Topics Supplementary Claims Search:  

Introduction

Sometimes, if an encounter Assessment has a specific charge code in addition to other charge codes, the Insurances expect that specific charge code to be billed in a separate Supplementary claim. This is possible with the help of ‘Supplementary Claim’ feature.

In PrognoCIS, supplementary claim is created

  • When original claim is associated to active insurance.
  • When a specific charge codes are defined as comma separated CPT  / HCPC codes in property
  • When these charge codes are used in encounter Assessment then supplementary claim is created along with original claim.

Important aspects about Supplementary Claims

  • Property Billing Parameters 2 > supplementary.claim.cpt.codes defines comma separated CPT Codes or range like 75956-75984. On creation of Claim, if any CPT Codes fall in this range, then a separate claim is created for these codes. Thus the encounter will have two claims created.
  • Like wise Property Billing Parameters 2 > supplementary.claim.hcpc.codes defines comma separated HCPC Codes or range like A0100-A0200. On creation of Claim, if any HCPC Codes fall in this range, then a separate claim is created for these codes. Thus the encounter will have two claims created.

Consider an Encounter with two codes 99212 and 75957 (X ray).
It will create First Default Claim with only 99212 and a Supplementary Claim with 75957.

These properties accept comma separated string. For example –

  • For CPT charge code – Enter comma separated string in property supplementary.claim.cpt.codes – 75956,75984 OR range like 75956-75984
  • For HCPC charge code – Enter comma separated string in property supplementary.claim.hcpc.codes – A0100,A0200 OR range like A0100-A02
  • Supplementary claim is not created ‘Self Pay’ claim.
  • ‘CoPay’ is not applied to Supplementary claim but is applicable to original claim if it was collected.
  • Charge codes in the supplementary claims must be ‘Billed’ to Insurance.
  • Whenever claim is created from encounter Assessment with checkbox 'Create Claim' as marked, system deletes existing claims created earlier from that encounter Assessment. Before deleting such claims, system checks whether the existing claim is in 'Billed or Ready to Send' state or not. If it is found that existing is in 'Billed or Ready to Send' state then existing claim is not deleted. Similarly, whenever new supplementary claim was created along with original claim from encounter Assessment, system deletes the existing supplementary claim along with original claim if those were not in 'Billed or Ready to Send' state.
  • Supplementary claim functionality is supported by Professional and Institutional claims (UB04).


The Billed Amount, Insurance Amount, Patient Amount and Contract Amount totals will be recomputed for Both Claims.

If on Close of Encounter, user tries to recreate the claim, then it recreates the first claim if not Billed. It will also check for Supplementary claim and recreate it, if not billed.