The Claims Page provides a comprehensive list of all claims contributing to insights and analytics across various reports. This page is designed to explore the details of individual claims.
Claims List
The main list of claims presents an organized table, offering key details about each claim, such as:
Date of Service: The date when services were rendered.
Patient Account #: A unique identifier for each patient’s account.
Billing & Rendering Providers: The medical professionals who billed for and delivered the services.
Mapped Payer: The insurance provider responsible for reimbursing the claim.
Line Items: Each individual service or item billed in the claim.
This table helps users quickly browse through claims, with options to filter and sort based on their needs. Additionally, users can view provider credentials, specialties, patient information, and more for each claim.
Claim Detail View
Clicking on a claim from the list opens the detail view, which allows users to explore the specifics of the claim. Here's what each section provides:
Patient Name: The full name of the patient.
Patient Account #: The unique identifier for the patient’s account.
Charged Amount: The total amount billed for all services in this claim.
Allowed Amount: The total amount allowed by the payer for payment.
Transactions: The number of transactions associated with the claim, useful for tracking multiple interactions or adjustments.
Line Item
Each claim is broken down by line item detailing:
Code: The procedure or service code.
Modifier: Any modifiers that adjust how the procedure is interpreted or billed.
Payment Issue: The payment status (e.g., Paid, Denied). Denied services are highlighted in red, while paid services are shown in green.
Service Date: The date the service was performed.
Adjustment Codes: Codes representing adjustments made by the payer.
Remark Codes: Additional codes providing explanations for adjustments or denials.
Units: The quantity of the service or procedure.
Charged: The amount billed for the service.
Allowed: The amount the payer approved for payment.
Payer Adjustment: The amount reduced or adjusted by the payer.
Payer Paid: The actual amount paid by the payer.
Patient Responsibility: The portion of the charge that the patient is responsible for.
Claim Detail View Sidebar
The Claim Detail View is divided into several sections displayed in the left-hand sidebar, which allows users to access specific information about a claim:
Overview
Patient Account #: The unique identifier for the patient’s account.
Date of Service: The date the service was rendered.
Patient Name and DOB: The patient’s full name and date of birth.
Mapped Payer: The insurance payer associated with the claim.
Subscriber ID: The subscriber’s insurance ID.
COB (Coordination of Benefits): Indicates the primary or secondary status of the payer.
Adjustment Codes: Lists any adjustments applied to the claim, with an option to view descriptions.
Remark Codes: Additional explanations regarding payments, if any.
Category: Categorizes the issue (e.g., Coding, Patient Responsibility, Reimbursement).
Payer
Insurance Product: The type of insurance product associated with the claim.
Class of Contract: The contract type for the insurance provider.
Mapped Payer: Details of the payer responsible for the claim.
COB: Indicates whether the payer is primary or secondary.
Claim
Date of Service: The specific date the service was provided.
Days from Service Date: The number of days elapsed since the service date.
Patient Account #: The internal reference number for the patient’s account.
Payer Claim ID: The payer’s reference number for this claim.
Total Charge: The total amount charged for the services.
Check # and Check Date: Check information for any payments made.
Prior Auth #: The authorization number, if applicable.
Latest Transaction: The latest transaction date and status.
Remit Transactions: Links to the list of remit transactions related to the claim.
Patient
Patient Name and DOB: The full name and date of birth of the patient.
Patient Address: The patient's address.
Subscriber Information: Name, ID, and DOB of the subscriber (insurance holder).
Subscriber Group: Insurance group details for the subscriber.
Provider
Rendering Provider: The name of the provider who performed the service.
Rendering Credential: The credential of the provider (e.g., MD, NP).
Rendering NPI: The National Provider Identifier for the provider.
Tax ID: The provider's tax ID number.
Place of Service: The location where services were rendered (e.g., office, hospital).
Service Location: The specific address where the services were provided.
Activity/Transactions
Transaction history: This offers a chronological view or can be filtered by specific transaction types, making it easy to track the claim’s progress and any changes that occurred during the claims process.
Timeline: Tracks the claim's lifecycle, including when it was filed, processed, and any remittances received.