Notice :
This article shows only the features related to the Claim Document functionality and the step-by-step of the older version of this window. To see the full Claim Document Module, click on the button.
Our latest Claim Document window allows you to search for invoices that must be claimed by insurance companies and to assign them to a single claim document that will include information for each one of these invoices. Here's how this functionality works:
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Go to Claim Document
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Select New record to get started
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You can perform a search by entering TPA, Customer, Minor Company, Document Number, Date Range and Encounter number (new) for invoices. After filling these parameters, click Search.
Note: Customer is mandatory and Date Range will appear with current date as default.
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Select all of those invoices that you would like to include by clicking on the left column checkbox. Please also notice that consolidated invoices will also be included, displaying Consolidated Invoice on Patient Encounter column. (See below our search by Encounter).
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Confirm
This will add the required invoices to detail.
6. Now, select your invoices if you would like to add them to the final document
7. Save
8. This will create the new record but as In Progress status. Now you can print the Claim Document and click process to complete.
9. Select Completed and confirm to finish. If you select voided it will be deleted and cannot be recovered back.
You can print claim format before and after completing this record. To do so, enter the document (if it's completed search for it on Claim Document menu) , click context menu and choose Claim Format:
This will download a PDF with the following information:
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Claim document information; document number, claim date and current status.
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Hospital Information and Insurance Company columns
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Total Amounts : Subtotal, Tax and Total.
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Invoices Detail with invoice number, date, subtotal, discount, net price, tax and Total.
Updates
Invoice search improved by Encounter number for Claim Documents
November 21, 2022.
Now, when filling up the header of a claim document, you can search for invoices by entering their Encounter number, displaying only those invoice that correspond with the encounter on search and improving your claim management processes. Here's how you can add invoices to the claim document when looking for any specific encounter.
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Enter Customer name and Minor if applies.
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Enter Encounter number (leave it blank if you do not have this data)
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Click on Search
4. You will now see how the Patient Encounter column appears first. The invoices for encounter that meet with your search will all be displayed, select them to add them.
5. Confirm
6. Save when you have added the invoices.
Now, in context menu of the added encounter, you will see a new button called Items detail.
On this detail window you will see the lisf ot products or services and their charges detail and their corresponding invoice. This will give users all of the information about the invoice charges that are to be claimed.
Fields for insurance adjudication status and reason codes
February 6th 2023
Now, the Item detail section for sales receipts attached to claim documents, will display two new colums for insurance adjudication status and reason codes. This information will allow users to view more details about the insurance coverage status and their response given.
To do so, click on context menu of any sales receipt attached to the claim document and select Items detail :
The two new columns A) Status, B) Adjudication Reason Code will appear to the right of the detail pop-up:
Demo :
Create Invoice Consolidated
February 13 2023
Now, you wil be able to generate a consolidated invoice for those claim documents with Completed status. This will allow you to complete charging fees for insurance companies after approving these charges.
See more details here :
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In order to generate a consolidated invoice from Claim Document window, first you must verify that this document status is Completed :
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Now, select the patient encounter charges and click context menu, then select Generate Invoice.
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You will be taken to Consolidated Invoice window, where you must select the charges that will be attached to this invoice.
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Click Save.
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These charges were now added to the detail, in order to group them select the Detail Type.
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Click Process (gear icon).
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Enter Billing Date.
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Save.
Generated invoice will be downloaded locally and it will look as the example below :
Abstracting Option for Claim Documents
February 20, 2023.
In order to improve the management of patient's coding information for Nphies integration, we have now added an additional button for Claim Documents patients where you can go to Abstracting window :
This option can be entered after adding the invoice charges to the detail (it will appear as Drafted) and if your user has access to this functionality.
You will be taken to Abstracting screen where you can fill every missing field required for coding and Nphies validation such as :
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Encounter Data
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Physician
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Diagnosis
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Coding
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Nphies Request / Response Data
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NPHIES Panel
This will allow you, for instance, to manage Nphies Claims for patients individually :
Nphies Approval Status & Added Items Detail Filters
March 27, 2023.
We have implemented two new features that will improve the usability of Claim Document screen by giving users details about claims Nphies status and filtering the search of items while viewing their data on Items detail option. See these features here :
Nphies Claim Status
Now, while viewing the claim document details, you will see the current Nphies status for each attached encounter. This data is directly imported from their Nphies status and will display any of the following status :
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Pending
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Approved
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Rejected
This information will also be listed for every charge that belongs to the attached encounters (context menu and Items Detail ) :
With this information, users can keep track of each encounter approval status from this window.
Items Search Filters
Also, while looking for items that belong to the attached encounters (click context menu of the encounter and select Items Detail), you will see new search filters that will allow you to look for specific charges and view their information more easily.
The added filters are the following :
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Invoice Number
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Nphies Status
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Description
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Service Type
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Product code
To apply any of the filters, click on search and you will only see the filtered products below :
Follow-up Functionality for Claim Document
May 8th 2023
Now, when attaching documents (search icon, after drafting the Claim Document), if any of these documents has any related or is a follow-encounter to a main encounter, this information will be shown under a new field called Follow-up Reference, allowing users to view if this encounter has any related and unbilled follow-up encounters or if it is a follow-up encounter. See all details here:
First, select all of those encounter invoices to attach and confirm :
If this encounter has any follow up encounters that lie between the given Date Range , you will see them all listed under the main encounter , in Follow Up Reference section :
If you go to Items Detail, you will see how every product included has the main encounter as their Provider Claim Number :
All of these charges will be included on the Consolidated Invoice and assigned to their main encounter.
Important :
If you attach any follow up encounter (which is not the main encounter) and their main encounter does not lie between the given Date Range applied in filters, you will see only this follow up encounter and their number in Follow-up reference, letting you know that this document is for a follow up encounter :
If their main encounter was not yet billed, it will be attached too to the Consolidated Invoice :
If it's already billed, you will not need to look for it since these pending charges belong only to the follow up encounter(s).
In order to avoid creating documents without main encounters, first look for the main encounter and attach it to the Claim Document. Then Cirrus can include all of its charges in Claim Document window as well and address them to their main encounter.
Send Batch Claims to Nphies in background processes
June 12, 2023.
Our latest Claim Document upgrade will allow users to send the batch of approval requests to Nphies before completing the document (Document action and Complete). This will allow users to check the Nphies response in Nphies messages log option for each pending patient and to exclude any rejected claims from the batch before completing this document.
This process will run as a background process and attached documents status will change according to the received response (Rejected or Approved). Then you can complete this document and create its consolidated invoice, where every charge has already been approved by their insurance.
See demo :
Send batch to nphies button will appear in context menu, make sure to send this batch once you have attached the documents you wish to include and before completing this document :
You will see the following message :
To check the Nphies delivery message of every pending document, click context menu of this attached document and select Nphies messages log :
You can also check by confirming their status or to view the approval message and status of every charge in Items detail.
If you complete this document, you will not be able to send this batch to Nphies again :
Issues Log in Claim Document
October 23, 2023.
New pop-up window for viewing any patient encounter issues related to the claim requests.
See article here :
We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.
Date: October 17, 2022.
Updated: November 21, 2022.
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