No. | Control Name | Type | Description |
1 | Your Claim ID | text field | Claim number.Default value: empty if it is set in Settings that user enters Claim ID manually, otherwise is a value in format [Provider ID]-[ID Prefix]-[auto-generated value]. |
2 | Payer Claim ID | text field | Claim number from the payer.Default value: empty.The field is not editable. |
| Visit Info |
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3 | Start Date | date picker | Visit start date.Default value: today.The latest saved Start Date will be preselected by default in new requests and e-claims. |
4 | End Date | date picker | Visit end date.Default value: unchecked.End Date must be greater than or equal to Start Date. If User sets Start Date > End Date, then End Date adjusts to Start Date automatically. |
5 | Set today as patient visit date | link label | On clicking the link label Start Date switches to today's date. |
6 | Visit Type | drop-down list | Patient visit type.Default value: 1 - No bed + No emergency room. Possible values: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 - National screening;8 - New visa screening;9 - Renewal visa screening;12 - Home;13 - Assisted living facility;14 - Mobile unit;41 - Ambulance - land;42 - Ambulance - air or water.The latest saved Visit Type will be preselected by default in new requests and e-claims. |
7 | Visit Start Type | drop-down list | Patient visit start type.Default value: empty. Possible values: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. |
8 | Visit End Type | drop-down list | Patient visit end type.Default value: empty. Possible values:1 - Discharged with approval;2 - Discharged against advice;3 - Discharged absent without leave;4 - Discharged transfer to acute care;5 - Deceased;6 - Not discharged;7 - Discharged transfer to non-acute care. |
| Diagnoses |
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9 | Type | drop-down list | Diagnosis type.Default value: empty. Possible values: Principal, Secondary, Admitting. A claim may have:- the principal diagnosis only;- the principal diagnosis and from one to several secondary / admitting diagnoses. |
10 | ICD9 Diagnosis | text field | Diagnosis from ICD9 code set.Default value: empty. Format: code: description. User can type it manually (e.g. a code) and press Enter key or they can select it from the list which opens by pressing […] button. |
11 | Selected Diagnoses | grid | All diagnoses added to a claim. The grid contains the following columns:- Type, shows value selected from Type drop-down list;- Code, shows value set in ICD9 Diagnosis field. |
12 | Add this diagnosis to your favourites | link label | The link label appears when ICD9 Diagnosis is set and this diagnosis is not in Favourites list yet. On clicking the link the diagnosis adds to Favourites list and link disappears. |
13 | Search for your favourite diagnosis | link label | On clicking the link label Your Favourite Diagnoses form opens where all diagnoses once added to favourites are listed. If user selects any of them and clicks on Select button, the form closes and the diagnosis appears in ICD9 Diagnosis field. |
14 | Add new diagnosis (Ctrl + N) | link label | On clicking the link label (or pressing Ctrl + N) an empty row adds to the Selected Diagnoses grid. |
15 | Remove this diagnosis (Ctrl + D) | link label | On clicking the link label (or pressing Ctrl + D) the highlighted row removes from the Selected Diagnoses grid. |