Case / Patient, Guarantor & Insurance Tab

Image Set and Coding Section

Allows you to select an image set and attach it to the case.

Image Set

Drop Down

No

Contains the images attached to the case.

Patient Section

Patient

Drop Down Search

Yes

Records the person who is the patient on the case.

SSN

Read-only

(Pulled from the Person Information)

Yes

The social security number of the patient on the case.

DOB

Read-only

(Pulled from the Person Information)

Yes

The date of birth of the patient on the case.

Age

Read-only

(Pulled from the Person Information)

Yes

The age of the patient on the case.

Phone

Read-only

(Pulled from the Person Information)

Yes

The phone number of the patient on the case.

Gender

Read-only

(Pulled from the Person Information)

Yes

The gender of the patient on the case.

Guarantor Section

Records the person or organization financially responsible for the account.

Type

Drop Down

Yes

The type of person financially responsible for the account. By default, the option is set to Patient. The options include:

• Patient - If the patient is the person financially responsible for payment

• Some Other Person - If a person other than the patient is financially responsible for payment, e.g., parent or guardian

• Organization - If a company or organization is financially responsible for payment, e.g., Worker Compensation carrier

Guarantor

Drop Down Search

Yes

The name of the person or organization financially responsible for the account.

Account

Read-only

(Pulled from the Accounts Information)

Yes

The guarantor account number. It is a link, that when clicked opens the Account / Active AR tab.

SSN

Read-only

(Pulled from the Accounts Information)

Yes

The social security number associated with the guarantor account.

DOB

Read-only

(Pulled from the Accounts Information)

Yes

The date of birth associated with the guarantor account.

Phone

Read-only

(Pulled from the Accounts Information)

Yes

The phone number associated with the guarantor account.

Insurance Section

Order

Read-only

(Pulled from the Person Information)

Yes

The rank designation of the payer as primary, secondary, tertiary, and payer responsible.

The rank is assigned according to the position of the payer in the list. A checkmark indicates that the payer is currently active. When a payer is selected, a rank is assigned based on the current position of the payer. As other payers are selected, the ranks are updated according to the position of the payer. For example, if a payer in the second row has a rank of 1, and then the payer in the first row is selected. The payer in the first row will now have a rank of 1 and the payer in the second row will be updated to a rank of 2.

Payer

Read-only

(Pulled from the Person Information)

Yes

The name of the company that owns the plan to which the claims are submitted.

Plan

Read-only

(Pulled from the Person Information)

Yes

The name of the plan to which claims are submitted. If the plan has an expiration date, it will not be on the list.

If the plan selected has been designated as a Miscellaneous Plan (via Plan > Claims tab), the Plan Address window opens after tabbing out of the Plan field.

Open

You must enter a name and address for the plan before any new information entered in the Add/Update Insurance window can be saved.

Subscriber

Read-only

(Pulled from the Person Information)

Yes

The person who owns the insurance coverage.

Subscriber #

Read-only

(Pulled from the Person Information)

Yes

The unique number issued by the payer to the employee who participates in a group plan. This number identifies the employee and can be the same as the Member ID, based on whether the insurance company issues separate numbers to identify its participants. This number comes from the information entered from creating or updating insurance information.

Member #

Read-only

(Pulled from the Person Information)

Yes

The unique number issued by the payer to identify the patient who participates in a group plan. Member IDs and Subscriber IDs can be the same or a different number based on whether the insurance company issues separate numbers to identify its participants. The member identification number is used by some payers to differentiate between the employee and the participating dependents, for example, 00 might identify the employee and 01 might identify the spouse of the employee.

Group #

Read-only

(Pulled from the Person Information)

No

The unique number issued by the payer to the owner of the insurance policy.

Eligibility Status

Read-only

(Pulled from the Eligibility tab)

No

The most recent eligibility check status, or the state of being qualified or entitled to benefits. Three possible values are:

• Active - patient is currently eligible

• Inactive - patient is not currently eligible

• Rejected - the Eligibility Inquiry did return a successful response

Last Checked

Read-only

(Pulled from the Eligibility tab)

No

The date and time the Eligibility was last checked.

Pre-Auth #

Free Text

No

The authorization number issued by the payer for authorization of the treatment or surgery. If you have the pre-authorization number, you can enter it in this column for the payer.

Referral #

Drop Down

No

The number issued by the primary or referring physician for a specific treatment or treatment series. If a referral number has been entered for the payer on the insurance window, click the applicable referral number from the list.

P&C Claim #

Free Text

No

The Property and Casualty insurance claim number associated with the insurance payer line.

Force Self Print

Checkbox

No

If selected, the electronic claim is printed on a pre-printed claim form, for example, the NUCC 1500 form.

Eligibility History Section

Case ID

The identification number of the case associated to the Eligibility Inquiry.

DOS

The date the service is rendered.

Eligibility Status

The status, or the state of being qualified or entitled to benefits. Three possible values are:

• Active - patient is currently eligible

• Inactive - patient is not currently eligible

• Rejected - the Eligibility Inquiry did return a successful response

Response Date

The date the Eligibility Inquiry 271 response was returned.

Actions

The number of open actions on the response.

Paperwork Attachments Section

Contains a list of the supporting documentation attached to an electronic claim. Paperwork attachments create the additional electronic (PWK) segment in the claim file to indicate:

• Type of documentation being sent

• How the documentation will be sent to the payer

Type

Display Only

(Pulled from Attachment)

Yes

The type of documentation being sent to the payer, for example, Medicaid Consent for Sterilization form.

Method

Display Only

(Pulled from Attachment)

Yes

The method the documentation will be sent to the payer, for example, email, mail, or fax.

Control #

Display Only

(Pulled from Attachment)

Yes

The control number the receiving payer can use to link the documentation with the claim.

Errors and Warning Section

This section reports problems detected through the Error Check validation process. Use the Display options to select the validations to verify.

In addition to errors and warnings, the date and time the last error check occurred is reported. If an error check has never been performed on a charge batch or case, the text displayed will be Last Check: (pending). Each time an error check is completed, this text is updated and displayed in the following format: Last Check: mm/dd/yyyy, hh:mm:ss AM/PM, for example, Last Check:  07/08/2013, 4:35:14 PM.

Display Filters

Checkboxes

No

This filter determines the type of errors or warnings listed in the Error Check list. Errors must be corrected before a case or charge batch can be submitted and claims can be generated. Warnings may or may not cause rejection of a claim and are not required to be corrected. A checkmark next to the display filter indicates that the filter is selected.

The filter options dynamically affect the contents of the error checklist. When you clear a checkbox, the list hides the applicable errors or warnings. When you click the checkbox again, the list refreshes, showing the hidden errors or warnings.

Type

Display Only

(System-generated)

Yes

The classification of the problem detected in a category during the Error Checking process. Cases in the charge batch are validated for certain conditions reported as errors or warnings.

Category

Display Only

(System-generated)

Yes

The component that may contain an error or warning when either condition is detected during error check validation, for example, Concurrency or Data. By default, all categories are selected and all errors and warnings are displayed on the Charge Batch Error Check tab. Errors must be corrected before a claim can be created. Warnings do not have to be corrected before a claim can be created.

The categories listed in the error check table are controlled by the Display filters on the Charge Batch Error Check tab. The following categories are available:

Error Code

Display Only

(Pulled from system generated/created Case Error Rule)

Yes

The system-assigned, unique error code for each error. 

Message

Display Only

(Pulled from system generated/created Case Error Rule)

Yes

The description of the error or warning.

Related Cases

Display Only

(System-generated)

No

A direct link to cases related to the case that has a warning or error. To go to a related case, click the direct link. If the related case has a warning or error that is corrected, the Error Check validation process will verify the case and remove it from the Charge Batch Error Check tab. 

Image Set and Coding Section

View

[Alt] + [V]

To preview the images in the image set.

1. Open the Image Set drop down arrow and select the image set to view.

2. Click View. The Image Viewer page opens with the image set displayed.

Coding

[Alt] + [O]

To review the coding form if the case has been coded from the image set.

1. Open the Image Set drop down arrow and select the image set to view.

2. Click Coding. The Coding window opens with the coding information for the case displayed.