1. © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Chapter 7: Creating Claims Computers in the Medical Office

2. 7-2 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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. 7-3 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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. 7-4 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Creating Claims  Claims are created in the Claim Management area of Medisoft

5. 7-5 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Creating Claims  When the Create Claims button is clicked, the Create Claims dialog box appears

6. 7-6 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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

7. 7-7 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Creating Claims  Once claims are created, they are listed in the Claim Management dialog box, with a status of Ready to Send

8. 7-8 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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. 7-9 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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. 7-10 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Editing Claims  In the Claim dialog box, changes are made to a claim, such as moving a transaction to another claim

11. 7-11 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Transmitting Claims  Claims are transmitted electronically to a clearinghouse, or directly to an insurance carrier

12. 7-12 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Transmitting Claims  The clearinghouse sends a report to the practice, to verify the claims that were transmitted

13. 7-13 © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education 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