Claim Editor Window
The Claim Editor in INSIGHT Billing is used throughout the life cycle of the claim to research and identify problems, edit information, and perform actions. It also provides a payer ledger of chronological transactions about the claim and a ledger broken out by payer. Use it to add or edit specific charges on the claim and other information associated with the claim such as the patient, payer, and case information. The Claim Editor is accessible a variety of ways:
- Double-click any row on the Claims tab.
- On the Edit menu, click Claim and then type a claim number.
- Click on the INSIGHT Billing toolbar and then type a claim number.
- Press F12 and then type a claim number.
The Claim Editor displays the current claim by default. Use the drop-down arrow to select older versions of the claim to display.
Note: The Auto Claim Status and Last Updated fields are only visible to Auto-Status clients.
Claim Editor buttons
The table below provides detailed information on each button in the Claim Editor.
Opens the Enter Charges dialog box and allows you to add a charge to the claim. See Manually Add, Edit, or Delete a Charge for more information about adding charges.
A warning message displays in red if you are trying to enter manual charges for an unsigned appointment.
|Previews a copy of the printed claim.|
|Reprints the selected claim. This button is disabled if you are viewing the current claim.|
|Previews a copy of the EDI file.|
|Saves any changes made and close the Claim Editor.|
|Saves the changes, the Claim Editor stays open.|
|Cancels any changes made and close the Claim Editor.|
Exports the claim information to Excel or a print preview.
Note: This is only available for the Charges and Ledger tabs.
|Validates whether or not the claim has all the necessary information. Warnings are displayed at the top of the window in red if action needs to be taken.|
|Checks whether or not the status of the claim has changed. Use this when a claim gets "stuck."|
|Sets the claim to At Payer status. Use this when a payer has sent your claim directly to the secondary payer and you do not want to submit a duplicate claim to the secondary payer.|
|Opens the Print Chart Notes dialog box and allows you to preview, print, or fax the patient's chart notes.|
|Opens the Create New Task dialog box for you to assign a new task related to the claim to someone in the clinic. See Create a New Task for more information about creating tasks.|
|Opens the Edit Note dialog box for you to enter a note about the claim. Notes entered appear at the top of the list and do not have an ID associated with them.|
Allows you to open the California Worker's Comp Info dialog box or Claim Information window to add ICN/DCN information to the claim, resubmit the UB or CMS-1500 claim, or add/edit UB or CMS-1500 claim information.
This button is only available for resubmitted claims. It is not available for new claims.
Adjusts the Start Date and End Date of the claim to match the service dates.
Claim Editor tabs
Information on the Claim Editor is organized into the following tabs:
Provides detailed information about the charges on the claim. The table below provides detailed information on each column on the Charges tab in the Claim Editor.
|Bill||When the check box is selected, the line will be billed.|
|Action||Allows you to resubmit, pass to patient, pass to next payer, or void the claim.|
|Edit||Opens the Enter Charges dialog box so you can edit charges on the claim. You cannot enter manual charges for an unsigned appointment.|
|Treat Date||Date of service for the charge.|
|Claim #||Claim number that INSIGHT assigns to the claim when it is created.|
|Treat Code||CPT code used to bill the charge.|
|Mod 1||Therapist-added modifier.|
|Mod 3||System-generated modifier that is used to identify the discipline code.|
|Mod 4||Typically reserved for KX modifiers. If the payer is Medicare and the patient has met the first Medicare Therapy Threshold, then INSIGHT prompts the physician at sign off.|
|Diag||Diagnosis used for the charge.|
|Units||Number of units billed.|
|Billed||Amount billed for the specified charge.|
|Paid||Amount paid for the specified charge.|
|Adjustment||Adjustment amount made for the specified charge.|
|Payer Index||Identifies which payer is currently handling the charge. 1 = primary payer, 2 = secondary payer, 3 = tertiary payer, 4 = guarantor.|
|Status||Status of the charge.|
|Hint||The denial reason posted either manually from a paper EOB or automatically from the ERA.|
|Caregiver Name||Name of the person who performed the care or procedure.|
|Supervisor||Supervisor name, designated in the Supervisor field of the Client Editor.|
|Discipline||Discipline code associated with the charge.|
|Clinic||Name of the clinic where the procedure was performed.|
|P.O.S||Place of service.|
Provides information similar to what is found in the Personal Information tab of the Client Editor. Editing demographic information here automatically updates the same fields in the Client Editor. See Add a New Client Record for more information about Client Editor fields.
Provides payer information and includes a list of insurance authorizations for the case or patient. This information is identical to the Payer Information section in the Case Info tab of the Client Editor.
Button descriptions are listed below.
|Allows you to edit or change payer information.|
|Removes all visible payer information.|
Allows you to send the claim to the appropriate payer if payers are added at different times.
For example, when a patient comes in for treatment but forgets to tell you that they have secondary insurance. Once the secondary insurance is added, use Repair Claims to send the bill to the secondary insurance instead of billing the patient. See Repair Claims for more information.
|Allows you to view the image of an insurance card that was attached for this case. See View and Print Attachments for more information.|
|Allows you to attach an image of an insurance card. See Attach an Insurance Card for more information.|
Provides case information for the charges on the claim. Editing case information here automatically updates the same fields on the Case Info tab in the Client Editor. See Enter Basic Case Information for more information about case information fields.
Claim Contact Info
Provides payer contact information such as the provider name, phone number, provider number, insurance ID, group number, name and date of birth of the insured and the patient's relationship to the insured.
Provides a view of everything that has happened on a claim in chronological ledger view. Use this tab to see where individual charges originated, when payments are made, and when charges transfer to the next payer. It also shows a running balance for the claim.
Double-click any of the primary, secondary, or tertiary payer entries to open the EOB Allocation Details window. INSIGHT displays a warning message if there is no payment or EOB information available.
If you double-click a row with the guarantor as the payer, then INSIGHT opens the Correct the application of patient payments window. See Correct a Patient Payment Already Applied to Patient Copay or Patient Balance and Correct a Patient Payment that Has Not Been Applied to Patient Copay or Patient Balance for more information.
The table below provides detailed information on each column on the Ledgers tab in the Claim Editor.
|Debit From||Amount debited from the payer.|
|Credit To||Amount credited to the patient's account.|
|Balance||Balance (up to the specified line) of the patient's account once money has been applied.|
|Transaction Date||Date the patient's account was credited or debited.|
|Action||Indicates what happened on the line and allows you to change or apply an action if the claim line has not been completed.|
|For Payer||Indicates which payer moved the money.|
|Service Date||Date and time of the appointment.|
|CPT||CPT code used for billing the specified line.|
|Payment||Description of the payment including the payer name, form of payment and amount.|
|Staff||Name of the staff member that posted the payment.|
|Note||Note made when payment is entered.|
Provides a view of all account activity by payer. Double-click on any of the entries to open the EOB Allocation Details window. A warning message displays if there is no payment or EOB information to display.
Provides a detailed history of all actions taken on the selected claim, including when and how it was submitted, how it was processed by the clearinghouse and the payer, and any attempts to verify auto-status.