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Introduction
Claims → Edit Screen displays all the claims which are either created from EMR or Billing module. Existing Claims which are either ‘Ready to Bill’ (E) or ‘Ready to Send’ (S) state in PrognosCIS TM System are allowed to edit from Claims → Edit Screen. Those claims which are already processed and billed then editing is allowed only when the claims are reopened.

Encounter Close screen of encounter this is assumed to be checked and treated accordingly. On Left hand side of Claim screen there are 3 buttons in green on Toolbar. Add, Search and Filter.

Add: The icon enable users to add new claims. On clicking the icon, create new Claim popup is invoked. The popup show 3 Radio Buttons.

Search: This Binocular is helpful to search a Claim in E, S, B, H and V status. Each column on this search has Sort Applicable. Navigation Buttons on this page are used to Navigate between pages. Search does not show Archived Claims and Penalty Invoices.

Filter: This is used to filter the claims depending on Different Criteria. As filter value is applied this Funnel Icon Turns as Green in color. Search starts showing all the claims which fall in the Entered filtered criteria.

All Claims List Box: This text Box shows 3 Values:

All Claims
Billed
Non Billed

When property billing.show.toolbar.listbox is ON, then only user could see this list box on Claim screen. By default the Property is turned Off. Based on the option selected related claims are displayed on the screen and on the search results. For instance, if option Billed claims is selected then all the claims that are billed status will be displayed in the search results. First claims from the search list if displayed on the claims edit screen. When option Non Billed is selected then all the claims that are either in Entered or Ready to Send are displayed in the search result. When option All Claims is selected then search result will display all the claims whether they are in Billed, Ready to Send or Entered status.

Navigation Icons: First, Previous, Next, Last are the 4 Navigation icons available on Toolbar to navigate to Claim screen. These Navigation Icons are governed by Search list. For Ex: If current Claim is 3nd in the Search List and there are total 1500 records in Claim search, click on First will take to 1st Claim , Previous will take to 2nd Claim, Next will take to 4th Claim in search list and Last will take to 1500th Claim i.e. the last Claim in the search.

Note: Next is NOT in chronological Order, it is in Reverse chronology OR in Order of Display in search.

Preview: Preview gives fair idea to user, which information is going to be printed on CMS 1500 or Send via EDI 837. Preview does not actually print Claim by CMS1500 or send Claim via EDI. User can view following options on Preview button:

Primary Insurance CMS as ICD 10
Secondary Insurance CMS as ICD 10
Tertiary Insurance CMS as ICD 10
Primary Insurance EDI as ICD 10
Secondary Insurance EDI as ICD 10
Statement for DOS
Primary Insurance UB04 as ICD 10
Secondary Insurance UB04 as ICD 10
Alternate CMS 1500
CMS 1500 for Employer
CMS 1500 for TPA
CMS 1500 For Patient as ICD 10
Patient Insurance EDI as ICD 10

Print: Print button is used to print the Claim; User can have following option on Print Popup: Primary Insurance CMS as ICD 10, Secondary Insurance CMS as ICD 10, Tertiary Insurance CMS as ICD 10, Primary Insurance UB04 as ICD 10, Primary Insurance UB04 as ICD 10, Statement for DOS and Alternate CMS1500. This Popup has Ok and Cancel button.

Fields and Icons on Edit Claims Screens (Charge Details Panel)

Patient: Name of the patient auto populates in the field with a hyperlink. Clicking on the hyperlink invokes the Patient information popup. User can make the desired changes related to patient information from this popup.

Patient Billing Notes:From this icon user can add important notes for the respective patient. Clicking on the icon invokes note popup in which notes once entered cannot be edited/deleted. After note is added the dollar sign of the icon turns Red. Newly added note appears on the top and old notes move down.

Rendering Doc: Displays the name of Rendering Doc entered on screen Claims → New Provider or from EMR → Encounter → Start New &rarr Rendering Provider. Rendering Doc is transferred to Billing Module when Claim is 'Billed' on Encounter close and that Non Billing Checkbox must be unchecked on Providers Master. Rendering Doc for the specific Claim can be changed using ‘I’ button.

Claim ID Hyperlink: It is unique Id auto generated by the system associated to Claim as soon as it is created. It is one up number which is incremented by one each time new Claim is created. Claim Id cannot be edited. Claim Id on Claims Edit screen is hyper linked. Click hyperlinked ‘Claim Id’ to view Claims Update History pop up. Claims Update History shows update history of edition of Claims from version V2B5 onwards. Claims Update history pop up displays information about:

· Claims / Charge Code level update

· Last user who had updated the Claim

Attach: Using this icon user can attach documents from their system. The icon only attaches documents with extension jpg, gif, jpeg, bmp, tif, tiff and pdf. If user tries to attach a document with any other extension then on Attach an alert message saying Only Specified Extensions Allowed: jpg, gif, jpeg, bmp, tif, tiff, pdf is displayed. On successful attachment of document a message saying The file is attached and saved is displayed. Attached document can be viewed only for that particular Claim Id. (There are two ways to view attached document - Claims Screen and on Attach icon).

View: On clicking this icon user can view the attached document. Icon is greyed out when no document is attached. DOB:System fetches the Date of birth of the patient from Patient Registration Screen and auto populates in the field. It is helpful to identify patient if duplicate first name and last name exists in the system. If patient is minor then DOB is displayed in red colorr.

Patient Alert: Patient alert is a pop up alert window that works as a reminder for user regarding the respective patient. There are several parameters that govern the occurrence of the pop up patient alert message. After the alert is added the icon turns red. The icon is governed by three properties:

patient.alert.hide.afterdays - This property decides the maximum number of days for which an alert an alert is visible from the day alert created/ Effective from date.
facesheet.showalert.fortypes -This property controls the occurrence of patient alert pop up. Here out of all parameters PA controls the patient alerts.
appointment.show.patientalert - Occurrence of patient alert pop up on the appointment screen is governed by this property. If this property is set to Y then the patient alert pop up is shown on the load of the screen but if the property is set to N then the patient alert pop up is not visible. However the patient alert icon continues to show red if the valid alert is present.

DOS: This displays the date of service on which encounter was created.

Amt Paid: It is the upfront payment (Copay) collected from patient. When hyperlinked ‘Amt Paid’ is clicked, it displays pop up ‘Copay’ having details about 'CoPay',Deductible', 'Visit', 'Advance' etc.

Chart No: This is typically entered for completing the backlog of existing Patients at the clinic. Chart No. is added to Patient Registration Page from EMR module and is displayed here.

Post Date: It is the date on which Claim was processed. It could be between visit date and date on Claim is processed. It is manual and editable field. Postdate cannot be further changed once Claim is processed. To alter ‘Post Date’ of processed Claims, Processed Claims needs to be Re-opened.

Sent Date: As soon as Claim is marked as ‘billed’ ‘Sent Date’ is automatically populated. This date is updated whenever Claim is reopened and processed again. Therefore, Sent Date is the last updated date on which Claim was reopened and processed. Dco No./ Voucher number of Billed Claim is displayed right after 'Sent Date' for 'Billed' Claim.

Edi Batch Number:After Sent date, EDI batch number is generated, if Claim is sent via EDI.

This Creation of Batch number is dependent on Property 837.oneclaim.perbatch. If 837.oneclaim.perbatch property is turned ON, one EDI Message will be generated per claim and hence a separate EDI Batch No. This EDI Batch No. is displayed on the claim. By default this property is ON. When turned OFF, all selected claims for processing from all Insurances will be considered in one EDI message and all these claims will get same EDI Batch No. assigned. If further, separate batches are required for specific payors, then their Payor IDs should be added in property 837.inswise.payorids4claimsbatch.Property 837.inswise.payorids4claimsbatch: Defines a comma separated list of Payor Ids for whom single EDI message will be generated for multiple claims or if set to ALL then, all selected claims for processing from all Insurances will be considered in one EDI message and all these claims will get same EDI Batch No assigned.

Pre Auth Hyperlink: It is valid PreAuth No. received from Insurance Company. It is hyperlinked and displays 'active' and 'Inactive' Pre Auth details in chronological sequence with 'open' PreAuth at top and closed at bottom.

Status: There are four statuses of Claims:

Entered Status
Ready to Bill – It is denoted as ‘E’. As soon as Claims are created, its status becomes ‘E’.
Ready to Send - It is denoted as ‘S’. When the Ready to Send check Box at the Bottom of page is checked, indicating now the EDI / paper Claims can be generated and send. Once the EDI/Paper Claims for Insurance / Patient are generated, this Claim cannot be edited.
Billed - It is denoted as ‘B’. It is set when All the associated EDI / paper Claims are generated and sent.
On Hold – It is denoted by ‘H’. It is used in scenarios like when posting of Claim has to put on hold due to some reason. Once a Claim enters into ‘On Hold’ status, reopen the Claim to resend it.
Void
Archived

Claim’s status is also displayed on Billing Home Page.

Progress Notes: The icon gets enabled only when the claims is created from EMR side. If the claim is created from billing module then the icon remains disabled. Clicking on the icon invokes Review Progress Notes popup with four tabs Default, My Notes, Attach and Procedures. When the Encounter is opened then Default tab is displayed as selected and when encounter is closed then by default My Notes tabs is shown selected. If any document is attached to the claim then it is displayed under Attach tab and when if any procedure is performed on the patient then those details are displayed under Procedure tab.

UB04 Claim: Enabled icon UB04 denotes that current claim is UB04 claim (Institutional Claim). Clicking on the icon invokes UB04 form popup.

Claim Ledger: It displays all the details related to payments received against claims (charge code wise details). The details are displayed only for Billed claims. If the clam is in entered status then no details are displayed on clicking the Claim ledger icon. If any charge code is marked as void then that entry is also displayed on the popup in red color. Claim ledger can also be printed by clicking on the print button.

Assign To:The icon is designed to invoke a Pop-UP window which helps the users to document specifics of assignments. The screen is divided in two halves for the ease of navigation and understanding. The Left side of window is designed to list the Assignment details and the right side is to document Actions taken by the assignee. The header section Lists task related activities such as: Claim ID, Claim ID and Patient Name and DOB. The tasks which are not related to claims or patients, will simply list the task ID generated internally in the header row.

Denied Charge Code to take action: Purpose of this popup is that while working on a Claim, user should be able to have a look on All Denied No action or WIP claims, so that appropriate action can be taken and user Close all pending tasks of that patient. This Popup is divided in To 2 parts ERA information which is Denied and Action's which user need to take on these ERA's. The icon is enabled only when Claim is in Billed status and there should be at least one claims of that patient, where Denied No Action or WIP has been received. Only Those Claims ERA's are listed in this popup for which Denied NO action or WIP has been taken for Charge codes. By Default all the ERA entries are shown as selected but if required user can deselect the required entries. The icon is disabled when required action is taken for all the ERA entries.

Claim Notes: The icon help users to write notes about the Claim for internal documentation purpose. Clicking on the icon invokes Claim Level Notes popup, where user can enter the notes. Notes once entered can neither be deleted nor edited. The header section of the popup display the Claim ID followed by Claim Date on left side and Patient name, DOB on right side. The newly added Claim Note will always be seen at the top followed by old Claim Notes. These Claim notes get stored in long group.

Claim Letter: The Doctor very often needs to send a letter with assessment and Plan to the Referring Doctor. Likewise he could be communicating with the Patient, Insurance Company amongst others. He could also be sending a letter referring the Patient to a specialist.

Patient Insurance: Patient insurance is denoted by Umbrella icon, which shows the insurances associated to a claim. Claim can have three insurances associated Primary, Secondary and Tertiary. Based on requirement user can assign or change Primary, Secondary and tertiary Insurances. When Insurance is associated to any patient or Claims the umbrella icon turns red . There can be multiple scenarios where user needs to assign secondary and tertiary Insurance after the claim is processed and sent to Primary Insurance.

Batch No: For better tracking of claims and generating End of the Day Reports and End of the Day closure, Batch numbers are recommended in PrognoCIS.

Type of Claim Checkboxes

Work Comp Employment, Auto Accident and Other Accidents

Accidental Claims can be created when Encounter type is defined as Work Comp or Auto Accident and patient insurance has defined 'Work Comp' or 'Auto accident'. User can create an Accidental claim directly from Claims → New by selecting Encounter type as Workers Compensation. If user creates a Claim with Encounter type as workers Comp but Insurance is not defined as 'Workers Comp', then on Ready to send and save user gets a message saying Pri Ins status is not Workers Comp. If Patient do not have any Insurance and on Claims → New screen if user select Encounter type as Workers Comp then a self-pay Claim gets created, which do not have 'Work comp' check box checked. These check boxes govern whether the created claim is of Type accident claim or not. When any of these check boxes are checked, then all three checkboxes are heighted in Red. Usually users are allowed to only one checkbox. When any of these check boxes are checked then Injury button gets enabled. This button help user to add Injury related information. Information entered on Injury button gets stored in I button on Save of Claim.

Provider SOF: It is Patient Signature on file. It is the authorization/ consent given by patient to release any medical or other information to process Claim. By default, ‘Patient SOF’ is checked and grayed. It is printed in Cell12 and Cell13 (Insurance subscribed by other and used by patient).

Pregnancy: Workflow of this checkbox is governed by a property billing.enable.pregnancy.cb when the property is turned ‘ON’ pregnancy checkbox will be checked irrespective of the status on the EMR module. However, when the property is turned ‘OFF’ then the status of Pregnancy check box continues to remain as it was initiated in the EMR side. By default this property is set to OFF.

Plan Payment: Checkbox 'Plan Payment' is displayed in red color and bold font for patient having assigned with 'Patient Payment Plan. It is automatically checked for such patients and having patient responsibility. Later user can uncheck it. The tooltip on the checkbox 'Plan Payment' displays Plan Name, Installment Amount and Next PayDate.

Bill to Employer: Checkbox 'Bill To Employer' is checked when Claim is Employer Billing Claim. When valid Employer is associated to Patient on Contacts Tab in Patient Registration and the Claim is either created Encounter Close or from Claims → New screen then 'Bill To Employer' gets checked automatically. When Employer Billing Claim is created from EMR side, then Claim's encounter is set to the 'Enc Type' on 'I' button as it is set on Patient's Appointment. Please refer help Employer Billing to learn more about it.

ICD Table

The table comprise of Codes for Diagnosis. It is diagnostic codes entered by Provider or Doctor from EMR module and are transferred through assessment screen to Claims when encounter is closed and Claims are created. Here Biller can add, update or delete them if required.

When Claims are created from Claims → New screen then ICD codes are not available. ICD codes are manually entered using '+' icon and these are added at ‘Claim Level’. ICD codes are printed on Cell21 of CMS1500 and at the most, twelve ICD codes are allowed to print and added at Claim level. Maximum number of ICDs’ which can be entered is governed by cms1500.max.icds. By default, it is set as 12.

Del Checkbox: Checking this checkbox will delete the ICD associated to the Claim. Each row in the ICD table is named as A, B, C and so on.
ICD 9: ICD 9 code can either be entered manually or can be selected from the Diagnosis Codes popup invoked on clicking the ‘+’ button.
ICD10: Just like ICD9, ICD10 codes can also be entered either manually or can be selected from the Diagnosis Codes popup invoked on clicking the ‘+’ button.
Name: This column displays the description of the selected ICD code. On selection of ICD9 or 10 the name gets auto-populated in the field.
Add: Clicking on this icon invokes Diagnosis Codes Popup of IMO search for ICD9 and ICD10.

Diagnosis Codes Popup: When Claim is created from EMR side, the ICD's on assessment which are marked as 'Bill' and are not marked as 'Non-Assessment' ICD's and which are not Duplicate on Assessment only those ICD's will be transferred on Claim. But, if Claim is created from Billing, then user has to manually click on '+' button and add those ICD codes. On Clicking + button of ICD popup with 4 tabs gets Invoked these tabs are General, Custom, preferred and Drilldown. The sequence of tabs is based on property icd.search.tabs.sequence.

Preferred: There are three types of preferred list, CP – Clinic preferred, MP – Medic Preferred and DS – Doctor Specialty. Preferred list changes with the change in login entity. The popup displays Description followed by ICD9 codes, ICD10 codes, SNOMED Int'l and Type. Column ICD9 display the list if ICD9 codes, column ‘ICD10’ display ICD10 codes corresponding to ICD9 codes. Mention about SNOMED Int'l and column Type displays the preference type, like CP – Clinic preferred, MP – Medic Preferred or DS – Doctor Specialty. In the preferred list user can view Standard ICD codes which are added in preferred.

General: When this tab is selected it displays this list of general ICDs. As user click on General tab, popup shows blank screen, user has to give input of 3 characters and after that auto search is invoked, which gives lit of all ICD codes where entered 3 characters are found in either code (ICD 9 Or ICD 10), or in ICD description, or in SNOMED. If user enters exact ICD number, then the list of that exact ICD code is given where it might have different Description and different Snomed combination.

Custom: This column displays the list of custom ICDs created manually.

Drill Down: From the General tab, users have provision to select ICD 10 codes alternatively to the preexisting ICD 9 code – this provision gives User a choice to select the appropriate code for the appropriate diagnosis at a granular level. For example, ‘Pregnancy' has same ICD 9 code for several different conditions in pregnancy whereas the ICD10 codes have multiple and varied codes for these conditions. Whereas, on the Drill Down tab, for each of these specific conditions there is a possibility for a User to ‘DRILL' the Search further to get to the exact ICD10 code that depicts the patient's pregnancy condition very specifically. The provision to actually drill further on the IMO search popup and find the appropriate ICD10 codes for the condition experienced by the Patient is the functionality available on the 'Drill-Down' tab. UI of Drill Down tab is quite different from other tabs. Icons present in the Drill Down screen are:

Location: Location is the venue or place where Provider or Doctor had examined the patient. Default location in Encounter is displayed in the dropdown list. But it can be changed if required for specific Claim. It can be configured from Settings → Configuration → Clinic →Locations.

Business Unit: Business Unit is like at different places different units are located and services are rendered to patients against rendering provider. Default value is displayed in the dropdown list. It can be configured from Settings → Configuration → Clinic → Business Unit.

Add: From the dropdown user can select the type of codes they wish to add in the Claim. Types of Charge applicable are:

CPT
HCPC
Spl Charges
Revenue Items (Available only when the Claim is UB04)
Items

Based on the selected option binocular icon present next the corresponding field gets enabled. Clicking on that icon user can select the Revenue Charges/Special Charge/ Items.

Buttons Governing Charge Code

After Claim is created from EMR side, when doctor add CPT/HCPC/Modifiers and ICD's to Assessment and load the Claim without visiting the Encounter close screen, then on load of Claim user gets validation message saying Assessment has been changed after last save of Claim. This is when EMR code button is enabled and on clicking the button user can add changed assessment data on Claim.

Copy Codes: The purpose of this button is to enable user to copy CPT/HCPC Codes for the Patient from his existing Claims. Codes will get copied despite of the fact whether the claim is in Billed statuses.

CrossOver: Usually, it is not recommended to send non-standard code to Insurances, CrossOver feature enable users to cross over the non-standard CPT/HCPC with the defined CPT/HCPC along with modifier.This functionality is used to change or replace one code with another. For example, on CPT Master for charge code 99203, a CoCPT 99213 is defined with modifier 21. Now, whenever charge code '99203' is used in claim and button 'Crossover' is used for this charge code then existing code '99203' would be replaced with code '99213' having modifier '21.

Cheatsheet: CheatSheet is a list of customized validations maintained by Clinic for different Insurances. These validations in CheatSheet evaluate the claims while processing for sending claim to insurance company. Biller can implement various validations according to the distinct requirement so that claims are not rejected by Insurance companies for stringent requirement specific to Insurance Company. Cheatsheet acts as a check list for the users to check the details filled in the claim to minimize or eliminate the possibility of rejection from the insurance companies. CheatSheet can be created with the help of .xls file from Claims → Edit Claims → CheatSheet. An .xls file can be downloaded by clicking on the ‘Download’ icon and after defining the CheatSheet validations the sheet can be uploaded by clicking the ‘Attach’ icon.

Claims Hx: Claim history button reflects details of all the claims that are associated to the patient. Details displayed on Claims History popup includes Claim Id, Service Date, Hospital From and upto date, Location, Provider, ICD9 Codes, ICS 10 Codes, Charge Codes, Modifiers, Type and Bill Amt.

Attach: User can send Claims Attachment for 2 clearing Houses: P2P and Gateway. For P2P many time Clinic need to visit older documents for patients, especially in case of Work Comp Claim. For Ex PR2, PR4 forms along with Chart Notes etc. So now, When Claims Clearing house is P2P and claim is work Comp type, then user can send Claim attachments to Clinic through P2P clearing house.

Denials: The buttons displays all the Denial details. Clicking on the button invokes a popup displaying all the details related to denials like Claim Id, Claim date, EOB No, Payor, Pri/Sec/Ter, Charge Code and Denial reason.

Fields on Charge Code Detail Frame

If the Claim is in Billed status then all buttons present in that charge row except CMS flag button are disabled. Further, if the Claim is in re-opened status then Modifiers, Pointers, ICD 10 Codes Search Button, CMS flag, From date, Upto date and Comments button gets enabled.

Del: On checking the checkbox and save the charge code entry gets deleted from charge code detail frame. The check box is disabled when the claim is in Billed or Re-open status.

Code: On adding the charge code by using the binocular icon, code gets auto populated in the field. On the tool tip of the added Charge CPT/HCPC Codes user is able to view the Code and its description. For Special Charge Codes and Item Codes we are able to view Code and Name of the Code.

Modifiers: Modifiers can be added along with CPT/HCFC Charge codes. Sequence of addition of Modifiers to a charge code is retained and displayed accordingly.

User can add modifiers from Group types → CPT Modifiers. Modifiers can be associated with charge code by following ways:

Modifiers can be associated to Charge code through the Binocular Search Button
Modifiers can be added manually in comma separated format or
Modifiers can be associated to CPT Master as default Modifiers
Modifiers can also be added from Encounter → Assessment Screen for that Charge Code.

After adding modifiers by any of the above ways it gets auto populated in modifiers on Modifiers Button of claims Screen. If the Modifiers are manually added, then on save of Claim it will check those Modifiers which have been manually added.

Fee: This displays the price of the medicine or injection used in the encounter. Price is getting displayed from the fees schedule. User can also change the fee manually.

Charges: Based on the units entered amount in the field ‘Charges’ gets auto populated in the field. For example, two injections have been used in the encounter of $20 then system will calculate fees with unit and will populate $40 in the field.

Users are allowed to add 0 amount charges on Claims and while posting a Claim system displays a validation message Zero Charge Rows: 1 : Do you still want to continue? If user clicks on Yes, then system mark that Claim as billed with 0 amount charge code.

Bill Pat: When the checkbox is checked the Claim is billed to the Patient. The checkbox is checked by default for all ‘Self Pay’ Claims.Depending on the type of Claim, this label changes to 'Bill Emp' and 'Bill to Pat'. User can manually check 'Bill Pat' check box, to create CMS for patient work flow.

Pointers: This field is enabled only when CPT/HCPC Codes are added to the Claim. This field is disabled when Special Charge Codes or Items are added to the Claim. Pointers get added by adding the Alphabets which are defined in the ICD Table. User can manually enter pointers without Comma. But on save of pointers those associated ICD codes get displayed on ICD 10 table as comma separated. For a single charge Code only 4 pointers can be added. When Pointers are added then on save the Pointers tab value gets wipe out and the value gets printed on ICD 10.

ICD10 codes: ICD 10 Codes, are nothing but the pointers. User can assign pointers to charge code by selecting it from Search binocular.

CMS Flag: Clicking on the icon invokes CMS Flags pop up provides capability to change few parameters associated to charge code at charge code level. 'Unit', 'Admin Qty' for NDC code can be defined on CMS flag. When user wants to discard a charge code from ‘Billing’, use 'DO NOT SEND' checkbox on CMS flag pop up. 'DO NOT SEND' marked charge code is highlighted with Red color background at charge code level in a Claim.

From Date: Enter the date on which the medication started. Date can be entered either manually or by using the colander icon present next to the field. By default present date is displayed in the field.

Upto date: Enter the date on which the medication ended. Date can be entered either manually or by using the colander icon present next to the field. By default present date is displayed in the field.

Comments: User can mention comment (if any) for future reference.

Action Checkboxes

Add Tax: Users can calculate tax for a new claim or for existing claim by checking the Add Tax checkbox. The functionality will be governed by two properties
claim.tax.percentage
claim.tax.charge.code

In the first property user need to set appropriate percentage value without percentage symbol. The property supports value upto 4 decimals. In the second property user need to add appropriate CPT/ HCPCS. It is only when appropriate Charge code is added to this property the Add Tax checkbox appears on Claims →Edit Claims screen

Workflow

When the Add Tax checkbox is checked a new row will get added on the claim with Non Standard or Standard CPT/HCPCS code defined in the property. Tax amount will be calculated as per the Percentage defined in the property claim.tax.percentage.
If the property claim.tax.charge.code is blank then Add Tax Checkbox is not displayed on Edit Claims screen.
When a Non Standard code is added on the claim and user clicks on Add Tax Checkbox, the latest amount against the charge code will get updated.
User can delete the code and re-add it.
User can modify the fee; however, after clicking the Add Tax Checkbox, the amount will be recalculated.
Add Tax will remain Checked when Tax is added on the claim
If user deletes the Tax code (Or Charge Code defined in the property claim.tax.charge.code) from the claim then checkbox Add Tax will get unchecked.
Tax amount will not consider the Voided Charge Codes for computing Taxes.
When Claim is Billed & Tax is already added on the claim, Add Tax Checkbox will be disabled and checked.
When claim is billed and Tax is not added on the claim, Add Tax Checkbox should be disabled and unchecked.

Limitations:

User can change the Charge Code defined in the property: claim.tax.charge.code any time.
If Tax code is already used on the claim and is changed Later, New code will be used to calculate the Tax on claim.
If in the property claim.tax.charge.code a particular charge code is defined but the Claim does not have any charge code & User checks the Add Tax checkbox to add Tax on claims, PrognoCIS will add the Tax code defined in the property with $0 amount.
If Charge Code other than Tax Code is voided after Claim is billed (By reopening the claim and using CMS Flag button), then user will explicitly have to void the charge code for Tax as well and reenter the same to ensure accurate Tax is reported on the claim.
When Claim with Calculated Tax is reopened and user tries to add /Void or Delete Charge Codes, then user needs to ensure Tax Code also is voided. New Tax Amount on such claims has to be calculated manually.

Buttons Governing Changes on Claim

Save: The button helps in saving the claim. The button gets enabled only when any change is made in the claim.

Send: This button helps in billing the claim. The button is governed by a property billing.disable.submit.claim, the button is displayed as enabled only when the property is set to Y. For billed claims the button send gets relabeled as re-send.

Delete: Claims can be deleted by clicking on this button. The button gets enabled only when the claim is in entered or ready to send status. It remains disabled for billed claims. For claims that are in re-opened status the button is enabled only when no voucher is received on the claim, else the button remains disabled.

Reset: Clicking on this button resets the unsaved data.

Re-calc: After charge codes are assigned to a claim and then changes are made in the fees schedule. Then clicking on the re-calc button re calculates the fees and charges.

Re-open: Clicking this button re-opens the billed claim. Enabling or disabling of this button depends on the role. If user is allowed to re-open a claim then the button is displayed as enabled else it is disabled.

Void: The button is helpful to mark a billed claim as void. The button is governed by a property billing.claim.hide.void.button, the button is displayed as enabled only when the property is set to Y. When the property is set to N the button is displayed as disabled.

Split: The button helps in splitting Employer claim in to separate TPA claims. Based on the CPTs added on the claim, the split button gets enabled on Claim screen.