- 10 Jul 2024
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Claim Grouping
- Updated on 10 Jul 2024
- 1 Minute to read
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The "Claim Grouping" feature allows you to create customized views and report filters, making it easy to generate reports related to Electronic Remittance Advice (ERA) payments, including both paid and unpaid claims.
On this page, you can configure groupings based on your organization's specific needs. For example, you can group claims by 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:
- Enter PAID in Group Name field.
- Click the button next to the New Group Name field.
- Select the Matching Claim Value type (Errors & Messages)
- Enter *PAID $*in the blank field next to Errors & Messages.
- The information will be automatically saved when clicking anywhere on the screen.
To create a group for unpaid ERA:
- Enter UNPAID in Group Name field.
- Click the button next to the New Group name Field.
- Select Errors & Messages the Matching Claim Value type in the dropdown.
- Enter !*PAID $*in the blank field next to Errors & Messages dropdown.
- 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:
Same Key, Different Values = OR:
- In other words, if you have same key but different values (e.g.,
payerid: 123
andpayerid: 456
), it's like saying the query must be "either one or the other" of the key's value. This is an "OR" condition.
Different Keys = AND:
- If you have different keys with single values (e.g., 'payerid: 123' and 'status: paid'), it's like saying the query must match both conditions at the same time. This is an "AND" condition.
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 (e.g. 1234567890), as well as the payer ID must be one or the other of the two values provided (600054 OR 87726). See image below.