Enter a New Claim

This page allows you to enter a new claim, correct an existing claim, update a claim line item, or void an existing claim line item.

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.

Claim Information

Complete information in the following controls to specify the authorization identification number and the client date of birth for the claim, and to select the type of claim:

In Authorization ID, enter the specific authorization identification number for the claim. You can click Authorization Search to search for an authorization as necessary. When clicked, the page refreshes and displays Authorization 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.

Authorization Search Criteria

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

In Authorization ID, enter the specific authorization identification number on which to search.
In Authorization Date, enter a specific date to search for authorizations active as of the date specified.
In Client Number, enter the specific client identification number on which to search.
In Level Of Care, select the level of care on which to search.
In Initiative, select the initiative on which to search.
As a provider, the name of your provider agency is automatically selected in the Provider Agency drop-down list. This information is read-only and cannot be changed.
In Provider Site, select the name of the provider agency site 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 Authorizations table. Or, click Reset to reset the search controls to their default values.

Authorization Search Results

The Authorizations table displays whenever Search is clicked. The following information is displayed for each authorization that matches the specified search criteria:

Click the Select link to select the authorization. When clicked, the page refreshes and the Authorization ID of the selected authorization is entered in the Authorization ID field under Claim Information.
Authorization ID displays the unique identification number for the authorization.
Initiative displays the funded program for which services have been authorized.
Level Of Care displays the level of care for which services have been authorized.
Client Name displays the last and first name of the client for which services have been authorized.
Client Number displays the unique client identification number for which services have been authorized.
Start Date displays the date on which the service is (or was) authorized to start.
End Date displays the date on which the service is (or was) authorized to end.
Provider Agency Name displays the name of the provider agency for which services have been authorized.
Provider Site Name displays the name of the provider agency site at which services have been authorized.

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 Package, select the service package associated with the service that was performed for the claim line item.
In CPT Code, select the CPT code for the claim line item. Up to 50 characters may be entered.
In Units, update the total number of units claimed for the claim line item.
In Clinician, select the name of the first clinician that performed services for the claim line item.
In Secondary Clinician, select the name of the second clinician that performed services 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 Package 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.
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.
Amt Denied displays the total amount denied for the claim line item.
Amt Paid Prev displays the total amount that was previously paid for the claim line item.
Denial Rsn displays the reason the claim line item was denied, if applicable.
First Clinician displays the name of the first clinician that performed services for the claim line item.
Second Clinician displays the name of the second clinician that performed services for the claim line item.
Is Void displays after the claim has been submitted and indicates whether the claim line item has been voided.

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 Check Claim to check the claim and verify that the information entered is accurate. When clicked, the page refreshes and the Claim Number field is updated to display CHK in the claim identification.

Click Submit 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: Once Submit Claim has been clicked and the claim has successfully been submitted, you can click Correct Claim to update the claim line items as necessary. When clicked, the page refreshes and the Edit link is enabled in the Service Claim Lines table.

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. You can complete the following tasks as necessary:

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.
Click Void Claim Line to void the claim line item as necessary. When clicked, the page refreshes and Yes is displayed in the Is Void column of the Service Claim Lines table.

Click Cancel Edit if you do not want to update or void the claim line item.

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 Package, select the service package associated with the service that was performed for the claim line item.
In CPT Code, select the CPT code for the claim line item. Up to 50 characters may be entered.
In Amount, update the total amount claimed for the claim line item.
In Clinician, select the name of the first clinician that performed services for the claim line item.
In Secondary Clinician, select the name of the second clinician that performed services 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.
CPT Code displays the CPT code of the claim line item.
Amt Received displays the total amount received for the claim line item.
Amt Billed displays the total amount billed for the claim line item.
Amt Denied displays the total amount denied for the claim line item.
Amt Paid Prev displays the total amount that was previously paid for the claim line item.
Denial Rsn displays the reason the claim line item was denied, if applicable.
First Clinician displays the name of the first clinician that performed services for the claim line item.
Second Clinician displays the name of the second clinician that performed services for the claim line item.
Is Void displays after the claim has been submitted and indicates whether the claim line item has been voided.

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

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. You can complete the following tasks as necessary:

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.
Click Void Claim Line to void the claim line item as necessary. When clicked, the page refreshes and Yes is displayed in the Is Void column of the Reimbursement Claim Lines table.

Click Cancel Edit if you do not want to update or void the claim line item.

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 Package, select the service package associated with the service that was performed for the claim line item.
In CPT Code, select the CPT code for the claim line item. Up to 50 characters may be entered.
In Units Per Day, enter the total number of units claimed per day for the claim line item
In Clinician, select the name of the first clinician that performed services for the claim line item.
In Secondary Clinician, select the name of the second clinician that performed services 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.
CPT Code displays the CPT code of the claim line item.
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.
Amt Denied displays the total amount denied for the claim line item.
Amount Paid Prev displays the total amount that was previously paid for the claim line item.
Denial Rsn displays the reason the claim line item was denied, if applicable.
First Clinician displays the name of the first clinician that performed services for the claim line item.
Second Clinician displays the name of the second clinician that performed services for the claim line item.
Is Void displays after the claim has been submitted and indicates whether the claim line item has been voided.

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

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. You can complete the following tasks as necessary:

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.
Click Void Claim Line to void the claim line item as necessary. When clicked, the page refreshes and Yes is displayed in the Is Void column of the Bulk Claim Lines table.

Click Cancel Edit if you do not want to update or void the claim line item.

Tutorials...

Access the Home Page

Correct a Claim

Submit a Bulk Claim

Submit a Reimbursement Claim

Submit a Service Claim

Update a Claim Line Item