You can enter either a Professional, Institutional or Dental claim. Claim entry requires more transaction code sets and you can access and edit them from those menus as well as setup the component.

The following topics describe settings for the Claim Entry/Edit function:

 

Follow the instructions below to edit or entry claims.

Click one of these menu items to open to the relevant screen.

The left menu in the "Professional Claim" window

Read the detailed descriptions further.

 

Colors for Tabs

Unlike other screens in the HIPAA Claim Master, the window for claim entry has a lot of colors (see Using the Claim Entry/Edit Function). We decided to do this to give a clear distinction between the different groups of information. There are so many screens in this application that it is easily confusing to the data entry person. To develop a sense of intuition of where one is in the process and flow of the program we decided to add colors. You  also have the choice to not use colors for the tabs:

You are free to customize the colors. Click the button with the three dots to the right of each color to display the color selection screen where you can choose the color for a particular segment.

The color palette selection button

The color selection window

 

New Claims

HIPAA Claim Entry lets you predefine the version of the claim that you enter. This choice will influence the screens that you are presented with. Claims you create will be written to the database according to the implementation guide for the version that you choose.

Claim version options

Version in New Claims

Set new claims to the X12 4010 or 5010 standards. A claim loaded into the claim editor will preserve the standard it was saved in originally.

Information in New Claims

Set new claims to use Production or Test data.

 

Save Claims

Before saving a claim to the database, it can be validated against the X12 standard. The compliance engine will warn users of errors that would make the claim fail compliance, such as missing segments, incorrect datatypes, unrecognized qualifiers or excessive characters in a particular field.

Claim compliance validation options

 

Save Entities

Saving entities to the database is an option for facilitating data entry. Providers, patients and payers are saved into a database after being entered for later retrieval. Entering a last name or ID will automatically fill the entity's remaining fields in the claim editor. They can be individually selected. To view currently saved entities, see entity editing.

Save entity to DB options

Checking an entity will allow a user to autofill a provider, payer, patient or subscriber in the claim editor by filling in the entity's ID.

 

Auto-Complete Mode

Entities saved to the database can be loaded into a provider, payer or patient form by typing out the relevant entity's name or ID. The ID and Name textboxes will suggest an entity to enter into the form and accepting will autocomplete the remaining details. To disable this capability for the ID or Name, check the appropriate box. To learn more about autocomplete for providers, payers and subscribers, see Provider, Patient and Payer Autocomplete.

Autocomplete options

Provider, Patient and Payer Tables

Filling in provider, patient, and payer details multiple times is a repetitive task that can be alleviated by storing the relevant entity in a table for later retrieval. For example, entering a provider's ID number will suggest a stored provider to select from and automatically fill the remaining fields in the provider form with the relevant data. To create the provider, patient or payer tables follow these steps:   1. Click Claim Entry/Edit  Create Tables for Entities Create tables for entities menu 2. This opens the Create SQL Tables window. Here you can create the StoredPatient, StoredProvider, and StoredPayer tables. Check the appropriate database is selected and click Execute Script to create a table. If the table has been changed in a new release, clicking Compare Script with existing table will create a script to adjust the table. Changes to database tables do not occur often. Create SQL Tables window 3. Click Execute Script. A new table will be created. Table creation success

Stored patients can be viewed and edited in this screen. To open the Stored Patients editor, click Claim Entry/Edit and then Stored Patients:

Stored patients menu option

A new window containing all patients, both subscribers and dependents, will be opened. To create the StoredPatient table, see Provider, Patient and Payer Tables.

Stored Patient editing screen

The table contains all patients present in the StoredPatient table. Selecting a patient in the table will fill out the Patient Information form. Editing the fields and clicking Save Patient into Database will modify the contents of the selected patient's row to match your changes.

To create a new patient, click the New Patient button below the Stored Patients table, fill in the Patient Information, and click the Save Patient into Database button to save the new patient.

To delete an existing patient, select the patient in the Stored Patients table and click the Delete Patient button.

Stored payers can be viewed and edited in this screen. To open the Stored Payers editor, click Claim Entry/Edit and then Stored Payers:

Stored payers menu option

 

A new window containing all payers stored in the StoredPayer table will be opened. To create the StoredPayer table, see Provider, Patient and Payer Tables.

Stored Payer editing screen

The table contains all payers present in the StoredPayer table. Selecting one will fill out the Payer Information form beneath it. Editing the payer fields and clicking Save Payer into Database will modify the contents of the selected payer's row to match your changes.

To create a new payer, click the New Payer button below the Stored Payers table, fill in the Payer Information, and click the Save Payer into Database button to save the new Payer.

To delete an existing payer, select the payer in the Stored Payers table and click the Delete Payer button.

Providers stored in the database  can be viewed and edited in the Stored Providers editing screen. To open the Providers editor, click Claim Entry/Edit and then Stored Providers:

Stored providers menu option

A new window containing all payers stored in the StoredProvider table will be opened. To create the StoredProvider table, see Provider, Patient and Payer Tables.

Stored Provider editing screen

The table contains all providers present in the StoredProvider table. Selecting one will fill out the Provider Information form to the right of the window. Editing these fields and later clicking Save Provider into Database will modify the contents of the selected provider's row to match your changes.

To create a new provider, click the New Provider button below the Stored Provider table, fill in the Provider Information, and click the Save Provider into Database button to save the new provider.

To delete an existing provider, select the provider in the Stored Providers table and click the Delete Provider button.

Some codesets are so numerous that it does not make sense to store them in an XML file. There are more than 25,000 procedure and revenue codes and more than 15,000 diagnosis codes in ICD-9 alone. For that reason we decided to store Procedure Codes, Diagnosis Codes, Revenue Codes and ZIP codes in the database. In the following example a Diagnosis Code table will be created.

Note: You need to configure the connection to the database first. See Setting up Database Connection.

 Alternately, a specific codeset's editor can be opened by clicking the appropriate Procedure, Diagnostic or Revenue Code option from either the Code Sets menu or the Claim Entry/Edit  Claim Entry/Edit CodeSets menu option.

Loading a Codeset Table can be done using a .xlsx spreadsheet, comma separated value (csv) textfile, or space delimited textfile. The following examples assume you have already opened a codeset's edit screen and will use the Diagnostic Codes codeset as an example.

The Diagnosis Codes codeset editing window.

 Tip: The diagnosis codes according to the International classification of Diseases (ICD) in the 9th revision are published by Ingenix or the AMA for example. You can also download them from the CDC-National Center for Health Statistics.

Loading from XLSX

 

Loading from Text File

There are two ways to determine column position from a text file in order to build a table: with a delimiter such as a comma or semicolon in a character delimited file or knowing the each column's position in a fixed width file.

To view/edit code sets in HIPAA Claim Master, follow the instructions below.

Diagnosis, Procedure, Revenue and ZIP code sets are too large to store in memory. They can be edited like any other codeset but the database tables to store them are created separately.

   As mentioned above, the procedure, diagnosis, revenue and ZIP codes are saved to a database. These four codesets have a slightly different codeset editing screen (shown below) but they behave in the same way. Since these codesets can grow very large, search boxes are provided to filter through codes or descriptions.

  
The slightly different "Procedure Codes" code set configuration window.

The codeset windows provide the following information:

4. Click on the "Save" button to save the changes. Changes to the procedure, diagnosis, revenue and ZIP codes are saved automatically to the database.