View/Editing Claims

View/Edit Claims

The View/Edit Claims page allows users to view and modify data in individual claims. This page appears whenever the View Claims button is selected.

For example, while reviewing claims under Pending Approvals, Rejected Claims, or Claim Reminders within the Manage Claims section, clicking the View Claims button will display the individual claims associated with that category.

Navigating Claims

To efficiently review a list of claims, such as rejected claims, use the Next (right) and Previous (left) arrows on the View/Edit Claims page. Clicking these arrows will load the next or previous claim in the list for review.

Additionally, the Return to Claim List arrow  navigates back to the claim list from which the claim was accessed.

On the Claim List page, users can begin sorting and filtering claims based on the available data columns.

Click the arrow located in the column header to sort the list in ascending or descending order.

Resizing Columns

Users can adjust column widths on any grid, including the Claim List. To resize a column:

1. Hover over the edge of the column header until the pointer changes to a double arrow.
2. Left-click and drag left or right to adjust the column width.

Approve Transmit

After saving a claim, it can be approved for transmission by administrative users or by users who have been granted this privilege under the Manage Users page.

Once you have finished editing and reviewing the claim, follow these steps:

1. Click the
2. A "Claim Valid" pop-up will display. Click the Approve Transmit Now link. If there are no errors, this action will transmit the claim.
3. Check the Manage Claims page for any possible errors.

Archiving a Claim

• Archiving a claim removes it from the Manage Claims menu while preserving access to historical data for reference or auditing purposes. Use the  at the bottom left of the claim form to archive a claim.
• Claims can also be archived in bulk from a claim list by selecting "Archive" from the Selected Actions drop-down menu.

Show History / Notes

Also, notice the  button at the bottom right of the claim.

Clicking this button will display the full history of changes and notes related to a claim. This includes the entire claim cycle, such as submission, archive, edits, re-submission, and more. It also provides visibility into any notes added to the claim.

Adding Notes

• To add notes, enter the information in the **Add Notes** field at the bottom of the page and click the Add Note/Reminder button.

• After adding a note, make sure to click the  button at the top of the page to save your changes.

Show History / Notes

The Show History / Notes tool is extremely useful for investigating where a claim was rejected. A claim can be rejected at the following levels:

• Claim.MD
• Payer’s Trading Partner
• Payer Directly

After the rejection date, the tool identifies which of these entities caused the rejection and provides details on the specific event responsible.

Viewing ERA from the Show History / Notes

1. Click the Show History / Notes button.
2. Click the EFT/Check# or Full ERA link to view the ERA.

Adding a Reminder

To add a reminder along with a note:

• Click the Add Reminder dropdown in the bottom right of the Show History / Notes box.
• Select the time period for the reminder to appear in the Manage Claims section.
• Click the Add Note/Reminder button.
• Selecting Now will immediately add the reminder to the Manage Claims list, while options like 1 week will schedule the reminder accordingly.

Clearing Reminders from Manage Claims Page

1. Go to the Manage Claims page.
2. Locate the claim and click the  button.
3. Click the Clear My [Reminder Date] Reminder button to remove the reminder.

Institutional Claims

For institutional claims, facility information must be entered on the claim form. At the bottom of the Billing Provider section (Box 1), there is a link labeled "Show Facility Name/Address." Click this link to reveal a field where the facility’s name and address can be entered. This ensures accurate reporting of the location where services were rendered.

Adding Diagnosis Code and Date of Service

1. In Box 21, review or edit the diagnosis code(s). If multiple codes are needed, enter them here.
2. In Box 24, add the Date of Service (type the date in ##/##/#### format or use the calendar feature). Also, enter the Procedure Code, Diagnosis Reference, and Units.
3. Click the  button at the top of the page when finished.

Adding Additional Charges

If a second service line is needed, click the Add Charge button to add a second line.

Deleting Charges

• To delete a service line, first remove the From Date for the line to be deleted.
• With the cursor in that field, press the TAB key to move to the next field, then press the DEL key to delete the information.
• Repeat this process for each field in the line.
• Once all fields in the line are blank, saving the claim will remove the entire line.

Additional Narrative

The Additional Narrative field is used for unspecified procedure and National Drug Code (NDC) classifications, allowing users to manually enter descriptions. This is useful for including details such as drug names and measurements when specific codes are unavailable. For example, users can describe a surgical tray containing five cotton swabs and two needles, ensuring accurate documentation.

Attachments

Note: Not all payers or their trading partners allow attachments.

View the list of payers that currently accept attachments: Payers That Allow Attachments

Once a claim is created or uploaded to a payer that accepts attachments, an Attach Documents link will be available at the top of the claim form in Claim.MD.

1. Click the Attach Documents link.
   
2. Click Select A File and choose a file from your local drive.
   
3. Close the Attach Document window.
4. The link will now indicate the number of attached documents.
   
5. Ensure you select the appropriate Attachment Type.

Other Actions

The Other Actions dropdown provides options related to the claim, including:

• Manage Appeals
• Manage Templates
• Check Eligibility

Manage Appeals

Selecting Manage Appeals will open a window with appeal form options and the ability to attach:

• The 1500 Claim Form
• ERA (Electronic Remittance Advice)
• Claim History
• Additional files using the Select Files... button

Once all options and attachments are selected, click Add Note/Reminder to proceed.

Submitting an Appeal

• Select the payer’s specific appeal form or a general claim appeal form from the dropdown.
• Review the information in the form. Fields highlighted in red indicate required information that must be entered.
• Additional documents, such as a paper version of the original claim or ERA, can be attached if those options were selected.
• Click Continue once all required information and attachments have been reviewed.

Appeal Submission Methods

Choose Your Submission Method:

1. Send Electronic Appeal: If the payer accepts electronic appeals, a Send Electronic Appeal option will appear along with a field for the Payer Claim # (ICN). If this option is not available, the payer does not accept electronic appeals.
   Enter the payer claim # and click Send Electronic Appeal.
   
2. Send 1st Class USPS: Claim.MD will print and send the claim information via 1st Class USPS to the payer.
   Please Note

   Additional fees may apply for this service. See pricing details here: Claim.MD Pricing.
   1. Select the default payer address from the dropdown or enter the address manually in the Mail TO field.
   2. Click Send Mail when completed.
   3. 
3. Send Fax: Enter the fax number and click Send Faxto send the appeal via Claim.MD.
   Please Note

   Additional fees may apply for this service. See pricing details here: Claim.MD Pricing.
   1. An Appeal Status window will display the Fax To number, attempts made, and the status (sent, failed, or aborted).
   2. The faxed appeal can be reviewed by clicking the View button.
   3. 
4. Manual Appeal: This method allows users to download the appeal packet and send it manually.
   Click Manual Appeal to download the PDF, print it, or email it to the payer.
   

Manage Templates

Templates can be created within the View / Edit screen to save time when entering repetitive provider data.

Creating a Claim Template

1. Click the button on the Manage Claims page.
   
2. Enter the data you want saved in the template. (Common fields include Box 33 - Billing Provider Tax ID and other provider details.)
3. Click the  button at the top of the form.
4. Select Manage Templates from the **Other Actions** dropdown. This will open the Template Manager window.
   
5. Enter a name for the template and click Create New Template. The template will be saved in the Claim Template list, making it available in the **Claim Template** dropdown when creating new claims.

Steps for Using a Claim Template

1. Click the button on the Manage Claims page.
2. Select the desired template from the Claim Template dropdown.
   
3. Enter the Patient Name and Service Date. If the patient has a previous claim, their information will be copied over automatically.
   
4. Click Create Claim.
   
5. All template data will populate in the new claim. Review and edit as necessary before submitting.

Check Eligibility

Eligibility can be checked from the View/Edit Claim page. Selecting this action will auto-populate the **Provider, Payer, and Patient Information** fields, eliminating the need to manually enter details.

Steps to Check Eligibility

1. From the Other Actions dropdown, select Check Eligibility.
2. The Eligibility Page will appear with auto-filled Provider, Payer, and Patient Information.
3. Click Check Eligibility. Eligibility details will appear on the right side of the screen.

Sending Claims by Fax or Mail

To Send a Claim by Fax

1. Verify that the payer accepts faxed claims, obtain their fax number, and modify the Payer ID to FAX01.
2. Enter the payer’s fax number in the Address 2 field.
   
3. Optional: When the Payer ID is set to FAX01 or PAPER, an Attach Documents link will appear for adding additional documents.
   
4. Click the Printer icon  on the top-right.
5. Select Print Claim With Form from the Claim Form dropdown.
6. Click Create PDF.
   
7. The PDF claim form will generate, ready for printing and faxing.

Faxing Claims: Page Limit & Guidelines

The maximum page limit per fax transmission is 30 pages. Follow these guidelines to ensure efficient claim submission:

• Page Limit: Claims should not exceed 30 pages per transmission.
  • For claims with six or fewer procedures, the total faxed pages should not exceed 28.
• Each claim submission includes two pages (front and back).
• Claims with more than six procedures may require extra pages.

To Send a Claim by Mail

1. If the payer accepts paper claims, set the Payer ID to PAPER.
   
2. If the claim was uploaded, the mailing address will match the uploaded file.
3. If the claim was manually entered enter the payer’s mailing address.
4. Click the Printer icon  at the top-right.
5. Select Print Claim With Form from the Claim Form dropdown.
6. Click Create PDF.
   
7. The PDF claim form will generate, ready for printing and mailing.

Get Help

Creating a Support Ticket

On the View/Edit Claim page, a  button is located at the top of the screen.

Clicking this button generates a support ticket, which will be displayed on the right side of the screen. This feature streamlines the support process by linking the ticket directly to the current claim, eliminating the need to manually search for claim details.

Submitting a Support Request

• In the blank field under Describe your issue, enter the details of the problem.
• Click Submit Support Request Submit Support Request to send the request to the support team.
• A ticket number will be assigned, and support will respond both:
  • Within the internal ticket system of that claim.
  • Via email (sent to the address listed in My Information under settings).

Tracking & Responding to Support Tickets

• To view open tickets, go to Support Tickets on the left-hand navigation menu.
• A list of active tickets will be displayed. Click on a ticket to view messages from support and reply in the green response field.
• Return to the View/Edit Claim screen. If a new response is received, a **red cross with an arrow** will appear pointing to the **Get Help** button.
• Click the Get Help button to view and reply to the ticket from this screen.