Adding Status Information
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Once we double click a request in the request grid or click the 'Start Responses' button a new screen pops up.
The screen to create the response. In this example the Claim Status and Status Codes are filler meant for demonstration.
The above picture shows us how to work with an individual request. The left side which is also a printable image, gives us all the information contained in the request. These example lines were found by preloading the response data by clicking 'Find Responses in DB' in the previous window. The same effect can be had by clicking 'Find Status' in this window and then loading the claim presented:
Loading a claim from DB.
In the above case the patient was the subscriber. Otherwise we would see two tabs in the upper right section, one for the subscriber, one for the dependent.
Dependent information in addition to the subscriber's information
The right side of the screen allows a user to enter manually the claim status codes on the Claim or Line level.
Filling in the Line Level Claim Status for Line 1 of a Claim Status.
The middle part allows us to input the status information on the claim level as well as adjudication dates and payment information. There are two drop down combo boxes that allow you to select a status category and a status on the claim level. Do this only if there is no information for the line level available. Generally you want to put the status information on the service line level.
If there is line information in the request, the lower part of the screen will list this under the "Claim Line Status" grid and allow for the input of the status information at the line level. In our database model we allow for six Status Categories and a Status field for each one per Claim Line as each represents a maximum of two STC EDI segments. The data
The Source tables and the Claim Master tables options handle these differently, as the Source tables have a field for each of these six Claim Statuses
Claim Status Codes and Categories in the ClaimStatus Responder's SourceDetail table.
while the Claim Master tables have only one pair of fields which holds all six possible Status Category / Status pairs.
Claim Status Codes and Categories in the Claim Master's ClaimDetail table.
Once the status information has been added, it can be saved by clicking the 'Save Response' button.
Save button on the top of the Create Response window.