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
Send Professional Claims.
Three radio buttons are present on this screen to allow users to filter and view claims based on the selected option:
New Claims: Select this radio button to see claims which are in Ready to Send status but have not yet been processed.
Overdue: Select this radio button to see claims which were sent earlier but for which EOB/payment has not yet been received. It is governed by Av. Response Time in Days on the Insurance Master Screen. Av. Response Time in Days is calculated based on Sent Date of the posted claim.
Resend Unpaid Claims Before: This option is like the Overdue option with the major difference being that it does not consider Av. Response Time in Days. If this option is selected, then users can edit the date (if required). The default date is computed as per the number of days from the property: billing.resendclaims.beforexdays. All claims which were sent earlier, before the specified date, and where there is no remittance against it are listed. Users can select the relevant ones and send the claims again by EDI or reprint the CMS and dispatch it.
This screen displays data in the following five tabs:
Pri-EDI: This tab displays the list of claims raised for Insurance Companies which are to be sent out via EDI and whose status is Ready to Send.
Sec-EDI: Once a remittance is received from Primary Insurance, if the Secondary Insurance was applicable and it's supported Clearing House option on the Insurance Master screen was not None, an entry is generated here.
Pri-CMS: This tab displays a list of claims whose status is Ready to Send and whose Primary Insurance does not support any Clearing House.
Sec-CMS: Once a remittance is received from Primary Insurance, if the Secondary Insurance was applicable and it's supported Clearing House option on the Insurance Master screen was None, an entry is generated here.
Ter-CMS: If the Tertiary Insurance was applicable and its Supported by Clearing House option on the Insurance Master screen was None, an entry is generated here.
Filter button:
Click on this icon to apply specific criteria or conditions to refine the data displayed on this screen.
On clicking this icon, the Filters popup is invoked which displays a list of predefined filters.
Click on a filter name to apply it to the screen.
Each predefined filter has a right arrow beside its name which when clicked, invokes a popup which displays filter conditions applied for that specific filter.
The filter conditions can be edited and saved to be used again when this screen is accessed in the future.
Add New Filter icon:
Click on this icon to invoke the Ad-Hoc Filter popup and create new filters.
Select All checkbox: Select this checkbox to select all claims displayed on the screen at once. You may also select them individually by selecting their corresponding checkboxes in the column. As a maximum of 200 claim records are displayed on this screen, this checkbox when selected, selects all 200 records. If an attempt is made to select more than 200 records, a validation message is displayed stating: Maximum of 200 records are selected. If the user unchecks one claim row, then this Select All checkbox will be unchecked. The number of selected claims is displayed in the tooltip on hovering the cursor over the Claim Count field.
The selection of claims on one page are retained upon switching to another page within the same tab and radio button. Upon selecting claims from one tab and then switching to another tab, a validation message popup is displayed stating: You are trying to switch to another tab without processing the claims selected in the <Name of current tab> tab. Do you want to process the selected claims? Note: If you click on No, the selected claims will be unchecked. If the Yes button on this popup is clicked, the popup closes, and processing of the selected claims begins. After processing is complete, the selected claims are removed from the tab and the screen redirects to Page 1 of the next selected tab. If No is clicked, the popup closes, the selected claims become unselected, and the screen redirects to Page 1 of the next selected tab.
Upon selecting claims from one tab and then switching to another radio button, a validation message popup is displayed stating: You are trying to switch to another radio button without processing the claims selected in the <Name of current radio button> radio button. Do you want to process the selected claims? Note: If you click on No, the selected claims will be unchecked. If the Yes button on this popup is clicked, the popup closes, and processing of the selected claims begins. After processing is complete, the selected claims are removed from the tab and the screen redirects to Page 1 of the first tab of the next selected radio button. If No is clicked, the popup closes, and the selected claims become unselected, and the screen redirects to Page 1 of the first tab of the next selected radio button.
Claim Id: This column displays unique claim IDs, which are hyperlinked and redirect to the Edit Claims screen when clicked.
Hide checkbox: Check this checkbox to mark the claim as sent without sending it out to the clearing house. This can be done in cases where a claim was reopened to make minor changes or add comments without materially affecting the claim amounts, and so it would not need to go out again to the Insurance company.
DOS: Displays the Date of Service or Encounter Date.
POS: Displays the Place of Service Code as selected on the Edit Claims screen.
Bill Date: Displays the date at which the claim was billed.
Patient: Displays the name of the patient.
Provider: Displays the name of the Provider.
Insurance: Displays the name of the Insurance company.
Status: Displays the status of the claim in which it will be sent to the Clearing House. The Legends button displays a list of validations and corresponding error codes due which claims may be held here or are ready to be processed. A status displayed with a green background indicates that the claim is ready to send, whereas a red background indicates that the claim is not allowed to be processed due to missing data.
Amount: Displays the charges billed to Insurance in the claim. Note that this does not include the charges billed directly to the patient in the claim.
Doc No: Displays ERAs and ELEs associated to the claim. The ERAs/ELEs under this column are hyperlinked to take the user to Remittance of the specific claim. This column is displayed under Sec-EDI, Sec-CMS and Ter-CMS tabs of this screen.
Claim Count: Displays the total number of claims as well as the number of selected claims on the selected tab. A tooltip is displayed on hovering the cursor over this field which states: X claims are selected out of total Y <Tab Name> <Radio Button Name> where X is the number of selected claims and Y is the number of claims available within that tab.
Total Amount: Displays the total sum of the amounts of all the claims displayed on the selected tab.
Pagination Arrows: Switch to the first page, previous page, next page or last page of the selected tab using these arrows. You may also enter a page number in the search box to move directly to that page. The entered page number must be less than or equal to the number of available pages. If the entered page number exceeds the total number of pages present on the tab, then a validation message is displayed stating: Page number value should be between 1 - X where X is the number of pages available within the selected tab.
Legends button:
Click on this button to invoke the EDI Readiness Status Legends popup and view the list of validations and corresponding error codes due to which claims may be held or are ready to be processed.
print notes button:
Click on this button to print details of the selected claims on the selected tab.
process button:
Although claims are processed automatically by a self-run scheduled process, you may click on this button to manually process the claims selected on the screen.
Claims are either printed through CMS1500 if they are paper claims or are sent via EDI.
Upon selecting the claims and clicking on this button, a message popup is displayed stating:
Do not close or refresh this window, there are claims being processed which will take a couple of minutes.
Click on the OK button to close this popup and wait as the claims are processed in the background.
No action can be taken on the screen while the claims are being processed.
Once the processing has finished, a confirmation message:
Claims processed successfully is displayed in green font on the screen.
The processed claims are removed from the tab and the screen jumps to the next page if more claims are present or displays a blank page if no claims are present.
Note:
Self pay claims cannot be processed.
