Paper claims are identified by the Icon in the first column. Electronic claims are blank.

1. When a charge is posted to the Ledger from the New Charges tab, an insurance claim is created. The claim is automatically inserted into the Pending Scrub section of the Claims Manager.

2. Claims are Scrubbed and placed in the Ready to Process section. If the claim needs to be corrected or edited, the claim will be placed in the On Hold section with a reason for rejection.

3. Once the claims are corrected and reprocessed/rebuilt to apply changes, they are Scrubbed again and moved to the Ready to Process section. If a claim is still getting placed in the On Hold section when Scrubbed, this will have to be repeated until the claim is error free and moved to the Ready to Process section.

4. When the Claims are Ready to Process, they are exported to the designated file for submission to the Receiver or Printed to a CMS 1500 claim form to be mailed to the Payer.

Note: Select a single Claim by Clicking the claim to highlight. To select random claims, Click on a Claim and while holding down the Ctrl key, left click on other claims to highlight. To Select all claims in a section, Click on the first claim to highlight and while holding down the Shift key, Click on the last claim to highlight those two and all the claims in between.

Posted: Date Claim was posted to the patient ledger and claim was created

Claim: Claim number used for identification and tracking. This number is automatically assigned when the claim is created

Physician: Performing Provider

Patient: Patient name

Primary: Identifies patient's Primary Payer

PRT: Primary Payer Routing (Paper claim or Electronically sent)

Secondary: Identifies patient's Secondary Payer

SRT: Secondary Payer Routing (Paper claim or Electronically sent)

Amont: Total amount of claim

File With: Filing claim with (Primary or Secondary)

Submission: Indicates to Payer if the claim is Original claim, Corrected claim, Replacement claim or a Voided claim

Status: Status of claim (On Hold, Pending Scrub or Ready to Submit)

Hold Notes: Hold notes gives a short explanation of why the claim is being placed in the On Hold section. This note will be attached if the claim is rejected in the Scrub process. It can also be typed by clicking in the grid if the claim is manually placed on hold by user

Claim Notes: Claim notes are automatically added when a claim is set to Refile, has been Rebuilt, etc.  It can also be typed by clicking in the grid if needed.  

Hold notes and Claim notes are for user reference only. Notes are not included on claims