Claim Processing (UB-04)

Claim Basics

3. The Claim ID field displays the ID. 
   Note: Claim IDs are automatically assigned to each claim.
4. The Funding Source field displays the funding source associated with the batch.
5. For Member Name Or ID, enter the member name, and select.
6. For Provider, enter the provider name, and select.
7. Select Process Report to generate the Valid Authorizations report, which details authorizations associated with the member.

Medical Record

8. Select the Type of Bill.
9. The Federal Tax ID# field displays the provider's tax ID (Provider Registration form), and can be edited.
10. Select the date(s) of service for Service Entry. Enter the date range using From Date and Through Date. Select the dates.
    Note: This requires enabling the Enable Multiple Service Date Entry registry setting. If the registry setting is not enabled, enter a date range and the services are applied to each day in the range.
11. For Covered Days, enter the number of days covered by the benefit plan.
12. For Non-Covered Days, enter the number of days that are not covered by the benefit plan.
13. Enter the Admission Date.
14. Enter the Admission Time.
15. Enter the Admission Type.
16. Enter the Admission Source.
17. For Discharge Hour, enter the time of discharge.
18. For Status, select the claim status.
19. Enter the Medical Record Number.

Charges

20. The Current Charges Entered field displays the total claim dollar amount.
21. The Total Fee Table Amount field displays the total charge for all services.
    Note: This value is calculated by adding the service fee amount and multiplying by the number of units for each procedure code. If there is no associated amount, 0.00 displays.
22. For Patient Paid Amount, enter the amount paid by the patient.
23. The Total Expected Disbursement is the total expected disbursement for all services under the claim, using their current claims processing expected disbursement calculations.

Diagnoses

24. Enter the Principal Diagnosis.
25. In the Diagnosis fields, enter additional diagnoses as appropriate.
26. Enter the Attending Physician name, and select.

Patient's Reason For Visit

27. For Reason For Visit, enter the reason, and select.

External Cause of Injury

28. In the External Cause Of Injury fields, enter the cause, and select.
29. For Present on Admission Indicator, select the presence of the injury at time of admission.

Diagnosis Related Group (DRG) Information

30. For DRG (2300-HI), select the diagnosis-related group.

Principal Procedure Information

31. For Procedure Code Principal (2300-HI-01-2), search for and select the procedure code.
32. For Procedure Date Principal (2300-HI-01-4), enter the date.

Other Procedure Information

33. In the Other Procedure Code fields, enter additional procedure codes.
34. In the Other Procedure Date fields, enter the corresponding dates.

Occurrence Span Information

35. In the Occurrence Span Code fields, select the occurrence codes that apply.
36. For Occurrence Span From and Through, enter the time period that applies to each occurrence code.

Value Information

37. In the Value Code fields, select the value codes that apply.
38. For Value Amount, enter the amount for each Value Code.

Condition Information

39. For Condition Code(s) (2300-HI), select the associated conditions.
40. Enter the Patient Account Number.
41. Select Submit.

Resources 

► Additional Section

• Service Detail

► Registry Settings

• Add Support For The Input Of Third Party Payer Amounts
• Allow All Procedure Code Types for UB Claim
• Allow Diagnosis Filing In Parent System
• Default Level Of Care From Service Authorization
• Disable Service Adjudication On Change
• Display Duration
• Eligibility Check Warning
• Enable 270/271 Submission on Service Authorization
• Enable 837 Encounter From PM
• Enable Additional Claim Level Fields
• Enable Additional Fields
• Enable Adjudication Rule for Inpatient Service On Date Of Discharge
• Enable Check for Duplicated Services
• Enable Client and Counselor Groups in Service Entry
• Enable Contracting Provider Program
• Enable Eligibility Check
• Enable Group Services
• Enable Multiple Service Date Entry
• Enable Private Pay Amount
• Enable Service Times
• Enable Update/Review Potential Liability Dist. Command Buttons
• Funding Source Service Authorization Count Method
• Include UPIN In Performing Provider Display
• MSO Location Field
• Require Diagnosis Entry
• Restrict Services Available For Addition/Deletion
• Service Fields To Be Retained
• Show Additional Values In The Display Valid Authorizations Display Box

► SQL Tables

• SYSTEM.batch_claim_lvl_core
• SYSTEM.batch_clm_svc_detail
• SYSTEM.batch_current_data