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Claims Management


Claims Management is used to filter and manage claims from claim creation to insurance and patient collections. Click on the Filter bar to display the filter options that are shown on the Claim Management Screen below. Select any combination of the following filters and click Apply. Click Clear Filter to clear filter selections.

Patient Name: Enter first and last name or just last name of patient. Facility: Select All or one facility to filter on. Encounter Date: Blank is All encounters or click on the field to select or enter a date range. Claim Creation Date: Blank is all claims or click on the field to select or enter a date range. Claim ID: Blank selects is all claims or enter a claim ID. Encounter number: Blank selects is all encounters or type an encounter ID in the field. Show Only Claims: Checking this box will show only finalized superbill charges, which are claims. If not checked, it will show all encounters, which can be converted to a claim by clicking the Create Claim link for that encounter. Provider: Select All Providers for all providers or an individual provider. Total Charges: Select from the list of conditions of greater than or equal to, less than or equal to or equal to and then enter the total charges amount. This is used to filter charges greater than or less than an entered amount. Total Payments: Select from the list of conditions of greater than or equal to, less than or equal to or equal to and then enter the total payments amount. This is used to filter charges greater than or less than an entered amount. Assigned to: Claims can be assigned to employee using the Assigned to feature. All claims can be filtered by selecting that employee. The default is All. Batch: Claims assigned to a batch can be viewed by selecting the batch name and clicking Apply Category: Claims can be assigned to a Collection Category. This is used to organize claims and track their progress through the collections process. The categories can be customized under Billing Setup. Days in Category: Select from the list of conditions of greater than or equal to, less than or equal to or equal to and then enter the number of days in a category to sort by. This filter is usually used with filtering on a category. Status: Select a status to filter claims by that status. Insurance: Select an insurance company to filter on. The default is All. Patient Balance: Select from the list of conditions of greater than or equal to, less than or equal to or equal to and then enter the patient balance amount. This is used to filter charges greater than or less than an entered amount. Insurance Balance: Select from the list of conditions of greater than or equal to, less than or equal to or equal to and then enter the insurance balance amount. This is used to filter charges greater than or less than an entered amount. Click the Apply button to generate the filtered list of claims. Clear Filter will remove all the filters.

Understanding the Claim Table Encounters that have been opened will display in the Claim Management table, but claims are not created until the Create Claim link is clicked or the claim is created through Add Claim. Encounters that are Finalized on the Superbill will display Encounter Finalized as the encounter status. Claims that are already created will display the link as Edit Claim. The claim table displays the Total charges, Patient Balance, Total Payments, and Insurance Balance. These columns of data can be sorted in ascending and descending order by clicking on the column title. To view details about the claim, click the great than symbol (>) in the left most column next to each row and the details of the claim will display, as shown here:

All the payment and adjustment details and status are shown with dates of the transactions. Update Claim Assignments To assign claims to employees, simply click on the claim to assign, select the employee to assign it to, and click the Update Button. To assign multiple claims, filter the list and check the Select All check box or press and hold the Ctrl Button and click on the each claim to highlight the claims and then assign them. Update Claim Category To assign claims to categories, simply click on the claim to assign, select the category to assign it to, and click the Update Button. To assign multiple claims, filter the list and check the Select All check box or press and hold the Ctrl Button and click on the each claim to highlight the claims and then assign them.

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