Import claims

To import claims, please follow the below steps,

Step 1. Select Claims > Import claims from the application menu.
A windows 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.

Step 2. Select the excel sheet you would like to import and then press Open.

SUCCESS: If 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) into the database along with the total value of all claims imported.

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.

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.

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.

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.

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.

Template

Use the following template to fill in claims:

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: If the patient is claiming insurance from an Insurer not included in the list of valid licenses - '@' followed by the name of the Insurer; If the patient is a resident of the Emirate of Abu Dhabi and is paying directly for services provided - SelfPay; If the patient is a resident of the Emirate of Abu Dhabi and neither claims insurance nor pays directly for services provided - ProFormaPayer; If the patient is not a resident of the Emirate of Abu Dhabi and is paying directly for services provided -MedicalTourismSelfPay; If the patient is not a resident of the Emirate of Abu Dhabi and neither claims insurance nor pays directly for services provided - MedicalTourismOther.
	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: 000-0000-0000000-0 - National without card; 111-1111-1111111-1 - Expatriate resident without a card; 222-2222-2222222-2 - Non-national, non-expat resident without a card; 999-9999-9999999-9 - Unknown status, without a card.
	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 2 = No bed + Emergency room 3 = Inpatient bed + No emergency room 4 = Inpatient bed + Emergency room 5 = Daycase bed + No emergency room 6 = Daycase bed + Emergency room 7 = Nationals screening 8 = New visa screening 9 = Renewal visa screening 12 = Home 13 = Assisted living facility 15 = Mobile unit 41 = Ambulance - land 42 = Ambulance - air or water
	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. For Elective patients, this will typically be the date and time of the visit registration/admission on arrival of the patient at the healthcare facility. For Emergency patients, this will typically be the date and time of the registration and admission on arrival of the patient at the healthcare facility. For Transfer patients between facilities (i.e. inter-hospital transfers), this will typically be the date and time of the visit registration and admission on arrival of the patient at the receiving healthcare facility. For Livebirth this will typically be the date and time of the registration and admission of the newborn at the healthcare facility. The Encounter start will also be the date and time of birth. For Stillbirth this will typically be the date and time of the registration of the stillborn at the healthcare facility. The Encounter start will also be the date and time of stillbirth. For Death on arrival, this will typically be the date and time of the visit registration on arrival of the patient at the healthcare facility for pronouncement.	dd/mm/yyyy hh:mm
	Encounter End	No	The time the patient ceases to be under the direct care of a responsible clinician. For inpatients and day patients this would be the discharge date and time. For emergency patients this would be the time that the patient was released from the ER.	dd/mm/yyyy hh:mm
	Encounter Start Type	No	The type which defines how the encounter started.	1 = Elective 2 = Emergency 3 = Transfer admission from acute care 4 = Live birth 5 = Still birth 6 = Dead on arrival 7 = Continuing encounter 8 = Transfer admission from non-acute care
	Encounter End Type	No	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	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 Identifies the principal diagnosis for the condition established after examination, the nature of a disease or illness. Secondary All conditions that co-exist at the time of admission, or develop subsequently, which affect the treatment received and/or the length of stay. Admitting The diagnosis that the physician identifies at the time of admission. Reason For Visit	Principal Secondary Admitting ReasonForVisit
	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 Year of Onset
	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 4 = HCPCS 5 = Trade Drug 6 = Dental 8 = Service Code 9 = DRG
	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