Create claim from prior request

If the payer has approved the request, the user can save it as a claim. Conversion is possible only if:

• the request type is Authorization;
• the request status is Approved;
• Payment Amount > 0 for at least one requested activity.
  
  

CONVERSION RULES

Patient Details tab (request) to Patient Details tab (claim)

All data from Patient Details tab of a prior request copies to Patient Details tab of a claim.

Request Details tab (request) to Patient Visit tab (claim)

1. Request Visit Type is copied to Visit Type.
2. Request Visit Start, Visit End is copied to Start Date, End Date respectively.
3. Request Diagnosis Type and ICD10 Diagnosis are copied to Diagnosis Type and ICD10 Diagnosis respectively.
4. Visit Start Type and Visit End Type are empty (new fields).
   
   

Procedure Details tab (request) to Procedure Details tab (claim)

1. Claim gets only those activities that have Payment Amount > 0.
2. Activity data:
   
   • Request Quantity is copied to Quantity;
   • Reply Patient Share / Quantity is copied to Unit Patient Share;
   • Reply Payment Amount / Quantity is copied to Unit Net Price;
   • Unit Gross Price calculates as Unit Net Price + Patient Share;
   • Request Authorization No is copied to Pre-Auth. No;
   • Discount and Copay are left empty (not copied);
   • Deductible is empty (new field);
   • Request Ordering Clinician and Performing Clinician are copied to Ordering Clinician and Performing Clinician respectively;
   • Comments data is copied to Comments data.
3. All controls except Start Date are disabled so the user may not change any data.

Step 1. Click Find Prior Requests button.
       Find Prior Requests form opens.

Step 2. Set a search value, select Request Status = Approved and click Search button.
       The search results grid appears. 

Step 3. Set focus on any record where Type = Authorization and click View button.
       Electronic Prior Request form opens. 

Step 4. Click Add Claim link.
       Electronic Claim form opens. All data from the prior request is copied to the claim according to the rules described above. 

Step 5. Click Save button.
       An information dialog appears informing that the claim is saved in the database.

Step 6. Click OK button.
       Electronic Claim form closes. The claim is saved.