Claim Grouping

The "Claim Grouping" feature is can be used to create customized views and report filters. This is particularly useful for generating reports related to Electronic Remittance Advice (ERA) payments that include both paid and unpaid claims.

On this page, groupings by specific criteria can be configured as per an organization's needs. For instance, claims can be grouped based on a specific Rendering Provider NPI (National Provider Identifier).

The following are examples of how to create groups. In this case it is demonstrating how to create PAID and UNPAID ERA Groups.

To create a group for paid ERA:

1. Enter PAID in Group Name field.
2. Click the Add button next to the New Group Name field. 
3. Select the Matching Claim Value type (Errors & Messages)
4. Enter *PAID $*in the blank field next to Errors & Messages. 
   1. The information will be automatically saved when clicking anywhere on the screen.

To create a group for unpaid ERA:

1. Enter UNPAID in Group Name field.
2. Click the Add  button next to the New Group name Field. 
3. Select Errors & Messages the Matching Claim Value type in the dropdown.
4. Enter !*PAID $*in the blank field next to Errors & Messages dropdown.
   1. The ! character next to *PAID* tells the system to exclusively retrieve ERA that are not paid. 

Grouping Logic

Consider the following guidelines to understand how grouping logic functions in Claim.MD:

More than one item with the same key is an OR. 

• In other words, if you have multiple items with the same key (e.g. payerid), it's like saying the match must be "either one or the other" of the key's value – that's an "OR." 

More than one item with a different key is an AND.

• In other words, if your items have different keys, it's like saying the match must be equivalent to "exactly" that key's value – that's an "AND."

so as an example:

• payerid = 60064
• payerid = 87726
• bill_npi = 1234567890

translates to:

(payerid ='60054' OR payerid='87726') AND bill_npi=1234567890)

This means the Billing NPI's value must match the single value provided, as well as the payer ID must be one or the other of the two values provided.