Introduction
The 'Additional Claim Information' pop-up provides the opportunity to alter changes which are specific to the claim selected on the Claims >> Edit Screen. Changes applied on a claim using the 'I' button are micro but not applied at large. For example, a user can set the Primary Insurance as the one which is actually the Secondary Insurance on the Patient Details screen. Changing the insurance status sequence on the Claims >> Edit Screen for that patient will not actually affect the details defined on Patient Insurance Details.Additional. The 'Additional Claim Information' button is present on the Claims >> Edit Screen.
Attending Provider: It is the Attending Provider fetched from the Encounter of the patient.
Rendering Provider: It is the Rendering Provider set at the Encounter level. Use the search binoculars to enter another Rendering Provider. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in Cell 24J, 25, 31, EDI: Loop 2310B.
Referring Provider: Enter the name of the provider who referred the patient after consultation to a specialist in the clinic. Sometimes, Referring Provider information is mandatory while certain types of claims are processed. Select the Referring Provider's name from the search list using the binocular icon. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:17 EDI: Loop 2310A.
Referring Ref. No: Enter the referring number given to the patient. The details about printing this specific information in EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in EDI: Loop 2300REF.
Referral Date: Enter the date on which the patient was referred to the clinic.
Resp Person Name: The Resp Person Name is pulled from the Patient Registration screen of the patient. It is a grayed-out field which cannot be modified.
Last Seen By Doc: The 'Last Seen By Doc' field is pulled from the EMR side, and it is set in the specialty template. The set value is mapped with the testcode '837.lastseen.provider.testcode' to send details to EDI with EDI claims. When it is not used in any specialty template, the field remains blank. Use the search binoculars if it is required to add it.
Last Seen Date: The 'Last Seen Date' field is pulled from the EMR side, and it is set in the specialty template. The set value is mapped with the testcode '837.lastseen.date.testcode' to send details to EDI with EDI claims. When it is not used in any specialty template, the field remains blank. Use the search binoculars if it is required to add it.
Home Care Contract Date: It is the date for the 'visit' type - Home. The 'Home Care Contract Date' field is pulled from the EMR side, and it is set in the specialty template. The set value is mapped with the testcode 'cms1500.home.care.date.testcode' to send details to CMS claims.
PreAuthorized Visits: If a valid PreAuth number is associated with the Encounter of the patient, then the PreAuth number is populated.
CLIA#: If a CLIA number is provided to the clinic and is set, then it is displayed.
Submitter Type: The Submitter Type is the entity that submitted the claim to the insurance company. It is a drop-down list, and the valid options are 'Clinic', 'Business Unit', 'Rendering Doc', and 'Service Location'. It is a property-driven parameter. The property is '837.submitter.type', and the valid parameters are 'CL', 'BU', 'AD', and 'SL'. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:17 EDI: Loop 2310A.
Billing Provider Type: The address is picked from the 'Billing Provider Type' by insurance companies to bill the claims. It is a drop-down list, and the valid options are 'Business Unit', 'Rendering Doc', 'Service Location', 'Business Unit Billing', and 'Service Location Billing'. It is a property-driven parameter. The property is '837.provider.type', and the valid parameters are 'BU', 'AD', 'SL', 'S2', and 'B2'. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:33 EDI: Loop 2010AA.
Pay to Provider Type: The Pay to Provider Type is the person or non-person entity who is billed by the insurance company for claims. It is a drop-down list, and the valid options are 'Business Unit' and 'Rendering Doc'. It is a property-driven parameter. The property is '837.paytoprovider.type', and the valid parameters are 'BU', 'AD', and 'CO'. The details about printing this specific information in EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in EDI: Loop 2010AB.
Hosp. From Date: It is the date on which the patient was hospitalized for treatment. When the 'Place of Service' is 'Inpatient', then 'Hosp. From Date' is necessary, and the system validates the 'Save' action once the claim is marked as 'Ready To Send'. The system enforces the user to enter the date for 'Inpatient'. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:18 EDI: Loop 2300DTP.
Hosp. Upto Date: It is the date on which the patient was discharged from the hospital after treatment. When the 'Place of Service' is 'Outpatient', then 'Hosp. Upto Date' is necessary, and the system validates the 'Save' action once the claim is marked as 'Ready To Send'. The system enforces the user to enter the date for 'Outpatient'. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:18 EDI: Loop 2300DTP.
ILLNESS (First Symptom): It is the date on which the first symptom of illness was reported to the clinic. It is fetched from the 'Injury and Illness' specialty template used in the assessment (EMR module) of the patient. In case the claim is created from the Claims >> New Claim screen, then it can be populated from the Billing module as well. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:14 EDI: Not reqd. in 5010.
Injury (Accident): It is the date when the accident occurred. It is important from the 'MotorAcc' and 'PersonalAcc' perspectives while the claim is being posted to the insurance company. It is fetched from the 'Injury and Illness' specialty template used in the assessment (EMR module). But in case the claim is built from the Claims >> New Screen, then the user can enter the details from the Billing module as well. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:14 EDI: Loop 2300DTP.
Pregnancy (LMP): Enter the date of the 'Last Menstrual Cycle' of the patient. It is used if the patient is pregnant. Standard date format is mm-dd-yyyy. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:14 EDI: Loop 2300DTP.
Anesthesia Start Time HHMM: It is the time at which the anesthesia administration to the patient started. The 'Anesthesia Start Time' is auto-populated if the specialty template for Anesthesia is used in the EMR module. In case the claim is created from the Billing module, then the user can enter the details from the Billing module as well. Standard format is HHMM. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in EDI: Loop 2300NTE.
Same or Similar Illness: It is the date when the 'Same or Similar Illness' resurfaced for the patient. It is fetched from the Injury and Illness specialty template used in the assessment of the patient. Standard date format is mm-dd-yyyy. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:15 EDI: Not reqd. in 5010.
Duration in Minutes: It is the actual duration for which the anesthesia administration was given to the patient. If the 'Anesthesia Start Time' and 'End Time' fields are populated, then the 'Duration' field is auto-calculated on the 'I' button. The details about printing this specific information in EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in EDI: Loop 2300DTP.
Entry Batch No: When the property 'use.claims.entry.batch' is set to 'Y', the batch number is automatically assigned to the claim, and it is seen on the 'I' button.
End Time HHMM: It is the time at which the anesthesia administration to the patient stopped. The 'End Time' is auto-populated if the specialty template for Anesthesia is used in the EMR module. In case the claim is created from the Billing module, then the user can enter the details from the Billing module as well. Standard format is HHMM. The details about printing this specific information in EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in EDI: Loop 2300NTE.
Send to Primary as: It is the status of the primary claims set while posting them to insurance companies. It is a drop-down list, and the valid options are 'Original', 'Corrected', 'Replacement', and 'Void'. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:22 EDI: Loop 2300DTP.
Send to Secondary as: It is the status of the secondary claims set while posting them to insurance companies. It is a drop-down list, and the valid options are 'Original', 'Corrected', 'Replacement', and 'Void'. The details about printing this specific information in CMS and EDI are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:22 EDI: Loop 2300DTP.
DCN ICN: It is the Medicaid Resubmission Code. The details about printing this specific information in CMS are displayed as a tooltip when the mouse hovers on the label. It is sent in CMS:22.
Cell 10D: It is reserved for local use for the clinic / provider. The information is sent in CMS:10D
Cell 19 for Local Use: It is reserved for local use for the clinic / provider. The information is sent in CMS:19
Encounter Type: The 'Encounter Type' dropdown is displayed only for 'Employer' billing claims. It displays the option set on the Edit Encounter screen for the 'Bill To' checkbox when the claim is created from the EMR side; otherwise, the user should select a valid Encounter Type for the claim using the 'I' button when created from the Claims >> New menu option.
|