Chapter 7: Creating Claims Computers in the Medical Office
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Transcript Chapter 7: Creating Claims Computers in the Medical Office
Computers in
the Medical Office
Chapter 7:
Creating Claims
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
7-2
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.
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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.
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© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
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Creating Claims
Claims are created in the Claim
Management area of Medisoft
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Creating Claims
When the Create Claims button is clicked,
the Create Claims dialog box appears
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Creating Claims
The Create Claims dialog box contains a
number of filters claims, including
Transaction
Dates
Case Indicator
Chart Numbers Location
Primary
Insurance
Provider
Billing Codes
Amount
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Creating Claims
Once claims are created, they are listed in
the Claim Management dialog box, with a
status of Ready to Send
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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
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7-9
Editing Claims
If any claims need to be edited, simply
highlight the claim in the Claim
Management dialog box and click the Edit
button
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Editing Claims
In the Claim dialog box, changes are made
to a claim, such as moving a transaction to
another claim
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Transmitting Claims
Claims are transmitted electronically to a
clearinghouse, or directly to an insurance
carrier
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Transmitting Claims
The clearinghouse sends a report to the
practice, to verify the claims that were
transmitted
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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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