EDI Claims

You can view details of a singular claim document from the EDI Claim Batches screen or the EDI Claims screen.

  1. Launch the Accounting module from CT Launcher.
  2. In the Billing section of the Accounting tab, click EDI Claims.
  3. Locate the Patient by selecting their name, entering their Account Number or their Claim Number. You can also open the Additional Selection Options area to search by Provider, Payer, Claim Dates, Batch Number, Service Date, and Procedure Code.
  4. Click Find.
  5. Select a claim from the Claims list.
  6. N O T E    
    The EDI Claims screen works like a large claims search function. By default you can search for patient name, patient account number, or claim number.

If you have already created a claims batch, you can view individual claims within that batch.

  1. Launch the Accounting module from CT Launcher.
  2. In the Billing section of the Accounting tab, click EDI Claim Batches.
  3. Create the batch or use one that you've already created. EDI Claim Batches
  4. In the EDI Claims Batches pane in the lower portion of the screen, click the batch name and then click View. This opens the EDI Claims screen and pre-fills the batch number in the search criteria area.
  5. Notice that the Claims tab opened. On it, locate the Patient by selecting their name, entering their Account Number or their Claim Number. You can also open the Additional Selection Options area to search by Provider, Payer, Claim Dates, Batch Number, Service Date, and Procedure Code.
  6. Select a claim from the Claims list and click View.
  7. N O T E    
    The EDI Claims screen works like a large claims search function. By default you can search for patient name, patient account number, or claim number.
DISCLAIMER:  In version 7.2.8 the ability to void or correct a claim without removing posted insurance payments was added. Versions prior to 7.2.8 will require the claim be in its original billed status prior to voiding or correcting.

Right-clicking a claim will give you several options for opening other areas of Accounting and allow you to perform other claim actions:

 

Click a claim to enable the following claim options:

ClosedCorrect

To correct a claim, fix the errors within the ChiroTouch system, and then select the claim you would like to correct in the EDI Claims screen.

  1. Click Correct to refresh this claim with corrected data.
  2. The Enter Payer Claim Control Number dialog box appears. Type this number and click OK. (You can find this number on the EOB file, ERA file, a claim status request and response transaction, or a rejection document.)
  3. A replacement claim is then created and the status is set to New. This claim will include a revised frequency field that states it is a "Replacement of prior claim", and this claim will be added to the next batch of claims.
  4. Once a claim is corrected, you may then re-export the claim from the EDI Claim Batches screen and resend the claim to your payor.

Once you have corrected a claim, you must re-send it to the payer so that they can process the corrected claim. These charges remain in a "Billed" state in the ChiroTouch system.

ClosedVoid

To void a claim, select the claim and click Void. Once you have voided a claim, you must re-send it to the payer so that they can cancel the voided claim. To void a claim, you must enter the payer-assigned control number for that claim. This claim will include a revised frequency field that states it is a "Void / cancel of prior claim", and this claim will then be added to the next batch of claims. Once a claim is voided, you may then re-export the claim from the EDI Claim Batches screen and send it to your payor for processing.

You can find this number on an ERA file, a claim status request and response transaction, or a rejection document. Once you void this claim, these claims are added to the next batch of claims and those charges are reverted back to "Waiting to be billed" in the ChiroTouch system.

ClosedRebill

Click Rebill to add charges from the selected claim to the next batch waiting to be billed. The current claim will be marked "Rebilled" in the ledger charge details. Note: This action cannot be undone.

ClosedView

Click View to view claim information as well as billing provider, subscriber, diagnoses codes, onset date, initial treatment date, rendering and referring providers, and charges. This screen allows you to see what information has been sent for a claim, and which entries map to which fields. The bottom of the claim displays the service lines attached for this claim.

To print the information, click Print.

ClosedCancel

To cancel a claim, select the claim and click Cancel. This button cancels the selected claim. All charges on the claim will be set to "Waiting to be Billed" status, and the claim will be marked as "Canceled". If the claim has not been sent to the payer, you may want to delete the claim instead.

ClosedDelete

To delete a claim, select the claim from the list and click Delete. All charges associated with that claim will be reverted to a "Waiting to be Billed" state and cannot be undone.

The following information is required when creating a workers comp claim.

Patient Information

  1. In Front Desk, click Patient Mgmt.
  2. Select the patient and click Pat. Info.
  3. Perform the following:
    • On the General tab - Enter the patient's Social Security Number, set their Status as Employed, and enter their associated employment information.
    • On the Condition tab - Select checkbox 10a, Employment, and enter their associated condition information.

Insurance Information

  1. In Front Desk, click Patient Mgmt.
  2. Select the patient and click Insurance.
  3. Set the Coverage Type to WORKCOMP.
  4. On the Insured's/Other Insured's tab, enter employer information including Insured Employer Name and Property and Casualty Claim Number.
  5. Enter the Insured ID#.
  6. Set the Effective Date and select the Electronic Claims>EDI checkbox.

NOTE:  
Once the claim is billed, the system will automatically change Insured/Other Insured > Relationship to Insured (box 6) to EMPLOYEE. This will change regardless of what displays in the Insured/Other Insured tab.

Payer Information

  1. Navigate to the ChiroTouch Accounting App.
  2. Click Maintenance.
  3. Click Trading Partners.
  4. Add a new Trading Partner or select a trading partner from the list.
  5. Under Registered Payers, select the Payer from the drop-down menu, and set the Claim Filing Indicator to WC – Worker Compensation.

Export Your Claim

  1. Open the Front Desk and click Patient Mgmt.
  2. Select the patient and click Ledger.
  3. Click Tools>Export Claims.
  4. Choose the appropriate insurance company, select the appropriate charges, and click Yes to export this claim.