Topics Claims: Additional Claim Information 'I' Search:  

Introduction

‘Additional Claim Information’ pop up provides opportunity to alter changes which are specific to claim selected on Claims >>Edit Screen. Changes applied on claim using ‘I’ button are micro but not applied at large. For example, user can set Primary Insurance as the one which is actually Secondary Insurance on Patient Details screen. Changing Insurance status sequence on Claims >> Edit Screen for that patient will not actually affect details defined on Patient Insurance Details.Additional. Button ‘Additional Claim Information’ is present on Claims >>Edit Screen.

Field Description on Additional Claim Information pop up

Attending Provider: It is Attending Provider fetched from Encounter of the patient.

Rendering Provider:  Rendering Provider which is set at Encounter Level. Use search binocular to enter other Rendering Provider. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in Cell24J, 25, 31, EDI: Loop 2310B.

Referring Provider:  Enter the name of the provider,  who had referred patient after consultation to specialist in the clinic. Sometimes, Referring provider information is mandatory while certain types of claims are processed. Select Referring Provider’s name from search list using binocular icon. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:17 EDI: Loop 2310A.

Referring Ref. No: Enter referring number given to patient. The details about printing this specific information in EDI is displayed as tooltip when mouse hovers on label. It is sent in EDI: Loop 2300REF.

Referral Date: Enter the date on which patient was referred to the clinic.

Resp Person Name: Resp Person Name is pulled from Patient Registration Screen of the patient. It is grayed out field which can not be modified.

Last Seen By Doc: Field 'Last Seen By Doc' is pulled from EMR side and it is set in the specialty template. The set value is mapped with testcode '837.lastseen.provider.testcode' to send details to EDI with EDI claims. When it is not used in any specialty template, field remains blank. Use search binocular if it is required to add.

Last Seen Date: Field 'Last Seen Date' is pulled from EMR side and it is set in the specialty template. The set value is mapped with testcode '837.lastseen.date.testcode' to send details to EDI with EDI claims. When it is not used in any specialty template, field remains blank. Use search binocular if it is required to add.

Home Care Contract Date: It is the date for 'visit' type - Home.Field 'Home Care Contract Date' is pulled from EMR side and it is set in the specialty template. The set value is mapped with testcode 'cms1500.home.care.date.testcode' to send details to CMS claims.

PreAuthorized Visits: If valid PreAuth number is associated to Encounter of the patient then PreAuth number is populated.

CLIA#: If CLIA number is provided to the clinic and is set then it is displayed.

Submitter Type: Submitter type is an entity who had submitted claim to the Insurance Company. It is drop down list and valid options are ‘Clinic’, ‘Business Unit’, ‘Rendering Doc’, ‘Service Location’. It is property driven parameter. Property '837.submitter.type' and valid parameters are ‘CL’, ‘BU’, ‘AD’, ‘SL’. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:17 EDI: Loop 2310A.


Billing Provider Type:  Address is picked from ‘Billing Provider Type’ by Insurance Companies to bill the claims. It is the drop down list and valid options are ‘Business Unit’, ‘Rendering Doc’ and ‘Service Location’, ‘Business Unit Billing’, ‘Service Location Billing’. It is property driven parameter. Property '837.provider.type' and valid parameters are ‘BU’, ‘AD’, ‘SL’, ‘S2’, ‘B2’. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:33 EDI: Loop 2010AA.

Pay to Provider Type: Pay to Provider type is the Person or Non Person entity,  who is billed by Insurance Company for claims. It is the drop down list and valid options are ‘Business Unit’, ‘Rendering Doc’. It is property driven parameter. Property '837.paytoprovider.type' and valid parameters are ‘BU’, ‘AD’, ‘CO’. The details about printing this specific information in EDI is displayed as tooltip when mouse hovers on label. It is sent in EDI: Loop 2010AB.

Hosp. From Date: It is the date on which patient was hospitalized for treatment. When ‘Place of Service’ is ‘Inpatient’ then ‘Hosp. From Date’ is necessary and system validates on action 'save' once claim is marked as 'Ready To Send'. Sysem enforces user to enter the date for 'Inpatient'. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:18 EDI: Loop 2300DTP.

Hosp. Upto Date: It is the date on which patient was relieved from hospital after treatment. When ‘Place of Service’ is ‘outpatient’ then ‘Hosp. Upto Date’ is necessary and system validates on action 'save' once claim is marked as 'Ready To Send'. Sysem enforces user to enter the date for 'Outpatient'. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:18 EDI: Loop 2300DTP.

ILLNESS (First Symptom): It is the date on which first symptom of illness was reported to the clinic. It is fetched from ‘Injury and Illness’ Specialty template used in assessment (EMR module) of the patient. In case, claim is created from Claims>>New Claim Screen then it can be populate from Billing module as well. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:14 EDI: Not reqd. in 5010.

Injury (Accident): It is the date when accident happened. It is important from 'MotorAcc’ and ‘PersonalAcc’ perspective while claim is being posted to Insurance Company. It is fetched from ‘Injury and Illness’ Specialty template used in assessment (EMR module). But in case, Claim is built from Claims >>New Screen then user can enter detail from Billing module as well. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:14 EDI: Loop 2300DTP.

Pregnancy (LMP): Enter the date of ‘Last Menstrual Cycle’ of the patient. It is used if patient is pregnant. Standard date format is mm-dd-yyyy. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:14 EDI: Loop 2300DTP.

Anesthesia Start Time HHMM: It is the time at which Anesthesia administration to patient started. ‘Anesthesia Start Time’ is auto populated if specialty template for Anesthesia is used in EMR module. In case, claim is created from Billing module then user can enter detail from Billing module as well. Standard format is HHMM. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in EDI: Loop 2300NTE.

Same or Similar Illness: It is the date when ‘Same or Similar Illness’ resurfaced to patient. It is fetched from Injury and Illness Specialty template used in assessment of the patient. Standard date format is mm-dd-yyyy. The details about printing this specific information in CMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:15 EDI: Not reqd. in 5010.

Duration in Minutes: It is actual duration for which Anesthesia administration was given to the patient. If ‘Anesthesia Start Time’ and ‘End Time’ fields are populated then ‘Duration’ field is auto calculated on ‘I’ button. The details about printing this specific information in EDI is displayed as tooltip when mouse hovers on label. It is sent in EDI: Loop 2300DTP.

Entry Batch No: When property 'use.claims.entry.batch' is set to 'Y', the batch numnber is automatically assigned to the claim and it is seen on 'I' button.

End Time HHMM: It is the time at which Anesthesia administration to patient stopped. ‘End Time’ is auto populated if specialty template for Anesthesia is used in EMR module. In case, claim is created from Billing module then user can enter detail from Billing module as well. Standard format is HHMM.The details about printing this specific information in EDI is displayed as tooltip when mouse hovers on label. It is sent in EDI: Loop 2300NTE.
 
Send to Primary as: It is the status of primary claims set while posting it to Insurance Companies. It is drop down list and valid options are ‘Original’, ‘Corrected’, ‘Replacement’, ‘Void’. The details about printing this specific information inCMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:22 EDI: Loop 2300DTP.

Send to Secondary as: It is the status of secondary claims set while posting it to Insurance Companies. It is drop down list and valid options are ‘Original’, ‘Corrected’, ‘Replacement’, ‘Void’. The details about printing this specific information inCMS and EDI is displayed as tooltip when mouse hovers on label. It is sent in CMS:22 EDI: Loop 2300DTP.

DCN ICN: It is Medicaid Resubmission Code. The details about printing this specific information in CMS is displayed as tooltip when mouse hovers on label. It is sent in CMS:22.

Cell 10D: It is reserved for local use for Clinic / provider. Information is sent in CMS:10D

Cell 19 for Local Use: It is reserved for local use for Clinic / provider. Information is sent in CMS:19

Encounter Type: Dropdown 'Encounter Type' is displayed only for 'Employer' Billing Claim. It displays option set in Edit Encounter screen for 'Bill To' checkbox when claim is created from EMR side otherwise user should select valid Encounter Type for claim using 'I' button when created from Claims >> New menu option.