Filter Icon: This icon is placed in the top-left corner. Clicking on the Filter Icon displays the Filters popup. Clicking on the Add New Filter Icon displays the Ad-Hoc Filter popup. The fields available on the Filter Screen are configurable.
Sort:
It allows sorting according to the sequence chosen on the popup. Sorting by Ascending/Descending up to three columns is allowed.
Manage Columns: Manage Columns is an additional filter which enables the user to select the required columns. Users can customize the columns and analyze details on the
Approve Claims screen. After clicking on the Manage Columns icon, a selection box is displayed which has two columns: Available Columns and Selected Columns. Available Columns are the total available columns from which the user can select columns to be displayed on the
Approve Claims screen. Simply click on the arrow button (→ or ←) to move it to either side. On clicking the right arrow →, the respective column name is added to the Selected Columns. After selecting the preferred columns, clicking the Apply button saves the changes made, and the same is reflected in the
Approve Claims screen. The Select and Claim ID fields available under Selected Columns are grayed out, and users cannot remove these two columns from the
Approve Claims screen. Also, the arrows are shown grayed out with a lighter shade, which prevents users from changing the position of the fixed columns.
| Category Name | Column Name |
| Assignments | Action Comments |
| Assign Status | |
| Assign To | |
| Claim Assign Date | |
| Done Comments | |
| Expected Date | |
| Followup Date | |
| Claim | Business Unit Code |
| Claim Batch No | |
| Claim Case No | |
| Claim Creation Date | |
| Claim Employer Name | |
| Claim Encounter Type | |
| Claim Hold Reason | |
| Claim ID | |
| Claim Reopened | |
| Claim Status | |
| Claim Type | |
| Claims with Errors | |
| Claims with Warning | |
| Coding Reviewed | |
| Claims with Errors and Warning | |
| Days Count Since DOS | |
| Eligibility Reviewed | |
| Location Code | |
| Select Checkbox | |
| Claim Amounts | Balance Amount |
| Bill Amount | |
| Claim Date | Date of Service |
| Claim Insurance | Clm Pri. Eligibility Details |
| Claim Pri Eligibility Status | |
| Claim Sec.Ins HMO Details | |
| Claim Pri. Insurance | |
| Claim Pri. Subscriber ID | |
| Claim Pri. Ins HMO Details | |
| Claim Sec. Eligibility Details | |
| Claim Sec. Eligibility Status | |
| Claim Sec. Insurance | |
| Claim Sec. Subscriber ID | |
| Claim Ter. Insurance | |
| Claim Ter. Insurance Subscriber ID | |
| Clm Pri. Last Active Elig Date | |
| Clm Sec. Last Active Elig Date | |
| Patient | Patient Chart No |
| Patient Date of Birth | |
| Patient Name | |
| Patient Insurance | Other Insurance |
| Pat Pri. Eligibility Details | |
| Pat Pri. Eligibility Status | |
| Pat Pri. Ins HMO Details | |
| Pat Pri Last Active Elig Date | |
| Pat Sec. Ins HMO Details | |
| Pat Sec. Eligibility Details | |
| Pat Pri. Last Active Elig Date | |
| Sec Bal Amount | |
| Pat Sec. Last Active Elig Date | |
| Pat Sec. Eligibility Status | |
| Pat Pri. Insurance | |
| Pat Sec. Insurance | |
| Pat Pri. Subscriber ID | |
| Patient Sec. Subscriber ID | |
| Patient Ter. Subscriber ID | |
| Patient Ter. Insurance | |
| Provider | Billing Provider Type |
| Pay To Provider Type | |
| Rendering Provider | |
| Attending Provider | |
| Referring Provider |
CH Icon: This is enabled for any clearing house setup and additional settings in the database table for the clearing house.
Print Icon:It
allows the printing of details of outstanding claims displayed on the Approve Claims screen. 
CSV Icon:It
allows the user to print the complete Approve Claims screen in Excel format. 
Properties:
The Properties button is visible only to users with Read Access to the Properties Master screen.
Clicking this button opens a popup displaying a list of properties from the Properties Master that are relevant to the Approve Claims screen.
Admin users can view both admin-level properties (displayed in red) and user-level properties (displayed in black), whereas clinic users can view only user-level properties (displayed in black).
Assign To Icon:
This icon is enabled only when the user selects more than two claims on the
Approve Claims screen using the Sel checkbox. Clicking the icon, the
user can assign the selected claims to other PrognoCIS user(s); a message
along with a date is allowed to be entered. 
Set Claim Status: This icon is enabled only
when the user has to select multiple claims and mark the claims as
On Hold and Ready to Send. Claim ID: All claims are listed here with the respective Claim IDs. On clicking the Claim ID hyperlink, the user is navigated to the Claim screen. A checkbox is present in front of all claim IDs, which enables the user to select the claim for executing any action using the Actions icon. A new Three-dotted icon is added to the Claim ID field which displays the Patient's Icon panel. When the user hovers the mouse over the three-dotted icon, different options which convey more information about that patient are displayed.
Note: Approve Claims also displays Penalty Invoices claims.
-
Assign To: Clicking on the Assign To icon, the Assign To popup is displayed.
-
Progress Note: Clicking the icon invokes the Progress Notes popup with four tabs: Default, My Notes, Attach, and Procedures. When the encounter is opened, the Default tab is displayed as selected, and when the encounter is closed, by default, the My Notes tab is shown selected. If any document is attached to the claim, then it is displayed under the Attach tab, and if any procedure is performed on the patient, those details are displayed under the Procedure tab.
Note: When a claim is created from the billing module, then Progress Note is disabled on the three-dotted icon on the Approve Claims screen. -
Assign ICD Pointers: This popup has two distinct sections:
- ICD 10 Codes section: All ICD codes at the claim header level are displayed in the ICD 10 Codes section with A to L standard IMO descriptions displayed. On hovering over each charge code, the description name is displayed to the user.
- Charge Codes section: The Charge Codes section displays the list of all charge codes associated with the claim along with the modifiers, units, bill amount, pointers, and the ICD-10 codes. The number of rows displayed on the screen is shown in this section. For example, if a claim contains 10 charge rows, then the same number of rows is displayed on this screen. Users can add or edit modifiers using the Search icon. Units and Bill Amount are read-only fields. The Pointers column accepts letters, which is identical to the Claims screen. Users can change or add pointers to the Dx codes. If the user wants to add numbers in the Pointers field, once the user adds ICD codes in the ICD 10 Codes section as comma-separated values in the same sequence as selected, then on clicking the OK button, the record is saved. The respective claim is updated, and the screen gets refreshed.
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Claim Notes: Clicking this icon invokes the 'Claim Notes' popup, displaying the claim-level details of the patient. -
Claim Letter:
Clicking this icon invokes the Claims Letter popup. -
Insurance Details: Clicking the icon allows the user to enter Insurance policy details. This information is needed to identify the insurance policies that the patient has subscribed to. In the case of multiple policies, they are identified as Primary, Secondary, and Tertiary Insurance.
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AR Calling:It displays the 'AR Calling' popup, which displays the details of the claims selected on the Claims Center list. The details are displayed for 'Patient Details', 'Claim', 'Primary Insurance', and 'Secondary Insurance'. The user can print 'AR Calling' details for later reference or even for tracking purposes with insurance companies using the 'Print' button. -
Patient Account: Clicking the icon invokes a report of the patient's account (highlighted by a blue band).
-
Patient Details:
Clicking this button invokes the
Patient Information
screen displaying patient details, and the user can also update the Patient
Details. -
Patient Billing Notes: Clicking the icon invokes a Notes popup to display or add Patient Billing Notes. It is important for the Biller to add notes; these notes can be seen for the patient on all screens where the Patient Billing Notes icon is visible. The Print button allows printing the notes.
-
Patient Notes:
Clicking this icon invokes the Patient Notes popup which displays additional information or notes related to the patient.
-
Patient Alert: Click the icon to add and display new Patient Alerts. Required by the front office while scheduling appointments, these can also be viewed from the Encounter, Appointment, and Billing screens. In Patient Alert, the user can define a date range, including the Effective From Date and Upto Date details for the alerts. The Delete option allows the user to delete an alert.
-
Encounter Details: Clicking the icon invokes the Encounter screen only if an encounter has been started; if the claim was created from the Billing side, then the message Nothing to Display is shown on the Billing Homepage.
-
Set Claim Status:
Selecting this option, the Ready
To
Send/Hold popup is invoked. Users can mark the claims as Ready to Send or
keep them on Hold. This popup displays two radio buttons:
Claims Ready
To
Send and On Hold (Please Select the Reason).
Claim Reopened: When a claim has been reopened, this column displays the 'Yes' keyword, and when a claim has not been reopened, this column displays the 'No' keyword.
Claim Batch No: Displays the claim's batch number in this field.
Claim Creation Date: This field displays the date when the claim was created.
Claims with Errors: This field displays the number of errors the claim has encountered. For example, if a claim has 3 errors, the number 3 is displayed in the column in red with a hyperlink. The count of errors is displayed with a hyperlink. Clicking the hyperlink displays all errors related to the claim as captured by PrognoCIS. Note: If there are no errors, then the count is displayed as 0.
Claims with Warning: This field displays the number of warnings the claim has encountered. The count of warnings is displayed with a hyperlink. Clicking the hyperlink displays all warnings related to the claim as captured by PrognoCIS. For example, if a claim has 3 warnings, the number 3 is displayed in the column in red with a hyperlink. Note: If there are no warnings, then the count is displayed as 0.
Coding Reviewed: This column displays the keyword 'Reviewed' for claims that have been marked as reviewed for Coding. If claims have not been marked as Reviewed for Coding, then this column is displayed blank. Claims can be marked as Reviewed for Coding by selecting the 'Coding Reviewed' checkbox on the 'ICD Pointers for Charge Codes' popup or by selecting the 'Mark claims as Reviewed for Coding' radio button on the 'Set Claim/s Status / Parameters' popup.
Eligibility Reviewed: This column displays the keyword 'Reviewed' for claims that have been marked as reviewed for Eligibility. If claims have not been marked as Reviewed for Eligibility, then this column is displayed blank. Claims can be marked as Reviewed for Eligibility by selecting the 'Mark claims as Reviewed for Eligibility' radio button on the 'Set Claim/s Status / Parameters' popup.
Note:
- Insurance and Self-Pay claims can be marked as reviewed for Eligibility.
- The Eligibility Reviewed condition is mandatory for marking Self-Pay claims as Billed. Once the Claim Status of Self-Pay claims is changed from Entered to Billed, such records are removed from the Approve Claims screen.
- Penalty Invoices and Employer claims cannot be marked as reviewed for Eligibility, as Eligibility is not applicable to them.
Claim Pri. Subscriber ID: The subscriber ID of the Primary Insurance is displayed.
Claim Pri. Eligibility Status: The Eligibility Status of the Primary Insurance is displayed. The values displayed are Active Coverage, R – Not Retrieved (Resubmit), A – Active, I – Inactive, O – Request Rejected, and N – Not Requested.
Claim Pri Last Active Elig Date: This field displays the date when the Primary Insurance Claim was last active.
Claim Pri. Ins HMO Details: This field displays the IE_MANAGED_CARE value.
Claim Pri Eligibility Details: This field displays a hyperlink with the label Claim Pri Eligibility Details. Clicking on the hyperlink invokes the HTML from TriZetto or Waystar, or a text message in the case of other clearinghouses.
Claim Sec. Subscriber ID: The subscriber ID of the Secondary Insurance.
Claim Sec. Eligibility Status: The Eligibility Status of the Secondary Insurance is displayed. The values displayed are Active Coverage, R – Not Retrieved (Resubmit), A – Active, I – Inactive, O – Request Rejected, and N – Not Requested.
Claim Sec. Last Active Elig Date: This field displays the date when the Primary Insurance Claim was last active.
Claim Sec. Ins HMO Details: This field displays the IE_MANAGED_CARE value.
Claim Ter. Subscriber ID: The subscriber ID of the Tertiary Insurance.
Other Insurance: This column shows if the claim has Insurance other than Primary, Secondary, and Tertiary Insurance associated. If the claim has other Insurance associated, then it shows the value as Yes; otherwise, it shows No. Active insurance that has the Mark Inactive / Expired checkbox unchecked on the Insurance popup is considered under this column.
Patient Pri. Insurance: This column populates the patient's default Primary Insurance.
Pat Pri. Subscriber ID: The subscriber ID of the Primary Insurance.
Pat Pri. Eligibility Status: The Eligibility Status of the Primary Insurance is displayed. The values displayed are Active Coverage, R – Not Retrieved (Resubmit), A – Active, I – Inactive, O – Request Rejected, and N – Not Requested.
Pat Pri. Last Active Elig Date: This field displays the last active eligibility date fetched for the patient.
Pat Pri. Eligibility Details: This field displays a hyperlink with the label Patients Pri Elig Details. Clicking on the hyperlink invokes the HTML from TriZetto or Waystar, or a text message in case of other clearinghouses.
Pat Sec. Insurance: This column populates the patient's default Secondary Insurance.
Pat Sec. Subscriber ID: The subscriber ID of the Secondary Insurance.
Pat Sec. Eligibility Status: The Eligibility Status of the Secondary Insurance is displayed. The values displayed are Active Coverage, R – Not Retrieved (Resubmit), A – Active, I – Inactive, O – Request Rejected, and N – Not Requested.
Patient's Sec Last Active Elig Date: This field displays the date when the Primary Insurance Claim was last active.
Patient's Sec Eligibility Details: This field displays a hyperlink with the label Patients Sec Elig Details. Clicking on this hyperlink invokes the HTML from TriZetto or Waystar, or a text message in the case of other clearinghouses.
Pat Ter. Insurance: This column displays the patient's default Tertiary Insurance.
Pat Ter. Subscriber ID: The subscriber ID of the patient's default Tertiary Insurance.
Claim Hold Reason: This column displays the claim's On Hold reason.
Rendering Provider: Displays the name of the Rendering Provider in this column.
Location Code: This column displays the location code of the claims.
Business Unit Code: Displays the Business Unit code in this column.
Patient Name: Displays the name of the patient.
Claim Case No: The Claim's Case No is displayed in this column. The Case Nos displayed in this column are hyperlinked. You can click the hyperlinked case number to open a popup titled "Case Management for Claim" with the corresponding case details. The Case Management for Claim popup is read-only for displaying the associated case number. No new cases can be added from this popup.
Claim Send Date: This is the claim send date. This date can change based on whether the claim is reopened and resent, or only resent. For example, if claim 5365 was earlier sent on 13-09-2016, then it will show the send date as 13-09-2016. Now, if the user resends this claim on 19-09-2016, then the system will show the send date as 19-09-2016.
Bill Amount: This column displays the total billed amount of the claim.
Balance Amount: This column displays the claim's balance amount.
Assign Status: Displays the Assign Status in this column.
Action Comments: Displays the comments of the assignment section of the assigned task.
Claim Assign Date: This is the date on which a claim was assigned to the respective person from PrognoCIS.
Done Comments: When a particular assignment is done, the comments are displayed.
Expected Date: Displays the expected date of the completed assignment. The expected date cannot be earlier than today's date (i.e., when the task is being assigned).
Followup Date: Displays the date in the Follow-up Date column.
Assign to: Displays the 'Assign To' name in this column.
Total Charge $: This field displays the total billed amount of the claims. It helps the Biller to track these approved claims, as the unpaid amount is visible at a glance.
Pagination: The user is able to navigate to any required page by simply entering the page number in the small text box shown below. Also, First (|<) and Last (>|) page buttons have been added to the pagination itself, enabling the user to navigate to the respective pages with a single click.
| See Also: | ICD Pointers for Charge Codes | Set Claim/s Status / Parameters | Filter Claims |