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Claim Follow-up Records widget

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The Claim Follow-Up Records widget displays all claims for the selected guarantor that have a claim follow-up record, but have not yet been flagged for electronic re-billing (i.e. the record does not have a Claim Submission Reason Code selected). This widget only includes records that were submitted via an 837, regardless of how the remittance was received.

The widget's drop-down list allows you to filter by:

  • A specified Guarantor or All.
  • A specified Denial Reason or All.

All Guarantors and Denial Reasons display by default.

The following fields should be shown in the widget:

  • Guarantor
  • Client Name (Last, First)
  • Client ID
    Program
  • Claim #
  • Service Date
  • CPT
  • Denial Reason (Code and Description)

The items should be listed in order by Guarantor, Client Name, Client ID and Program.

To display the Claim Follow-Up form for a selected record, double-click that record in the list.

Widget SQL Statement

This widget contains a filter which cannot be replicated by creating a new widget. However, we are including the SQL for those who want to create a customized Claim Follow-Up Widget without filtering capabilities.

SELECT %NOLOCK claim_follow_up.PATID, claim_follow_up.EPISODE_NUMBER, patient_current_demographics.patient_name, claim_follow_up.GUARANTOR_ID, billing_guar_table.guarantor_name, claim_follow_up.CLAIM_NUMBER, billing_tx_history.date_of_service, claim_follow_up.den_reas_835_code, claim_follow_up.den_reas_835_value_long, billing_tx_history.JOIN_TO_TX_HISTORY, billing_tx_history.SERVICE_CODE, billing_tx_history.duration, billing_tx_history.duration, billing_tx_history.program_code, billing_tx_history.program_value FROM ((((SYSTEM.claim_follow_up claim_follow_up INNER JOIN SYSTEM.claim_follow_up_svcs claim_follow_up_svcs ON (claim_follow_up_svcs.PATID = claim_follow_up.PATID AND claim_follow_up_svcs.DEN_stuff = claim_follow_up.DEN_stuff AND claim_follow_up_svcs.FACILITY = claim_follow_up.FACILITY)) INNER JOIN SYSTEM.billing_tx_history billing_tx_history ON (billing_tx_history.PATID = claim_follow_up_svcs.PATID AND billing_tx_history.JOIN_TO_TX_HISTORY = claim_follow_up_svcs.JOIN_TO_TX_HISTORY AND billing_tx_history.FACILITY = claim_follow_up_svcs.FACILITY)) INNER JOIN SYSTEM.patient_current_demographics patient_current_demographics ON (patient_current_demographics.PATID = claim_follow_up.PATID AND patient_current_demographics.FACILITY = claim_follow_up.FACILITY)) INNER JOIN SYSTEM.billing_guar_table billing_guar_table ON (billing_guar_table.GUARANTOR_ID = claim_follow_up.GUARANTOR_ID AND billing_guar_table.FACILITY = claim_follow_up.FACILITY)) LEFT OUTER JOIN SYSTEM.billing_rebill_tx_assign billing_rebill_tx_assign ON (billing_rebill_tx_assign.PATID = claim_follow_up.PATID AND billing_rebill_tx_assign.CLAIM_NUMBER = claim_follow_up.CLAIM_NUMBER AND billing_rebill_tx_assign.JOIN_TO_TX_HISTORY= claim_follow_up_svcs.JOIN_TO_TX_HISTORY AND billing_rebill_tx_assign.FACILITY = claim_follow_up.FACILITY) WHERE claim_follow_up.FACILITY=? AND billing_rebill_tx_assign.ID IS NULL ORDER BY billing_guar_table.guarantor_name, patient_current_demographics.patient_name, claim_follow_up.PATID, billing_tx_history.program_value

See the Billing Widget Console for more information.