Create standalone claim

There are several ways to create a standalone claim.
 

Step 1. Select Claims > New Claim from the menu.
       Electronic Claim form opens. Patient Details tab is active.

Step 2. Fill in available patient data or load patient data using Find Patient field.

       The tab is similar to Patient Details form with some exceptions:

• by default, mandatory fields are Payer ID, Member ID, MRN, Emirates ID;
• there is Self-Pay checkbox to set up a non-insurance claim.

Step 3. Go to Encounter Details tab.

Step 4. Enter the visit details.

• • Encounter type is today by default. Encounter type must be greater than or equal to Encounter type.
    If the user clicks Set today as patient visit date link label, then Start Date switches to today's date.
  • Encounter type is 1 - No bed + No emergency room by default, Encounter start type and Encounter end type are empty. If Encounter type = 3 - Inpatient bed + No emergency room or 4 - Inpatient bed + Emergency room, then Encounter end type and Encounter end become mandatory.
  • Transfer source is disabled by default. It enables and becomes mandatory if the user selects Encounter start type = 3 or 8. If the facility is not in the list of licensed providers, the user can enter '@' followed by the name of the facility.
  • Transfer destination is disabled by default. It enables and becomes mandatory if the user selects Encounter end type = 4 or 7. If the facility is not in the list of licensed providers, the user can enter '@' followed by the name of the facility.
  • Diagnosis type can be Principal, Secondary, Admitting, Reason For Visit. The principal diagnosis is mandatory and can be set only once in a claim. At the same time, a claim may have several Secondary diagnoses.
  • ICD10 diagnosis can be selected from the corresponding search list which opens by clicking […] button. Another option is to enter the value or a part of it manually in the field (e.g. code 098.49) and press Enter key. The data will load automatically.

Learn more

Step 5. Go to Procedure Details tab.

Step 6. Enter activities details.

1. • Type maybe one of the following: CPT, HCPCS, Trade Drug, Dental, Service, APR-DRG.
   • Procedure, or activity, is selected from the list for the corresponding procedure type, 
   • Ordering clinician, Performing clinician – from the list of clinician licenses by clicking on […] button (or entering the value manually in the field and press Enter key).
   • Unit gross price, Patient share, Unit net price are set manually. Unit Gross Price must be equal to Unit Patient Share + Unit Net Price. The procedure may have zero prices. However, at least one procedure must have Unit net price > 0. Trade drug must always have a price.
   • Quantity can be decimal in the range of 0.0001- 999.9999.
   • VAT percent may be numeric in the range of 0-100%. Then VAT Amount, always disabled, calculates as Unit Net Price x VAT Percent / 100.
   • Selected procedures grid shows a summary of all procedures added to the claim.
   • Totals line shows Total Gross amount, Total Patient Share, Total Net amount values for all procedures.

Learn more

Step 7. Click Save.
       An information dialog appears informing that the claim is saved in the database.

Step 8. Click OK.
       Electronic Claim form closes. The claim is saved.

ALTERNATIVE WORKFLOWS

Create a claim from Find Patient form

1. Select Patients > Find Patients from the menu. 
   Patient Search form opens.
2. Set search value and click Search. 
   The search results grid appears.
3. Set focus on any record and click Add Claim. 
   Electronic Claim form opens. Patient Details tab is active and the patient data is already filled in.
4. Go to Encounter Details tab and fill the data.
5. Go to Procedure Details tab and fill the data.
6. Click Save. 
   An information dialog appears informing that the claim is saved in the database.
7. Click OK.
   Electronic Claim form closes. The claim is saved.

Create a claim from Find & Submit E-Claims form

1. Select Claims > Find Claims from the menu. 
   Find Claims form opens.
2. Click Add. 
   Electronic Claim form opens. Patient Details tab is active.
3. On Patient Details tab fill patient data.
4. Go to Encounter Details tab and fill the data.
5. Go to Procedure Details tab and fill the data.
6. Click Save. 
   An information dialog appears informing that the claim is saved in the database.
7. Click OK.
   Electronic Claim form closes. The claim is saved.