Generate Claim
The Generate Claim option enables you to generate a paper or electronic claim for the selected transaction(s) from the RCM Ledger. The charge(s) must be eligible for claims processing in order for a claim to be generated. If the charge currently has a billed date associated to it, use the Rebill option to remove the bill date, then Generate Claim. Only charges out to Insurance can have claims generated for them from this option.
To generate a claim from the RCM Ledger
Select the charge or charges you wish to include on the claim from the RCM Ledger. Use Click + ctrl to select multiple charges.
Right-click and select Generate Claim. The Generate Individual Claim dialogGenerate Individual Claim dialog appears.
All charges that are currently the responsibility of any of the patient's insurance carriers and not already marked as Billed will populate the Available Charges area.
Under Output Options, you can filter the charges shown by:
- Selecting one of these options: PrimaryPrimary
or Other
PayorOther
Payor, or All.
Shows only charges that have been transferred to the Secondary or Tertiary Insurance.
Shows only charges that are the responsibility of the Primary Insurance.
Selecting a specific payor from the Charges for Payor drop down menu. Only charges assigned to that payor will be shown.
Selecting Document Needed to show only charges that have been marked as Document Needed.
Select a specific facility from the list of all facilities for the business entity to filter the available charges to show only those for the facility selected.
- Selecting one of these options: PrimaryPrimary
or Other
PayorOther
Payor, or All.
- Under Output Options, select Paper to generate a paper claim form or EMC to generate an electronic claim. Settings in the Insurance Carrier dictionary in the Administration module determine which type of paper form or EMC module is to be used.
- When you generate claims using the following steps, all charges now shown (after filtering options were applied in step 4) in Available Charges will be included. To select specific charges for billing from this list, highlight them. Use Click + ctrl to select multiples.
- Click the Preview button
from the Sheet Bar to put the charges through the AmkaiOffice “scrubbing”
process to check for any errors that must be corrected before the
selected charges can be billed. The system will provide a report on
the next screen
that appearsnext screen
that appears.
- The charges shown in the Billed charges section at the top of this screen are ready to be billed. You can select Go > Back from the Sheet Bar to return to the Generate Individual Claim dialog and then proceed to step 9 below to bill these charges.
- Any charges impacted by Error Messages on the bottom part of the screen will not be billed until the errors are corrected. Correct any errors shown in the Error Messages section of this screen by navigating to the screens where the corrections need to be made. The error message will typically include the screen on which the correction should be made. Then repeat steps 1 - 7 to prepare these charges for billing.
- Once back on the Generate Individual Claim dialog, you can generate
claims for the charges now shown in Available Charges by selecting
Bill from the Sheet Bar: The
Billed ChargesBilled Charges
screen appears.
To print paper claims:
- Click Paper from the Sheet Bar. The Printing ScreenPrinting Screen
appears. The Papers section of this screen lists the statements
that were generated (one per patient). Click herehere to learn
about the fields in the list of statements.
Date: Displays the date and time that will be used for the bill date if charges are marked as Billed
Module Name: Displays the EMC dictionary item that could have been used for the claim
Form Kind: Displays the type of form that the claim will be printed on
Charges: Displays the total number of charges that will appear on the printed claim
Print Status: Displays False when the claim has yet to be printed, and True when the claim has been printed
- Select from these
fieldsthese
fields on the Printing screen to choose
the form type and other printing options.
Form Type: Select the form to print one form type at a time: HCFA 1500 or UB04. Select the form type and then click Print, then select the other form type and click Print.
Select All: Highlights all displayed charges, so you can print all of them (only the highlighted charges will print)
Select None: Highlights none of the displayed charges. You can then highlight individual charges from the list to print.
Show Printed: When checked, claims that have already been printed will still be displayed, when unchecked, only claims that have not been printed will be displayed
Use Background Form: When checked, will print the background of the claim form (for use if printing on plain white paper to display the background of the claim form). This printout is not intended to be used for processing claims and should not be mailed to a payor for reimbursement.
- Click Print. Select
the parameters for your print job from the print dialog and
click OK. A confirmation
messageconfirmation
message appears asking if you want to
mark the charges as billed.
- Select one of the following options:
- Click Yes to mark the charges as Billed.
- Click No. The charges will not be marked Billed. You will need to repeat this process to generate and print claims at a later time.
- Click Paper from the Sheet Bar. The Printing ScreenPrinting Screen
appears. The Papers section of this screen lists the statements
that were generated (one per patient). Click herehere to learn
about the fields in the list of statements.
To file electronic claims:
Click EMC from the Sheet Bar. The EMC Output screenEMC Output screen appears. This screen lists all the claims that were generated. Click herehere to learn about the fields in the list of claims.
- Date: Displays the current date and time that will be used for the bill date if charges are marked as Billed
- Module Name: Displays the EMC dictionary item that could have been used for the claim
- Form Kind: Displays the type of form that the claim will be printed on
- Claims: Displays the total number of claims that are present in each electronic file
- Output File: Displays the location of the electronic claim file created
Select one of the following options:
- Click Yes to mark the charges as Billed. You will then need to submit the file to the clearing house for payment.
- Click No. The charges will not be marked Billed. You will need to repeat this process to generate claims at a later time.