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Introduction

Sometimes, if an Encounter Assessment has a specific charge code in addition to other charge codes, the insurance companies expect that specific charge code to be billed in a separate supplementary claim. This is possible with the help of the 'Supplementary Claim' feature.

In PrognoCIS, a supplementary claim is created:

  • When the original claim is associated with active insurance.
  • When specific charge codes are defined as comma-separated CPT  / HCPCS codes in the property:
  • When these charge codes are used in the Encounter Assessment, a supplementary claim is created along with the original claim.

Important Aspects of Supplementary Claims

  • The property Billing Parameters 2 > supplementary.claim.cpt.codes defines comma-separated CPT codes or a range like 75956-75984. Upon creation of the claim, if any CPT codes fall in this range, then a separate claim is created for these codes. Thus, the encounter will have two claims created.
  • Likewise, the property Billing Parameters 2 > supplementary.claim.hcpc.codes defines comma-separated HCPCS codes or a range like A0100-A0200. Upon creation of the claim, if any HCPCS codes fall in this range, then a separate claim is created for these codes. Thus, the encounter will have two claims created.

Consider an encounter with two codes, 99212 and 75957 (X-ray).
It will create the first default claim with only 99212 and a supplementary claim with 75957.

These properties accept a comma-separated string. For example:

  • For CPT charge codes - Enter a comma-separated string in the property supplementary.claim.cpt.codes - 75956,75984 OR a range like 75956-75984
  • For HCPCS charge codes - Enter a comma-separated string in the property supplementary.claim.hcpc.codes - A0100,A0200 OR a range like A0100-A02
  • A supplementary claim is not created for a 'Self Pay' claim.
  • 'CoPay' is not applied to the supplementary claim but is applicable to the original claim if it was collected.
  • Charge codes in the supplementary claims must be 'Billed' to insurance.
  • Whenever a claim is created from the Encounter Assessment with the 'Create Claim' checkbox marked, the system deletes existing claims created earlier from that Encounter Assessment. Before deleting such claims, the system checks whether the existing claim is in the 'Billed' or 'Ready to Send' state. If it is found that the existing claim is in the 'Billed' or 'Ready to Send' state, then the existing claim is not deleted. Similarly, whenever a new supplementary claim is created along with the original claim from the Encounter Assessment, the system deletes the existing supplementary claim along with the original claim if they are not in the 'Billed' or 'Ready to Send' state.
  • The supplementary claim functionality is supported by Professional and Institutional claims (UB04).


The Billed Amount, Insurance Amount, Patient Amount, and Contract Amount totals will be recomputed for both claims.

If, on Close of Encounter, the user tries to recreate the claim, then the system recreates the first claim if it is not Billed. The system will also check for a supplementary claim and recreate it if it is not Billed.