| Topics | Unprocessed Claims | Search: |
Introduction:
Unprocessed Claims are claims whose status is not yet marked as 'Billed'.
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
Unprocessed Claims.
Select Checkbox: The Select Checkbox is positioned in front of each Claim ID, providing users with the ability to choose specific claims for executing various actions through the Actions icon. Claim ID: All the Unprocessed Claims are listed on the screen with their respective Claim IDs. Click the hyperlinked Claim ID to navigate to the claim on the Edit Claims screen. Clicking the vertical ellipsis
Assign Status: Displays the Assign Status in this column. When the property claim.assignstatus.as.trackstatus.name is set to On, the Track Status value is displayed in this column. Example: If the Code column in the Track Status Notes popup displays "51 - ERA Received" and the property claim.assignstatus.as.trackstatus.name is set to On, the Assign Status column will display the value "ERA Received." If the property is set to Off, then the Assign Status column on this screen for a claim displays the value saved in the Action Required dropdown on the Assign To popup when action is yet to be taken. Once the action is taken, the Assign Status column shows the value saved in the Status dropdown of the Assign To popup. By default, this property is Off. Assign To: Shows the name of the user to whom the claim task is assigned. Claim Assign Date: Shows the date on which a claim was assigned to the user. Done Comments: Shows the comments related to the completed action. Expected Date: Displays the expected date of the completed assignment. The expected date cannot be less than today's date, i.e., when the task is being assigned. Follow Up Date: Displays the date for following up on the assigned task. Claim Batch No: Displays the claim's or penalty invoice's batch number. Claim BU Code: Shows the Business Unit Code assigned to the claim. Claim BU Name: Shows the Business Unit Name corresponding to the code. Claim Case No: Displays the case number of the claim in this column. The case numbers displayed in this column are hyperlinked. Claim Charge Codes: Shows the Charge Codes associated with the claim. Claim Creation Date: Displays the date when the claim was created. Claim DOS: Shows the date of service of the claim. Claim Employer Name: Displays the employer's name associated with the claim. Claim Enc Type: Displays the claim's encounter type. Claim Enc Type Name: Displays the name of the claim's encounter type. Claim ICD10s: Shows the ICD-10 codes associated with the claim. Claim On Hold Reason: Displays the reason why the claim has been put on hold. Claim Reopened: Displays the claim's reopened status as 'Yes' or 'No'. Claim Status: Shows the status of the claim, such as 'E' (which stands for Entered) or 'H' (which stands for On Hold). Claim TPA Name: Shows the TPA associated with the claim. Attending Provider: Displays the name of the attending provider. Billing Provider Type: Displays the billing provider type name in this column. Pay-to-Provider Type: Displays the pay-to-provider type name in this column. Balance Amount: This column displays the claim's balance amount. Billed Amount: This column displays the total billed amount of the claim. Copay Amount: Shows the copay amount for the patient. Claim Type: Displays the type of the claim in this column. Claims with Errors: This field displays the number of errors the claim has encountered. For example, if the claim has 3 errors, the number 3 is displayed in the column in red with a hyperlink. The error count is displayed as a hyperlink. Clicking the hyperlink displays all errors related to the claim as captured by PrognoCIS. Note: If there are no errors, the count is displayed as 0. Claims with Errors/Warnings: This field displays the number of warnings and errors the claim has encountered. Claims with Warnings: This field displays the number of warnings the claim has encountered. The warning count is displayed as a hyperlink. Clicking the hyperlink displays all warnings related to the claim as captured by PrognoCIS. For example, if the claim has 3 warnings, the number 3 is displayed in the column in red with a hyperlink. Note: If there are no warnings, the count is displayed as 0. Days Count Since DOS: Displays the difference in days between the claim's date of service and the current date. Invoice Number: Shows the penalty invoice number, if any. Claim Location Code: This column displays the location code of claims. Claim Location Name: Shows the name of the claim location. Claim Pri. Eligibility Details: This field displays a hyperlink with the label "Claim Pri. Eligibility Details". Clicking the hyperlink invokes the HTML from TriZetto or Waystar, or a text message in the case of other clearinghouses. Claim Pri. Eligibility Status: Displays the eligibility status of the primary insurance. The values displayed are: Active Coverage, R – Not Retrieved (Resubmit), A – Active, I – Inactive, O – Request Rejected, and N – Not Requested. Claim Pri. Subscriber ID: Displays the subscriber ID of the primary insurance. Claim Primary Insurance: Shows the claim's primary insurance. Claim Sec. Subscriber ID: Displays the subscriber ID of the secondary insurance on the claim. Claim Sec. Eligibility Details: This field displays a hyperlink with the label "Claim Sec. Eligibility Details". Clicking the hyperlink invokes the HTML from TriZetto or Waystar, or a text message in the case of other clearinghouses. Claim Sec. Eligibility Status: Displays the eligibility status of the secondary insurance. The values displayed are: Active Coverage, R – Not Retrieved (Resubmit), A – Active, I – Inactive, O – Request Rejected, and N – Not Requested. Claim Secondary Insurance: Shows the claim's secondary insurance. Claim Ter. Insurance: Shows the claim's tertiary insurance. Claim Ter. Subscriber ID: Displays the subscriber ID of the tertiary insurance on the claim. Patient Chart No: Displays the patient's chart number in this column. Patient DOB: Displays the date of birth of the patient in this column. Referring Provider: Displays the referring provider's name in this column. Patient Name: This column displays the name of the patient. Rendering Provider: This column displays the name of the rendering doctor associated with the claim. Claim Count: This displays the total count of claims on the screen. Total Charge $: This displays the total billed amount of claims on the screen. Pagination: Pagination on the Unprocessed Claims screen helps users navigate through multiple pages of claims efficiently. The following options are available:
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| See Also: | Filter Claims |