Account Inquiry and Maintenance. Module 6

Transcription

1 Account Inquiry and Maintenance Module 6

2 Table of Contents Query Accounts for AR Follow up... 3 Query a patient account... 4 Account Statement Summary... 6 Statement Messages... 7 Patient Account Summary... 8 Viewing Patient Statements On-line Account Pending Detail Transactions Account Posted Detail Transactions Transaction Update Transaction Reversal Demand a Claim, EOB, and Statement Claims EOB s Statements Detailed Account Information Report Detailed Transaction Display Screen Viewing Error Corrections Insurance Claims Maintenance Screen Insurance Claims Rejections... 50

3 Query Accounts for AR Follow up MM7 Use Shift F12 Query to obtain a count of records To get a count a user will need to be in the query/search mode, enter their parameters, and select <Shift F12>. The Help Message displays a count of patient accounts that match the specific search criteria entered when querying/searching for information. The following are examples of how Shift F12 can be used. Exception Codes Exception Codes provide a great feature to flag accounts for various reasons. The exception codes are customizable and can be used to signify past due accounts, mail returns, bankruptcy or accounts turned out to collection. This code appears when appointments are scheduled and can be set to require an override prior to booking. Some examples of possible automatic exception codes are below: o Past Due at the appropriate billing age in the Group Master Record, PD can be used or any custom code desired. o CP when the collection edit is ran and the account qualifies for collection activity o CA when the account is turned out to collections. Using greater than, less than or equal Greater than(>), less than(<) or equal (=) symbols can be used in the balance field to query a set of accounts to establish a work list of follow up accounts. Consider selecting a specific financial class (Self Pay) along with balances >$500 to establish a follow up call task list. Financial Class

4 Select a specific financial class to research, then use the <Shift F12> feature to obtain a count of all patients that are listed in this class. To view each account use <F2> to display all the accounts in one by one. Follow up using Follow up field (and initial field) Users can choose to use a follow up tickler feature by using the Follow up and Initials fields. Query accounts in the future by user initials and or a follow up date. Using the two fields together, along with the Comment Record tab to create an easy way to keep track of accounts that need more attention at a future date. Reports can also be generated to capture accounts that contain information in these fields. Query a Patient s Account MM7, query patient The Patient Account screen, MM7, is already in a query mode when displayed. The user will only need to enter the specific search criteria and then Execute Query from the taskbar or <F2> on the keyboard. The user can enter any of the following or any combination to find the patient account. Account number Patient name Phone number (s) Date of Birth Social Security Number Address To search using only a portion of known information the user may use the Clinix wildcard (%) or the underscore (_) to fill in missing information. (e.g. Enter Clin% in the last name field and %vid in the first name field) Hold Statements

5 The Hold Stm field defaults as an N and is used to hold patient statements Although the field will allow a Y to be entered, this must be done with caution. If a Y is used no statement will generate; the statement cycles will continue to cycle every 28 days causing the balance to age. When the Y is manually removed, depending on how long the account was flagged, there is a chance that the account may pass directly to collection status with the aged balance and no communication to the patient. The best use of this field is to choose a number of cycles to hold the statement (1-9), and then the system will not generate a statement for that number of cycles. The number entered will decrement at each 28 day cycle and the balance will not age. When the number of cycles held is zero, the account will fall back into the schedule of patient statements. Accounts with Hold Stm field flagged are included in the end of month reports generated.

6 Account Statement Summary MM7, query a patient, select button, then select the tab Use the Patient Summary tab or <Shft F7> on the keyboard. This screen will provide the statement dates, types and balances associated. Notice that after no activity from the preset number of statements, the system then generates a collection letter. See field names and descriptions below. Field Name Account Balance Forward Account Balance Insurance Balance Patient Balance Age FC Imm Bill Statement Date Stmt Type Field Description Patient Statement Summary Patient account number. Account balance from previous statement Current account balance Balance for Insurance responsibility Balance for Patient responsibility Age of the Account Primary Financial Class Check box to cause an immediate statement to go to the patient. Date of patient statement Statement Type. PT= Patient Statement, CL= Collection Letter

7 Statement Messages Patient Account Screen MM7 There are 2 different types of statement messages that can be created. 1. A message to broadcast to a specific patient. For example, to request that the specific patient provides proof of insurance on the next visit. 2. A message to broadcast to all patients within a statement cycle. For example, to advise your patients that they may receive two invoices during the transition to a new system. This message code can be attached to any account. Messages are set up by selecting the LOV button. Then creating or selecting a message from the Statement Messages screen displayed on the next page. The box to the right of the message code displays how many statements this message should print for the account. If you leave this field blank, the message will appear on the statements until the Msg Cd is removed from the account. Messages broadcast to all patients can be removed by accessing the Statement Message screen then use the Remove Record icon or <Cntl E> on the rows identified as ALLS.

8 Step by Step to create an individual Statement Message Query the specific patient account from MM7, select the Msg Cd' LOV Group Code - enter the group code on a blank line. Msg Code - create a new code to use any character or symbol may be used with the exception of ALLS * see below for ALLS code used to broadcast to all patients. Line - begin with line 1, if the message exceeds the max characters allowed continue on to the next line identifying it as line 2 Text - free text message up to 70 characters Save by using the save icon or <F4> from the keyboard Double click on the message and the code will return back to the patient account screen. Once on the patient account screen, use the next box to indicate how many cycles the message should appear on the statement. The system will automatically count this number down. Step by Step to create a Statement Message for all patients Query any patient account from MM7, select the Msg Cd LOV Group Code - enter the group code on a blank line. Msg Code - use code ALLS to broadcast to all patients. Line, begin with line 1 if the message exceeds the max characters allowed continue on to the next line identifying it as line 2 Text - free text message up to 70 characters Save by using the save icon or <F4> from the keyboard Double click on the message and the code will return back to the patient account screen. To stop printing this message, the user must manually remove the ALLS code from the statement messages table by using the Remove Record icon, or <Cntl E>. Patient Account Summary MM7, query patient, then select the tab

9 Choose the Summary tab or <Ctr G> on the keyboard. The Account Summary screen provides a financial snapshot of the patient s account. See field name and field descriptions below for additional information. Field Name Group Account Last Name First Name Account Balance Pending Charges Pending Payments Pending Adjustments Estimated Balance Insurance Balance Pre Scrub Balance Field Description Account Summary Group code Patient account number Patient's Last Name Patient's First Name Account Summary Current full account balance posted to the account. Includes both insurance and patient monies. Charges still in a batch that has not been released and had the nightly post/process performed. Payments in a batch pending release and nightly post stated as above in charges. Adjustments in a batch pending release and nightly post stated as above in charges and payments. Account balance plus or minus what is in Pending Transactions when the batch(es) are released and the nightly post/process has been performed. Balance for Insurance responsibility Balance of Insurance Claim Rejections in up front scrubber pending correction prior to sending claim to insurance carrier for payment (MM2.13 and sent in nightly report run)

10 Patient Balance Balance for Patient responsibility Unallocated Balance Balance of Unallocated transactions (sent in nightly report run) Account Age Current aging cycle of the patients balance. Balance Forward Account balance from previous statement Copay on open claims Balance of copay amounts on open claims Account Age Analysis Current Account Balance less than 30 days old 30 day day Account Balance separated by 30 day increments Last Activity Summary Last Charge Amount Amount of last detail charge posted Last Charge Date Date of last detail charge posted Last Charge Code Code on last detail charge posted Last Payment Amount Amount of last detail payment posted Last Payment Date Date of last detail payment posted Last Payment Code Code on last detail payment posted Last Adjustment Amount Last Adjustment Date Last Adjustment Code Date Last Insurance Claims Date Last Collection Letter Number of Letters Mailed Date Last Patient Statement Number of Statements Charges Payments Adjustments Charges Payments Adjustments Amount of last detail adjustment posted Date of last detail adjustment posted Code on last detail adjustment posted Date on Last Insurance claim filed Date on Last Collection Letter sent Number of Collection letters sent Date on Last Patient Statement Number of Patient Statements sent Current Month Charges that are posted to the current month Payments that are posted to the current month Adjustments that are posted to the current month Total All charges posted through last end of month run All payments posted through last end of month run All adjustments posted through last end of month run

11 Viewing Patient Statements On-line This is an optional feature. If desired, contact your client manager to sign up for View Logic. To view a copy of the statement that was sent to the patient select the of the screen or <F9> on the keyboard. tab at the top Clinix will store links for up to 12 months of statements and/or letters that have been sent to that patient. Although this feature is not billed by Clinix, charges from viewlogic are by statement not by view.

12 Account Pending Detail Transactions Account Summary screen or from MM7, query patient, then select the tab or <F12>, tab or <F10> Pending transactions have been entered on the account in a batch. The batch has not yet processed through the nightly post. Once the batch is released and processed through the nightly post the pending transactions will move to the account detail and be included in the account balance. On this screen Charges will display in black font, Payments in green font, and Adjustments in red font for easy recognition. The following field name and field description below provides additional information. Field Name Group Acct Patient Name Balance Date T Entry Procedure Description Field Description Account Pending Transactions Group code Patient account number Patient Last Name, First Name Account Balance (not including pending transactions) Date of Service Type of transaction: C= Charge, P= Payment, A= Adjustment Date of Entry on transaction Code for transaction Description of transaction

13 PDoc Batch Amount IT E Itembal Comment DOS Time Ins Date Den1 Den2 Den3 Den4 User Performing Provider Batch number used when entering transaction Amount of transaction Primary insurance type on patient account Error correct, if 'E' in column due to a transaction update Line item balance Displays last comment saved or comment that has been tagged. Displays the time of the service if this feature is utilized. Displays the insurance key code that an ANSI code has been attached to a charge. Displays the date the ANSI code was entered on a charge. Displays an ANSI code if entered on a charge. ANSI Response Displays an ANSI code if entered on a charge. ANSI Response Displays an ANSI code if entered on a charge. ANSI Response Displays an ANSI code if entered on a charge. ANSI Response User that posted the ANSI responses

14 Detailed Transaction Display This screen can be accessed by clicking on the pending transaction line item and then either click on the tab or use the <F12> function key. The tab will display the Detailed Transaction Display screen for further information on the pending transaction. More information regarding this screen is included later in this document.

15 Account Posted Detail Transactions Account Summary Screen tab or <F11> OR from MM7, query patient, then select the tab or <Shft F8> Field name and field description below provides additional information. Field Name Group Account DOB Ins. Balance Batch Nbr INS1 INS2 INS3 FC First Name Last Name Bal Comment DOS Entry Dte Field Description Account Detail Information Group code Patient account number Patient's date of birth Insurance Responsibility Balance Batch number used when entering transaction Insurance code for Primary Insurance Insurance code for Secondary Insurance Insurance code for Tertiary Insurance Primary financial class Patient's first name Patient's last Account Balance (not including pending transactions) Displays last comment or tagged comment Date of Service Date of Entry on transaction

16 T Procedure Description PfDoc IT CS Error Corr Amount Unalloc Item Bal Resp Appeal Loc Status Denial? Reason for Denial Type of transaction: C= Charge, P= Payment, A= Adjustment Code for transaction Description of transaction Performing Provider Primary insurance type on patient account Collection Status: CP- Collection Pending, CA- Collection Agency when line item collections active Error correct, if 'E' in column due to a transaction update Amount of transaction Amount of transaction that is not allocated to a charge Line item balance Responsibility of the line item: I=Insurance, P=Patient, X= Insurance Rejection Appeals Tracking flag Location connected to transaction Status of claim: O=Open, C= Closed, D=Demand Destination of the Claim: Y= Deny this claim and stop secondary filing; S= Deny this claim and file secondary claim; R= refile this claim; N= default value Insurance Claim Denial Code Reason Ins Sequence Ins Code File Date RC CPT ST User Clinix Rejection Code and Description Rejection Date Date Den. Posted Insurance Den. Posted Rsn1 rsn1 Rsn2 rsn2 Rsn3 rsn3 Rsn4 Insurance Sequence Insurance Code Claim file date Internal Rejection Code used with up front scrubber Code for transaction Batch status: P=Posted; H=Hold or Pending User that posted the ANSI responses Internal Rejection Code Description used with up front scrubber Date of Rejection due to up front scrubber Date Denial posted Insurance Denial posted ANSI Response ANSI Response ANSI Response ANSI Response ANSI Response ANSI Response ANSI Response rsn4 ANSI Response The Account Detail screen represents all transactions that have been posted to the account in a batch and released then processed through the nightly post run. All transactions are color coded for easy recognition as displayed in the legend.

17 Charges in black font Payments in green font Adjustments in red font Debit Pay/Adj in bold purple font represents that a payment or an adjustment has been error corrected on the account therefore, resulting in a debit transaction. Unallocated Red/Green in bold red or green unallocated adjustment in red or payments in green. Chg with Pending Pay/Adj in italic bold blue font this indicates that a payment or adjustment is in pending on this charge line item. Pay/Adj tied to Suspense in bold orange font a payment or an adjustment that is attached to a charge is in suspended transaction which is stored on MM6.10. CS field displays Collection Pending (CP) or at Agency (CA) when the collection edit or turnover have occurred. These parameters are set on MM1.22 to identify when accounts/line items should be flagged to have additional collection activity. When these conditions are met the account/line item receives an exception code of CP. Reports are generated, once approved by the client, the account/line items are turned out to the collection agency and the CP code is updated to a CA. Error Corrections are hidden when this form is accessed unless the user needs to see all error corrections that have been made on an account; to view - select the tab. After selecting the Add Error tab or <Ctr O>, the error corrections will be indicated with an E in column header with an Error Corr. Remove Zero Balance Line Items - Select the tab to remove zero balance lines- Select the Item Bal tabs again to return the zero balance lines To efficiently use this screen the user may use the Query within a Query feature to break down areas of the screen. The following are example of possible actions, after each query use <F1>, <F2> to refresh the screen.

18 Step by Step examples to research the account detail information screen. o Who is Responsible? o Select Enter a Query, or <F1> to clear screen o Place cursor in the Resp column, enter a P for patient, I for insurance, or X for charges that did not make it through the upfront scrubber. o Select Execute a Query or <F2> o Only the line items that are for that responsibility will display o Transactions tied to a Date of Service o Select Enter a Query, or <F1> to clear screen o While cursor is in DOS column, enter the date of service o Select Execute a Query or <F2> o Only line items that are related to the date of service will appear, including charges, payments and adjustments no matter when the entry date occurred

19 o Transactions type o Select Enter a Query, or <F1> to clear screen o While cursor is in T column, enter C, P or A o Select Execute a Query or <F2> o Only line items that are related to specific type will appear o The user can use a combination of the search criteria as well. For example, to view a specific doctor, for only on type of charge the user can: o Select Enter a Query, or <F1> to clear screen o Place cursor in the Procedure column, enter a code o Tab, Enter or select the column PfDoc, enter a doctor code o Select Execute a Query or <F2> o Payment Detail for specific charge line Click on the blue selector button to the left of a charge to see the screen below. It will show a quick reference guide of the payments and adjustments tied to that specific charge. It will also show the history of the ANSI codes posted with that charge if recorded. o Insurance Claim Status When a charge line item is highlighted the information at the lower left corner provides a snapshot of the insurance claim status.

20 Loc - indicates the location of service rendered Status - indicates the status of the claim: O=Open, C= Closed, D=Demand Denial? - indicates the destination of the claim: Y= Deny this claim and stop secondary filing; S= Deny this claim and file secondary claim; R= refile this claim; N= default value. This will be discussed, in detail, later in this document. Reason for Denial - custom reason code defined by client Ins. Sequence - insurance sequence displays which sequence the charge is at Ins Code - insurance key code File Date - claim file date CPT - CPT code The user can access the Patient Insurance Record by using the and then can further query the Insurance Master Record. LOV buttons to view more information, Select the desired insurance sequence LOV The Patient Insurance Record will launch providing specific subscriber information Select the Company LOV button to launch the Insurance Master Record providing specific carrier information Insurance Rejection Reason

21 When a charge line item with an insurance rejection (an X appears in the Resp column) a user can see the reason by looking in the lower right side of the screen. Clinix Rejection Code and Description, internal number to identify reason and descripion Rejection Date, date rejected The user can see the reason the charge line item rejected. Then go to MM5.5 to correct claim so at the night post Clinix can resubmit the claim to be filed. This process is detailed in the section Insurance Claim Rejections.

22 Transaction Update MM7, query patient, then select the tab <Shft F8> Correcting a Transaction Record Used for transactions that have already been released and posted during the nightly post. If a transaction is still pending in a batch the user can correct this by accessing the batch prior to the nightly post.

23 Step by Step to complete a transaction update Choose the transaction that you wish to update by clicking on it Then select or <F11> from the keyboard The user can update any fields necessary. o The account number can be changed which will move the to another account o Examples of possible updates are: correcting the diagnosis, changing the procedure, adding a modifier, or adding a referring provider. If a carrier requires that a corrected claim be sent and noted, the user will use the drop down arrow for the Freq Code field (boxed above) to show as a replacement. This number will be included in the electronic loop when filing the claim and will be marked on a paper claim. Options include original, replacement, or voids After making the desired change(s), save the transaction using, the Save icon, or <F4> on the keyboard. Note: if a comment has been tagged it will display on this screen as shown above by the arrow. The field name and field description below provides additional information. Field Name Group Account Patient Name Balance Financial Class Field Description Transaction Update This is the group code that is set within the database. Patient account number Patient's full name Account Balance (not including pending transactions) Primary financial class

24 Guarantor Bar Code DX1-DX12 Patient Diagnosis Description Accession Number CRN Ins File Seq File Claim Freq Code Attending Phy Referring Doc Ref Prov Ref NPI Location Admit Discharge To Date Last Seen Acc/Emp? Auto? Other? Assign St 1st Sym/LMP Flag Ty Procedure Guarantor number This is used by some clients if database is set up. These fields are for the diagnosis that needs to be on the insurance claim. Displays the Diagnosis description when cursor is activated in the DX1-12 field This field is utilized by clients if there is an internal lab in the practice in order to enter the accession number, if applicable. Medicare ICN number to be used for secondary filing Insurance Filing Sequence Y if claim was filed Code used if corrected claim is filed electronically. Valid entries: 1- original, 7-corrected, 8-void Attending Physician code and name Referring Doctor code and name This field will automatically default the Referring Doctor s UPIN number if entered on MM1.2 This field will automatically default the Referring Doctor s NPI number if entered on MM1.2. Location code, Location description This field is for the hospital admit date, if applicable. This field is for the hospital discharge date, if applicable. This field is utilized if there are multiple dates included on a claim. This field is for the date last seen, if needed This field is utilized if the reason for a patient s visit is due to an accident or was employer related. This field is utilized if the reason for a patient s visit is due to an automobile accident. This field is utilized if the reason for the patient s visit is due to an accident other than Employer or Automobile. This field will populate whether the practice accepts assignment or does not accept assignment for the insurance company that is attached to a patients account. This flag is set on the Insurance Master record, MM1.4. This field will need to have the state that the automobile accident happened in if the Auto? Field is set to a Y. This field is to be used if the date of the first symptom or the date of the patient s last menstrual period needs to appear on an insurance claim. This field should only be used for maternity claims. If a Y is entered in this field it will trigger the last menstrual period date that is completed in the 1 st Sym/LMP to populate in box 14 on the CMS 1500 paper claim. This field represents the type of transaction that is being posted. The options are C for Charge, P for Payment, or A for Adjustment. This field is where the code of the transaction line item will be entered.

25 MD MD MD Debit/Credit Unit Amount This field is for the 1 st Modifier on a charge line item, if necessary. This field is for the 2 nd Modifier on a charge line item, if necessary. This field is for the 3 rd Modifier on a charge line item, if necessary. This field will automatically populate according to what type of transaction is being posted. The options are D for Debit, charges will be a debit, or, C for Credit, payments and adjustments will be a credit unless the transaction being posted is a refund. If the code is pertaining to a refund this column will then populate a D for debit. This field is for the dollar amount of the transaction that is being posted. Note: For charges, the dollar amount will automatically populate if the fee is attached to the procedure code in MM1.10. Also, this field will automatically populate for a payment if the transaction being posted is a copay and the copay dollar amount is attached to the patient s insurance record. Performing This field is for the Performing doctor. This field will automatically populate the doctor number that was entered in the APhy field. Team Use a Y to flag that this procedure was performed as a Team ExtDoc Quantity IT Test Code Ercode D1 D2 D3 D4 DOS Time POS Physician Extender provider number if Team flagged This field can be utilized if the transaction line needs to be multiplied. This field represents the Insurance Type that is attached to the insurance record in MM1.4. This reflects the patient s primary insurance. If an Explode Code is used, it will populate here. Emergency Room code This field is to rank the diagnosis code that needs to appear first on an insurance claim. This field is to rank the diagnosis code that needs to appear second on an insurance claim. This field is to rank the diagnosis code that needs to appear third on an insurance claim. This field is to rank the diagnosis code that needs to appear fourth on an insurance claim. This is the Date of Service for the transaction line item. Note: This field will automatically populate if the Default Date of Service was entered on the Batch Control screen. Time of Service This field is for the Place of Service

26 TOS Amount Proc Des IT D. OPS NDC Code NDC qty NDC U.M. Anes Time Begin End Mins Phy St Emer Ans Type Type of Service This field will populate the dollar amount for the transaction line item being posted. Procedure description Insurance Type Description This field stands for Other Payor Source. This is used for Ohio Medicaid when it is secondary to any carrier other than Medicare. The code that is entered in this field will print in Block 10D of the CMS-1500 form. The payor source code can be found in the Ohio Medicaid Manual. This field is utilized if the procedure code is a J code for an injection. NDC quantity NDC unit of measure Enter begin time (HH:MM), AM or PM (A/P) Enter end time (HH:MM), AM or PM (A/P). Calculated based on times entered. Physical Status, use LOV to determine the physical status of the patient. Enter Y if related to an emergent procedure. Optional, additional information use LOV button Basic Auto populated to display the units allowed per procedure code. Age Calculated patient age. Position Optional, additional information use LOV button. Time Units Optional, additional information use LOV button. PhyStat Units Amount allowed based on Physical Status entered. Other Optional, enter a range between 00 to 99

27 Upon saving the changes to the transaction the user will see a pop-up which showa that two records were applied and saved, this refers to the error correction and the new charge created. If the transaction had payments and/or adjustments attached, the user will see the following pop-up message. To reattach the payment to the new charge line item, select Yes from the pop-up message. The same pop up message will display but this time the two records applied are the payments that were error corrected from the original transaction then saved to the new charge created.

28 The system will automatically do the following actions: Create a batch with the number The original transaction will be marked error corrected and backed off with a minus A new transaction will be created and placed in pending transactions The batch will be released and posted during the nightly run The original claim will close Open a new claim for the charge(s) that have been corrected.

29 Transaction Reversal MM7, query patient, then select the tab <Shft F8> Transactions Made in Error Used for transactions that have already been released and posted during the nightly post. If a transaction is still pending in a batch the user can correct it by accessing the batch prior to the nightly post. Step by Step to complete a transaction reversal: Highlight the transaction to update. Select or <F8> from the keyboard

30 No changes can be made only a reversal. Save the transaction using tab, the Save icon, or <F4> on the keyboard. The field name and field description below provides additional information. Field Name Group Account Name Balance Financial Class DX1-DX12 Attending Phy Referring Doc Ref Prov Ref NPI Location Accession Number CRN Ins File Seq File Claim Field Description Transaction Reversal Group code Patient account number, Patient name Patient's full name Account Balance (not including pending transactions) Primary financial class These fields are for the diagnosis that needs to be on the insurance claim. Attending Physician code and name Referring Doctor code and name This field will automatically default the Referring Doctor s UPIN number if entered on MM1.2 This field will automatically default the Referring Doctor s NPI number if entered on MM1.2. Location code, Location description This field is utilized by clients if there is an internal lab in the practice in order to enter the accession number, if applicable. Medicare ICN number to be used for secondary filing Insurance Filing Sequence Y if claim was filed

31 Freq Code Admit Discharge To Date Last Seen Acc/Emp? Auto? Other? Assign St 1st Sym/LMP Flag Blank Type Procedure Mod1 Mod2 Mod3 Debit/Credit Code used if corrected claim is filed electronically. Valid entries: 1- original, 7-corrected, 8-void This field is for the hospital admit date, if applicable. This field is for the hospital discharge date, if applicable. This field is utilized if there are multiple dates included on a claim. This field is for the date last seen, if needed This field is utilized if the reason for a patient s visit is due to an accident or was employer related. This field is utilized if the reason for a patient s visit is due to an automobile accident. This field is utilized if the reason for the patient s visit is due to an accident other than Employer or Automobile. This field will populate whether the practice accepts assignment or does not accept assignment for the insurance company that is attached to a patients account. This flag is set on the Insurance Master record, MM1.4. This field will need to have the state that the automobile accident happened in if the Auto? Field is set to a Y. This field is to be used if the date of the first symptom or the date of the patient s last menstrual period needs to appear on an insurance claim. This field should only be used for maternity claims. If a Y is entered in this field it will trigger the last menstrual period date that is completed in the 1 st Sym/LMP to populate in box 14 on the CMS 1500 paper claim. Cursor displays her upon entry to the form. This field represents the type of transaction that is being posted. The options are C for Charge, P for Payment, or A for Adjustment. This field is where the code of the transaction line item will be entered. This field is for the 1 st Modifier on a charge line item, if necessary. This field is for the 2 nd Modifier on a charge line item, if necessary. This field is for the 3 rd Modifier on a charge line item, if necessary. This field will automatically populate according to what type of transaction is being posted. The options are D for Debit, charges will be a debit, or, C for Credit, payments and adjustments will be a credit unless the transaction being posted is a refund. If the codes is pertaining to a refund this column will then populate a D for debit. Unit Amount This field is for the dollar amount of the transaction that is being posted. Note: For charges, the dollar amount will automatically populate if the fee is attached to the procedure code in MM1.10. Also, this field will automatically populate for a payment if the transaction being posted is a copay and the copay dollar amount is attached to the patient s insurance record.

32 Performing Team ExtDoc Quantity IT Test Code Ercode D1 D2 D3 D4 DOS Time POS TOS Amount Proc Des IT D. OPS NDC Code NDC qty NDC U.M. Beg Time End Time Mins Units Phy St This field is for the Performing doctor. This field will automatically populate the doctor number that was entered in the APhy field. Use a Y to flag that this procedure was performed as a Team Physician Extender provider number if Team flagged This field can be utilized if the transaction line needs to be multiplied. This field represents the Insurance Type that is attached to the insurance record in MM1.4. This reflects the patient s primary insurance. If an Explode Code is used, it will populate here. Emergency Room code This field is to rank the diagnosis code that needs to appear first on an insurance claim. This field is to rank the diagnosis code that needs to appear second on an insurance claim. This field is to rank the diagnosis code that needs to appear third on an insurance claim. This field is to rank the diagnosis code that needs to appear fourth on an insurance claim. This is the Date of Service for the transaction line item. Note: This field will automatically populate if the Default Date of Service was entered on the Batch Control screen. Time of Service This field is for the Place of Service Type of Service This field will populate the dollar amount for the transaction line item being posted. Procedure description Insurance Type Description This field stands for Other Payor Source. This is used for Ohio Medicaid when it is secondary to any carrier other than Medicare. The code that is entered in this field will print in Block 10D of the CMS-1500 form. The payor source code can be found in the Ohio Medicaid Manual. This field is utilized if the procedure code is a J code for an injection. NDC quantity NDC unit of measure Enter begin time (HH:MM), AM or PM (A/P). Enter end time (HH:MM), AM or PM (A/P). Calculated based on times entered. Amount allowed based on Physical Status entered Physical Status, use LOV to determine the physical status of the patient.

33 Emer Units Type Basic POS Enter Y if related to an emergent procedure. The amount of units used for the transaction Optional, additional information use LOV button. Auto populated to display the units allowed per procedure code. Place of Service If there are any unallocated payments or adjustments on the account the user will see the following pop-up message. To allocate the payment or adjustment to the new charge line item, select Yes from the pop-up message. The Payment/Adjustment Allocation screen will launch, follow the step by step instructions below to reallocate the transactions below.

34 Step by Step to Allocate a Payment or Adjustment The Group Code, Batch Number, Account number will display along with the Unallocated Amt and Balance. Unallocated Payments/Adjustment Block This block will display any unallocated payments and/or adjustments that are posted to the patient s account but are not attached to a charge line item. All Charge Items Block This block will display any open charges that are on the patient s account. Note: The charges will be listed with the most current DOS to the oldest DOS. Highlight the payment or adjustment line item that needs to be allocated and either click on the tab or use the <F8> function key. At this time the user will see an asterisk * displayed in the St column indicating this is the line item that the user will allocate. Also the dollar amount of the payment or adjustment will be displayed in the Unalloc.Amt field and the cursor will default to the Alct Amt field in the All Charge Items block. The payment and/or adjustment can be applied to any charge line item that the user prefers to allocate it to. Note: Once the payment and/or adjustment have been reallocated, the user will then Save. After the allocation has been completed, the Item Bal on the line item will decrease by the amount of the payment or adjustment that was allocated and that payment or adjustment will no longer be displayed in the Unallocated Payments/Adjustments block. If there are multiple unallocated payments or adjustments, the process can be repeated to allocate each line item. If the user does not want to allocate all of the payments or adjustments, when exiting out of the screen a pop up will appear that states Are you sure you want to exit without reallocating?

35 The user may opt to continue to allocate payments by selecting No or exit by selecting Yes. The system will automatically do the following actions: Create a batch with the number The original transaction will be marked error corrected The batch will be released and posted during the nightly run Demand a Claim, EOB, and Statement MM7, query patient, then select the tab, select the tab <Shft F7> Claims The following field name and field description below provides additional information. Field Name Field Description Request Insurance Claims/EOBS

36 Format Group Group Name Account Patient Name Doctor Doctor Name Ins Co Ins Co Name Begin Date End Date Printer Copies Ins Seq# For This Patient: INS Co1 INS Co2 INS C03 This field has several options that a user can select by clicking on the down arrow. The options are: o 1- Form CMS-1500 This option will print a paper claim o 2- Form IDPA This option will print a Illinois Medicaid 2360 form. o 3- Form UB-04 This option will print a facility UB04 claims. o 4- Form C-4 This option will print a New York workers comp claim form. o 5 Form MI BCBS This option will print a special Blue Cross Blue Shield form for Michigan. o 6 Form IL 2210 This option will print an Illinois Medicaid DME form. o 7 Form IL 1443 This option will print an Illinois Medicaid Podiatry form. o 8 Form CMS-1500 Old This option will print a paper claim the format previous to ICD- 10 o E Demand EOB This option will print a demand Computer Generated Admittance Advice. This is the database group number that is stored on MM1.8. This will automatically populate This is the patient s account number. This will automatically populate This field is for the doctor that performed the service. Can either enter a valid Doctor or leave it blank for ALL doctors. This field will automatically populate the doctor s name according to the doctor that was entered in the Doctor field. This field is for the insurance company key code. Can leave it blank for Primary Ins, put C for Courtesy claim, or enter a valid INS Co. This field will automatically populate the insurance company name according to the insurance key code that was entered in the Ins Co field. This field is for the beginning date of the claim. This field is for the ending date of the claim. This field is for the selection of the printer where the CMS-1500 forms are loaded. This field is for the number of CMS-1500 paper claims that need to be printed. This field is for the sequence number if the claim is for insurance other than the primary. These 3 fields will automatically populate according to the insurance records that are attached to the patient s account. This will automatically populate the patient s primary insurance key code and Insurance Type (IT). This will automatically populate the patient s secondary insurance key code and Insurance Type (IT). This will automatically populate the patient s tertiary insurance key code and Insurance Type (IT). Step by Step to print a demand insurance claim: Click on the Demand Insurance tab or use <Shift F7> on the keyboard. This will advance a user to the Request Insurance Claim/EOBS screen. In the Format field, the default will be 1-Form CMS Leave as defaulted to CMS Select either the <tab> or <enter> key. Group - will automatically populate the database group code, if it is defaulted on MM1.1. Group Name - will automatically populate. Account number - will automatically populate. Doctor As shown in the help message a user can enter a valid doctor number, or leave the field blank for ALL doctors. INS Co field shown in the help message that a user can leave this field blank for the Primary Insurance, enter a C for Courtesy claim, or put a valid INS Co key code to be selected from the fields on the right of the screen titled INS Co1, INS Co 2, INS Co 3.

37 Begin Date shown in the help message a user can enter the beginning date, or use <Enter> to default to the date of 01/01/91. End Date shown in the help message a user can enter an Ending date, or use <Enter> to default to the current system date. Printer The user will choose the printer from the drop down with the CMS-1500 forms loaded. Copies A user can print multiple copies, if needed. Ins Seq# - A user can enter the Ins Seq number in this field depending on which insurance company the CMS-1500 is needed. This field will override the INS Co field. Once all of the above information has been completed, the user will click on the tab or use the <F8> function key from the keyboard. EOB s Step by Step to print a demand EOB: Click on the Demand Insurance tab or use <Shift F7> on the keyboard. This will advance the user to the Request Insurance Claim/EOBS screen. In the Format field, the default will be 1-Form CMS Change the field to E-Demand EOB. Select either the <tab> or <enter> key. Group field will automatically populate the database group code if it is defaulted on MM1.1. Group Name field will automatically populate. Account number field will automatically populate. Doctor field As shown in the help message, a user can enter a valid doctor number, or leave the field blank for ALL doctors. INS Co field As shown in the help message a user can leave this field blank for the Primary Insurance or put a valid INS Co key code to be selected from the fields on the right of the screen titled INS Co1, INS Co 2, INS Co 3.

38 Begin Date As shown in the help message, a user can enter the beginning date or use <Enter> to default to the date of 01/01/91. End Date As shown in the help message, a user can enter an Ending date or use <Enter> to default to the current system date. Printer The user will choose which printer to use from the dropdown or can leave set to view and print from the PDF. Copies A user can print multiple copies, if needed. Ins Seq# - A user can enter the Ins Seq number in this field depending on which insurance company the EOB needs to be printed. This field will override the INS Co field. Once all of the above information has been completed, the user will click on the tab or use the <F8> function key from the keyboard. The computer generated EOB breaks the patient information away from a bulk remittance received for multiple patients. There is no need to go to the filing cabinet to find the paper EOB and blacking out the extra PHI for other patients to send a copy to the secondary insurance. To ensure all carriers will generate this efficient computer generated EOB MM1.4 must be flagged as Y for EOB.

39 Statements MM7, query patient, then select the tab, select the tab Step by Step to print a patient statement: Click on the or use <F6> on the keyboard. This will advance a user to the Request a Patient Statement screen. Group field will automatically populate the database group code if it is defaulted on MM1.1. Group Name field will automatically populate. Account number field will automatically populate. Guarantor field will automatically populate. Printer/View The user will choose, from the drop down, which printer to use. Number of Copies A user can print multiple copies, if needed. Beginning Date of Service enter the beginning date. Ending Date of Service enter an ending date, or use <Enter> to default to the current system date. Transaction Type Choose C=Charges, P=Payments, A=Adjustments or leave blank for all. Once all of the above information has been completed, the user will click on the tab or use the <F8> function key from the keyboard.

40 When a user generates a patient statement, as above, it will not look like the one that is mailed to the patient from Letter Logic. The statement message is boxed in red above. This is a good feature to use when a patient requests a statement of all payments made to the practice for a range of time. A demand statement will not reset the computer generated statement cycle.

41 Detailed Account Information Report MM7, query patient, select the tab, select the tab Step by step to run a Detailed Account Information report On parameters pop-up window o Choose printer using the down arrow button or leave on VIEW o Select radio button for Guarantor or For Account o Type select C for charges, P for payments or A for adjustments or leave blank for all transactions o Error Corrections?- enter a Y to display error corrections o Copies- select number of copies to print o Date Range- Select radio button for by Service date or Entry Date o From and To- enter dates to display specific range or leave blank for all o Select OK for report to print

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43 Detailed Transaction Display Screen MM7, query patient, select the wish to view select the tab, then with your cursor on the transaction you tab. Use Detail Transaction Display tab or <F12>. This screen is for display only. The following field name and field description below provides additional information. Field Name Batch Account Patient Name Group FC Dept Accession Ticket Bar Code Balance Allowed Field Description Detailed Transaction Display This is the batch that has been opened to post transactions in. Patient account number Patient's full name This is the group code that is set within the database. Primary financial class This field is for the department of where the transaction occurred This field is utilized by clients if there is an internal lab in the practice in order to enter the accession number, if applicable. This field is not used at this time. This field is used if a bar code system is in place. Account Balance (not including pending transactions) Amount the Insurance will allow for code

44 Co Insurance Deductible Co-pay Withhold ICD DX1-DX12 Admit Discharge To Date Acc/Emp Auto Other? Assign ST Amount the patient is responsible for co-insurance Amount of the patient deductible Amount of the patient copay Amount the Insurance will withhold These fields are for the diagnosis that needs to be on the insurance claim. This field is for the hospital admit date, if applicable. This field is for the hospital discharge date, if applicable. This field is utilized if there are multiple dates included on a claim. This field is utilized if the reason for a patient s visit is due to an accident or was employer related. This field is utilized if the reason for a patient s visit is due to an automobile accident. This field is utilized if the reason for the patient s visit is due to an accident other than Employer or Automobile. This field will populate whether the practice accepts assignment or does not accept assignment for the insurance company that is attached to a patients account. This flag is set on the Insurance Master record, MM1.4. This field will need to have the state that the automobile accident happened in if the Auto? Field is set to a Y. 1st Sym/Lmp Flag Freq Code This field is to be used if the date of the first symptom or the date of the patient s last menstrual period needs to appear on an insurance claim. This field should only be used for maternity claims. If a Y is entered in this field it will trigger the last menstrual period date that is completed in the 1 st Sym/LMP to populate in box 14 on the CMS 1500 paper claim. Code used if corrected claim is filed electronically. Attending Location Type Procedure MD1 MD2 MD3 The Attending Doctor number and Name. The location where services were rendered. This field represents the type of transaction that is being posted. The options are C for Charge, P for Payment, or A for Adjustment. This field the code of the transaction line and description. This field is for the 1 st Modifier on a charge line item, if necessary. This field is for the 2 nd Modifier on a charge line item, if necessary. This field is for the 3 rd Modifier on a charge line item, if necessary.

45 D/C Unit Amt Performing Team ExtDoc Quantity IT D1 D2 D3 D4 D.O.S. POS TOS Code Amount Ref Doc Ref NPI Ref Last Seen NDC Ins Seq Post Date File Date Deposit Date Hospital Lab Procedure This field will automatically populate according to what type of transaction is being posted. The options are D for Debit, charges will be a debit, or, C for Credit, payments and adjustments will be a credit unless the transaction being posted is a refund. If the code is pertaining to a refund this column will then populate a D for debit. This field is for the dollar amount of the transaction that is being posted. Note: For charges, the dollar amount will automatically populate if the fee is attached to the procedure code in MM1.10. Also, this field will automatically populate for a payment if the transaction being posted is a copay and the copay dollar amount is attached to the patient s insurance record. This field is for the Performing doctor. This field will automatically populate the doctor number that was entered in the APhy field. Use a Y to flag that this procedure was performed as a Team Physician Extender provider number if Team flagged This field can be utilized if the transaction line needs to be multiplied. This field represents the Insurance Type code and description that is attached to the insurance record in MM1.4. This reflects the patient s primary insurance. This field is to rank the diagnosis code that needs to appear first on an insurance claim. This field is to rank the diagnosis code that needs to appear second on an insurance claim. This field is to rank the diagnosis code that needs to appear third on an insurance claim. This field is to rank the diagnosis code that needs to appear fourth on an insurance claim. This is the Date of Service for the transaction line item. Note: This field will automatically populate if the Default Date of Service was entered on the Batch Control screen. This field is for the Place of Service Type of Service This field will populate the dollar amount for the transaction line item being posted. This field is for a Referring Doctor code and name if one is needed on the claim. This field will automatically default the Referring Doctor s NPI number if entered on MM1.2. This field is for the date last seen, if needed This field is utilized if the procedure code is a J code for an injection. Insurance Sequence number Date transaction posted in system Date claim filed Date of the Deposit (date on batch control screen) Custom field not used at this time. Y or N if related to a lab procedure

46 Ops Test Code EDI Name Network CRN Clinix Rejection Code and Description RC desc Rej Date Orig User Orig. Screen Updated User Updated Screen Chk Date Check Ref. # Bank Batch ID Lock Box Begin Time End Time Minutes Units Units Phy St Type Emergency Basic Position This field stands for Other Payor Source. This is used for Ohio Medicaid when it is secondary to any carrier other than Medicare. The code that is entered in this field will print in Block 10D of the CMS-1500 form. The payor source code can be found in the Ohio Medicaid Manual. Explode Code Internal use Network code for managed care Medicare ICN number to be used for secondary filing Insurance Claim Rejection Code (from the upfront scrubber) and Description Insurance Claim Rejection Code Description Date of the Insurance Claim Rejection Original User posting transaction Original screen used to post transaction User Id for updated transaction Screen used for update Date of the payment or the date of the deposit. Check Reference number entered Bank Batch id for identification Lock Box used for deposit Begin time (HH:MM), AM or PM (A/P). End time (HH:MM), AM or PM (A/P). Calculated based on times entered. The physical status of the patient. Optional, additional information use LOV button Y if related to an emergent procedure. Auto populated to display the units allowed per procedure code. Optional, additional information.

47 Viewing Error Corrections MM7, query patient Error corrections that have been created throughout the day can be viewed by selecting tab. Error corrections that have moved to the detail can be viewed by selecting the tab. o Error corrections are hidden by default o Use the tab to include in the list or <Ctrl O>

48 Insurance Claims Maintenance Screen MM7, query patient, select the tab or <F10> tab, then select the This screen can be used in the event that a claim must be refiled manually. During the nightly run, the system will pick up and file any charge lines that are set for close and refile primary (CR), close and bill the patient (CY), close and bill the secondary (CS). Step by Step to manually Close and Refile a claim Status - change from O to C to close all the lines on the claim Denied? - choose the next destination, (can use tab Ctr b- User Documentation) o Y= Deny this claim and stop the secondary filing o S= Deny this claim and file the secondary claim o R= Refile this claim o N= default entry Reason - optional can set a reason for internal use for informational purpose only Save using the save icon from the taskbar or <F4> on the keyboard.

49 The following field name and field description below provides additional information. Field Name Status Denied? Ins Seq Reason Account Doc Ins Code EMC Claim Amount From Date To Date File Date Closed Date Closed By Claim # Lab A Field Description Insurance Claims Maint (Open & Close) Status of Claim: O= Open, C=Closed, D=Demand Destination of the Claim: Y= Deny this claim and stop secondary filing; S= Deny this claim and file secondary claim; R= refile this claim; N= default value Insurance Sequence number Insurance Claim Denial Code Reason Patient account number Performing Provider Insurance Key The method the claim filed: E=Electronic Medicare, C=Electronic Medicaid, B=Electronic BCBS, N=Electronic Emdeon, Blank= paper Amount of the claim Beginning date of service Ending date of service Date claim was filed Date claim was closed User that closed claim Internal system claim number Y or N if lab procedure Y or N if the claim Accepts Assignment

50 Insurance Claims Rejections MM 5.5 Clinix will put all charges through an up-front scrubber or pre-edit prior to submitting the claim to the carrier. This feature performs a check of 48+ data elements that are necessary for a claim to be paid. These rejections MUST BE WORKED or they will not file to the carrier.

51 A sample of the rejection codes is shown in the above screen shot. To populate the screen use the Execute Query icon or <F2> from the keyboard. There are three (3) options that a user can select from. Show All Clinix Claim Rejections This will be the default radio button. When this option is selected, the user will execute the query and all claim rejections will be displayed. Show Only Rejections With a Zero Line Item Balance When this radio button is selected only rejections that have a zero balance will be displayed. Show Only Rejections With a Line Item Balance When this radio button is selected only rejections that have a balance will be displayed. Use the appropriate LOV button at the top of each column to access the account, doctor table, location, or procedure table. The following are a few examples: If the rejection is related to a missing provider number, use the Doctor LOV button to access the Doctor table to insert the missing number and be sure to save. If the rejection is related to insurance effective dates, use the Account LOV button to access the patient account screen, then use <F8> to see the Patient Insurance record, correct dates and save. The query within a query feature can be used on this screen to work rejections by type, if desired. The system will automatically sweep this screen during the nightly run for any updates. The claim will be sent back through the scrubber to ensure that all data elements are clean before submitting the claim to the carrier. Rejections will print on the ndc3991 report that is included in the standard daily reports. Please see below field name and field descriptions for further information.