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Claim Processing with Override (UB-04)

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Add claims and services from UB-04 billing forms to an open batch. The Claim Processing with Override (UB-04) form also provides users with override capabilities (as defined in User Definition/User Role Definition) and the ability to resolve pending claims and approve denied services.

Prerequisites:

  • A batch must be created in the Batch Creation form.
  • Claims must have an open status.
  1. Go to: myAvatar MSO > Claims Processing > Claim Processing with Override (UB-04).
  2. For Select Batch, search for and select the batch by name or ID.

Claim Basics

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

Medical Record

  1. Select the Type of Bill.
  2. The Federal Tax ID# field displays the provider's tax ID (Provider Registration form), and can be edited.
  3. 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.
  4. For Covered Days, enter the number of days covered by the benefit plan.
  5. For Non-Covered Days, enter the number of days that are not covered by the benefit plan.
  6. Enter the Admission Date.
  7. Enter the Admission Time.
  8. Enter the Admission Type.
  9. Enter the Admission Source.
  10. For Discharge Hour, enter the time of discharge.
  11. For Status, select the claim status.
  12. Enter the Medical Record Number.

Charges

  1. The Current Charges Entered field displays the total claim dollar amount.
  2. 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.
  3. For Patient Paid Amount, enter the amount paid by the patient.
  4. The Total Expected Disbursement is the total expected disbursement for all services under the claim, using their current claims processing expected disbursement calculations.

Diagnoses

  1. Enter the Principal Diagnosis.
  2. In the Diagnosis fields, enter additional diagnoses as appropriate.
  3. Enter the Attending Physician name, and select.

Patient's Reason For Visit

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

External Cause of Injury

  1. In the External Cause Of Injury fields, enter the cause, and select.
  2. For Present on Admission Indicator, select the presence of the injury at time of admission.
  1. For DRG (2300-HI), select the diagnosis-related group.

Principal Procedure Information

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

Other Procedure Information

  1. In the Other Procedure Code fields, enter additional procedure codes.
  2. In the Other Procedure Date fields, enter the corresponding dates.

Occurrence Span Information

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

Value Information

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

Condition Information

  1. For Condition Code(s) (2300-HI), select the associated conditions.
  2. Enter the Patient Account Number.
  3. Select Submit.
► Additional Section
► Registry Settings
► SQL Tables
  • SYSTEM.batch_claim_lvl_core
  • SYSTEM.batch_clm_svc_detail
  • SYSTEM.batch_current_data