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 the
Send Institutional Claims screen.
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 UB04 claims that are in Ready to Send status but have not yet been processed.
Overdue: Select this radio button to see UB04 claims that were sent earlier but for which the EOB/payment has not yet been received. It is governed by the Av. Response Time in Days setting on the Insurance Master screen. The Av. Response Time in Days is calculated based on the 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 the Av. Response Time in Days setting. If this option is selected, 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 that were sent earlier, before the specified date, and for which there is no remittance against them are listed. Users can select the relevant claims and send them again via EDI, or reprint the UB04 and dispatch them.
This screen displays data in the following five tabs:
Pri-EDI: This tab displays the list of claims raised for insurance companies that are to be sent out via EDI and whose status is Ready to Send.
Sec-EDI: Once a remittance is received from the primary insurance, if secondary insurance was applicable and its supported Clearing House option on the Insurance Master screen was not None, an entry is generated here.
Pri-UB04: This tab displays a list of UB04 claims whose status is Ready to Send and whose primary insurance does not support any Clearing House.
Sec-UB04: Once a remittance is received from the primary insurance, if secondary insurance was applicable and its supported Clearing House option on the Insurance Master screen was None, an entry is generated here.
Filter Button:
Click this icon to apply specific criteria or conditions to refine the data displayed on this screen.
When you click this icon, the Filters popup is displayed, which lists predefined filters.
Click a filter name to apply it to the screen.
Each predefined filter has a right arrow beside its name that, when clicked, opens a popup displaying the filter conditions applied for that specific filter.
The filter conditions can be edited and saved to be used again when the screen is accessed in the future.
Add New Filter Icon:
Click this icon to open 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 can also select them individually by selecting their corresponding checkboxes in the column. Because a maximum of 200 claim records can be displayed on this screen, selecting this checkbox 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 a claim row, the Select All checkbox is unchecked. The number of selected claims is displayed in the tooltip when you hover the cursor over the Claim Count field.
The selection of claims on one page is 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 the 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 are deselected, 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 the 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, the selected claims are deselected, 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: Select this checkbox to mark the claim as sent without sending it to the Clearing House. This can be done when a claim is reopened to make minor changes or add comments that do not materially affect the claim amount, meaning it does not need to be sent to the insurance company again.
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 on which the UB04 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 in which the claim will be sent to the Clearing House. The Legends button displays a list of validations and corresponding error codes due to which claims may be held here or are ready to be processed. A status displayed with a green background indicates that the UB04 claim is ready to be sent, whereas a red background indicates that the UB04 claim cannot 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 with the claim. The ERAs/ELEs under this column are hyperlinked to take the user to the remittance of the specific claim. This column is displayed under the Sec-EDI and Sec-UB04 tabs of this screen.
Claim Count: Displays the total number of UB04 claims as well as the number of selected UB04 claims on the selected tab. A tooltip is displayed when 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 UB04 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 can also enter a page number in the search box to navigate 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, 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 this button to open the EDI Readiness Status Legends popup and view the list of validations and corresponding error codes due to which UB04 claims may be held or are ready to be processed.
Print Notes Button:
Click this button to print the details of the selected claims on the selected tab.
Process Button:
Although UB04 claims are processed automatically by a scheduled background process, you can click this button to manually process the UB04 claims selected on the screen.
Claims are either printed as paper UB04 claims or sent via EDI.
After selecting the claims and clicking 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 the OK button to close this popup and wait while the claims are processed in the background.
No other actions can be performed on the screen while the claims are being processed.
Once processing is complete, a confirmation message:
Claims processed successfully is displayed in a green font on the screen.
The processed claims are removed from the tab and the screen navigates to the next page if more claims are present or displays a blank page if no claims are present.