listed are created in the Work Queue editor. The editor is accessed from the Work Queue List (Claim Dashboard).
Payer Group
Payer Groups are created/edited/deleted using the Payer Group popup screen. This screen is accessed by clicking on the Edit button next to the selection pull down list box. Payer
Type
The Payer Type consists of one of five major payer types (Medicare, Medicaid, Commercial, Blue, and Champus). Payer
Name
The payer list is inclusive of all payers associated with all possible providers. Refer to the 'Provider Setup' option in the Setup and Configuration screen.
Claim Status
These are the possible statuses of claims (i.e. Incomplete, New, Paid)
Queue Status
These are the Queue Statuses associated with a particular group of claims. These statuses are set for each claim in the Claim Log screen.
If you do not use Queue Statuses, ignore this criteria and use the default setting (Open). 'Other' Claim Statuses are custom statuses based on client requirements. Billed Date This is the date range the claim was billed to the payer.
The 'Save View' button is used to save the current View Configuration setting. This permits future quick access for commonly used criteria. The 'Set View' button is used refresh the Dashboard screen with new
data based on your selected criteria.
Listing Follow Up Claims. Displays a list of Follow Up claims by Claim Number. This list may be sorted according to column heading.
NOTE
This list does necessarily relate to California Medical ''Follow-Up'' Claims processing. Rather, this feature sets reminders to help billing personnel process claims.
Summary by Claim Status. Displays the distribution of claims in the system by statuses. The status scope is determined by the View Configuration setting. This list may be sorted according to column heading.
'Cdollars' are processed queue status claim counts and 'Odollars' are open queue status claim counts. For these columns to accurately reflect their values, billing personnel should change the Queue Status of a claim from 'Open' to 'Processed' in the Claim Log screen.
Listing by High Dollar Amount. Provides a high profile view of the high dollar claims in the system. This list may be sorted according to column heading.
Click on the Claim# (Number) to open the claim for corrections. After all corrections have been made, save the claim. The claim should save in the 'New' status. If the View Configuration screen does not permit 'New' claims to display, the claim should disappear from the list.
SEARCH CLAIM SCREEN
The Search Claim screen is used to find and display claims using various search criteria for a selected Provider. Once claims are listed in the results screen, they can be organized and selected for viewing or editing. Search criteria includes: Claim Status, Status Date, Batch ID, Claims Attachment, Patient Account, or the Patient Last/First Name. If you want to display ALL the claims, regardless of status, choose the '--ANY--' Claim Status and click on the Search button. If you wish to view search results for all providers, leave the default Provider selection as '--ANY--'. You may also obtain a list of claims that require attachments from this screen.
The Claim Search has various methods of locating claims in the Claim Master system. The following section describes each of the methods used to locate claims.
Claim Status: Provides the status of a claim as it moves through the Claim Master system. The Claim Master Web-Native available claim statuses are listed below:
Claim Master Statuses
Status Description
'ANY' List all claims, regardless of status, for a chosen provider. Incomplete Claims with errors or omissions. The claim failed the edit
and requires correction by a biller.
New A claim with no edits. These claims are ready for submission to the clearinghouse.
Submitted Claims submitted to the Clearinghouse. Rejected Claims rejected by the payer.
Paid Claims paid by the payer.
Hold Claims captured into Claim Master but not submitted to the medi.com clearinghouse pending review and action by the biller.
Review Claims in Medical Review.
Temporary Submitted claims pending successful submission to the clearinghouse.
Deleted Claims that have been deleted from the Claim Master system.
Status Date From/Thru: Specifies the date range for performing claim searches in Claim Master Web-Native.
Attachment: Select this check box if you wish to search for claims that require attachments.
Patient Account: The assigned patient account number.
Patient Last Name: The last name of the patient who is associated with the claim.
Batchid: This is the confirmation number received when you submitted the claim(s) to the clearinghouse. If you wish to retrieve your Batchid number, you may obtain it by viewing the Submission
Report.
Search Button: This initiates the search after your criteria has been selected.
Main Menu Button: Returns back to the main Claim Master menu.
Search Results Listing
After performing a claim search, the results are listed on the same search screen. If the result list contains more than 18 entries, the results will be displayed on multiple pages with the total entries and page count listed as seen below.
You may sort the results list by a particular column topic. For example, sort the results list by 'Total Amount Due' to work high dollar claims first. To toggle a results column, click on the column heading to set the sort order by ascending or descending. The example below is sorted by 'Status Time'.
The Search Claim results listing displays the following:
Batch ID: This is the submission batch identification number created when claims are submitted to the clearinghouse. If this field is empty, the claim has not been submitted.
Patient Name: The full name of the individual to whom the services were provided.
Patient Account: Unique identification number assigned by the provider.
DOS From/Thru: Date of service, such as the start date of the service, the end date of the service, or the single day date of the service.
Total Amount Due: Corresponds to the Balance Due (FL 30). The balance due for services rendered by the provider.
Status: The current status of the claim in the Claim Master system.
Status Time: This is the last time the status was changed. This time will update when the claim is saved.
FC: This is a medi.com internal Financial Class (FC). The following financial classes apply:
Financial Classes
C = Medicare
D = Medicaid
F = Commercial Insurance Carrier G = Blue Cross / Blue Shield
H = Champus
Edit Link: The Edit link takes you directly into the claim if it has a 'New' status assigned to it. Otherwise, the link will take you directly into the Claim Edit screen that contains a list of edits for the claim.
CLAIM EDIT SCREEN
The Claim Edit screen displays all claim edits for the current claim. As a general practice, you will fix all the edits on this screen. This will be indicated with all the 'touched' indicators checked. After fixing all the edits, you will check the claim for errors by validating the claim. If the claim still has errors, the edit(s) will reappear on this screen.
Claim Edit Screen
The Claim Edit Screen has the following user selections:
Touched (Indicator): This check box indicates the edit has been modified on the claim form. This will help you keep track of work performed as you work the claim.
Overridden: Use this check box to override the selected edit. If the text box is grayed out, you cannot override the edit.
Fix Edit: Click on this link to go directly into the claim form where the edit occurred. To view corrective information for the edit, place your mouse cursor over the Fix Edit link.
Attachment Required: Select this check box if your claim has an attachment. When you submit your claims to the clearinghouse, a report of claims with attachments will be printed. If you checked the Attachment Required box, the claim will appear on the attachment report.
NOTE
Most payers do not accept electronic attachments. Selecting this option does not attach electronic versions of attachments unless agreed on during the setup and installation process.
CLAIM LOG SCREEN
The Claim Log screen performs the following functions:
• Displays a running history of changes made to individual claims.
• Keeps track of all changes down to the locator level (Audit). • Permits the setting of reminders (Follow Up Marks) to work
claims at a later date. Days may be set 1 to 45 days.
• Enter comments about the claim (i.e. claim resolution or notes for Management).
• Exclusively assign the claim to another user in another work queue.
• Controls the display of claims in the Claim Dashboard. For example, Work Queue Statuses (Cdollars and Odollars ).
Claim Log Screen Description
The Claim Log Screen has the following elements:
Status (not displayed on column heading): This column indicates the status of the claim when the action was recorded in the log.
Time: This is the time the log entry was created for the action performed by the system.
Operator: This is the billing person who implemented the action responsible for the log entry.
Comment: The Comment field displays information about the claim for a particular part of the claims process. For rejected claims (R Status), the comment field includes reasons for the claim rejection.
NOTE
997 or TA1 confirmations are functional acknowledgments for an electronic (EDI) transaction. These reports do not provide claim level information.
Audit|Followup|Clear: The Audit Link launches a popup screen displaying changes made to the claim. The Audit popup screen displays the Field Locator, Old Value, and New Value. This is especially helpful when wanting to see work performed on a claim for troubleshooting purposes. The column may also contain a Follow Up
date with a check box next to it. The Follow Up date is set on the same screen. Remove (Clear) the Follow Up date by checking the box and clicking the 'Save Comment Only' button.
Queue Action: Assign the current claim to another work queue. NOTE
Work Queues are typically created and assigned by administrators using the 'Add/Edit Work Queue' in the Claim Dashboard.
Followup Mark: Use this feature as a 'Tickler Reminder' to work claims temporally set aide. Follow Up Reminders popup in the Claim Dashboard screen (Lower Left Area). This is especially useful when waiting for documents to finish processing the claim.
Status: Controls the queue status in the Claim Dashboard. If the 'Processed' status is selected, the claim will show up as 'Processed' in the Dashboard. If the 'Open' status is selected, the claim will show up as 'Open' in the Dashboard. You do not need to save the claim when changing the status.
Unbilled Reason: Create an entry in the Claim Log specifying the reason the claim was not billed.
Comments Text Area: Enter comments regarding your claim in this area. Information entered into the comments field stay with the claim while it is in the Claim Master system. These comments are not forwarded to the payer.
Claim Audit Screen
The Claim Audit screen is used to display claim modification details. The screen displays every change made to the claim including the locator id, the old and new values. Click on the 'Detail' link (if available) to display further information about the claim. Claim Audit Screen
Logging into Claim Master
LOGGING INTO CLAIM MASTER WEB-NATIVE
IMPORTANT
Always use Internet Explorer 5.5 (or greater) when accessing the medi.com web site. Correct operation of the web site is not guaranteed using other web browsers.
The Claim Master Web-Native log on process consists of:
• Accessing the Claim Master Web-Native Log In screen via medi.com/WebMD Web site.
• Completing the log on process to Claim Master Perform the following to access Claim Master Web-Enabled: 1. Using your Internet connection, go to www.medi.com.
After pressing the Log In button, the following screen is displayed. Log In entry screen.
Note: The administrator username and password should have been given to you during enrollment. If you do not have an administrator username and password, please call the medi.com Help Desk at 800.616.1626.
3. Enter your user name in the Username text box. Press the Tab key or move the cursor to the Password text box.
4. Enter your assigned Password.
5. Click the Sign In button, or press the Enter key.
6. The medi.com main services screen is displayed. Click on the CM WEB link in areas shown below.
NOTE
If an Internet Explorer Security Alert window appears, uncheck the box in the lower left corner of the window and click continue.
7. The Claim Master Web-Native main menu should now appear. Claim Master Main Menu
Claims Processing
CAPTURING CLAIMS
NOTE: Batch files submitted to medi.com have to be in ANSI 837P or a pre-approved Proprietary format. Please contact our Help Desk for additional information (1-800-616-1626).
Claims enter Claim Master either manually by hand-key or via a batch file. When naming a file for capturing in Claim Master, use the following naming convention:
'HCFAMMDD.TXT' uppercase only!
(Where MMDD = 2-digit Month and Day) To capture a batch file in Claim Master perform the following:
1. Select Capture Claim Files from HMS/PMS from the Claim Master main menu.
2. A Java Plug-in Security Warning will appear. Click on Grant this session to continue with the upload process.
3. Select the batch file from your file system by clicking on the Add button.
Upload Claim Batch Screen
4. From the 'Select files to upload' dialog box, select the file for uploading to medi.com from your own system.
Claim Capture (Upload) Progress Screen
After your files have been sent to medi.com, you will receive a screen confirmation of the transaction.
CLAIM CAPTURE
CONFIRMATION
NOTE
It may take several minutes before the confirmation information is available in Claim Master. If you do not see a confirmation report or an update on the Upload Batch History screen, please check again after a few minutes.
You may verify the claim capture using the following two methods: • Batch Upload Report (Claim Capture Report)
• Upload Batch History Screen Batch Upload Report (Claim Capture Report)
Batch Upload Report. The Batch Upload report is available from the Reports Menu using the FileBox option. Access the Upload Report using the following menu selections:
View Reports (Claim Master Main Menu)
Downloadable Reports from Filebox (Reports Menu)
Capture (Filebox Menu)
Please refer to the Claim Master Reports section of this Users Guide for more information on this report.
Upload Batch History
Upload Batch History. The Capture Batch History displays information about your batch capture activity from your billing system into Web-Native. Access the Claim Upload History screen using the following menu selections
View Reports (Claim Master Main Menu)
Batch Submission History (Reports Menu)
Upload Batch History screen
From the Search/View Upload Batch History screen you may perform searches for batch uploads based on: Upload Status, Invoice Number, File Name, and Upload Dates.
Please refer to the Claim Master Reports section of this Users Guide for more information on this screen.
EDITING AND
COMPLETING CLAIMS
This section describes the claim editing process. You will use Claim Master Web-Native to correct 'Incomplete' claims and change their statuses to 'New'. Claims will then be submitted to the clearinghouse for processing and delivery to specific payers.
To edit 'Incomplete' claims perform the following:
1. Select 'Search Professional Claim' from the main Claim Master menu. The Search Claim screen will be displayed.
2. Select 'Incomplete' from the Claim Status search options.
A list of 'Incomplete' claims will be displayed.
3. Select the claim you wish to work on from the incomplete claims listing. Click on the Edit link to open the claim. A list of all the edits for that claim will be displayed (next screen).
Claim Edit Listing
If you place your mouse cursor over the edit row, a description of edit will be displayed.
4. From the Claim Edit screen, begin correcting edits by clicking on the Fix Edit link under the Command column. After selecting 'Fix Edit', you will be taken to the appropriate form locator to make corrections (see next screen).
Claim Editing
5. Correct the edit by entering the proper data.
6. After finishing the edit, you may proceed to the next edit/error by selecting Next Edit in the Error Message portion of the claim screen.
7. The list of edits will reappear. A check mark, in the Touched column, should now appear for the last worked edit.
TIP - PROVIDER NUMBER
For edit: 'aa12 PROVIDER NUMBER IS NOT SETUP/VALID' The Provider Number (top line near the 33 Provider ID) represents the provider number found in the incoming data downloaded during the claim capture process. The Provider Group number (In the Primary Payer section of the form) represents the provider number as it is found in the Claim Master software. If you receive the error ''aa12 PROVIDER NUMBER IS NOT SETUP/INVALI"', verify these two numbers match. If they do not match, then check your provider number in your data file or check your provider setup performed during the enrollment process.
Claim Edit Screen
8. Continue to work through the list of edits until all of them have been corrected. All claim edits should be completed before validating, or revalidating, the claim.
NOTE
DO NOT validate each individual claim edit after correction. Slow system performance may result.
9. Verify claim correctness by clicking the Validate tab link. If any edits still exist, they will display on the Claim Edit screen. 10. Claims with attachments. Select Attachment Required, in the
Claim Log screen if you have required documentation. If you select Attachment Required, the current claim will be included on the Attachment Report (EMC Documentation) that is printed when you submit your claims to the clearinghouse. Selecting this option does not necessarily mean the attachment is electronically
submitted to the payer.
11. Save the claim. Select the Save tab to save and exit the current claim. After saving the claim, a confirmation screen will display showing the (status of the claim, total charges etc.).
After viewing the save confirmation screen (above), select the Exit
tabto return to theIncomplete Claims List.
12. Continue to select claims from the Claim Edit listing until all claims are changed to the 'New' status.
Copy/Split Location
COPYING CLAIMS
Claim Master permits copying of an existing claim to a new claim. The new claim will have the 'Held' status assigned to it. The copied claim gives you the option of using the same Patient Control Number with a sequence number or entering a custom Patient Control Number of your own (i.e. a number with a suffix).
To copy claims, perform the following:
1. Make sure the 'Copy' radio button is selected. 2. Click the 'Action' button.
3. Enter the new Patient Control Number (PCN) for the new claim.
4. After the Copy Success message appears, you may go back to the original claim or go into the new-copied claim.
NOTE If you do not go into your copied claim and save it, you will loose your copied claim.
The result will be a new claim identified with a new Patient Control Number (PCN). The copied claim will have the 'New' status assigned to it.
SPLITTING CLAIMS
The Split Claim feature creates a new claim with the same sequenced Patient Control Number. Individual line items, within the claim, can be split the following ways:
• Moved - Removed from the original claim and added to the new claim.
• Copied - Kept on the original claim and copied to the new claim.
• Not Changed - The default 'blank' action does nothing to the original claim.
To split claims, perform the following: 1. Open the claim you wish to split. 2. Select the 'Split' radio button. 2. Click the 'Action' button.
3. A popup window will appear permitting the splitting of each line item.
Split Dialog Box
4. Select the Action. Choose the type of 'action' for each line item. If you wish to leave the claim line 'as is', leave the Action blank.
5. Click on the Split button.
6. After the Split Success message appears, you may go back to the original claim or go into the claim with the split line items. 7. Save the claim.
NOTE If go into the new claim with the split lines and make chages to the claim, you must Save the claim. Otherwise, you will lose the new split claim and all other work performed on the claim.
VALIDATING CLAIMS
Validation (Error Checking)
Use the Validate function to check your claim for errors. To validate a claim, click on the validate tab link.
If the claim was acceptable, you will see the following message:
After viewing the 'No Errors' screen (above), press Enter. The claim will be saved and it will no longer appear on the Incomplete Claims List. Claim Master will now change the status of the claim from 'Incomplete' to 'New'.
If a claim had edits through the validation process you will see the Claim Edit screen similar to the one below.
Web-Native Validation Results (with errors)
Claim Edit Field Descriptions Field Value Description
Touched This check box indicates the edit has been modified on the claim form. This helps track work performed on the claim.
A checked box does not mean that the claim has been validated and is error free.
Overridden Place a check in this box to override the edit. If the box is grayed out, you cannot override the edit.
Type This is a medi.com programming number and has no relevance to your billing tasks.
Code Field locator number indicates where the edit occurred. Message Message relating to the edit. Use this information to help
correct the claim edit.
Command The Fix Edit link takes you directly to the locator in the claim form where the edit failed.
MAKING NOTES
NOTE
Notes entered on the Claim Log screen are not submitted to the payer. After finishing claim corrections and before saving the claim, you may
enter notes about the work performed on the claim. To make a note about the claim:
1. Select the Edit/Log tab.
2. Select the Claim Log link in the line below the tabs. 3. Enter your comments in the space provided on the screen.
4. When you have finished entering your comments, click on the Save Comments Only button.
Comments entered will appear in Claim Log.
SETTING THE QUEUE STATUS
Queue Statuses help billing personnel track claim work. Worker productivity is also derived from the Queue Status setting. Claims entering the system are automatically assigned the 'Open' status. After completing work on a claim, change the status to 'Processed'. To change the status:
1. Select the Edit/Log tab.
2. Select the Claim Log link in the line below the tabs.
3. Click the 'Processed' radio button (lower left side of screen). 4. Save the changed status by clicking on the Save Comments Only
button.
Changes made to the Queue Status are reflected on the Claim Dashboard screen (Listing by High Dollar) column.
SETTING REMINDERS (Followup Marks)
Use this feature as a 'Tickler Reminder' to work claims temporally set aside. To set a reminder in the Claim Log screen:
1. Choose a Followup Wait mark time period (1 to 45 days) from the Wait Mark drop down list box.
2. Save the Follow Up mark by clicking on the Save Comments Only button.
Follow Up reminders will appear on the Claim Dashboard screen (Listing Follow Up Claim).
SAVING CLAIMS
If you wish to save the claim, select the Save tab in the upper right hand corner of the screen. After selecting Save, the following message will appear:
Click OK to continue to save the claim. The following screen will appear confirming the save.
DELETING CLAIMS
To delete a claim from Claim Master, perform the following: 1. Open the claim you wish to delete.
2. From the Patient & Subscriber screen, select 'DELETED' from the 'Save As' pull-down list.
3. After selecting DELETED, save the claim by clicking on the Save
tab. You should receive the following message confirming the deletion.
EXITING CLAIMS
To exit a claim, click on the Exit tab. The following dialog box will appear warning you that the claim will not be automatically saved.
Select OK to save and exit the claim or Cancel to exit without saving.
SUBMITTING CLAIMS
If there are claims in a 'New' status, they may be submitted to the clearinghouse. Only claims with a 'New' status are submitted. To submit claims, select Submit Professional Claim from the main
menu. After your selection, the following screen will appear.
To continue with the submission process, click OK. Claim Master now sends the claim batch to the medi.com clearinghouse for processing. Claims will have their status changed from 'New' to 'Submitted'. The following confirmation will display after a successful submission:
CONFIRMING CLAIMS
SUBMISSIONS
NOTE
In some cases, it may take to 24 to 48 hours to be able to see a confirmation.
There are several ways to obtain confirmations for your claims submission to the medi.com clearinghouse.
• The Claims Control Center. Use the Claim Master Submitted Claim Summary, in the Claim Control Center (CCC), to view claim activity to the clearinghouse. Use the
Payer Control Summary to monitor claim activity to the payer(s). Access the CCC from the main medi.com service selection screen. Please refer to the Claim Control Center Users Guide for details.
• Search Claim Screen. Use the Search Claim screen to list claims submitted to the clearinghouse. Use the "Submitted" claim status criteria to find claims.
• Batch Submission Report. The Batch Submission report is automatically created every time you submit claims to the clearinghouse. The report is available in under the View Reports main menu. See the Claim Master Reports section for more information.
• EMC Documentation. In addition to the confirmations above, an Attachment Report is printed immediately after submission if you have claims that require EMC
documentation. See the Claim Master Reports section for more information.
Claim Dashboard Work Queues
This section describes how to use the Claim Dashboard to find and prioritize claims. This section also describes how to use and set up Work Queues.
NOTE
Refer to Section 3, Claim Master Screen Descriptions to obtain screen and field descriptions for the Claim Dashboard.
VIEWING CLAIMS INVENTORY
The Claim Dashboard is a high-level reporting tool that graphically displays the distribution of claims by Error Type and Claims Status. Claim Search
Search for claims in the system by Patient Account Number, Patient Name, Payer Type, Payer Name, and Medical Record Number. You may enter more than one query selection (i.e. First and Last Name). To use the Claim Search Feature perform the following:
1. Enter one or more of the following criteria: • Patient Account Number
• Last Name • First Name • Payer Type • Payer Name
• Medical Record Number
2. Click on the Search button to view the query results. Claim Search Query Results Listing
NOTE
The Claim Dashboard Search differs significantly from the standard claim search accessed from the main menu (Search Professional Claim). The scope of the Claim Dashboard Search is limited by the parameters, or settings, within the Dashboard.
Standard Queries
You may view the distribution of claims in the system by Types of Edits (errors), Assigned Work Queue groups, or preset user views. Standard Queries portion of the Claim Dashboard screen
To use the Standard Queries perform the following:
• Summary by Edit Number. Click on this link to view receive a claims summary displayed by edit number.
• Summary by Work Queue Group. Click on this link to view the distribution of Work Queue Groups and their subordinate assigned work queues.
• Search Claims by View. Click on this link to obtain a claims summary listed by the 'View Configuration' view. The selected view is a previously saved 'View Configuration' setting.
View Configuration - General Instructions
Use View Configuration to control information displayed on the dashboard according to various criteria selected (i.e. Work Queues, Payer Type, Claim Statuses). The View Configuration also controls the scope of how other functions work while in a particular view. To set the View Configuration, perform the following:
1. Select one or more criteria within the View Configuration portion of the dashboard: • Work Queue • Payer Name • Payer Group • Payer Type • Claim Status • Queue Status • Billing Date
2. Click on the Set View button. The dashboard screen should now refresh according to the criteria you selected.
View Configuration - Saving Views
The 'Save View' button is used to save the current View Configuration setting. This permits quick re-configuring of the screen based upon saved configuration settings. To save the current view, simply click on the Save View button. Enter a name for the 'View' you wish to create. Click on the Save View button to finish.
View Configuration - Using Payer Groups
One of the many criteria available for users in the View Configuration is Payer Groupings. Payer Groupings provides the ability to perform queries based on groups of payers (i.e. Medicare). Before using this option, payers need to be 'grouped' using the Payer Group Editor. Enter Payer Group Editor using the Edit button as seen below.
Payer Group Editor
To create a new Payer Group:
1. Select one or more payers from the Payer Selection Box on the right-hand side of the screen. Hold down the CTRL key to make multiple selections.
3. Enter the name for the new Payer Group you wish to create. 4. Click on the Add Group button to compete the addition. 5. To close the editor window, click on the Finish Edit button.
Listing Follow Up Claims
The Listing Follow Up Claim feature works in conjunction with the set Follow Up Mark setting found within each claim (Claim Log) in the system. Claims that have a Follow Up Marks set are displayed on this portion of the Claim Dashboard.
You may enter a claim to view the follow up reason by clicking on the
Claim # link on the Follow Up screen. You may also sort the list by clicking on the column headings.
Summary by Claim Status
The Summary by Claim Status provides a visual representation of claims in the Claim Master system by their current status. 'Pdollars' are processed (closed) queue status claim counts and 'Odollars' are open queue status claim counts. For these columns to accurately reflect their values, billing personnel should change the Queue Status of a claim from 'Open' to 'Processed' in the Claim Log screen. If you do not use 'Queue Statuses', the 'Cdollar'(count) will always be zero.
NOTE The View Configuration controls the statuses displayed.
Listing by High Dollar Amount
This listing provides a high-level overview of high dollar claims in the Claim Master system. Click on the Claim# to enter the Claim Edit screen for the particular claim displayed. Once in the Claim Edit screen, you can begin correcting the claim.
USING WORK QUEUES
Work Queues permit the organization and assignment of claims to billing personnel. This permits management to assign claims to billing personnel. Once a claim is assigned to a particular employee, it will remain in their queue until it is assigned exclusively to another person. Work queues can be automated to assign new claims in the system to the assigned personnel upon download. Billing personnel are assigned to work queues according to various selected criteria (i.e. Patient Name, Claim Age, Provider, and Payer). Claims may appear in multiple queues if the Administrator designed the queues using overlapping criteria.
This section describes how to use the Claim Dashboard Work Queue to set-up and assign users.
Viewing Work Queue Assignments
The Work Queue Dashboard Listing displays all work queues created in the system. The display provides a high-level view of claims residing in the system according to assigned work queue. To view assigned work queues click on the Claim Dashboard
Management Link on the Claim Dashboard Management Home
page.
Work Queue Listing
Work Queue Listing Descriptions
Field Name Description
Work Queue The Work Queue columns list all the work queues
in the system by Name, assigned Group, and
Description. Clicking on the Work Queue name
opens the Claim Dashboard Home page with the current view displaying information for the name selected.
Auto Assign If this is selected (default), during the data import
run, Claim Master will automatically assign new incoming claims into selected queues.
Manual Assign If this is selected, the queue will be displayed in the drop down selection box for manual
assignment. If you do not want a certain queue to accept manual assignment, you can deselect this option.
Status: Incomplete Hold Rejected
These columns display the distribution of claims by their status.
Adding a Work Queue
To Add an new Work Queue click on the Add New Work Queue link. The Work Queue Editor will open. Refer to instructions in the next section.
Deleting a Work Queue
To Delete a Work Queue, click on the Del link in the corresponding row. A message box will appear asking for a confirmation.
Editing a Work Queue
To Edit a Work Queue, click on the Edit link in the selected row. The Work Queue Editor will open with the fields filled out with the selected queue's information.
Work Queue Editor (Add or Modify Work Queues)
The Work Queue editor is where new queues are created or edited. Access the Work Queue Editor using the following links:
Claim Dash Board Work Queue (Claim Master Main Menu)
Work Queue List (Claim Dashboard Management Home)
Add New Work Queue (Work Queue List)
OR
The Work Queue editor permits:
• Creation of new individual work queues • Creation of Work Queue Groups • Editing of existing work queues Work Queue Editor
Work Queue Field Descriptions
Work Queue Name: The name assigned to the individual work queue. This can be a name of an individual or functional billing function. The name can be a combination of alpha/numeric characters. Try to make the name short and easily identifiable.
Work Queue Group: The name assigned to a functional group. For example, Medicare A-N could be the name for a group of queues that handle Medicare claims with patient last names 'A' thru 'N'.
Work Queue Description: A short description, which will be displayed in the Work Queue Configuration Summary Page.
Enable Auto Assignment: If this is selected (default), when claims are loaded into Claim Master, they will be automatically assigned to pre-defined work queues.
Accept Manual Assignment: When this check box is selected (selected by default), the user can reassign claims to other queues in the Claim Log screen. If 'Accept Manual Assignment' is not checked in the Claim Dashboard Work Queue Editor then no queue names will show up for reassignment on the Claim Log Screen (See Below).
Auto Assignment Conditions
Queue Assignment Conditions: These conditional parameters control how claims are automatically assigned to a queue. If a condition is left 'as is' or blank, it will not become part of the assignment criteria.
NOTES
If either of the "From" or "Thru" values are not entered, the condition will include any values toward that end. If both ends are empty, the condition is ignored (any value will satisfy).
The "From" and "Thru" values are inclusive on both ends. Therefore, add "Zs" at the end of the "Thru" value. For example, if you want the first letter of the last name to be from B-K, you have to enter "B" on the "From" end, and "KZZZZZZZZ" on the "Thru" end.
• Patient Last Name From-Thru: Enter a letter in one or both of these fields. Leaving the fields blank will cause the query to ignore this condition. When entering the 'Thru' value, enter the letter followed by 'ZZZZZ' (i.e. KZZZZZ). A blank 'True' value is equal to infinity. • Total Charge From-Thru: Place a dollar amount in the
From - Thru text boxes. Use this condition to assign claims to billing personnel based on the Total Claim Charge.
• Patient Account# From-Thru: To split up claims by Account# among billing personnel, enter the Patient Account# in the From-Thru fields. The Patient Account number is ordered according to a numeric-alpha split. Numeric characters are sorted first - then alpha characters (i.e. a,b,z…).
• Claim Age Between-And: Enter claim age values (i.e. '1' and '30' days) in the 'Between' - 'And' fields. This condition splits claims among billing personnel according to claim age. Typical age periods are (0-30 days, 30-60 days, 60-90 days). Use the Aged Claim Report, under the Management Reports, option to view the distribution of claims according to their age in the system.
• Claim Status: Assign claims to a particular queue according to status (i.e. Incomplete, Hold, Rejected, Review, etc.). By default, all statuses are enabled.
• Provider(s): Select providers by clicking on the Add>>
or Select All buttons. You may also select multiple providers by holding down the CTRL key and choosing providers with your mouse. This condition permits assignment of claims according to provider(s). Undo provider selections by using the Remove << button. • Payer Type: Set claim distribution according to payer
type (Commercial, Blue Cross/Blue Shield, Medicare, Medicaid, and Champus).
• Payer Group: Assign claim distribution according to pre-configured payer groupings. Payer groups are created from the View Configuration screen (Payer Group - Edit). Refer to previous section on Using Payer Groups under the View Configuration section.
• Payer Name(s): Select providers by clicking on the
Add>> or Select All buttons. You may also select multiple payer names by holding down the CTRL key and choosing payers with your mouse. This condition permits assignment of claims according to payers(s). Undo payer name selections by using the Remove <<
button.
NOTE
If multiple condition selections are used, the first condition has the priority.
After choosing your conditions and options, click the button to save the queue.
Claim Master Reports
Claim Master permits you to view and/or print detailed reports relating to claims processing and submission. Contact your medi.com
customer service representative for information on retaining claims and reports data on your own system.
NOTES
1) Manual sample report values may not be accurate because they are not shown in their entirety.
2) Reports associated with a batch upload or submission to the clearinghouse are found in other applicable sections of this manual.
To view reports, select View Reports from the main menu. The Reports Menu should now appear:
Main Reports Menu
Claim File Capture History
The Search/View Claim File Capture History report displays
information about your claim batch capture activity from your Practice Management System (PMS) or Hospital Information System (HIS) to medi.com.
You may search for capture history reports using the following criteria:
Capture Status:
Capture (Upload) Status Codes Code Value Description
Queued The capture job is queued. For each client there can only be one current parsing/importing job running. If you upload more than one file, or you upload another file before the first one finishes, all the additional file will be queued until the first one completes processing.
Parsing The claim file is being parsed/imported. Finished The capture is complete.
Failed The capture process failed for any reason. Manual The capture is being manually processed by
support or engineering at medi.com.
Invoice Number: Enter an Invoice Number to view claim capture history. The invoice number is automatically generated when capturing claims into Claim Master. This number is displayed on the confirmation screen after the claims capture session.
File Name: Use the batch file name to locate and view claim capture history. This is the name of the batch file captured by Claim Master.
Upload (From-Thru) Dates: Use the date option to search for and display claim capture history within a specified date range. You may set the From-Thru dates using a pop-up calendar. The calendar is accessed using the [….] link.
Claim Capture History Field Descriptions
Skipped New Incomplete CM Total
Del Upload Time File Name/Note
Cnt Amt Cnt Amt Cnt Amt Cnt Amt
Std Rpt
DEL 470 05/13/04 11:29 MEDI_0512.DAT 1 $15,300.00 223 $120,600.06 135 64194.03 358 $184,794.09 FAU470.TXT
Search/View Upload Batch History screen has the following field column values:
Claim Capture History Report Values Field Name Description
Del Only available for Administrators! Click on this
link to delete the associated batch. Batches can only be deleted for the last 7 days of history only. Consult your Administrator if you need to delete a batch file.
Batch Number. (i.e. 470) This number is assigned when claims are captured into Claim Master. Use this number in case you need to call our support Help Desk.
Upload Time The time the batch file uploaded from your computer to medi.com.
File Name/Note The batch file name AND any associated notes made at the time of capture.
Skipped Claims were not captured into Claim Master. Providers must submit claims by paper or other means to the payer.
New Claims imported successfully into Claim Master. These claims require no billing rework and can be passed on to the payer(s), via the clearinghouse, for payment.
Incomplete These claims did not pass through payer specific edits. Billing personnel must correct errors/edits before submitting claims to the payers.
CM Total Totals based on the previous three categories (Skipped, New, Incomplete)
Std Rpt This is a link to open the report in a text editor (i.e. Notepad or WordPad). You may download the report to your local computer or open the file directly in a text editor.
Batch Submission History
The Batch Submission History screen is used to search for and find claims submissions reports. These reports display claims sent to the medi.com clearinghouse for processing and forwarding to the payers. Access this screen using the following menu selections:
View Reports (Claim Master Main Menu)
Batch Submission History (Reports Menu)
Batch Submission History Screen
There are two ways to search for submission reports:
Batch ID: Enter the Batch ID number and click on the Search button.
Submitted From/Thru Dates: Enter the date range for the
submission reports you wish to view. The Submitted From date range represents the beginning or start of the search range. The Thru date range represents the end date for your selection criteria. You may set the From-Thru dates using a pop-up calendar. The calendar is accessed using the [….] link.
Search/View Batch Submission History column values: Batch Submission History Report Values
Field Name Description
Batch ID This number identifies the submission batch file. It is automatically assigned when the batch is submitted to medi.com. Use this number if you require support. Submit Time This is the time of the submission to the clearinghouse. Operator The operator is the name (ID) of the person who
submitted the claims.
Count The count represents the number of claims submitted to the clearinghouse.
Amount The amount represents the total dollar value of all the claims submitted to the clearinghouse.
Status This is the status of the batch file submitted to the clearinghouse. If the batch was successfully transmitted, the status will be 'submitted'.
Status Time The time the batch was submitted to the medi.com clearinghouse.
Management Reports
Claim Master Web-Native provides several reports for management to monitor claims submissions and aged claim inventories.
Claim Summary Report
This high-level report provides a summary of claims in the system by status. The report is based on a selected date range and date type. This report may be displayed according to Download Date, Claim Service Date and/or Claim Status Date.
Claim Summary Query Criteria
Report Parameters
Download Date: Creates a report based on the download date into Claim Master from your Hospital or Physician management system.
Claim Service Date: The Service Date is the date the services were rendered to the patient by the provider.
Claim Status Date: The Status Date is the date the status changed to the current status.
Reporting Period From/To: Enter the dates you wish to view the report output for (Reporting Period). The Reporting Period pertains to one of the three criteria set above (Download Date, Service Date, or Claim Status Date).
To run this report, enter criteria for the Claim Summary Report from the Management Reports Screen. Enter the following criteria:
1. Select one of the following date criteria: • Download Date
• Claim Service Date • Claim Status Date
2. Select the Reporting from/to date. Enter the date or click on the calendar icon to select the date from a pop-up calendar.
The report will be generated, printed, and recorded in the system. See samples below.
Claim Summary Report Sample - Criteria: Download Date
Claim Summary Report By 0 for Period 10/04/2004 to 10/08/2004
Status Count Charges % of Total
Deleted 19 $3,554.00 0.73%
New 1 $214.00 0.04%
Rejected 1,125 $201,499.00 41.16%
Submitted 1,486 $284,228.84 58.07%
Grand Total 2,631 $489,495.84 100%
Claim Summary Report Sample - Criteria: Claim Service Date
Claim Summary Report By 1 for Period 10/04/2004 to 10/08/2004
Status Count Charges % of Total
Incomplete 1 $107.00 0.4%
New 56 $15,746.00 59.59%
Submitted 37 $10,572.00 40.01%
Grand Total 94 $26,425.00 100%
Claim Summary Report Sample - Criteria: Claim Status Date
Claim Summary Report By 2 for Period 10/04/2004 to 10/08/2004
Status Count Charges % of Total
Deleted 249 $35,122.00 4.93% Hold 30 $5,808.00 0.81% Incomplete 21 $3,415.00 0.48% New 904 $163,273.00 22.9% Rejected 1,234 $221,029.00 31.01% Submitted 1,486 $284,228.84 39.87% Grand Total 3,924 $712,875.84 100%
Report Field Descriptions Code Value Description
Status Displays the claim status for the row selected. Count The number of claims for the associated status. Charges Total charges for all the claims for a particular status. % of Total The percentage of claims represented for this particular
Claim Detail Report