The Claim Creation window is used to enter the details of the claim before sending it to the eClaims ability or printing it out on paper. This window will allow the user to select the correct insurance company and the correct Diagnosis Code System. To access this window, select a charge or multiple charges in the ledger and choose "Create Insurance Claim" from the Print menu.
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Print Statement Checkbox and FormThe Print Statement checkbox in the Claim Creation window allows you to generate both documents at the same time. While most offices choose to print statements in bulk through the Statement Manager, or individually using the Print Menu in the ledger, this option has some convenient features. If your office generates statements at the time of filing the claim, this saves the extra steps used when printing individually. Other offices use this to print a one time statement for a patient using a different statement form, without needing to change any default settings. For example: Your office uses the 4 column statement for regular bills, but you need a statement with code and diagnosis information for the patient's flex spending card. Instead of changing the entire office's preferences from the default 4 column form, you would simply print through this menu. Create Insurance Claim CheckboxThese boxes will be checked by default when you are using the Claim Creation window. However, you may disable them on a one-time basis if you are simply needing to print a statement and generate the patient's Clinical Summary. Export Clinical Summary to the Patient Portal CheckboxThis box is used if your office needs to export summaries for a Medicare Incentive or if you use the Portal and want this information relayed to the patient every time a claim is created. When checked, MacPractice will open a new dialogue box allowing you to choose what details to send. If you are not participating in any program requiring the summaries and your office does not need these, you can disable this feature. Uncheck the "Export Clinical Summary" box; this setting is remembered per computer. Once unchecked, it will remain that way on this computer until changed back. There are several other ways to print or export the Clinical Summary. |
Claim Table
Within the Claim Creation Table, you can make additional adjustments to the claim to insure it is properly generated before it is printed or electronically submitted to the clearinghouse.
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Create Claim CheckboxThese boxes will be checked by default when you are using the Claim Creation window. However, you may disable them on a one-time basis if you are simply needing to print a statement and generate the patient's Clinical Summary. Insurance Carrier and Other InsuranceThis popup shows which insurance company this particular claim is being sent to. When creating a primary claim, this field will pull in the first insurance listed on the Patient tab. If the patient has secondary insurance, it will display in the Other Insurance popup. Once the primary claim has been paid and a new claim is created for the secondary insurance, the order of insurances here will switch. Form/TemplateThis box controls which paper form or eClaim template will be used to generate the claim. You may set up a specific form per insurance company in the Insurance References.
If the Claim Form you're looking for is not available in the list (for example, you are a Dental practice and your ADA 2019 form is not available in the Form list), you can review the Forms available in the References Ability > Forms node. You can activate (or de-activate) Forms to use by checking (or unchecking) the Form Active checkbox. Note that only Forms with a Form Type of "Insurance" will be available options when selecting a Claim Form. Prior AuthIn order to include a prior authorization number on a claim, select the prior authorization number you wish to include on the claim from the Prior Auth pop-up menu. The number of remaining visits will be listed in parenthesis after the authorization number. This information will pull into Box 23 on the CMS Claim Form and Box 2 on the ADA Claim Form. If "None" is your only option, visit our THIS article for more information on creating a new Prior Authorization. Accept Assignment CheckboxesThe Accept column in the claim creation table can be checked or unchecked to add or remove the Accept Assignment indicator on the fly. When the Accept box is checked or unchecked, the status will be mirrored by the 'Accept Assignment' checkbox in the lower-left corner of the claim creation window. Likewise, if you change the status of the checkbox in the lower-left corner of the window, the 'Accept' box in the claim creation table will check or uncheck to reflect that status. For more information visit our "How do I Indicate Accept Assignment in MacPractice?" article. If you are unsure what Accept Assignment means, take a look at our "What is the Purpose of Accept Assignment for Claims?" article. Secondary CheckboxThis box indicates that this is a secondary insurance claim. When the primary payment has been entered or the primary claim has been closed, the secondary claim can be created. MacPractice will change the order of insurances to show the correct insurance as the carrier for this claim and automatically check the secondary checkbox. If this is not a secondary claim, you can manually uncheck it or change the order of the carriers. For more information on creating Secondary Claims, visit our How To article. Diagnosis Code SystemThe diagnosis code system that is used will come from the Insurance Companies Reference > Claims tab. At this point, most carriers use ICD-10; however, if a particular insurance still wants ICD-9 or you use your own custom codes, you could change this on a per carrier basis. If the reference is set to "Use Coding Preference Default", then it will base this information in the MacPractice menu > Preferences > Coding > Billing Diagnosis option You can manually override this per claim by updating the code system in this menu on the Claim Creation Window. If the coding system used on this claim does not match the codes on the charges, MacPractice will indicate that the diagnosis codes are Not Mapped and will require you to select the correct codes prior to creating the claim. For more information, visit our Claim Creation Code Mapping article. Ins. Paid and Pat. PaidThese fields display the amounts of payments applied to the charges. It will always display the credits on the claim creation window, regardless of whether you choose to have the payments display on the claims themselves. This information can show up in Box 29 on the CMS Claim form based on what you have selected in the Insurance Companies Reference > Claims tab. Split ReasonMost offices prefer to have all of the patient's procedures on a single claim being filed. However, claims will sometimes need to be split into multiple claims. How can I tell if my claim is being split? Reasons for Split Claims
Preferences that control Claim Splitting
Resubmission Code and Resubmission ReferenceMacPractice's default claim form does not have this field enabled. However, we have created a new form for offices who need to add a resubmission code/reference in Box 22 of the CMS Claim Form. The form will pull from these two text fields, otherwise it will be left blank. For the new forms, click these links:
The downloaded file should be in an .fgen format, which can only be used by MacPractice. To install the form, simply double click on it, then follow the prompt in MacPractice to import. If no such prompt appears, you can also navigate to the References Ability, select the Forms node, click the Green Plus button in the side to create a new record, and then click the "Import..." button. You'll need to name the Form before importing when doing it this way. You may choose to make this your default form or just use it on a case by case basis. Claim Detail TabThis tab will give a summary of the information selected above in greater detail. The name and address of the insurance company selected above is based on the information within the Insurance Reference. If the patient does not have an Insurance Plan selected in the Primary/Secondary tabs, The insurance company address will pull from the Company Info tab. If there is a plan selected for this patient, the address of the specific plan will pull from the Plan tab > Demographic sub-tab. |
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