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Claims history

The Claims History tab displays a summary of all claims and deleted claims associated to a member and their details.

Note: You'll only see claims your user role is authorized to view. If the claim is from a fund you can't access, it won’t display.

Access claims history

If you're in a Claim session looking at a specific claim and want to see all claims for that individual:

  • From the Patient menu, select Claims History.

OR

  • If you need to find a claim and only have the member or dependent’s information, Search for and open the member or dependent record.

    From the Claims menu, select Claim History.


    Field Column Description

    From Incur Date

    The start date for the service provided.

    Thru Incur Date

    The end date for the service provided.

    Ref No

    The reference number for the claim.

    Status

    The status of the claim. See Claim statuses for descriptions.

    Provider Name

    The billing or service provider's name.

    Note: For HRA claims paid to the member, this field displays the user-defined provider name (see CLM SAC 87 Option 6).

    Billed Amt

    The amount billed for the claim.

    Paid Amt

    The actual benefit amount paid.
    Patient Liability

    Amount the patient owes.

    Bill Provider Tax ID

    The tax ID number for the billing provider or organization that issued the bill for the services listed on the claim.

    Operator

    The operator that entered the claim into the system. HIPAA refers to an electronic claim.

    Plan Type

    The claim benefit plan type (e.g. medical, dental, or vision). The first claim line determines the claim plan type.

    From Action Date

    The last date the claim was updated (either when the operator saved the claim or it when it was updated).

    Group

    The group the claim was processed under.
    Case No. If a claim has a disputed case associated with it, the case number will show here. For more information see Disputed cases.
    Adj. Displays a Green flag if the claim is an adjustment or associated with an adjustment. The original and any reversed, adjusted, or reissued claims are grouped together.
    Linked to Refno The claim number created for the adjusted original claim.
    Linked to Status The status of the linked claim refno. SeeClaim statuses for details.
    Linked From Refno The claim refno of the original claim that was adjusted.
    Linked From Status The status of the linked from claim refno.
    Deleted Claims subtab
    Ref No Refno for the deleted claim.
    Operator

    User ID of the operator who deleted the claim.
    Date Date the claim was deleted.
    Adjusted Claims subtab
    Adj Seq The sequence number of the adjusted claims. The default order is descending.
    Claim Ref#

    The reference number for the claim.
    Status

    The status of the claim. See Claim statuses for descriptions.
    Adjusted From The claim from which the adjusted claim was created.
    Adjusted To The next claim an adjustment was applied to. The most recent adjusted claim won't display anything in this column.
    From Action Date The last date the claim was adjusted (either when the operator saved the claim or it when it was updated).
    Reason Code

    The reason the adjustment was made. These codes are site-specific and can vary depending on need, examples include:

    • O—Operator override.
    • R—Reversion, the claim was reversed.
    • M—Maximum.
    • C—Over Considered.
    • A—Already allowed under a prior pay type.
    Adj Operator The ID of the operator who adjusted the claim.
    Prior Pay Adj The prior payment amount for the associated claim, if applicable.
    Paid Amt The amount paid for the claim.
    • To print or export the data from the table, click gear icon and select the appropriate option. See Common features for more information on printing and exporting data from a table.
    • If you want to see all claims for a member with multiple claims, click Load All at the bottom of the table to view all the member’s associated claims.
    • When you initially open claims history, you might need to move columns to the desired position. Once you move columns, the table layout is saved and displays the next time you open Claims History.
    • Claims initially display in descending Refno order. Any adjusted claims are grouped together with the associated claims (reissue, void, original, adjusted, recalled, etc.). Adjusted claims are marked with a in the Adj column.
    Note: The number of claims that displays depends on your SAC settings. The default is all claims from the past 24 months. Contact your basys representative to set or change SAC (System Administration Control) settings. Don't change SACs without first consulting basys as changing them can affect other functions and global system settings.
    Hint: From the history, right-click and select Open or double-click to select additional options.

To search for claims by specific parameters (procedure, PPO, benefit, schedule codes, or Incur date ranges, etc.), use the Claim History Filter.

  1. Click Filter icon at the top right of the screen to display the Claims History Filter window.

  2. Choose a Type value from the list.
  3. Select a value or click Filter icon in the Code list to select a value from a window. If you chose Incur Date, type or select the date ranges to search.
    • To remove any codes, click the remove delete or remove icon icon or to clear all filters click Clear Filters.
  4. Click Apply. The Type and Code table updates. Continue to select and apply values to filter as needed.

  5. Click Apply to search based on your filter criteria. The results display in the Claims History table and the search filter criteria you chose displays at the bottom for your reference.

  6. Continue adding or removing filter criteria from the filter Filter icon window or click clear filter icon to remove the search criteria.

    Hint: From history right-click and select Open or double-click to view the claim in Claim Information.
  1. Select consecutive rows (select and then use the shift key) or select consecutive or non-consecutive specific rows (use Ctrl and the mouse). You can’t do this on a filtered list.

  2. Right-click and select Open or use Ctrl+O to open a Multiple Claims tab with a View Claim list that contains the claim Refnos you selected.

  3. When you select a claim from the list, the Claim Information tab displays for that claim.

    • If you select a single claim, using the Ctrl+O shortcut acts the same as double-clicking a row and displays the Claim Information tab for that one claim.

      Note: If you don’t have permission to view a fund's data, it won’t display.

From the Claims History tab, view any claims associated to the member that were deleted.

  1. Access claims history.

  2. Click Deleted Claims to display any deleted claim Refnos, the Operator ID who deleted the claim, and the date the claim was deleted.

See the original and adjusted claims in claims history and view the associated claims, in order of the occurrence, based on the adjusted claim in the Adjusted Claims subtab.

  1. Access claims history.

    Claims History showing adjusted claims

    • The associated adjustment claims () display in descending adjustment order.

    • The Linked to and Linked From columns display how the related reference numbers have been assigned and the status for each adjusted claim.

      Hint: Move columns and create views to display the information you want to see. See Views.
  2. Click an adjusted claim to display additional claim information for the claim and associated adjusted claims in a subtab.

  3. Click the Adjusted Claims subtab.

    Claims history adjusted claims subtab

    • The claims associated to the selected adjustment claim show in the order they were created.
    • This information also displays in the adjustment viewport in Claims Information. To open the claim information session, click the claim. See Claim information.

See Recall a released claim to recall a claim from Claims History.

Copy claims or claim information from claim history or create a supplemental, FSA, or duplicate claim

You can copy information for a single row or multiple rows from the Claims History list and paste the copied information into an existing or new Correspondence record, Word, Excel, or other application, or copy claim information to create an FSAClosed Accounts offered and administered by employers that provide a way for employees to set aside, out of their paycheck, pretax dollars to pay for the employee’s share of insurance premiums or medical expenses not covered by the employer’s health plan., Supplemental, or Duplicate claim.

You must have the correct security access to copy claims or claim information.

  1. Use your mouse to select the rows and then right-click to display a menu.

    Note: Copy claim information in a landscape or portrait format depending on where you're pasting the information (e.g. portrait for spreadsheets, landscape for text files).
  2. Select consecutive or non-consecutive specific rows (use Ctrl and the mouse).

  3. When you paste the copied rows, the Claim Refnos are pasted in the same order as they are displayed in the Claims History list.

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