Enter a Contracted Claim

This page allows you to enter a new contracted claim.

NOTE: You can click the icon to expand information or the icon to collapse information on this page.

This page contains one or more tables. You can click a specific column heading in a table to sort the data in the table in ascending order by the selected column. Once selected, you can click the column heading again to sort the data in descending order. When more than one page of data is available, you can click the buttons at the bottom left of the table to navigate through the various pages, or you can select a specific page in the Page drop-down list to display data for a specific page.

Contracted Claim Information

Complete information in the following controls to specify the provider and client information for the claim, and to select the type of claim:

In Provider Agency, select the name of the provider agency for the claim.
In Provider Site, select the name of the provider site for the claim.
In Client Number, enter the specific client identification number for the claim. You can click Client Search to search for a client as necessary. When clicked, the page refreshes and displays Client Search functionality.
In Client Date Of Birth, enter the date of birth of the client for which the claim is to be entered.
In Claim Type, select the type of claim to enter.

Click Enter Detail to enter claim line item information for the claim. The page refreshes and displays Claim Detail information. Once Enter Detail has been clicked, you can click Reset to reset the page without clearing the information that has already been entered in the controls under Claim Information.

Client Search Criteria

When Client Search is clicked, the page refreshes and displays Client Search functionality. Complete information in one or more of the following controls to search for a client and/or filter the list of results displayed:

In Last Name, enter the last name of the client on which to search. You can enter partial information to widen your search.
In Date Of Birth, enter the date of birth on which to search.
In Social Security Number, enter the specific Social Security Number on which to search.

Click Search to perform a search based on the search criteria specified. The page refreshes and results found to match the search criteria are displayed in the Clients table. Or, click Reset to reset the search controls to their default values.

Client Search Results

The Clients table displays whenever Search is clicked. In the columns of the table, the following information is displayed for each client that matches the specified search criteria:

Click the Select link to select the client. When clicked, the page refreshes and the selected client's information is entered in the Client Number and Client Date Of Birth fields under Contracted Claim Information.
First Name displays the first name of the client.
Last Name displays the last name of the client.
Client Number displays the unique identification number for the client.
Date Of Birth displays the date on which the client was born.

Claim Detail

Claim Detail displays whenever Enter Detail is clicked. The following read-only information is displayed for the claim and the client associated with the claim:

Claim Number displays the unique identification number automatically assigned for the claim by the application.
Client Number displays the unique identification number for the client.
Client Name displays the first and last name of the client.

NOTE: The page displays differently depending on the type of claim that was selected in Claim Type. Claim Detail information displayed is specific to each of these types of claims:

Service Claim Line Entry

When Service is selected in Claim Type and Enter Detail is clicked, the Service Claim Line Entry functionality is available. You can add a new claim lines to the Service claim by completing the following information:

Line Number displays the unique identification number for the claim line item. This information is automatically assigned by the application when a new claim line is entered and is read-only and cannot be changed.
In Service Date, enter the date on which the service was performed for the claim line item.
In Service, select the name of the service that was performed for the claim line item.
In Units, update the total number of units claimed for the claim line item.
In Amount, enter the total amount claimed for the claim line item.

Click Add Claim Line to add the new claim line to the Service Claim Lines table. Or, click Reset Entry to reset the controls to their default values.

Service Claim Lines

The Service Claim Lines table contains the following information for each claim line item that has been added for the Service claim:

Click the Edit link to update the selected claim line item. When clicked, the page refreshes and the claim line item information is populated in the fields under Claim Detail. You can update the information displayed and click Update Claim Line to save the changes.
Click the Delete link to delete the selected claim line item. When clicked, the page refreshes and the claim line item is removed from the Service Claim Lines table.
Line # displays the unique identification number for the claim line item.
Service Date displays the date on which the service was performed for the claim line item.
Service displays the name of the service that was performed for the claim line item.
CPT Code displays the CPT code of the claim line item.
Service Units displays the total number of units received for the claim line item.
Amt Billed displays the total amount billed for the claim line item.

Click Enter New Claim to enter a new claim. The page refreshes and the controls under Contracted Claim Information are reset to their default values.

Click Save Claim to submit the claim. When clicked, the page refreshes and a message displays under Claim Detail indicating whether the claim was submitted successfully.

NOTE: You can click the Edit link in the Service Claim Lines table to update the claim line item information. When clicked, the page refreshes and the claim line item information is populated in the fields under Service Claim Line Entry. Update the information displayed under Service Claim Line Entry and click Update Claim Line to update the claim line item information as necessary. When clicked, the page refreshes and the claim line item information is updated in the Service Claim Lines table.

Reimbursement Claim Line Entry

When Reimbursement is selected in Claim Type and Enter Detail is clicked, the Reimbursement Claim Line Entry functionality is available. You can add a new claim lines to the Reimbursement claim by completing the following information:

Line Number displays the unique identification number for the claim line item. This information is automatically assigned by the application when a new claim line is entered and is read-only and cannot be changed.
In Service Date, enter the date on which the service was performed for the claim line item.
In Service, select the name of the service that was performed for the claim line item.
In Amount, enter the total amount claimed for the claim line item.

Click Add Claim Line to add the new claim line to the Reimbursement Claim Lines table. Or, click Reset Entry to reset the controls to their default values.

Reimbursement Claim Lines

The Reimbursement Claim Lines table contains the following information for each claim line item that has been added for the Reimbursement claim:

Click the Edit link to update the selected claim line item. When clicked, the page refreshes and the claim line item information is populated in the fields under Claim Detail. You can update the information displayed and click Update Claim Line to save the changes.
Click the Delete link to delete the selected claim line item. When clicked, the page refreshes and the claim line item is removed from the Reimbursement Claim Lines table.
Line # displays the unique identification number for the claim line item.
Service Date displays the date on which the service was performed for the claim line item.
Service displays the name of the service that was performed for the claim line item.
Service Units displays the total number of units received for the claim line item.
Amt Billed displays the total amount billed for the claim line item.

Click Enter New Claim to enter a new claim. The page refreshes and the controls under Contracted Claim Information are reset to their default values.

Click Save Claim to submit the claim. When clicked, the page refreshes and a message displays under Claim Detail indicating whether the claim was submitted successfully.

NOTE: You can click the Edit link in the Reimbursement Claim Lines table to update the claim line item information. When clicked, the page refreshes and the claim line item information is populated in the fields under Reimbursement Claim Line Entry. Update the information displayed under Reimbursement Claim Line Entry and click Update Claim Line to update the claim line item information as necessary. When clicked, the page refreshes and the claim line item information is updated in the Reimbursement Claim Lines table.

Bulk Claim Line Entry

When Bulk is selected in Claim Type and Enter Detail is clicked, the Bulk Claim Line Entry functionality is available. You can add a new claim lines to the Bulk claim by completing the following information:

In Start Date, enter the date on which the service began for the claim line item.
In End Date, enter the date on which the service ended for the claim line item.
In Service, select the name of the service that was performed for the claim line item.
In Units Per Day, enter the total number of units claimed per day for the claim line item
In Amount, enter the total amount claimed for the claim line item.

Click Add Claim Lines to add the new claim lines to the Bulk Claim Lines table. Or, click Clear Claim Input to reset the controls to their default values.

Bulk Claim Lines

The Bulk Claim Lines table contains the following information for each claim line item that has been added for the Bulk claim:

Click the Edit link to update the selected claim line item. When clicked, the page refreshes and the claim line item information is populated in the fields under Claim Detail. You can update the information displayed and click Update Claim Line to save the changes.
Click the Delete link to delete the selected claim line item. When clicked, the page refreshes and the claim line item is removed from the Bulk Claim Lines table.
Line # displays the unique identification number for the claim line item.
Service Date displays the date on which the service was performed for the claim line item.
Service displays the name of the service that was performed for the claim line item.
CPT Code displays the CPT code of the claim line item.
Service Units displays the total number of units received for the claim line item.
Amt Billed displays the total amount billed for the claim line item.

Click Enter New Claim to enter a new claim. The page refreshes and the controls under Claim Information are reset to their default values.

Click Save Claim to submit the claim. When clicked, the page refreshes and a message displays under Claim Detail indicating whether the claim was submitted successfully.

NOTE: You can click the Edit link in the Bulk Claim Lines table to update the claim line item information. When clicked, the page refreshes and the claim line item information is populated in the fields under Bulk Claim Line Entry. Update the information displayed under Bulk Claim Line Entry and click Update Claim Line to update the claim line item information as necessary. When clicked, the page refreshes and the claim line item information is updated in the Bulk Claim Lines table.

Tutorials...

Access the Home Page

Enter a Contracted Bulk Claim

Enter a Contracted Reimbursement Claim

Enter a Contracted Service Claim

Update a Contracted Claim Line Item