Topics Claim Letter Search:  
Introduction: The Doctor very often is required to send a letter with Assessment and Plan to the Referring Doctor. Like wise he needs to communicate with the Patient, Insurance company and many others. Sometimes, the provider is required to send a referral letter to a specialist. All these letters must be a part of Claim Letter. This Claim Letter icon is available on various screens. The list of screens are as follows:
  • Claims → Edit Claims
  • Claims → Unprocessed
  • Claims → Returned/Rejected
  • Claims → Processed → By Claims and By Charges
  • Claims → Outstanding → Outstanding Claims
  • Claims → Claims Center
  • Claims → Charges Center
  • AR/Follow-up → Assigned Tasks
  • AR/Follow-up → Denied
  • AR/Follow-up → Disputed
  • Remittance → EOB/ERA
  • Remittance → Patient Payment → Receipts
  • Remittance → Misc Credit → Insurance Credit
  • Remittance → Misc Credit → Pat Item Return
Field Description:

Letter To: The drop-down list displays the following values depending upon the conditions as mentioned:
  1. Referring Provider: This is visible only if any of the following conditions are fulfilled: i. If Billing module is ON then the name of Referring Provider at the Billing end is displayed. ii. If Billing module is OFF then name of the Referring Provider of the current encounter at EMR end is displayed.

    2. Note: If case system is not able to pick the value from the patient’s current encounter then the value is picked from patient’s registration details.
  2. Refer to Provider: This is visible only if Refer to Provider set from Edit Encounter screen.
  3. Patient: This is the currently selected name of the Patient, this is a default value that is displayed in the drop-down list.
  4. Others: This option is always visible and will be displayed as it is.
  5. Patient Employer: Visible only if the Employer details have been entered for the Patient (via tab: Patient → Register → tab: Contacts → Employer and relative fields) then the value is displayed on the To drop-down list.
    Note: Employer name could either be selected from the search or can be added manually.
  6. Patient’s Primary Insurance: Visible if Patient’s Primary Insurance details are available on Insurance popup.
  7. Patient’s Secondary Insurance: Visible if Patient’s Secondary Insurance details are available on Insurance popup.
  8. Patient’s Tertiary Insurance: Visible if Patient’s Tertiary Insurance details are available on Insurance popup.
  9. Emergency Contact: Visible if the patient’s Emergency contact details have been entered in the system (i.e. on Patient Registration screen → section: Emergency Contact Details).
  10. Spouse/ Parent/ Legal Guardian (SPL): Visible if any of the patient’s relation details have entered in the system (from Patient Registration screen à section: Spouse/Parent/Legal Guardian details).
  11. Subscriber Primary Insurance: Visible if the name of the policy holder or Subscriber of Patient’s Primary Insurance is other than self as entered in the system via the Insurance popup.
  12. Subscriber Secondary Insurance: Visible if the name of the policy holder or Subscriber of Patient’s Secondary Insurance is other than self as entered in the system via the Insurance popup.
  13. Subscriber Tertiary Insurance: Visible if the name of the policy holder or Subscriber of Patient’s Tertiary Insurance is other than self as entered in the system via the Insurance popup.
  14. Primary Care Physician 1: Visible if the name of the first Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  15. Primary Care Physician 2: Visible if the name of the second Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  16. Primary Care Physician 3: Visible if the name of the third Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  17. Primary Care Physician 4: Visible if the name of the fourth Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  18. Primary Care Physician 5: Visible if the name of the fifth Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  19. Responsible Person: Visible if the patient’s Responsible Person entered is NOT equal to self. Responsible Person is added from the Billing tab on Patient Registration screen.
  20. Primary Insurance Attorney: Visible if the Primary Insurance of the Patient has the Attorney details entered from the Insurance popup.
  21. Secondary Insurance Attorney: Visible if the Secondary Insurance of the Patient has the Attorney details entered from the Insurance popup.
  22. Tertiary Insurance Attorney: Visible if the Tertiary Insurance of the Patient has the Attorney details entered from the Insurance popup.
  23. Primary Insurance Adjustor: Visible if the Primary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
  24. Secondary Insurance Adjustor: Visible if the Secondary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
  25. Tertiary Insurance Adjustor: Visible if the Tertiary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
  26. Patient Attorney: Visible if patient’s attorney’s name has been entered in the Billing Info tab on the Patient Registration screen
  27. Patient Adjustor: Visible if Patient Adjustor’s name is entered in any Case associated to the patient from the Case Management popup.
  28. Case Manager 1: Visible if the first Case Manager’s name has been added from Case Management popup.
  29. Case Manager 2: Visible if the second Case Manager’s name has been added from Case Management popup.
  30. Case Manager 3: Visible if the third Case Manager’s name has been added from Case Management popup.
  31. Rendering Doc (Billing): Visible if Billing Module is ON and Rendering Doctor’s details is available with Patient’s Claim details.
  32. Attending Doc (Billing): Visible if Billing Module is ON and Attending Doctor’s details is available on the Patient’s Registration screen.
  33. Operating Doctor: Visible if Billing module is ON and the UB04 form details have Operating Doctor’s name or details entered.
  34. Operating Assistant Doctor 1: Visible if Billing module is ON and the UB04 form details have the first Operating Assistant Doctor’s name or details entered.
  35. Operating Assistant Doctor2: Visible if Billing module is ON and the UB04 form details have the second Operating Assistant Doctor’s name or details entered.
  36. Case Insurance Company: Visible if a case is present for the patient and if Insurance has been assigned to this case from the ‘Insurance/Employer/Patient’ Section on the Case Management popup.
  37. Case Insurance Attorney: Visible if an Attorney has been assigned for the case from the Case Management popup.
  38. Case Insurance Adjustor: Visible if an Adjustor’s detail has been entered for the Insurance in the case from the Case Management popup.
  39. Case Patient Attorney: Visible if an Attorney has been assigned for the patient from the Case Management popup.
  40. Case Patient Adjustor: Visible if an Adjustor’s detail has been entered for the patient in the case from the Case Management popup.
  41. Collection Agency: Visible if a Claim has been sent to a collection agency.
  42. Encounter Case Employer: Visible if a case has been assigned specifically to an Encounter via Edit Encounter.
  43. Encounter Case Employer Job: Visible if Employer Job has been associated to a case from the Insurance popup.
  44. Claim Case Employer: Visible if Employer Job has been associated to a case from the Insurance popup.
  45. Claim TPA (Third Party Agency): Visible on process of Claim having Employer details and also the third-party agency details associated (from the Employer’s TPA Master screen).
  46. Claim Employer TPA Contact: Visible if the associated TPA agency has a contact person’s name entered in records.
  47. Patient Employer Department: Visible if the Employer Department has been associated to Patient.
  48. Claim Employer: Visible if Employer Claim is created
  49. Claim Employer Department: Visible if the Employer Claim has Department associated on Patient Registration and can be seen on Claims I button popup of the Claims screen.
Claim: Displays the Claim ID of the Patient.

Patient: Displays the Patient's name. To select another Patient, click the Patient search icon.

Address Book: Click on the Search icon next to the 'Address Book' dropdown to invoke 'Address Book' Search List. This popup shows the list of all Address Book records saved on Settings → Configuration → Users column → 'Address Book' Master screen. User can select only three Address Book records from the Search popup. On selecting the fourth record, an error message Selected Max No Of Codes is displayed in a popup with an 'OK' button. If the Address Book records have Fax, Email and Address saved on the 'Address' popup of the 'Address Book' Master screen then on selecting records from the 'Address Book' Search popup, the stored data is populated in the 'Name', 'e-mail', 'Fax' and 'Address' fields of the 'Claim Letter' screen respectively.

Date: This field displays the date. By default, it takes the current date.

To/Cc: The user needs to select the desired option from the list i.e. either To or Cc. The first row is always saved as To.

Name, e-mail, Fax and Address: Name is a mandatory field. User can also enter name with the email and/or fax and/or address fields.

Send: The checkbox 'Send' is automatically checked for all the rows when any information (like Name, Email, Fax or Address) is entered.

Subject: Enter Subject for the Letter in this box. By default, Subject will be set to Template Name selected.

Status: The status is set by the system as:
  • Entered Status on clicking Save by a user who has been assigned entry rights only.
  • Approved Status on clicking Save by a user who has been assigned approval rights.
  • Sent Status on clicking Send.
EMR Docs button: On click of this button, it displays the list of documents attached from EMR side. If the documents are selected using the checkbox then the documents are displayed besides Clear hyperlink. User is also provided with a detach button to detach the document.

Billing Docs button: On click of this button, it displays the list of documents supported. On selecting the checkbox, the documents are displayed besides Clear hyperlink. User is also given provision to detach the document using the detach button.

Clear hyperlink: If Clear hyperlink is clicked, it removes the selected displayed documents.

Set Sequence: Icon allows the user to set the sequence for displaying the attachments according to the User’s requirement. When the User clicks on , the attached documents popup displays the list of attached document’s Date and Type. To set the sequence for attached documents, user has the options to either ‘drag and drop’ the document (where it is required to be displayed) and click on Move Up/Move Dn button to set the document sequence where it is required.
Note: The Set Sequence iconon the Claims Letter screen is enabled only after User saves the Attachments

More Attachments button is enabled only when multiple attachments like more than 4 attachments is displayed which contains the rest of the attached documents.

Select Tag:To add new contents at any position, move the cursor to that position and click there. Now select any Tag from the List Box. The program selects the tag, generates the relevant contents and inserts them at the cursor position. The generated contents can be a small string (like a Patient Name) or could be a multiple line string.
The cc list and subject can be printed as part of the Letter by using special Tags.
Tag [LETTER_SUBJECT] is used to print Subject and [LETTER_CC] is used to print CC.

Letter: The dropdown displays the list of template to be attached to the letter. Template type with subtype 'CLMLET' is listed in Letter option.

Edit Button: Click on this button to invoke 'Edit Claim Letter Template' popup to edit the values of the selected Claim Fillable Template.

Letter Contents: The Text of the letter generated based on the template and the Tags used is shown here. The user can add / delete / change the contents. The text editor tool bar provides a wide range of functionality, with standard buttons, tool tips and functionality.

Actions buttons:

save button: Clicking the save button will save the changes.

delete button: Clicking the delete button will delete the record.

close button: Clicking the close button will close the popup.

save as button: save as button on the Claim Letter popup will be shown disabled.

Action icons on Claims Letter:
There are 4 action icons on the top right corner of the screen. These icons offer different ways of sharing the selected letters and documents from this screen via print, fax, email, download and directly on all the Portals of PrognoCIS.

Print: Click on this icon to print the selected letters. On closing the print window, the Status changes from Approved to Sent which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Print.

Fax: Click on this icon to fax the selected letters provided that the fax number of the sender and receiver is present. In case the fax number of the selected receiver is not present, an error message, “Fax number is not present for the selected receiver is displayed.” On sending the fax, the Status changes from Approved to Sent which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Fax. Fax Cover Sheet gets displayed on selecting a template in the property, bizfax.BL.coversheet.template and sending a Fax through Fax mechanism from Claim Letters screen. Selected Template can be removed from the property by clicking on the Clear link. By default, template selected in the property, bizfax.BL.coversheet.template is same as bizfax.LT.coversheet.template property.
Note: If the HylaFAX property prognocis.fax.hylafaxapi is turned On from the Properties Master screen, then the documents are sent via the HylaFAX functionality. In this case, the status of the order can be seen by clicking on the Sent hyperlink, which invokes the Status popup.

Email: Click on this icon to email the selected Letters to the Provider, Insurance, Employers, Attorney, Adjuster etc. On clicking the icon, a warning message, “Sending patient health data over email is not advisable for HIPAA compliance reasons. Do you want to continue? Non secured email recipient: <email address of the receiver>” is displayed. On clicking the Ok button, the receiver gets 2 emails. One contains the letters in form of attachments and the other one with a message, “<Password> is the password to open an attachment of the mail with subject, 'No Subject' from PrognoCIS - Electronic Medical Record System.” If the email id of the sender/receiver is missing, then on clicking the Email icon, an error message, “Cannot send as the Email ID of the sender/receiver is missing” is displayed. On successfully sending the email, the Status changes from Approved to Sent which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Email.

Share on Portal: On clicking this icon, Select Portal popup is invoked. This popup displays the Portal names that are configured for the client. In Front of every Portal name, a toggle button is provided. Users can turn the button On for the Portals where the selected documents need to be shared and click on the Save button on the popup to share the documents.After selecting the documents that need to be shared, it is necessary to save them by clicking on the Save button displayed at the bottom of the screen. If a User tries to share the documents without saving them, then on clicking the Share on Portal icon, “Cannot be shared to portals without saving” message is displayed. If there are no portals configured for the User, then on clicking the Share on Portal icon, the popup displays a message “Not applicable for sharing.” On successfully sharing the letters on portals, the Status changes from Approved to Send which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Portal.
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