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Claim Entry Batch
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Introduction:

For better tracking of claims and generating End of the Day Reports and the End of the Day closure, batch numbers are recommended in PrognoCIS. There are 2 types of batches: the Claims Entry Batch used on Claims and the Receipts Batch used on all payment posting transactions. This document will focus primarily on 'Claims Entry Batch'.

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 Claim Batches.

Pre-requisites for Using the Claims Entry Batch Feature

The following properties govern the Claims Entry Batch behavior:

  • The property use.claims.entry.batch needs to be turned ON, i.e., set to 'Y' in order to use this feature.
  • The property billing.entrybatch.prefix can be changed to set your preferred prefix assigned to a Batch Number. The default is EB. Special characters in the prefix are: YY for the calendar year and MM for the month number.
  • The property billing.entrybatch.length decides the number of digits of the generated serial number used in the Entry Batch. This does not include the prefix. The total length including the prefix should not exceed 20 characters. The default is 5.

Note:  Once the Claims Entry Batch property use.claims.entry.batch is set to Y, it becomes mandatory to assign a Batch Number to each Claim.

Batch Number: It is an auto-generated number by the system. The prefix and length of the batch number can be set using the properties billing.entrybatch.prefix and billing.entrybatch.length.

Location Code:  Select the location from the drop-down list. The list of locations displayed in the drop-down is populated from the Location Master. By default, the 'All' option is displayed.

Number of Claims: Enter the number of claims to be associated with the batch. Note: This field is mostly used to keep track of the paper trail.

Number of Charge Lines: Enter the number of charge codes to be associated with the batch. Note: This field is mostly used to keep track of the paper trail.

CoPay Amount: Enter the CoPay Amount.

Charge Amount: Enter the Charge Amount.

Batch Creation Date: By default, the system displays today's date as the Batch Creation Date. The user can also modify the batch creation date with a backdate and click the Save button.

Assigned To: Using the Search Assign To search icon, the selected user can be assigned to the batch.

Close Date: Select the date from the calendar icon to close the created batch.

Note:
• When the batch is closed, the batch number cannot be associated with or changed for the Billed and Reopened Claims.
• Once the batch is closed, the batch number cannot be associated with any other Claim or newly created Claim. The Claim Batch field is grayed out on the Claims screen.
• When a batch is closed, any claim in 'Ready to Send (S)' status with the associated batch number is changed to 'Ready to Bill (E)' status. The Batch No field will get reset and enabled, and the Post Date also gets reset.

Business Unit: Select the business unit from the drop-down list, and the selected business unit can be assigned to the batch. By default, the 'All' option is displayed.

Claims with mismatched Locations: This field displays the total count of claims with mismatched locations for the batch.

Claims with mismatched Business Units: This field displays the total count of claims with different business units for the batch.

Claims Entry Batch Table: This table displays the claim status, count, and amount for all the claims associated with the selected Batch Number. The available statuses are Entered, On Hold, Void, Ready to Send, Billed/Posted, and Employer/TPA.

Note: The Employer/TPA category displays the count and amount for claims billed to the employer or Third-Party Administrators (TPA).

Report Button on the Claim Batch Screen

Clicking on the Report button displays the Claims Batch Report screen. This report helps in analyzing the vouchers associated with the batch. The report can be printed and exported to Excel.  When clicked, it shows the User Batch Report with a list of claims unprocessed and processed separately with their details like DOS, Claim ID, Patient Name, Status, Bill Amt, and Modified Date.

Close - Clicking the Close button closes the popup.

Print - Clicking the Print button allows the user to print the report.

CSV - Clicking the CSV button exports the report in CSV format.

Buttons on the Screen

Save: This button helps in saving the claim batch. The button is enabled only when a change is made to the batch.

Delete: This button is enabled only when a new batch is added and the batch number is not used in any voucher.

 Reset: Clicking this button resets the unsaved data.

 Re-Open: This button is enabled only when the Close Date is entered and the same voucher is not used on any voucher.