Claim Master
Web-Native
Institutional - UB-92
January 2007
Table of Contents
CLAIM MASTER INTRODUCTION ... 1
CLAIM MASTER SCREEN DESCRIPTIONS ... 3
CLAIM MASTER MAIN MENU ... 3
837 INSTITUTIONAL CLAIM FORM SCREENS ... 4
General Layout ... 4
Tool Bar Tabs ... 5
Quick Links ... 6
Edit Message Area... 8
Patient/Claim Screen ... 10
Claim Lines Screen... 11
Insured/Payer Information Screen. ... 12
Insured/Payer Information Screen (Adjustment Link). ... 13
Treatment/Other Information... 14
EDIT/LOG SCREENS ... 15
Edit/Log Quick link Access... 15
Claim Edit Screen... 15
Claim Log Screen ... 17
Claim Log Screen Description... 18
Claim Log CCC Popup Screen Description ... 19
Claim Audit Screen ... 20
CLAIM DASHBOARD WORK QUEUES ... 21
SEARCH CLAIM SCREEN... 26
Search Results Listing ... 28
POPUP SEARCH SCREENS... 30
Search Insured - Popup... 30
Search Procedure Code - Popup ... 31
Search ICD9 Procedure Code - Popup ... 32
Search Physician - Popup ... 33
Search Payer - Popup... 34
Search Patient - Popup... 35
Search Revenue Code - Popup ... 36
Search Diagnosis Code & Description - Popup... 37
Search HCPCS Code & Description - Popup ... 38
LOGGING INTO CLAIM MASTER... 39
LOGGING INTO CLAIM MASTER INSTITUTIONAL ... 39
CLAIMS PROCESSING ... 43
CAPTURING CLAIMS ... 43
CLAIM CAPTURE CONFIRMATION ... 45
EDITING AND COMPLETING CLAIMS... 46
SERVICE LINE FUNCTIONS ... 50
COMBINING CLAIM LINES ... 50
DELETING CLAIM LINES ... 50
CLAIM-LEVEL FUNCTIONS ... 52 COPYING CLAIMS ... 52 SPLITTING CLAIMS... 53 COMBINE CLAIMS... 54 DELETING CLAIMS ... 55 VALIDATING CLAIMS ... 55
CHANGING CLAIM STATUS ... 57
PRINTING CLAIMS ... 57
PRINTING OPTONS and PREFERENCES ... 58
FORM ALIGNMENT - LASER PRINTER ADJUSTMENT... 58
ADOBE ACROBAT PRINTNG INSTRUCTIONS ... 58
Printing from Acrobat 5.0... 59
Printing from Acrobat 6.0... 59
Printing from Acrobat 7.0.X and above... 60
MAKING NOTES... 60
SETTING THE QUEUE STATUS... 60
SETTING REMINDERS (Follow-up Marks) ... 61
SAVING CLAIMS ... 61
EXITING CLAIMS... 62
SUBMITTING CLAIMS... 62
CLAIM SUBMISSTION CONFIRMATION ... 63
SECONDARY BILLING WITH CLAIM MASTER... 65
Scenario 1 Use Submitted Claim for Secondary, Tertiary, and Quaternary Billing ... 66
Scenario 2 Import (Drop) Secondary, Tertiary, and Quaternary Claim from your HIS ... 69
Scenario 3 Hand-key Secondary, Tertiary, and Quaternary Claims ... 72
ERA Linking ... 74
CLAIM DASHBOARD WORK QUEUES ... 75
VIEWING CLAIMS INVENTORY... 75
Claim Search ... 75
Standard Queries ... 77
View Configuration - General Instructions ... 77
View Configuration - Saving Views... 78
View Configuration - Using Payer Groups... 78
Listing Follow Up Claims ... 79
Summary by Claim Status ... 80
List of Claims by Dollar Value... 80
USING WORK QUEUES... 81
Viewing Work Queue Assignments ... 81
Work Queue Editor (Add or Modify Work Queues) ... 82
Work Queue Field Descriptions ... 84
Auto Assignment Conditions... 85
CLAIM MASTER REPORTS ... 87
Claim File Capture History... 87
Batch Submission History... 89
Management Reports... 91
Aged Claim Summary Report ... 92
Claim Audit Report ... 93
Claim Detail Report... 94
Claim Summary Report ... 96
Daily Reconciliation Summary Report... 98
Override Claims Report... 99
Rejected Claims Report ... 101
Downloadable Reports from Filebox... 102
Claim File Capture Report... 102
Payer Reports... 104
ACCESSING THE HELP DESK... 107 APPENDIX B - WEB-NATIVE SYSTEM REQUIREMENTS ... 111 APPENDIX C - CLEARINGHOUSE REPORTS ... 113
Copyright Contents of the Emdeon documentation and software is copyrighted as a collective work under the laws of United States and other copyright laws.
Microsoft ® , and Windows ® are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.
© 2007 Emdeon Business Services LLC. All rights reserved. Only current Emdeon 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.
Claim Master Web-Native
837 Health Care Claim: Institutional
User Guide Version 3.0
Change Log
Rev # Date Author Page(s) Nature of Change
Draft 03/15/05 J. Elmer All First Release
2 04/28/06 J. Elmer All Incorporated release notes application changes, New Emdeon Logo, New Contact Information, and Coordination of Benefits (COB) instructions, Detailed Printing Instructions.
3 12/06/06 J. Elmer All Updated login instructions, Interface ‘button’ changes, New Management Reports, Updated Dashboard functions.
Claim Master Introduction
Overview
Claim Master Web-Native provides the ability for billing personnel to edit, validate, and submit claims electronically to their payers via the clearinghouse. Claims entering Claim Master are scrubbed for errors and completeness. If there are any claims that require correction, they are reworked and revalidated. Once all claims are clean ('New' status assigned to them), they are submitted to the payers via theclearinghouse.
NOTES
1) We will refer to 'UB-92' throughout this User Guide as '837 Institutional Claims'. This is because the printed UB-92 form format is being
supplemented 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 does not contain Setup and Configuration instruction and information. Please refer to the Web-Native Institutional Administrators Guide for Setup/Configuration information. HI
4) Claim Master Web-Native uses popup screens to display information pertaining to the claim. Please disable any popup blockers while using Claim Master. If you need help, contact your system administrator. 5) The Claim Master System Administrator can grant or deny user rights to perform actions on software features or functions. When this icon is encountered in the text of this User Guide, it indicates the description or instructions contain Administrator Controlled Privileges. User Privileges are controlled in the User Authority Setup (Setup/Configuration) portion of the software.
COMPLIANT
HIPAA Compliant
This version of Claim Master is based on the new HIPAA compliant EDI ASC X12 837 data set for Institutional Healthcare Claims. While the software contains many data elements of the old UB-92 health claim, newer HIPAA compliant data elements have been added.IMPORTANT
For Claim Master to work properly, the software must receive
healthcare data from your system in the proper HIPAA compliant (UB-92) 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. Call 877-271-0054 (Option 1).
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 Hotkeys. The following Keyboard Hotkeys are available in Claim Master Web-Native: <F7> - Previous Error, <F8> - Next Error, <F9> - Validate Claim, <Ctrl -S> - Save Claim, <Esc> - Exit Claim.
• F1 - Help. The F1-Help information is now contained in the User Guide. Please download the latest User Guide from our Support Center website.
• 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 are hand-keyed on a per 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 In c o m p le te 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 (no edits) or assigned 'incomplete' status (requires
editing) Claims enter Claim Master via a 'Batch' file or manually
by 'Hand-Key' entry.
Transaction Control Center
Claims are formatted and submitted to payers. Claim statuses are changed to 'Submitted'. Claim Transactions are monitored for reports in the CCC and
Claim Master Claim Capture Report
Submission Report HIS/PMS
CLAIM MASTER
Claims Editing
Track claim transactions through the entire billing
process
Claim Control Center (Included with Claim Master)
Electronic Remittance Advice (ERA) describing
payment information ERA MANAGER EOB Printing 835 RA Monitored Transactions Claim Master Clearinghouse Payer Responses Accept/ Reject Accept/ Reject
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 of all major program functions. The table below summarizes all of the major program functions accessed from the Main Menu.
Main Menu Link Description
Capture Claim Files From Hospital Management System (HMS)
Capture a claim batch into the Claim Master system from your Hospital Management System (HMS). Claim Dashboard Work
Queue
Quickly identify, prioritize, and find claims based on various criteria (i.e. Dollar Amount and/or Error Code). Setup automated assignment of claims (Work Queues) to billing personnel.
Create Institutional Claim Hand-key billing data to create a claim.
Search Institutional Claim Search for claims, by provider, using the following criteria: Claim Status, Total Charge, Status Date, Batch ID, Claims Attachment, Payer Sequence, Patient Control Number, or Patient Last/First Name. Report Menu View various Claim Master reports.
Submit Institutional Claim Submit complete ('New') status claims to the clearinghouse.
Setup/Configuration Setup and manage behind-the-scenes look up tables, user settings, and user screen elements.
837 INSTITUTIONAL CLAIM FORM SCREENS
The Institutional field locators and other information are presented on several screens. The various screens are accessed after entering the claim screen or claim edit screen.
General Layout
There are five major working areas of the Claim Master form screens:
• Navigation Bar. The top navigation bar provides the location of the current active screen in relation to the Main Menu.
• Claim Header contains information about the claim. This
includes Provider, Payer, and Patient information for the particular claim.
• Error Message and Selection area is displayed after a claim edit is selected. This area contains specific information about the claim edit. Use the links in this area to navigate to the next/previous claim edits.
• Claim Form Tool Bar permits easy navigation to all the 837 Institutional Claim Form elements as well as major program functions (Save, Exit, Validate, and Print).
• Claim Form (837 Institutional Data Elements) contains claim specific information.
Tool Bar Tabs
The Claim Tool Bar Tabs contains links to all the 837 Institutional Claim data elements. The 837 Institutional 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/Claim Info: The Patient/Claim Info tab contains demographic information such as address and other personal data for the current claim.
Claim Lines: Claim lines contain itemized service/treatment information including a description of services rendered,
REV/HCPCS/POS codes, date of service, and other claim line data. Insured/Payer Info: This tab includes Payer, Provider, Insured's
Information as well as Employer data.
Treatment/Other Info: This tab contains Diagnosis/Procedure codes relating to the patients care, Attending Physician
Information, Special Remarks, and Authorization information. Edit/Log: This tab contains two separate screens with different
functionality. The Claim Edit screen provides a list of 'edits', or corrections, in order to make the claim ready for submission to the clearinghouse. The Claim Log screen is accessed from the Claim Edit screen. This screen displays a running history of changes made to individual claims.
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.
Quick Links
Sub-Menu Quick Links permit quick access to other application functions relating to the tabs above them. Quick links are located directly below the Tool Bar Tabs. Most quick links relate to Secondary Billing (Coordination of Benefits) functions and extra features of the software. The Print Overlay and Print Image links relate to printing and are persistently displayed no matter which tabs are clicked. Checking Eligibility and ERA 'linking' are also accomplished through the Quick Links when product data is available. Quick Links available for each Tool Bar Tab
NOTE
Eligibility, ERA, and Claim Status functionality is controlled in the Setup and Configuration / Client Profile screen. Separate products/services may be required.
The following Quick Links are available within Claim Master Institutional.
Claim Lines - Original Lines: displays the same content as when a user clicks on the Claim Lines tab.
Claim Lines - Adjustment: display additional Claim Line adjudication fields necessary for Coordination of Benefits billing. Use these fields for secondary, tertiary, quaternary claims.
Claim Lines – Additional Info: displays additional claim line information for drug related services. These include: NDC (National Drug Code), Count, Type, Unit Price, Prescription.
Insured Payer Info - Original Info: View the Original Print Image or ANSI 837 claim data as it was loaded (Captured) into Claim Master. Insured Payer Info - Adjustment: permits viewing of Adjudication
Information and CAS Adjustment Information. If the payer is Medicare, additional Medicare specific fields will appear.
Insured Payer Info - Eligibility: this displays Eligibility Information for the current patient (Patient Control Number). A 'switch' must be turned on to display the Eligibility link. Contact Support if you wish to have this feature enabled.
Insured Payer Info - ERA: This links to the ERA for claim specific 835 remittance information (see note below).
Insured Payer Info - Claim Status: displays the current status of the claim at the currently selected payer. A 'switch' must be turned on to display the 'Claim Status' link. Contact Support if you wish to have this feature enabled.
NOTE
Eligibility, ERA, and Claim Status functionality is controlled in the Setup and Configuration / Client Profile screen. Separate products/services may be required.
Claim Edit: this screen provides a list of 'edits', or corrections, in order to make the claim ready for submission to the clearinghouse. As the edits are corrected and validated, they are removed from the Claim Edit list. The Claim Edit screen also contains an override feature and a way to 'flag' attachments for individual claims.
Claim Log: this screen displays a running history of changes made to individual claims. This screen also permits users to add Claim Notes, assign individual claims to specific billing queues, and/or set follow-up wait marks for future reminders.
Original Image: This displays the raw claim file before it was imported (captured) into Claim Master. This is useful for trouble shooting claim related data issues.
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 Overlays have an optional watermark that can be applied to them. The optional watermark displays as "Reference Only - Invalid for Submission".
Print Image: This permits users to print single claims to a local printer loaded with blank Institutional forms.
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. You may also use the <F7> - Function Key to see the previous error or the <F8> Function Key to see the next error.
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 67 is to 'Please Check the Principal 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'.
NOTE Selecting the text box DOES NOT OVERRIDE the edit. The Claim Master form screens contain data elements corresponding
to the 837 Institutional healthcare claim form locators. The Institutional claim elements are found on the following screens:
837-Institutional Data Element Locations Claim Screen
Name
Screen Access Description
Patient/Claim Info
Navigation Tab. Contains Patient, Payer, and Insured account information.
Claim Lines Navigation Tab. Displays information about the nature of the illness, Procedures, Dates of Services, Data, Charges, and Billing Codes.
Insured/Payers Info
Navigation Tab. Contains Authorization, Payer, and Insured's information for commercial and/or government entities.
Treatment/Other Info
Navigation Tab. Provides Diagnosis Coding information, Physician Information, and Provider data.
Edit/Log
(Claim/Log)
Navigation Tab.
The Claim Log is accessed via the 'Claim Log' link on the Claim Edit screen.
Claim Edit Screen displays claim edits (Errors on the claim). Claim edits within the forms can be accessed directly from this screen using the 'Fix Edit' link.
Attachments can also be specified from this screen. The Claim Log screen is accessed via a link on this screen.
The Claim Log screen is accessed from the Claim Edit screen. This screen displays a running history of changes made to individual claims. This screen also permits users to add Claim Notes, assign claims to billing queues, and/or set follow-up wait marks for future reminders.
Institutional Screen Icon Descriptions
Screen Icon Icon Description
The Show/Hide icon displays or hides additional 837 field locator information on the various claim form screens.
Clicking on this icon opens a popup search screen. The search screens are used to find and populate the selected field with relevant information.
Fill in selected fields with Patient Information.
Initiate a calculation to complete an Estimated Amount Due. Used to delete an individual claim line or a delete a payer insured line.
Patient/Claim Screen
Enter Patient information for the claim on this screen. Patient/Claim Screen
Items to 'Note' on this screen.
Data Elements Icon Notes
5 Provider Federal Tax ID Show/Hide Additional Provider Info: Location Code, Institutional Code, Entity Code 3 Patient Control Number Search Patient popup screen. Use Set link to populate the form from the popup. 12 Patient Name Show/Hide Additional Patient Information: Type, Race, Class, Ref Number, etc.
Unlabeled Show/Hide Unlabeled additional fields 2, 11, 31
Condition Codes 24-30 Show/Hide Additional Condition Codes Occurrence Codes 32-35 Show/Hide Additional Occurrence Codes 36 Occurrence Span Show/Hide Additional Occurrence Span Codes
38 Responsible Party (Icon) Click on the icon to fill in Responsible Party information from Patient Information
Value Codes 39-41 Show/Hide Additional Value Codes
'Q' Field The Q field. 1 = An Individual, 2 = An Organization. Form dynamically changes according to value.
Copy Claim button Copy open claim to a new claim with the 'Held' Status assigned to the new claim. Split Claim button Creates a new claim with claim lines split off the original claim.
Combine Claim button Combines two separate claims (different PCN's) into the current open claim. Delete Claim button Deletes the current open claim.
Claim Lines Screen.
The Claim Lines Screen is used to enter details for rendered medical services. This screen corresponds the Field Locators 42-49 on the UB-92 form.
Institutional Claim Lines
Items to 'Note' on this screen.
Data Elements Icon Notes
Claim Line CAS Info Show/Hide Line Adjudication Information - CAS Additional Claim Line
Drug Related Info
Show/Hide Additional Line info for the specific line selected. NDC, Units, Unit Price, Prescription
42 Rev Code Search Rev Code popup screen.
44 HCPCS Search HCPCS Codes popup screen.
Set Checkbox Check checkbox is used for Combine OR Delete Lines.
Delete Claim Line Delete the current selected claim line. Warning! - Deleting the claim line using this method cannot be undone.
Combine Lines Combine lines using a combination of the 'Set' checkboxes and Combine Lines button. Undo Combine Line This button only appears after lines have been combined. Otherwise, it is not displayed. Delete Lines Delete lines using a combination of the 'Set' checkboxes and Delete Lines button. Undo Delete Lines This button only appears after lines have been deleted. Otherwise, it is not displayed. Original Lines Link View the Original Print Image or ANSI 837 claim data as it was loaded into Claim Master. Adjustment Link Displays additional billing fields necessary to perform Coordination of Benefits billing. Additional Info Link Displays additional claim line information for drug related services.
Insured/Payer Information Screen.
Use this screen to select payers and Coordination of Benefits (COB). Insured/Payers Information screen
Items to 'Note' on this screen.
Data Element Icon Notes
50 Payer (Icon) Delete the entire payer line using this icon.
50 Payer (Icon) Search for a Payer. Displays a Search Payer popup screen.
50 Payer Show/Hide Additional Payer Info. Payer Name, Street, Claim File Ind., Financial Class, Ins Plan. 50 Payer Status The status of the entire claim can be changed from the primary line-level status setting.
51 Provider ID Alterations to the NPI field must be made in Provider and/or Physician Setup screens. 55 Payer - Est
Amount Due
Auto-Calc Function. Calculate Estimated Amount Due by clicking on theicon. If the selected payer is greater than the 'current payer', the 'Estimated Amount Due' in FL 55 will not be calculated.
58 Insured's Last Name
First select (highlight with mouse) the last name in the Insured's box below. Then click on the icon to display search for detailed Insured's Information.
58 Insured's Name (Icon)
Fill in the Insured's Name from the patient information entered on the Patient/Claim Info tab. 58 Insured's Name Show/Hide Additional Insured's Info.
Original Info Link Used for Coordination of Billing (COB) reference.
Adjustment Link Used to display additional COB fields. Select a payer before clicking on this link. Eligibility Link Displays Eligibility Information for the current patient. Configurable link.
ERA Link Displays ERA Information if it is available for the previously paid claim. Configurable link. Claim Status Displays the current status of the claim at the currently selected payer.
Taxonomy Manually key-in the Providers Taxonomy code or select a code from the taxonomy popup window to bypass the entries entered on the Provider Setup screen. Entries are validated against the ‘Health Care Provider Taxonomy Code Set’ to ensure only valid codes are entered.
Insured/Payer Information Screen (Adjustment Link). Use this screen to enter COB Adjudication Information when
performing secondary/tertiary/quaternary billing. The Medicare information, outlined in red below, only displays when the selected payer is Medicare. If the current claim has a payer sequence of secondary, tertiary, or quaternary and an RA exists for the previous paid claim, these fields may automatically fill in when the system captures the claim into Claim Master.
Insured/Payer Info - Adjustment Link screen.
Items to 'Note' on this screen.
Data Element Icon Notes
Select Group Code Displays CAS Group Code popup selections.
Treatment/Other Information.
This screen has data entries for Other Diagnosis and Procedure Codes, Physician Information and Other Authorization data.
Treatment/Other Information (Other Diagnosis and Procedure Codes)
Items to 'Note' on this screen.
Data Element Icon Notes
Other Diagnosis Codes 68-75 Show/Hide Additional Other Diagnosis Codes 67 Principal Diagnosis Codes Search Diagnosis Code & Description Popup Screen Other Diagnosis Codes 68-75 Search Diagnosis Code & Description Popup Screen
76 Admit Dx Admitting Diagnosis Code - Search Diagnosis Code & Description Popup Screen
77 E-Code E-Code - Search Diagnosis Code & Description Popup Screen
79 Coding Method 4=CPT 4 , 5=HCPCS, 9=ICD9 - Popup Displays codes according to this setting. 81 Other Procedure Codes Show/Hide additional Other Procedure Codes
82 Attending Physician Search Attending Physician Popup Screen 82 Attending Physician Attending Physician Pass Thru (Line 1 and Line 2)
Taxonomy Manually key-in the Physicians Taxonomy code or select a code from the taxonomy popup window to bypass the entries entered on the Physician Setup screen. Entries are validated against the ‘Health Care Provider Taxonomy Code Set’ to ensure only valid codes are entered.
83 Other Physician 1 Search Other Physician Popup Screen
83 Name(Last, First MI) Other Physician Pass Thru (Line 1 and Line 2)
Other Physician 2 Search Other Physician Popup Screen
EDIT/LOG SCREENS
Edit/Log Quick link AccessBy default, when you click on the Edit/Log Tab, the Claim Edit screen is displayed. To display the Claim Log screen, click on the Claim Log 'quick link' directly below the tab.
Claim Edit Screen
The Claim Edit screen displays all claim edits for the current claim. Corrected edits on this screen will be indicated by checks in the 'Touched' column. After correcting all edits, the claim will require validation. 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.
Type: The type code is an internal clearinghouse number used for troubleshooting.
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 attachment(s). Claims flagged with attachments will display in the Attachment Report (Management Report). In addition, claims can be searched for and found, in the Search Claim screen, using
'Attachments' as the Search Claim criteria.
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 (Detail 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 Claim Status. For example, View Configuration – View by ‘Open’ or ‘Closed’ claims.
• Provides a payer information popup screen for submitted claims via the CCC link.
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|CCC: This column provides links to several reporting functions. Some, or all, of the functions may be present depending the current status, claim history, and/or follow-up settings of the claim. Functions found in this column may include:
Detail Audit. The AuditLink 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.
Bridge Audit. Documents manipulations made to the claim during the claim capture process as defined per client requirements (bridge specification).
'Followup'. The Follow-up date, with a check box next to it, displays any current follow-up dates set for the claim. The Follow-up date is set on the same screen.
Clear. This removes any Follow-up Dates set in the system. Remove (Clear) the Follow-up date by checking the box and clicking the 'Save Comment Only' button.
CCC. The CCC link only appears for submitted claims. Selecting the CCC link opens a popup screen containing submitted claim handling information and payer
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.
Follow-up Mark: Use this feature as a 'Tickler Reminder' to set claims aside until the specified date for future work. 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 Log CCC Popup Screen Description
The CCC link on the Claim Log only appears for submitted claims. Selecting the CCC link opens the CCC popup screen containing claim file transmission information as well as payer acknowledgement information.
Claim Audit Screen
The Claim Audit screen is accessed from the Claim Log screen (Detail Audit Link). The Claim Audit screen is used to display claim
modification details. The screen displays every change made to a claim including the locator id, the old, and new values. Click on the 'Detail' link to display further information about the claim.
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. Dollar Amounts 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 Control Number, Patient Last Name, Payer Information, Bill Type, or Type of Bill. The criteria/display for the Claim Search and Search Results can be customized from the Setup/Configuration screen.
NOTE
Your screen may differ from the one below due to different Claim Dashboard Setup and Configuration settings.
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.
Standard Queries:
• 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.
• Search Claims by View. Search and view claims using previously saved Configuration View settings.
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). Bill Type 3 position number for the Type of Bill (i.e. 131)
Type of Bill Type of Bill Category. For example; Medicare Part B, Hospital Inpatient, or Hospital Outpatient.
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 criterion and use the default setting (Open). 'Other' Claim Statuses are custom statuses based on client requirements. Attachment Yes = Included Claims with Attachments in current view
No = Exclude Claims with Attachments in current view Billed Date This is the date range the claim was billed to the payer. Status Date
Claim Capture
Use the ‘From’ ‘Thru’ date selection, below these options, to: 1) View claims where the statuses have changed within a specified period (statuses determined from above check boxes). OR 2) View claims captured into the system within a specified time period.
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 to refresh the Dashboard screen with
Listing Follow Up Claims. Displays a list of Follow Up claims by Claim Number. This list may be sorted according to column heading.
Summary by Claim Status. Provides a graphical display of Open or Closed claims, by status, as set by settings in the View Configuration.
The Total Cnt and Total Amt represent the sum total for all statuses displayed in this area according to settings in the View Configuration. To view all claims belonging to a particular status, click on the status or status icon in the far left column. A listing of all claims, with the same status, will be displayed.
List of Claims by Dollar Value. Provides a high profile view of the high dollar claims in the system. This list may be sorted according to column heading. The criteria for this feature can be customized from the Setup/Configuration screen.
NOTE
Your screen may differ from the one below because Claim Dashboard Setup and Configuration settings.
Click on the 'Claim#' to open the claim for editing. 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.
If you wish to display ALL claims, regardless of criteria, keep all options set to '--ANY--' and click the Search button. Entering specific search criteria in one, or more, fields and leaving the other fields set to '--ANY--' will render specific search results for the field(s) you specified. When using the ‘From’ ‘Thru’ fields, you may enter specific information in the ‘From’ field and leave the ‘Thru’ field blank. You may view claims with attachments from this screen.
Search Claim option descriptions:
Provider: Search for claims by available provider.
Total Chg (From-Thru): You may search for claims based on minimum and maximum dollar values. If the first 'From' field is left blank, the minimum dollar value will be $0.00 by default.
Capture Batch ID: This is the confirmation number received when you captured (loaded) claims into Claim Master from your HIS system. If you wish to retrieve your Batch ID number, you may obtain it by viewing the Batch Upload Report from the Claim File Capture History screen. The ID is also displayed on the Claim File Capture History screen.
Payer Sequence: Use this feature to search for Primary, Secondary, Tertiary, Quaternary, or Non-Primary claims. The payer sequence (P/S) is displayed in the claim header.
Total # Payer: Perform a search according to the total number of payers on a claim. Options are: 1, 2, 3, 4, Other, 2 or more.
Payer Ids: Search for claims by a specific payer. Use the Search Payer popup screen to make the selection. After you make the selection, you may place your mouse cursor over the ID to display the payer name.
Payer Type: Claims may be searched according to payer types. For example, Commercial or Government payers like Medicare or Medicaid. The default Payer Type --ANY-- will permit all payers to be included in the search query.
Claim Status: Provides the status of a claim as it moves through the Claim Master system. The Claim Master Institutional available claim statuses are listed in the table below:
Status Date (From-Thru): From/Thru: Specifies the date range for performing claim searches in Claim Master Institutional.
Attachment: Select this check box if you wish to search for claims that require attachments.
Patient Control #: Unique identification number assigned by the provider. Patient Last Name (From-Thru): The last name of the patient associated
with the claim.
First Name: The first name of the patient associated with the claim. 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 Claims without edits or with overridden edits 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 put on Hold per Client specific criteria. Claims require action by the biller before qualifying for submission to the clearinghouse.
Med Review Claims captured into Claim Master but put in Med Review per Client specific criteria. Claims require review and action by the biller before qualifying for submission to the clearinghouse. Temporary Submitted claims pending successful submission to the
clearinghouse.
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 symbol indicates the active column and ascending/descending order. Search Claim Results - sorted by'Patient Name'
The Search Claim results listing displays the following:
Patient Name: The full name of the individual to whom the services were provided.
Patient Control #: Unique identification number assigned by the provider. TOB: Type of Bill
PT: Payer Type. Code identifying type of claim Payer Types
C = Medicare
D = Medicaid
F = Commercial Insurance Carrier
G = Blue Cross / Blue Shield
H = Champus
Payer Name: The full name of the payer responsible for the charges on the claim.
PS (Payer Sequence): The Payer Sequence is used to identify current payer of a claim for Coordination of Benefits billing. The claim will be identified as Primary, Secondary, Tertiary, or Quaternary. The payer sequence (P/S) appears in the claim header of the claim.
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 Charge: Corresponds to the Balance Due (UB-FL 55). Sum of the Line Charges for the claim.
Status: The current status of the claim in the Claim Master system. Status Date: This is the last time the status was changed. This time
will update when the claim is saved.
Batch ID: The batch ID is an Emdeon assigned number given to the claims batch file as it is captured into Claim Master. The Batch ID number can also be viewed in the Claim File Capture History screen. The field will be blank for hand keyed, copied, or split claims.
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.
POPUP SEARCH SCREENS
There are several popup screens available through out the claim screens. Most of them permit entry of search criteria that allow you to find information to fill in the various form locators. All popup screens are accessed from the various forms via the Search Icon . The following paragraphs describe each popup search screen.
Search Insured - Popup
The Search Insured popup helps find and populate Insured information in field locator 58. This popup is accessed from the Insured/Payer Info screen. To use this field, you must first select an Insured's Name by mouse clicking in a Name field. You may search for Insured information by Last Name, First Name, or Cert ID. After the search results are displayed, you may set the information on the form from the search results by selecting the Set link.
Popup Name: Search Insured
Accessed From: Insured/Payer Screen.
Search Criteria Descriptions
Description
Last Name Insured Last Name
First Name Insured's First Name
Cert ID Identification Number assigned to the Insured by the Payer
Search Display Field Descriptions
Search Field
Cert ID Identification Number assigned to the Insured by the Payer
Last Name Insured's Last Name
First Name Insured's First Name
MI Insured's Middle Initial
DOB Insured's Date of Birth
Sex Insured's Gender
Address (Street, Etc.)
Insured's Mailing Address
Set This link populates the form locator with the selected search result listing.
Search Procedure Code - Popup
The Principal (FL 80) and Other (FL 81) Procedure Code(s)
functionality is based on the Coding Method selected in Field Locator 79. The settings for Field Locator 79 are 4=CPT 4 , 5=HCPCS, 9=ICD9. The Procedure Code popup screens find and populate Procedure Codes
in Field Locators 80 and 81. The popup screens are accessed from the Treatment/Other Info screen. To use the popup screens in FL 80-81, you must first select the Coding Method in FL 79.
To populate the form, from the popup search results listing, click on the applicable desired code in the Code/Description column OR drag-and-drop the information from the popup into the code field on the form.
Popup screen (FL 79 = 4 CPT or 5 HCPCS)
Popup Name: Search Procedure Code & Description
Accessed From: Treatment/Other Info Screen
Search Criteria Descriptions
Description
Complete Indicator that the entire HCPCS Code table will be searched
Code CPT or HCPCS Code
Starts With Word believed to start the Procedure Code description Keywords Keyword believed to be part of the Procedure Code description
Search Display Field Descriptions
Search Field
Code Procedure Code
Description Procedure Code Description
Begin Procedure Code Effective Date
Search ICD9 Procedure Code - Popup
To populate the form, from the popup search results listing, click on the applicable desired code in the Code/Description column OR drag-and-drop the information from the popup into the code field on the form.
Popup screen (FL 79 = 9 ICD9)
Popup Name: Search ICD9 Procedure Code & Description
Accessed From: Treatment/Other Info Screen
Search Criteria Descriptions
Description
Subset Subset codes are defined in the Setup/Configuration portion of the software. If these codes are defined, you may search and use these codes exclusively instead of the entire code set Complete Indicator that the entire ICD-9 Procedure Code table will be
searched
Code ICD-9 Procedure Code
Starts With Word believed to start the Procedure Code description Keywords Keyword believed to be part of the Procedure Code description
Search Display Field Descriptions
Search Field
Code Procedure Code
Description Procedure Code Description
Begin Procedure Code Effective Date
Search Physician - Popup
The Search Physician popup screen finds and populates the Attending Physician (82) and Other Physician (83) Field Locators. The popup screens are accessed from the Treatment/Other Info screen. Physician search criteria includes the Physicians Last Name, First Name, License Number, NPI, and UPIN. Physicians can be added to the table if authorized according to User Authority settings. After a Physician is found, populate the form by clicking the Select link for the applicable doctor.
Popup Name: Search Physician
Accessed From: Treatment/Other Info
Search Criteria Descriptions
Description
Physicians Last Name
Physicians Last Name First Name Physicians First Name
NPI National Provider Identifier. 10-position numeric identifier License Physicians Medical License Number
UPIN The Unique Physician Identification Number (UPIN) Directory of practicing physicians in the United States. It contains physician practitioners who are enrolled in the Medicare Program. Add
Physician
Physicians can be added to the table if authorized according to User Authority settings.
Search Display Field Descriptions
Physician Name
Attending Physician that rendered services to the patient. Degree The Physicians type of educational degree.
NPI National Provider Identifier. 10-position numeric identifier License License number on record for the physician
UPIN This is the standard Unique Physician Identifier Number (UPIN) as assigned by Medicare.
Tax ID The Federal Tax ID assigned to the physicians practice. Taxonomy The provider 10-digit taxonomy code is an identifier that
corresponds closely to an area of practice expertise or specialty. Grouping A Claim Master feature that permits the grouping together of
multiple physicians according to specialty or type of practice. Edit Update physician information using the Edit Physician screen. Select Click on this link to populate the form with data on this line. The
Search Payer - Popup
The Search Payer popup screen finds and populates the Payer entries in Field Locator 50. The Search Payer screen is accessed from the Insured/Payer Info screen. The additional payer information displayed using the Show/Hide icon also displays the Search Payer popup screen. Payer search criteria include the Payer ID and Payer Name. After a Payer is found, populate the form by clicking on the Payer Name and dragging it into the desired form locator.
Popup Name: Search Payer
Accessed From: Insured/Payer Info screen
Search Criteria Descriptions
Description
Subset Subset payer listings are defined in the Setup/Configuration portion of the software. If these payer listings are defined, you may search and use these payers exclusively instead of the entire payer table.
Complete Indicator that the entire Payer Table will be searched. Payer ID Payer Identification.
Payer Name Payer Name as listed in the payer table. Starts With Word believed to start the Payer Name. Keywords Keyword believed to be part of the Payer Name.
Search Display Field Descriptions
Search Field
Payer Name x3 columns
The Payer Name as found in the payer table. Payer ID
X3 columns
Search Patient - Popup
The Patient Search popup screen finds and populates the Patient information in field locators 12 and 13. The Patient Search screen is accessed from the Patient/Claim Info screen. Search criteria include: patients last name, Patient's first name, and the Patient Control Number. After the search results are displayed, you may set the information on the form from the search results by selecting the Set link.
Popup Name: Search Patient
Accessed From: Patient/Claim Info
Search Criteria Descriptions
Description
Patient Last Name
Patient’s Last Name First Name Patient’s First Name Patent
Control #
The Patient Control Number (PCN) is a unique number assigned by the provider to retrieve individual patient accounts and case records, and to post payments. It also may help identify the patient’s medical record
Search Display Field Descriptions
Search Field
Patient Control #
The Patient Control Number (PCN) is a unique number assigned by the provider to retrieve individual patient accounts and case records, and to post payments. It also may help identify the patient’s medical record
Last Name Patient's Last Name
First Name Patient's First Name
MI Patient's Middle Initial
DOB Patient's Date of Birth
Sex Patient's Gender
Address (Street, Etc.)
Patient's Mailing Address
Set This link populates the form locator with the selected search result listing.
Search Revenue Code - Popup
The Revenue Code popup screen finds and populates the Revenue Code entries in the various claim lines. The Revenue Code screen is accessed from each claim line on the Claim Lines screen. Revenue Code search criteria include the Code ID or Description. After the correct Revenue Code is found, populate the claim line by single clicking on the chosen codes description within the popup screen. The popup screen will automatically close after the selection is made.
Popup Name: Search Revenue Code & Description
Accessed From: Claim Lines Screen
Search Criteria Descriptions
Description
Complete Indicator that the entire Revenue Code table will be searched
Code Revenue Code
Starts With Word believed to start the Revenue Code description Keywords Keyword believed to be part of the Revenue Code description
Search Display Field Descriptions
Search Field
Code Revenue Code
Search Diagnosis Code & Description - Popup
The Search Diagnosis Codes popup screen finds and populates the Search Diagnosis Code entries in Field Locators 68-75. The Search Diagnosis Codes screen is accessed from the Treatment/Other Info screen and the 'Other Diagnosis Codes' additional fields screen. Search criteria include: a Description of the Diagnosis Code or entering the Diagnosis Code ID. There is the option to search the entire code set or subset according to parameters set in the software (Setup/Configuration). After the correct Diagnosis Code is found, you may populate the form by clicking on the chosen code and dragging it into the desired form locator.
Popup Name: Search Diagnosis Code & Description
Accessed From: Treatment/Other Info screen
Search Criteria Descriptions
Description
Subset Subset Diagnosis Codes are defined in the Setup/Configuration portion of the software. If these codes are defined, you may search and use these codes exclusively instead of the entire code set
Complete Indicator that the entire Diagnosis Code table will be searched
Code Diagnosis Code
Starts With Word believed to start the Diagnosis Code description Keywords Keyword believed to be part of the Diagnosis Code description
Search Display Field Descriptions
Search Field
Code Diagnosis Code
Description Diagnosis Code Description
Begin Diagnosis Code Effective Date
Search HCPCS Code & Description - Popup
The HCPCS Code popup screen finds and populates the HCPCS Code entries in the various claim lines. The HCPCS Code screen is
accessed from each claim line on the Claim Lines screen. HCPCS Code search criteria include the Code ID or Description. After the correct HCPCS Code is found, populate the claim line by single-clicking on the chosen codes description within the popup screen. The popup screen will automatically close after the selection is made.
Popup Name: Search HCPCS Code & Description
Accessed From: Claim Lines Screen
Search Criteria Descriptions
Description
Subset Subset HCPCS codes are defined in the Setup/Configuration portion of the software. If these codes are defined, you may search and use these codes exclusively instead of the entire code set
Complete Indicator that the entire HCPCS Code table will be searched
Code HCPCS Code
Description Search query parameter. Enter part of the description into this field
Starts With Word believed to start the HCPCS Code description Keywords Keyword believed to be part of the HCPCS Code description
Search Display Field Descriptions
Search Field
Code HCPCS Code
Description HCPCS Code Description
Begin HCPCS Code Effective Date
Logging into Claim Master
LOGGING INTO CLAIM MASTER INSTITUTIONAL
Login Sequence from Emdeon.com
IMPORTANT
1) Always use Internet Explorer 5.5 (or greater) when accessing the Claim Master software. Correct operation of the Web site is not guaranteed using other Web browsers.
2) The password for every Claim Master user changes every 90 days. Each password must have at least eight characters in length. In addition, Passwords are required to contain at least one number (0-9), 1 special character (such as #,@,!), and the rest may be alpha
characters (a-z or A-Z).
3) Please disable any pop-up blockers to ensure things function properly. In most cases, you can disable them through your Internet Explorer toolbar by going to Tools/Popup Blocker/Turn Off Popup Blocker.
Perform the following to access the Claim Master application: 1. Using Internet Explorer and your Internet connection, go to
www.emdeon.com.
2. From the main Emdeon web page click on the Business Services Customer Login link. The Product Login page will now appear. Product Login - Emdeon.com
3. From the Product Login web page, click on the Claim Master link. After pressing the Claim Master link, the following screen is displayed. Account Login screen.
Note: The administrator username and password should have been given to you during implementation. If you do not have an
administrator username and password, please call the Emdeon Help Desk at 877-271-0054 (Option 1).
4. Enter your user name in the User Name text box. Press the Tab key or move the cursor to the Password text box.
6. Click the Login button, or press the Enter key.
7. The Emdeon Provider Portal should now appear (below).
NOTE
The Emdeon Provider Portal screen display may differ according to installation. Some installations may have charts and graphs available for providing high-level views of existing claims inventory.
Emdeon Provider Portal
NOTE
If an Internet Explorer Security Alert window appears, uncheck the box in the lower left corner of the window and click continue.
7. Select Claim Master from the My Applications selection links. After selecting Claim Master from the My Applications menu, the Claim Master main menu will appear.
Claim Master Main Menu
8. If you have Institutional and Professional Claim Master, multiple facilities, and multiple Client ID's, you will see the following additional screen. Select Institutional Claim (UB92) to proceed into Claim Master Institutional.
Claims Processing
CAPTURING CLAIMS
NOTE: Batch files submitted to Emdeon have to be in a standard Print Image, Super UB92, ANSI 837 or some other pre-approved proprietary format. Please contact our Help Desk for additional information (877-271-0054 - Option 1).
Claims enter Claim via a batch file. The name of the batch file does not matter.
To capture a batch file in Claim Master perform the following: 1. Select Capture Claim Files from HMS from the main menu.
2. A Java Plug-in Security Warning will appear. Click on the Yes button to continue with the claim capture process.
Java Plug-in Warning
3. Select the batch file from your file system by clicking on the Add button.
Claim File Capture Screen
4. From the 'Select files to upload' dialog box, select the file for uploading to Emdeon from your own system.
5. When your files have been selected, click on the Submit button.
Claim Capture (Upload) Progress Screen
After your files have been sent to Emdeon 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 Claim File Capture History screen, please check again after a few minutes.
You may verify the claim capture using the following three methods within Claim Master:
• Claim File Capture History Screen. The Claim File Capture History Screen is selected from the Report Menu.
• Claim File Capture Reports (File Box). These reports provide details (Skipped, New, Incomplete, etc.) for each batch captured into Claim Master.
• Claim Log. The first entry in the Claim Log indicates the date/time, batch file name, and Batch ID associated with a claim capture.
Please refer to the Reports section, of this user guide, for more information.
EDITING AND
COMPLETING CLAIMS
This section describes the claim editing process. You will use Claim Master 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 Institutional Claim' from the main Claim Master menu. The Search Claim screen will be displayed.
2. Select 'Incomplete' from the Claim Status search options.
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 Search Results Listing
After selecting a claim from the Search Claim Results listing (above), the Claim Edit screen (below) will now be displayed. Claim Edit Screen
If you place your mouse cursor over the edit row OR Fix Edit link, 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).
Correcting Claims from the Claim Edit Screen
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 Unfixed 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.
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.
SERVICE LINE FUNCTIONS
Perform these operations from the Claim Lines screen. COMBINING CLAIM LINES
Claim Lines can be combined from the Claim Lines screen using a combination of the Set check boxes and the Combine Lines button. To combine lines in Claim Master, perform the following:
1. Open the claim you wish to combine lines on.
2. Select the claims lines you wish to combine by checking the Set boxes on the claim line. Select two or more lines to combine. All claim lines will roll upward into the first checked claim.
3. Click on the Combine Lines button.
NOTE
The 'Undo Combine Lines' button appears only after combining lines. To 'undo' combine lines, click the Undo Combine Lines on the bottom of the screen.
You will receive the following message:
4. Select OK to finish combining lines. DELETING CLAIM LINES
Claim Lines are deleted on the Claim Lines Screen. There are two ways to delete claim lines in Claim Master:
Method 1. Use a combination of the Set Checkbox and Delete Lines button. This method provides an 'Undo' feature if you change your mind and decide not to delete the claim line(s).
Method 2. Use the button to the far right of the claim line. This method does not provide an 'Undo' feature.
Deleting Claim Lines - Method 1.
Claim Master permits the deleting of multiple claim lines. To delete claims in Claim Master, perform the following:
1. Open the first claim you wish to delete claim lines on.
2. Select the claims lines you wish to delete by checking the Set boxes on the claim line. If you wish, you may select two or more lines to delete.
3. Click on the Delete Lines button. You will receive the following message:
4. Click OK to finish deleting the claim line(s).
5. If you wish to undelete the claim line(s), click on the Undo Delete Lines button.
NOTE
The 'Undo Delete Lines' button appears only after deleting claim lines. Deleting individual claim lines - Method 2.
To delete individual claim lines in Claim Master, perform the following:
1.