ServiceXG Basics

Save a claim

Save a claim from the Claims Entry or Claims Processing screens.

Go to: Home > Administration Processes> Claims Entry or Processing> Claims Entry or Processing

1. Enter the Header workspace information including the Received Dt, Member, Patient, and Provider. Patient notes, patient alerts, and provider alerts might display. Press Enter to move through the alerts.

2. Enter the Lines information including Diagnosis Codes, Procedure Code, Billed Amount, Quantity, and BCode.

3. The Detail viewport then reflects the information entered in the Lines workspace.

   

4. When you have finished entering the required claim information, click or use Ctrl + S to validate and calculate the claim. If there are any edits to resolve, they display. You can resolve the edits and save again or choose to resolve the edits at a later time.
   • What happens when you Save a claim?

   1. Validation

      Hint: You can validate a claim during processing or entry by clicking Verify at the bottom of the Lines workspace or with the F7 key.
      • Field validation checks to ensure that data is entered into a field correctly. For example a date field validation checks for the MMDDYY format.
      • Other validation includes matching diagnosis codes to the type code, verifying the patient eligibility, etc.
   2. Calculation

      Deductibles, co-payments, maximums, coordination of benefits, and other variables are used along with your system schedule to determine the final allowed amount.

   3. Save
      • Depending on your system settings the Summary viewport or the messages workspace might display for Audits, Referrals,PPA A way to recover a previous overpayment by deducting the amount from a check issued to the same payee until the overpayment is recovered. This reduction has no impact on the benefit of a claim; the impact is on the amount of the check., or Dual COB A provision for determining benefits when a member has more than one benefit plan. messages. You might be prompted for a supplemental claim or an FSA 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..
      • A list of pends that need to be resolved (to get the claim to R—Released status) display in the Edits window with any pend codes and messages.
        • Messages and pends display in the navigator. See 4 Navigator.
      • If the claim is free of edits and audits, it's released to R—Released status, otherwise the claim is set to a held status (HP, HA, etc.).
      • If additional claims are created for Dual COB, split claim A claim will create two payments (one to the member and one to the provider) under certain conditions (e.g. a portion was prepaid, prepaid amount exceeds member's liability, etc.)., Supplemental, or FSA claims, the appropriate messages with claim reference numbers (refnos) display.
        • If one additional claim is created, the appropriate message for the claim type shows, or if it’s an FSA 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. or supplemental claim the claim opens.
5. The following messages could show depending on the claim and your system configuration.
   • The following message displays in the navigator: Please Review the claim and Save to continue.
   • You might receive the following message: This claim has open pends. Please review the claim and save to continue.
   • If there are any unresolved edits, the Edits window opens. You can resolve the edits and save again, or you don't have to resolve the edits at this time.
   • If the claim encounters an audit condition, you might receive the following message: This claim is being audited. Please review the claim and save to continue.
   • If you save a claim with a claimant-level pend and the patient has existing pended claims with the same claimant-level pend, the following message displays in the navigator: Other claims exist with the same claimant level pends. No statement will be generated.
   • If you try to save the claim with no lines, you'll receive the following message: Cannot save a claim with no lines.
   • If you save a claim when referrals have been used, you'll receive the following message: Review applied referral(s).
   • If you save a claim with referrals that are or will be over-applied, you'll receive the following message: Continuing to save will over-apply referral(s).
6. Click . The refno for the saved record displays as the Last Refno in the snapshot.

SEE ALSO