Template
Use the following template to fill in claims: (template) Claim.Submission.xlsx
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The table below describes each column in the expected Excel file.
| Worksheet | Column | Description | Possible Values |
|---|---|---|---|
| Claims | Sender ID | The license number (eClaimLink ID) of a healthcare entity that is the sender of the transaction. | https://www.eclaimlink.ae > DHD > Codes and Lists > FacilitiesProviders |
| Receiver ID | The license number (eClaimLink ID) of a healthcare entity that is the receiver of the transaction. | https://www.eclaimlink.ae > DHD > Codes and Lists > Payers | |
| Claim ID | A unique number assigned by a healthcare provider to identify the claim. This is also known as the provider’s claim reference number. If the patient is not insured and pays out of pocket, this is the external invoice reference number. | ||
| ID Payer | A unique number assigned by an insurer to identify the claim. It helps the provider and payer to locate the claim. | ||
| Member ID | The patient’s insurance member number, if the patient is claiming insurance. Otherwise, the field is empty. | ||
| Payer ID | If the patient is claiming insurance cover, this is the Insurer's license number. | https://www.eclaimlink.ae > DHD > Codes and Lists > Payers | |
| Provider ID | The license number (eClaimLink ID) of the provider claiming from the payer. - This can be a facility or a clinician. - Provider ID is sometimes also known as the billing provider. - In general, the facility that hosted the encounter is also the one that claims from the payer. In these cases, Provider ID = Facility ID. | https://www.eclaimlink.ae > DHD > Codes and Lists > Facilities > Providers | |
| Weight | The patient's weight in kilograms. - For DRG purposes, patient weight is mandatory for newborn and neonate encounters. - IR DRG definition of the Neonatal period: Age on admission is 7 days or less. - The newborn/neonatal period is exactly 7 days commencing on the date of birth (day 0) and ending on the completion of day 7. - The birth weight is limited to be between 150 grams and 9000 grams. | ||
| Emirates ID Number | The unique number the government assigns to a citizen. | NNN-NNNN-NNNNNNN-N When Emirates ID is not available:
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| Facility ID | The license number (eClaimLink ID)of the facility responsible for the encounter. | https://www.eclaimlink.ae > DHD > Codes and Lists > Facilities > Providers | |
| Encounter Type | The type of encounter (inpatients, daycases, emergencies and outpatients). They vary according to whether the encounter went past midnight, lasted for more than 24 hours, involved a hospital bed and whether they involved an emergency room. | 1 = No bed + No emergency room | |
| Patient ID | The unique number a healthcare provider assigns to a patient. This is often known as the medical record number. | ||
| Encounter Start | The date and time at which the patient comes under the care of a responsible clinician.
| dd/mm/yyyy hh:mm | |
| Encounter End | The time the patient ceases to be under the direct care of a responsible clinician.
| dd/mm/yyyy hh:mm | |
| Encounter Start Type | The type which defines how the encounter started. | 1 = Elective | |
| Encounter End Type | The type which defines how the patient was discharged. | 1 = Discharged with approval 2 = Discharged against advice 3 = Discharged absent without leave 4 = Discharge transfer to acute care 5 = Deceased 6 = Not discharged 7 = Discharge transfer to non-acute care. | |
| Transfer Source | The license number (eClaimLink ID) of the healthcare facility from where a hospital transfer originated (Encounter Start Type = 3 Transfer). - If the patient has insurance coverage, it is eClaimLink insurance ID. - If the patient is neither insured by a DHA insurance nor paying - SelfPay. | ||
| Transfer Destination | The license number (eClaimLink ID) of the healthcare facility to which a hospital transfer is made at the end of an Encounter (Encounter End Type = 4 Transfer). - If the patient has insurance coverage, it is eClaimLink insurance ID. | ||
| Patient Instructions | Patient instructions for the claim. | ||
| Comments | Comments to the claim. | ||
| Attachment | Required attachment to prove a claim. |
Extension: .pdf, .jpg, .jpeg | |
| Resubmission Type | The type of resubmission of a claim. | correction internal complaint | |
| Resubmission Comment | The comment left by the provider during the resubmission, e.g. explanation of the reason for such action. | ||
| Resubmission Attachment | The required attachment which needs to be added during resubmission to prove a claim. | Extension: pdf | |
| Package Name | The name of the insurance package. | ||
| Diagnoses | Claim ID | Reference to Claim ID on Claims worksheet | |
| Diagnosis Type | The type of diagnosis being recorded.
| Principal | |
| Diagnosis Code | The value for the diagnosis code as per the coding manual. | ICD10-CM | |
| Dx Info Type | The type of additional information for the diagnosis. Present On Admission (POA) indicator it refers to the associated diagnosis code and is defined as present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered as present on admission. The POA Indicator is applied to the principal diagnosis as well as all secondary diagnoses and the external cause of injury codes that are reported. | POA | |
| Dx Info Code | The code value related to the DxInfoType.
| Y = Yes N = No U = Unknown W = Clinically undetermined 1 = Unreported / Not used OP = Outpatient claim | |
| Activities | Claim ID | Reference to Claim ID on Claims worksheet | |
| Activity ID | Unique identifier of activity within a claim. | ||
| Activity Start | The date and time at which an activity started. For a DRG code, it is the date and time of discharge. If the date, but not the time is recorded, the time is assumed to be 00:00. | dd/mm/yyyy hh:mm | |
| Activity Type | The type of activity/procedure. | 3 = CPT | |
| Activity Code | An activity code, specified by its type for the activity performed. | ||
| Quantity | The number of units for an activity. | NNN.DDDD | |
| Net | The net charges billed by the provider to the payer for an activity. | ||
| Patient Share | The amount a patient owes the provider according to the terms of their insurance plan/product. - If the patient has no insurance coverage for the visit, they are considered self-pay and liable for the entire amount, per their signed consent for treatment. | ||
| Clinician | The license number of the clinician responsible for the activity. In general, this is the person providing the treatment or care for the patient. | https://www.eclaimlink.ae > DHD > Codes and Lists > Clinicians | |
| Prior Authorization ID | The corresponding prior authorization number. | ||
| Patient Instructions | Patient instructions for the activity. | ||
| Comments | Comments to the activity. | ||
| Attachment | Required attachment to prove the activity. |
Extension: .pdf, .jpg, .jpeg | |
| Observations | Claim ID | Reference to Claim ID on Claims worksheet | |
| Activity ID | Reference to Activity ID on Activities worksheet | ||
| Observation Type | The type of observation | LOINC Text File Universal Dental Financial Grouping ERX Result ROM (Risk of Mortality) ExcludeFromDRG | |
| Observation Code | The code describing the observation value. | ||
| Observation Value | The observed value of the activity. Restriction: Must be expressed in SI Units. | ||
| Observation Value Type | Unit of measure for the observation value. |
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