Add an Institutional Claim

Menu Path

Treatment > Treatment History > Add/Edit Claim

Details

• After installation of ProviderConnect version 2.190 and Avatar ProviderConnect 2008 Update 58 in the Avatar system, the Diagnosis Code Upload function within the Avatar PM ProviderConnect System Defaults form must be used to ensure correct and complete Diagnosis Code availability within the ProviderConnect Institutional Service Entry form.
• Beginning with ProviderConnect version 2.191:
  • The Claim/Service Entry workflow (Institutional Claim Entry and Professional Claim Entry forms) replaces the Service Entry/Add Treatment workflow by default. All services originating in both ProviderConnect and Avatar MSO will include (and be associated with) claim-level data.
  • The Tx_HideClaims system configuration item is disabled (set to 'False') by default upon installation of ProviderConnect version 2.191, and the new Claim/Service Entry workflow will be used. To preserve the pre-version 2.191 Service Entry/Add Treatment workflow, enable the Tx_HideClaims system configuration item (set to 'True').
    Setting Tx_HideClaims to 'True' is not recommended without first consulting a Netsmart representative.

Before You Begin

• Verify the Tx_HideClaims system configuration item is set to 'False' (disabled).
• Set the Tx_AllowInstitutionalServices system configuration item to 'True'.

Steps

1. In the Main Menu click Lookup Client.

• The Search Criteria screen displays.

2. Enter the client's name, ID, social security number.

• To display all clients, enter no data, click Search by Criteria.

3. Click Search By Criteria.

• The Search Results screen displays.

4. Click a client ID number.

• The ProviderConnect Demographic screen displays for the client and agency.

5. In the Client Sidebar menu click Treatment.

• The Treatment History screen displays.

6. Above the client's treatment history, click Add Institutional Claim.

• The Add/Edit Claim screen displays.

7. Select the client's funding source.
8. Enter the admission date in the format MM/DD/YY or MM/DD/CCYY. 
9. Enter the admission hour in the format HH:MM AM or PM.
10. Select the admission type.
11. Select the admission source. 
12. Enter the discharge hour in the format HH:MM AM or PM.
13. Type the principal procedure code, click Enter. Click the code from the list. 
14. Enter the principal procedure date in the format HH:MM AM or PM.
15. For the DRG, type the number, click Enter. Click the number from the list. 
16. In the 'Reason for Visit' fields, type the number for the reason, click Enter. Click the reason from the list. 
17. In the 'Diagnosis' fields, type the number, click Enter. Click the diagnosis from the list. 
18. In the 'Value' fields:

• Type the number, click Enter. Click the code from the list. 
• Enter the amount.

19. In the Occurrence fields:

• Click in the field and select the code from the list. 
• Enter the date of the occurrence in the format HH:MM AM or PM.

20. In the 'Occurrence Span' fields: 

• For the code, click in the field and select the code from the list. 
• Enter the beginning and ending dates.

21. In the 'External Cause of Injury' fields, type the number, click Enter. Click the code from the list. 
22. In the 'Other Procedure Code' fields:

• Click in the field and select the code from the list. 
• Enter the date in the format HH:MM AM or PM.

23. Click Add Claim.