Creating a Claim Manually

To create an insurance claim manually:

In the patient chart or from one of the Financial Functions windows, click the Claims button. The Claims window is displayed.

Click Add New. If there is more than one responsible party for this patient, the Policy Holders window is displayed.

Select the responsible party who is the policy holder for the claim being entered and click OK.

If the responsible party has more than one carrier, the Insurance Plans window is displayed.

Select the carrier you want to make a claim against and click OK. The Add New Claim window is displayed.

If there is a single policy holder and only one carrier, the Add New Claim window is displayed.

Select the type of claim you want to create and click OK. The Adding Claim Form window is displayed.

Use the scroll bar to view the entire form, and use the mouse to click in the fields in which you need to enter information. Many of the fields are automatically populated by the software. Click here to view some fields you might need to fill in, depending on the claim type.

First Visit Date — Type the date of the patient’s first visit.
When entering new claims (Actual, One-Time, and Continuation of Treatment), be sure to enter the First Visit Date in the claim window. If you forget this date, the insurance carrier can reject the claim.
Description of Services — Type the treatment description, using the following buttons:
Click Insert Line to add a line to the Description of Services section.
Click Delete Line to delete a line.
Click Clear Line to remove the text from a line.
Click Add Procedures. The Procedures window is displayed, enabling you to include a procedure code in the Description of Services section. Select a procedure from the list and click OK.
Click Remarks to add comments to an electronic claim. The software stores comment information differently for electronic claims. For actual charge lines in the Description of Service section to be saved for electronic submission, the software stores the lines found with Date, Proc. No, and Fee all in one line.

When the electronic claim is created, the comment lines are stored in a separate area from lines containing the Date, Proc. No. (ADA Code), and Fee. Use the Remarks window to add up to 103 characters of comment information.

Comments are items that the insurance carrier needs in addition to the normal procedure code, date, and fee. These items are not included on the electronic claim if placed in the Description of Services section.
Months Tx. Remaining — Type the number of months left in the patient’s treatment.
This field is often mandatory for a carrier to process Continuation of Treatment claims.

Use the buttons at the bottom of the window to add additional information to the claim:

Click OK.

The Medicaid ID prints in fields 52A and 58 on the ADA 2012 insurance claim form.

Claim Type	Fields to Populate
Pre-Authorization	First Visit Date Description of Services
Actual	First Visit Date Months Tx. Remaining Description of Services
Continuation of Treatment	First Visit Date Months Tx. Remaining
One-Time	First Visit Date Description of Services