PrognoCIS Help: Approve Claims

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Introduction: Approve Claims option is available under the Unprocessed Claims option and above the Send Claims screen. Clicking on the Approve Claims, Approve Claims screen is invoked. Approve Claims screen display the list of all claims which are in Entered, Ready to Send and On Hold status. The claims with reopened status are also displayed on this screen.

Filter icon: This icon is placed at the top left corner. Clicking on the Filter icon, Filters popup is displayed. Clicking on the Add New Filter icon, Ad-Hoc Filter popup is displayed. The fields available on the Filter screen are configurable.

Sort: It allows sorting according to sequence chosen on pop up. Sorting by Ascending/ Descending up to three columns are allowed.

Manage Columns: Manage Columns is an additional filter which enables the user to select 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 will be displayed which has two columns- Available Columns and Selected Columns. Available Columns are the total available columns from where User can select columns to be displayed on the Approve Claims screen.Simply click on arrow button (→or ←) to move it either side. On clicking the right arrow →, the respective column name is added to 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 field available under the Selected Columns, these two fields are grayed out and the users cannot remove these two columns from the Approve Claims screen. Also, the arrows are shown grayed out with a lighter shade which helps the 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 setting in database table for clearing house

Print icon:It allows printing of details of oustanding claims displayed on Approve claims screen.

CSV icon:It allows to print the complete Approve Claims screen in Excel format.

Properties: This button is exclusively visible to users with Read Access to the Properties Master screen. Access to this button is strategically granted to enhance user functionality. Clicking the Properties button triggers a popup, presenting a list of properties from the Properties Master screen in PrognoCIS that cater to Approve Claims.

Assign To icon: This icon is enabled only when the user selects more than two claims on Approve Claims screen using the Sel checkbox. Clicking on the icon, user can assign the selected claim to other PrognoCIS user(s); a message along with date is allowed to be entered.

Set Claim Status: This icon is enabled only when the user have to select multilpe claims and mark the same claim as on HOLD and Ready To Send

Claim ID: All the claims are listed here with the respective Claim Ids. On click of Claim ID Hyperlink, user is navigated to Claim screen. A check box is present in front of all the claim ids, which enable user to select the claim for executing any action using the actions icon. A new Three-dotted icon: is added in the Claim ID field which displays the Patient's Icon panel. When User hovers the mouse over three dotted icon, different options which convey more information about that Patient is displayed.
Note: Approve Claims also displays Penalty Invoices Claims.

Assign To: Clicking on the Assign To icon, Assign To popup is displayed.
Progress Note: Clicking on the icon invokes Progress Notes popup with four tabs Default, My Notes, Attach, and Procedures. When the Encounter is opened then the Default tab is displayed as selected and when the encounter is closed then by default My Notes tabs are 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 the Procedure tab. Note: When Claim is created from billing module then Progress Note is disabled on three dotted Approve Claims
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 description are displayed. On hover over on each charge code, description name is displayed to the user.
- Charge Codes section: The Charge code section displays the list of all the charge codes associated with the Claim along with the Modifiers, Units, Bill Amount, Pointers and the ICD 10 codes. The no of rows displayed on the screen is displayed in this section. For e.g. If a claim contains 10 charge rows, then the same number of rows are displayed on this screen. Users can add or edit modifiers using the search icon. Units and Bill Amounts are read only fields. The Pointers column accepts letters, which is identical to the claims screen. Users can change/add pointers to the dx codes. If the user s to add numbers in Pointers field Once the user adds ICD Codes in the ICD 10 codes section as comma-separated values in the same sequence as selected as that of then on click of OK button the record is saved. The respective claim is updated, and the screen gets refreshed.
Claim Notes: Clicking on this icon invokes the ‘Claim Notes popup, displaying the Claim level details of the Patient.
Claim Letter: Clicking this icon invokes Claims Letter popup.
Insurance Details: Clicking on the icon allows entering Insurance policy details. This information is needed to identify the Insurance policies that the Patient has subscribed to. In case of multiple policies, they are identified as Primary, Secondary, and Tertiary Insurance.
AR Calling:It displays pop up 'AR Calling' which displays the details of the claims selected on Claims Center list. The details are displayed about 'Patient Details', 'Claim', 'Primary Insurance' and 'Secondary Insurance'. User can print 'AR Calling' details for referring it later or even for tarcking purpose with Insurance Companies using button 'Print'.
Patient Account: Clicking on the icon invokes a report of the Patient (highlighted by a blue band) account.
Patient Details: Clicking on this button invokes the Patient Information screen displaying Patient details and user can also update the Patient Details.
Patient Billing Notes: Clicking on the icon invokes a Notes pop-up 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 Patient Billing Notes icon can be seen. Print button allows taking print of the notes.
Patient Notes: A click on this icon invokes the Patient Notes popup which displays additional information or notes related to the patient.
Patient Alert: Click on the icon to add new Patient Alerts and display them,required by the front office while taking Appointments, it can also be viewed from Encounter, Appointment and Billing screen as well. In Patient Alert, user can define Date range that is Effective From Date and Upto Date details for the alerts. Delete option allows the user to delete an alert.
Encounter Details: Clicking on the icon invokes the encounter screen only if Encounter has been started or if Claim is created from Billing side then message Nothing to Display . is shown on Billing Homepage.
Set Claim Status: Selecting this option, the Ready To Send/Hold popup is invoked. Users can mark the claims READY TO SEND or keep the claims on HOLD. This popup is displayed with 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 no in this field.

Claim Creation Date: This field displays date of the claim when it was created.

Claims with Errors: This field displays the no of errors the claim has encountered. For e.g. If Claim has 3 Errors, Number 3 is displayed on the column in red color with a hyperlink. The count of error is displayed with a hyperlink. Clicking on the hyperlink, invokes all errors related to the claim as captured by PrognoCIS are displayed. Note: If there are no errors then the count is displayed as 0.

Claims with Warning: This field displays the no of warning the claim has encountered. The count of error is displayed with a hyperlink. Clicking on the hyperlink, invokes all warning related to the claim as captured by PrognoCIS are displayed. For e.g. If Claim has 3 warning, number 3 is displayed on the column in red color with a hyperlink. Note: If there are no warning then the count is displayed as 0.

Coding Reviewed: This column displays the keyword 'Reviewed' for Claim/s that have been marked as reviewed for Coding. If Claim/s have not been marked as Reviewed for Coding then this column is shown blank. Claim/s 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 Claim/s as Reviewed for Coding' radio button on the 'Set Claim/s Status / Parameters' popup.

Eligibility Reviewed: This column displays the keyword 'Reviewed' for Claim/s that have been marked as reviewed for Eligibility. If Claim/s have not been marked as Reviewed for Eligibility then this column is shown blank. Claim/s can be marked as Reviewed for Eligibility by selecting the 'Mark Claim/s 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.
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 for them.

Claims with Errors and Warning: This field displays the no of warning and error the claim has encountered.

Claim Pri. Subscriber ID: The subscriber ID Of the primary Insurance is displayed.

Claim Pri. Eligibility Status: 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: The 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 hyperlink with a label Claim Pri Eligibility Details. Clicking on the hyperlink invokes the HTML from Trizetto or WAYSTAR or a text message in case of other clearinghouses.

Claim Sec. Subscriber ID: The subscriber ID Of the Secondary Insurance.

Claim Sec. Eligibility Status: 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: The field display 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 values as Yes else it shows No. The insurance which is active, and which has Mark Inactive / Expired checkbox unchecked on the Insurance popup is considered under this column.

Patient Pri. Insurance: This column populates Patient's Default Primary Insurance.

Pat Pri. Subscriber ID: The subscriber ID Of the Primary Insurance.

Pat Pri. Eligibility Status: 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: The field display the last active eligibility date fetched of the Patient.

Pat Pri. Eligibility Details: This field displays hyperlink with a 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 Patient's Default Secondary Insurance.

Pat Sec. Subscriber ID: The subscriber ID Of the Secondary Insurance.

Pat Sec. Eligibility Status: 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: The field displays the date when the Primary Insurance Claim was last active.

Patient's Sec Eligibility Details: The hyperlink with a label Patients Sec Elig Details. Clicking on this hyperlink, invokes the HTML from Trizetto or WAYSTAR or Text message in case of other clearinghouses.

Pat Ter. Insurance: This column displays Patient's Default Tertiary Insurance.

Pat Ter. Subscriber ID: The subscriber ID Of 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: The column displays the location code of claims.

Business Unit Code: Displays the Business unit code in this column.

Patient Name: Displays the name of the Patient.

Claim Case No: 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: It is the claim sent date. This date can change based on if Claim is reopened and resend or only resend. Ex:- If a Claim 5365 was earlier sent on 13 -09-2016 then it will show send date as 13-09-2016. Now if user resends this claim on 19-09-2016, then system will show send date 19-09-2016.

Bill Amount: This column displays Total Billed amount of the Claim is displayed.

Balance Amount: This column displays the Claim's Balance amount.

Assign Status: Displays the Assign Status in this column.

Action Comments: Displays 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 expected date of the assignment completed. Expected date cannot be less than todays 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 total Billed amount to claims. It helps 'Biller' to track these Approve claims as amount unpaid is visible at a glance.

Pagination: User is able to navigate to any required page by simply entering the page number in a small text-box as shown below. Also, now First (|<) and Last (>|) page buttons have been added in the Pagination itself enabling User to navigate to the respective pages on a single click.