There is a possibility to import claims to the Greenrain Facility database instead of manual entering. Greenrain Facility validates an input Excel file and inserts claims into the database pending upload (Status = Ready for Submission).
To import claims, please follow the below steps,
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Step 0. Prepare Excel file with claims for import. The expected format is provided below.
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Step 1. Select Claims > Import claims from the application menu.
A windows The file explorer box opens, allowing you to choose the excel sheet containing the claims you would like to import. The claims excel sheet has to be of a specified format and can be manually created or often it can also be a data/excel sheet downloaded and modified to the required format from the hospital EMR.
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Step 2. Select the excel sheet you would like to import and then press Opennecessary Excel file and click Open.
Either Success or Validation Failed dialog appears.
SUCCESS: If the The parsing is successful, then click Yes on the following prompt that asks you to confirm that you would like to import the claims you seek to import. Once imported the next prompt would show you a summary of all total number of claims imported (not submitted) .
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Step 3a. Click Yes.
Once the claims are imported, the information dialog appears showing the total number of the claims imported into the database along with the total value of all claims imported.
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FAILED: (excel sheet contains errors or is not according to specified format), if so, please click Yes on the prompt that appears and the dialogue box will show you the errors encountered while parsing your excel sheet. Kindly fix them and try importing again.
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Step 3. Select Claims > Find claims to search for the claims you have just uploaded based on applying specific filters on the screen. You will note that the claims are in 'Ready for submission' status.
Step 4. Review the claims that you have to if needed and proceed to select all claims that you would like to upload using the checkboxes as shown and click Generate button.
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Step 4. When the integrated claims submission box appears, click Upload. You will note that this upload screen clubs all your selected claims into 1 file, prepares them for upload to a payor, denotes the total claimed value of all claims you are about to upload, indicates patient share and also shows you how many claims are embedded into this upload. The below image is only for TEST purposes and no actual claims have been uploaded.
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SUCCESS: Upload was successful with no errors found. Furthermore, the status of claims changes to ‘Submitted to payor’ and the claims upload can also be verified within Greenrain Messenger. Click OK to proceed.
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FAILED: (Claims upload has failed), if so, please click Yes on the prompt to proceed followed by clicking Show errors link to display the errors. In our case, it is a simulated date mismatch issue, but nevertheless, please fix the errors with the claims and try again for another upload.
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Net of these claims.
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Step 4a. Select Claims > Find Claims from the menu.
Find Claims form opens.
Step 5a. Set a search value to find just imported claims and click Search.
The search results grid appears. The imported claims have Status = Ready for Submission.
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FAILED: The Excel sheet contains validation errors or has an inappropriate format.
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Step 3b. Click Yes.
Validation Report dialog appears showing the description of all errors found.
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You need to resolve the errors according to their location and try uploading again.
Template
Use the following template to fill in claims:
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The table below describes each column in the expected Excel file.
Worksheet | Column | Mandatory | Description | Possible Values |
|---|---|---|---|---|
Claims | Sender ID | No | The license number of a healthcare entity that is the sender of the transaction. The column is ignored until multiple facilities support in Greenrain Facility. | https://www.haad.ae/shafafiya > Dictionary > Licenses > Facilities |
Receiver ID | Yes | The license number of a healthcare entity that is the receiver of the transaction. | https://www.haad.ae/shafafiya > Dictionary > Licenses > Insurers | |
Claim ID | Yes | 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. Greenrain Facility uses Claim ID value from the Excel file instead of generating it automatically specified in Settings. | ||
Member ID | Yes | The patient’s insurance member number, if the patient is claiming insurance. Otherwise, it equals to Facility ID#Patient ID. | ||
Payer ID | Yes | If the patient is claiming insurance cover, this is the Insurer's license number. | https://www.haad.ae/shafafiya > Dictionary > Licenses > Insurers Other values:
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Provider ID | No | The facility license number of the healthcare provider claiming from the payer. Greenrain Facility uses the Healthcare Provider License linked to the license key. The column is ignored until multiple facilities support in Greenrain Facility. | https://www.haad.ae/shafafiya > Dictionary > Licenses > Facilities | |
Emirates ID Number | Yes | The unique number the government assigns to a citizen. | NNN-NNNN-NNNNNNN-N When Emirates ID is not available:
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Encounter Type | Yes | 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 | Yes | The unique number a healthcare provider assigns to a patient. This is often known as the medical record number. | ||
Encounter Start | Yes | The date and time at which the patient comes under the care of a responsible clinician.
| dd/mm/yyyy hh:mm | |
Encounter End | No | The time the patient ceases to be under the direct care of a responsible clinician.
| dd/mm/yyyy hh:mm | |
Encounter Start Type | No | The type which defines how the encounter started. | 1 = Elective | |
Encounter End Type | No | The type which defines how the patient was discharged. | 1 = Discharged with approval | |
Transfer Source | No | The license number of a healthcare facility from where a hospital transfer originated (Encounter Start Type = 3 Transfer). If the facility is not in the list of licensed providers, it equals to '@' followed by the name of the facility. | ||
Transfer Destination | No | The license number of a healthcare facility to which a hospital transfer is made at the end of an encounter (Encounter End Type = 4 Transfer). If the facility is not in the list of licensed providers, it equals to '@' followed by the name of the facility. | ||
Package Name | No | The name of the insurance package. | https://www.haad.ae/shafafiya > Dictionary > Codes > Benefit Packages | |
Diagnoses | Claim ID | Yes | Reference to Claim ID on Claims worksheet | |
Diagnosis Type | Yes | The type of diagnosis being recorded.
| Principal | |
Diagnosis Code | Yes | The value for the diagnosis code as per the coding manual. | ICD10-CM | |
Dx Info Type | No | The type of additional information for the diagnosis. | POA | |
Dx Info Code | No | The code value related to the DxInfoType. | Y, N, U, W or 1 | |
Activities | Claim ID | Yes | Reference to Claim ID on Claims worksheet | |
Activity Start | Yes | 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 | Yes | The type of activity/procedure. | 3 = CPT | |
Activity Code | Yes | An activity code, specified by its type for the activity performed. | ||
Quantity | Yes | The number of units for an activity. | NNN.DDDD | |
Net | Yes | The net charges billed by the provider to the payer for an activity. | ||
Patient Share | No | Any fee that payer is expecting the provider to collect from the patient. | ||
Ordering Clinician | Yes | The license number of the clinician who ordered the service or referred the patient for the service. | https://www.haad.ae/shafafiya > Dictionary > Licenses > Clinicians | |
Clinician | Yes | 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.haad.ae/shafafiya > Dictionary > Licenses > Clinicians | |
Prior Authorization ID | No | The corresponding prior authorization number. | ||
VAT | No | The Value Added Tax amount appropriated for the activity. If the value in the Excel file is empty, it is set to 0. | number, two decimals | |
VAT Percent | No | The Value Added Tax rate. If the value in the Excel file is empty, it is set to 0. | [0...100], one decimal |