Topics Claim Letter Search:  
Introduction: The doctor is very often required to send a letter with the Assessment and Plan to the Referring Doctor. Likewise, they need 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 the Claim Letter. The Claim Letter icon is available on various screens. The list of screens is 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 on the conditions mentioned:
  1. Referring Provider: This is visible only if any of the following conditions are fulfilled: i. If the Billing module is ON, then the name of the Referring Provider at the billing end is displayed. ii. If the Billing module is OFF, then the name of the Referring Provider of the current encounter at the EMR end is displayed.

    2. Note: In case the system is not able to pick the value from the patient's current encounter, then the value is picked from the patient's registration details.
  2. Refer to Provider: This is visible only if the Refer to Provider is set from the Edit Encounter screen.
  3. Patient: This is the currently selected name of the patient; this is the default value that is displayed in the drop-down list.
  4. Others: This option is always visible and will be displayed as 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 in the To drop-down list.
    Note: The Employer name can either be selected from the search or added manually.
  6. Patient's Primary Insurance: Visible if the patient's Primary Insurance details are available in the Insurance popup.
  7. Patient's Secondary Insurance: Visible if the patient's Secondary Insurance details are available in the Insurance popup.
  8. Patient's Tertiary Insurance: Visible if the patient's Tertiary Insurance details are available in the Insurance popup.
  9. Emergency Contact: Visible if the patient's Emergency contact details have been entered in the system (i.e., on the Patient Registration screen → Emergency Contact Details section).
  10. Spouse/ Parent/ Legal Guardian (SPL): Visible if any of the patient's relation details have been entered in the system (from the Patient Registration screen → Spouse/Parent/Legal Guardian Details section).
  11. Subscriber Primary Insurance: Visible if the name of the policy holder or subscriber of the 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 the 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 the 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 the 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 the 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 the 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 the 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 the Physician tab on the Patient Registration screen.
  19. Responsible Person: Visible if the patient's Responsible Person entered is NOT equal to self. The Responsible Person is added from the Billing tab on the 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 the patient's attorney's name has been entered in the Billing Info tab on the Patient Registration screen.
  27. Patient Adjustor: Visible if the Patient Adjustor's name is entered in any case associated with the patient from the Case Management popup.
  28. Case Manager 1: Visible if the first Case Manager's name has been added from the Case Management popup.
  29. Case Manager 2: Visible if the second Case Manager's name has been added from the Case Management popup.
  30. Case Manager 3: Visible if the third Case Manager's name has been added from the Case Management popup.
  31. Rendering Doc (Billing): Visible if the Billing module is ON and the Rendering Doctor's details are available with the patient's Claim details.
  32. Attending Doc (Billing): Visible if the Billing module is ON and the Attending Doctor's details are available on the Patient Registration screen.
  33. Operating Doctor: Visible if the Billing module is ON and the UB04 form details have the Operating Doctor's name or details entered.
  34. Operating Assistant Doctor 1: Visible if the Billing module is ON and the UB04 form details have the first Operating Assistant Doctor's name or details entered.
  35. Operating Assistant Doctor 2: Visible if the 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 to the case from the Case Management popup.
  38. Case Insurance Adjustor: Visible if an Adjustor's details have been entered for the insurance in the case from the Case Management popup.
  39. Case Patient Attorney: Visible if an attorney has been assigned to the patient from the Case Management popup.
  40. Case Patient Adjustor: Visible if an Adjustor's details have 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 an Employer Job has been associated with a case from the Insurance popup.
  44. Claim Case Employer: Visible if an Employer Job has been associated with a case from the Insurance popup.
  45. Claim TPA (Third-Party Agency): Visible during the processing of a claim that has employer details and also has associated third-party agency details (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 the records.
  47. Patient Employer Department: Visible if the Employer Department has been associated with the patient.
  48. Claim Employer: Visible if an Employer Claim is created.
  49. Claim Employer Department: Visible if the Employer Claim has a department associated on Patient Registration and can be seen on the 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 the Search icon next to the 'Address Book' dropdown to invoke the 'Address Book' Search List. This popup shows the list of all Address Book records saved in the Settings → Configuration → Users column → 'Address Book' Master screen. Users can select only three Address Book records from the Search popup. Upon 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 a fax, email, and address saved in the 'Address' popup of the 'Address Book' Master screen, then upon selecting records from the 'Address Book' Search popup, the stored data is populated in the 'Name', 'Email', '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, Email, Fax, and Address: Name is a mandatory field. Users can also enter a name with the Email, Fax, and/or Address fields.

Send: The 'Send' checkbox is automatically selected for all rows when any information (such as Name, Email, Fax, or Address) is entered.

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

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

Billing Docs Button: Clicking this button displays the list of documents supported. Upon selecting the checkbox, the documents are displayed beside the Clear hyperlink. The user is also given the option to detach the document using the Detach button.

Clear hyperlink: Clicking the Clear hyperlink removes the selected displayed documents.

Set Sequence: This icon allows the user to set the sequence for displaying the attachments according to their requirements. When the user clicks the icon, the attached documents popup displays the list of the attached documents' Date and Type. To set the sequence for the attached documents, the user has the option to either 'drag and drop' the document (where it is required to be displayed) or click the Move Up/Move Dn button to set the document sequence where it is required.
Note: The Set Sequence icon on the Claims Letter screen is enabled only after the user saves the attachments.

The More Attachments button is enabled only when multiple attachments (more than four) are displayed, which contain the rest of the attached documents.

Select Tag: To add new content 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 content, and inserts it at the cursor position. The generated content can be a short string (such as a Patient Name) or a multiple-line string.
The CC list and subject can be printed as part of the letter by using special tags.
The [LETTER_SUBJECT] tag is used to print the Subject, and [LETTER_CC] is used to print the CC.

Letter: The dropdown displays the list of templates to be attached to the letter. Template types with the subtype 'CLMLET' are listed in the Letter option.

Edit Button: Click this button to invoke the '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, or change the content. The text editor toolbar provides a wide range of features with standard buttons, tooltips, and options.

Action Buttons:

Save Button: Clicking the Save button saves the changes.

Delete Button: Clicking the Delete button deletes the record.

Close Button: Clicking the Close button closes the popup.

Save As Button: The Save As button on the Claim Letter popup is shown disabled.

Action Icons on Claims Letter:
There are four action icons in 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 this icon to print the selected letters. On closing the print window, the Status changes from Approved to Sent, which is displayed as a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Print.

Fax: Click this icon to fax the selected letters, provided that the fax numbers of the sender and receiver are present. If the fax number of the selected receiver is not present, an error message, "Fax number is not present for the selected receiver," is displayed. Upon sending the fax, the Status changes from Approved to Sent, which is displayed as a hyperlink. On clicking the hyperlink, the Message Events popup is invoked, displaying the Send Type as Fax. A Fax Cover Sheet is displayed when selecting a template in the property, bizfax.BL.coversheet.template and sending a fax through the fax mechanism from the Claim Letters screen. The selected template can be removed from the property by clicking the Clear link. By default, the template selected in the property bizfax.BL.coversheet.template is the same as the 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 viewed by clicking the Sent hyperlink, which invokes the Status popup.

Email: Click this icon to email the selected letters to the Provider, Insurance, Employer, Attorney, Adjustor, etc. Upon 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. Upon clicking the OK button, the receiver receives two emails. One contains the letters as attachments, and the other contains 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 or receiver is missing, then upon clicking the Email icon, an error message, "Cannot send as the Email ID of the sender/receiver is missing," is displayed. Upon successfully sending the email, the Status changes from Approved to Sent, which is displayed as a hyperlink. On clicking the hyperlink, the Message Events popup is invoked, displaying the Send Type as Email.

Share on Portal: Upon clicking this icon, the Select Portal popup is invoked. This popup displays the portal names 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 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 the Save button displayed at the bottom of the screen. If a user tries to share the documents without saving them, then upon clicking the Share on Portal icon, the message "Cannot be shared to portals without saving" is displayed. If there are no portals configured for the user, then upon clicking the Share on Portal icon, the popup displays the message "Not applicable for sharing." Upon successfully sharing the letters on portals, the Status changes from Approved to Sent, which is displayed as a hyperlink. On clicking the hyperlink, the Message Events popup is invoked, displaying the Send Type as Portal.