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Computers in the Medical Office

Computers in the Medical Office. Chapter 7: Creating Claims. Creating Claims. Once the services a patient has received been entered into the practice management program, the next step is to create insurance claims.

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Computers in the Medical Office

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  1. Computers inthe Medical Office Chapter 7: Creating Claims

  2. Creating Claims • Once the services a patient has received been entered into the practice management program, the next step is to create insurance claims. • The insurance claim is the most important document for correct reimbursement. • Claims communicate information about a patient’s diagnosis and procedures and the charges to a payer.

  3. Creating Claims • HIPAA standard transaction for electronic claims is the HIPAA X12-837 Health Care Claim or Equivalent Encounter Information (837P). • Paper format is known as the CMS-1500 claim form.

  4. Creating Claims • Claims are created in the Claim Management area of Medisoft

  5. Creating Claims • When the Create Claims button is clicked, the Create Claims dialog box appears

  6. Creating Claims • The Create Claims dialog box contains a number of filters claims, including

  7. Creating Claims • Once claims are created, they are listed in the Claim Management dialog box, with a status of Ready to Send

  8. Selecting/Filtering Claims • Medisoft’s List Only feature selects only those claims that meet specified criteria, such as: • Chart number • Date created • Insurance carrier • EDI receiver • Billing date

  9. Editing Claims • If any claims need to be edited, simply highlight the claim in the Claim Management dialog box and click the Edit button

  10. Editing Claims • In the Claim dialog box, changes are made to a claim, such as moving a transaction to another claim

  11. Transmitting Claims • Claims are transmitted electronically to a clearinghouse, or directly to an insurance carrier

  12. Transmitting Claims • The clearinghouse sends a report to the practice, to verify the claims that were transmitted

  13. Transmitting Claims • The clearinghouse also sends an audit/edit report to the practice, which lists potential problems with claims • Corrections are made before the claims actually reach the insurance carrier

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