This page highlights all the details in a claim that is in Paper Claims stage. You have all the details needed to then submit the claim manually by paper.
Encounter ID
The encounter identifier used to link medical records, claims, and billing activity for a single visit.
Status
This status reflects the case’s progress within the current billing stage only (e.g. EOB Reconciliation). It applies to the task assigned to the selected assignee in this tab.
When the assignee completes the task, the case will be marked complete for this stage, but this does not mean the entire claim has been fully processed.
Key Actions
Use these actions to manage the claim:
Defer
Defer the case to be worked on at a later time.
Print
Print the CMS-1500 form.
Message
Send a message about this specific encounter to a member of your team.
Assign
Assign this case to someone on the team
Remove
Remove the claim from the current queue.
Patient Information
This section highlights key patient information, including the patient’s name, Billing Account ID, EHR ID, primary and secondary payers, provider, date of service, and the assignee currently responsible for the case.
Service/Claim/Notes
This side tab provides additional context and detailed information to help you better understand and manage the case.
Service
View service-related details such as surgeries performed, physician notes, clinical documentation from the EHR, operative notes, hospital consult notes, other chart notes, the facility code and name, and the hospital admission date.
Claim
Review key claim information and actions, including submission dates, submission method, and other claim-related details.
Notes
Add notes about the case and document actions taken to keep your team aligned and informed.
Encounter
In this section, you can view and manage encounter-related information, including the date of service, claim submission method, resubmission code, original payer claim ID, facility name and code, hospital admission and discharge dates, service facility NPI, Box 19 notes, prior authorization number, and rendering provider.
Charges
In this section, you can view and manage the charges to be filed on the claim, including procedure codes and modifiers, units, and the associated diagnosis codes.
Payment Summary
This section breaks down charges at the procedure level to help you understand how each service was billed and paid. For each procedure code, you can see the number of units billed, the payer responsible, the original charge, the allowed amount, any adjustments, amounts paid by insurance and the patient, the write-off, and the remaining balance.
EOB
This section displays all EOBs that have been posted for the claim.
EOB for Inactive Payer
This section will show any EOBs for Inactive Payers that are related to the claim.
Submit
Click Submit when you’re finished working on the case to close out the task.