Insurance Claim Queue Features Available in HTML5

“it just makes sense” August, 2018

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Insurance Claim Queue Features Available in HTML5

As part of the 5.2 release, the Insurance Claim Queue window is now available in HTML5 and provides the same functionalities that are also available in Silverlight:

• View a Claim from the Insurance Claim Queue

• Open Information from the Insurance Claims Queue

• Add a Manual Claim

• Submit a Claim

• View the Claim Status

• View the Claim Status Report

• Change a Claim’s Status

• Correct a Rejected Claim

• Claim History

• Delete a Claim History Note

• Correct Claim Information – Edit Patient Window

• Rebuilding Claims

• View the Initial Claim from the Contract Window

The Insurance Queue From the Insurance Claim Queue window, you can do the following regarding claims – viewing, adding, printing, e-filing, changing a claim status and looking up specific patient claims. Note: If using our integrated electronic claim submission service, Change Healthcare, you can also get the status of a claim by downloading reports directly from Change Healthcare. You can access the Insurance Claim Queue window from the Financial menu.

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Insurance Claim Queue window

Buttons

Button Description

Reload Queue

Print Claims

Send Claims

Add Claim

Edit Claim

Set Status (for a claim)

Claim History

Fields The following fields are used to query which claims you desire to access:

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Field Description

Claim Status The status of the claim you want to display –New (default), Printed – Submitted – Rejected – Paid – Partially Paid – Deleted.

Include Substatuses Any identified further defined statuses.

Claim Type One of the following claim types: Continuation – Initial – One-Time or Pre-Determination or view them All.

Location The specific location, if you have several offices.

Patient Patient you’re looking up claims for.

Use Date Range Checked if using a date range. Note: Start and End dates need to be entered.

Start Date Start date of the date range.

End Date Last date of the date range.

Rank Desired insurance as it is listed on the Insurance tab from the Edit Patient window. Note: This is NOT an indication of primary and secondary.

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View a Claim from the Insurance Claim Queue 1. From the Insurance Claim Queue window, check the box to the left of the claim you want to

open.

2. Click Edit Claim. The ADA Dental Claim Form displays.

3. Click Close.

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Editing Patient Information from the Insurance Claims Queue

If you need to correct any information on the claim form, click , the shortcut menu called Insurance Claim Actions.

The shortcut menu provides quick access to the following features:

• Edit Patient

• Financial Ledger

• Contract

• Edit Insurance Company

• Edit Insurance Billing Center

1. From the Insurance Claim Queue window, click the Insurance Claim Actions menu . The menu displays.

2. Select the desired option from the following:

• Edit Patient

• Financial Ledger

• Contract

• Edit Insurance Company

• Edit Insurance Billing Center The corresponding window displays.

3. Make and save the desired change.

4. Return to the Insurance Claim Queue window.

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5. Select the desired claim and click Edit Claim. The claim displays.

6. From the Claim window, click Rebuild Claim. The system updates the claim.

7. Click Save and then Close. The Insurance Claim Queue window displays. Note: From the Insurance Claim Queue window, click Reload Queue to update the content displayed on the window.

Add a Manual Claim 1. From the Insurance Claim Queue window, click Add Claim. The Add Claim dialog box displays.

2. Select the Patient.

3. Select the Insurance Plan.

4. Select the Claim Type.

5. Select the Claim Date.

6. Click Add. The new claim displays.

7. Click Close. The Insurance Claim Queue window displays. The claim is listed on the Insurance Claim Queue table.

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Submit a Claim 1. From the Insurance Claim Queue window, check the box next to the claim to send.

2. Do one of the following:

Are you enrolled in Change Healthcare?

Then click…

Yes Send Claims. Cloud9 sends the selected claim to the Change Healthcare to be processed.

No Print Claims. The selected claim prints.

View a Claim Status

1. From the Insurance Claim Queue window, click in the Claim Status field or use the dropdown arrow. The list of available statuses display.

2. Select the desired status.

3. Click Reload Queue. The Insurance Claim Queue table displays a list of the claims with the selected status.

View the Claim Status Report As the claim is being sent to Change Healthcare, reports are being downloaded indicating the status of past-submitted claims. You can choose to view the reports after downloading or open the report later. If you choose to view later, be sure to view these reports within 24 hours after submission.

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View Claim Report Immediately after Submitting Claim

1. From the Financial menu, click Insurance Claim Queue.

2. Do NOT select any claims and click Send Claims. This updates the report and the statuses of claims in the queue.

View Claim Report Later after Submitting Claim

Note: This information comes directly from Change Healthcare.

1. From the Reports menu, click Reports.

2. Select Claim Status Reports from the list, click Lookup.

3. In the From Date and To Date fields, enter the desired date range.

4. Click Search.

5. Select the File Name of the report you want to view.

6. Click OK.

Change a Claim’s Status

1. From the Insurance Claim Queue window, check the box next to the claim that needs to have its status changed.

2. Click (Set) Status.

The Set Claims Status dialog box displays.

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3. In the New Claims Status field, select the desired status.

Note: Marking a claim as Paid or Partially Paid is considered a best practice. Marking the submitted claim properly will help you stay on top of paid claims.

4. Click Select.

5. Click Reload Queue . The claim’s status is updated.

Correct and Resubmit a Rejected Claim

1. From the Insurance Claim Queue window, select Rejected from the Claim Status field.

2. Click Reload Queue . The rejected claims display on the table.

3. Select the desired rejected claim.

4. Click Edit Claim. The claim displays.

5. Make the desired changes to the claim.

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6. Click Save. The Insurance Claim Queue displays.

7. Click Send Claims for e-filing. A Send Claims confirmation dialog box displays.

8. Click OK.

9. In the Claim Status field, select Submitted/Re-submitted. The status of the claim becomes Submitted/Re-submitted. Note: If you don’t see the claim on the table, select (All) in the Claim Status field and click Reload Queue. Since the status was changed, the original status query may not display the updated claim.

Claim History The Claim History window tracks the actions and associated details taken for a claim. In addition, you can add or delete a note to provide information for future reference.

Button Description

Reload History

Add Note

Delete Note

Close (window)

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Accessing the Claim History

1. From the Insurance Claim Queue window, select the checkbox next to the desired claim.

2. Click History. The Claim History window displays and lists the history entries.

Adding a Note

1. From the Claim History window, click Add Note .

2. Type the note in the box.

3. Click Save. The note displays on the table.

Deleting a Note

1. From the Claim History window, select the desired claim to delete. The row becomes highlighted.

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2. Click Delete . The Delete Note confirmation dialog box displays.

3. Click Yes. The note is removed from the table.