Daily Claims (NS)

The Daily Claims tab shows all claims for today and the Provider selected. This includes both submitted and unsubmitted claims, claims made from appointments and walk-in claims, GOV, WCB, and private insurer claims.

Completing the Claim Details (NS)

Complete the Claim Details Window

Patient Information Section

1. If a claim has been opened from an appointment, the patient is already loaded. If you are creating a new bill from Daily Claims, you need to load a patient using the Search Tool. Either type in the patient's name (part name) in the Simple Patient Section or type their Last Name and/or First Name in the Advanced Patient section. If the patient is not in your database, type in all their details in the Advanced Patient section and click the Add button.
2. Check the Patient Details are correct. If any of the details are incorrect, correct the relevant information.
3. Select an Admission Date if required (for hospital billing).
4. Ensure the Date of Service and Provider in the Details section are correct.
5. Click the Ellipses button  to change or add Referred By information, if required.

Claim Table Information

To make entering information quicker and easier most information is now entered in the claim table.

1. Type in the Service Code.
2. Enter the Diagnostic Codes.
3. Enter the Fee Modifier(s) if applicable.
4. Double click in the Facility cell and select from the list displayed.
5. Double click in the Location cell and select from the list displayed.
6. Double click in the Insurer cell and select from the list displayed.
7. Add the Calls / Enc. #, if applicable.
8. The Percentage defaults to 100%. If a different percentage is required click the dropdown list  and select from the list displayed.
9. Click the Resubmit checkbox and select from the list displayed, the default is Auto.

Other Details

1. Click the dropdown list  and select the BA# from the list displayed.
2. Click the dropdown list  and select the Locum BA# from the list displayed, if applicable.
3. Click the dropdown list  and select the Pay To from the list displayed.
4. Select a Start & End Time if required.
   Note for MSI Claims: For codes specified in the Physician's Manual, the start and end time must reflect time blocks where 80% of the duration is spent directly with the patient(s). For more information please refer to the Physician's Manual.
5. Type in a Submission Note, if required. This is a note transmitted with the claim to the insurer. Alternatively click the Ellipses button  and select a note from the list already set up in your clinic.
6. Click the dropdown list  and select the Speciality from the list displayed.
7. Type in an Internal Note, if required. This is a note for your office and is not transmitted with the claim to the insurer.
8. Click the dropdown list  and select a Options from the list displayed.
9. Type in an Injury Code, if applicable.
10. Type in the Pre-Authorization Number if there is one.
11. Click Save to save your changes.

Billing Time Based Codes

When billing time based codes, ensure that the Claim Details have the appropriate amount of multiples based on the Start and End times before submitting.

For Procedures that require face to face time, enter the applicable time for the billable amount of multiples in the Claim Details and verify the multiples. See the Physician's Manual for applicable procedures. 

Completing the Claim Details for a Time Based Code:

A: Enter Start Time with patient.
B: Enter End Time for appropriate applicable multiples for the Procedure.
C: Verify that the multiples are accurate for the Procedure in the Multiples column.
D: In the Submission Note field enter in face to face time with the patient.
Tip: Time spent with the patient can be tracked in the Encounter Note by pressing the F12 button on the keyboard to add a time stamp when seeing the patient and pressing F12 again when the patient leaves.

Automatic Claim Assessing

The Automatic Claim Assessing check box, when enabled, allows Accuro to automatically calculate the Multiples, Claimed Units, and Amount for the selected Bill on the Claim Details. The setting can be enabled or disabled per Bill in the Claim Details window. Automatic Claim Assessing is enabled by default.

Note: When enabled the Automatic Claim Assessing will overwrite any manual changes to Multiples, Claimed Units, and Amount that were manually updated when it was disabled.

When Automatic Claim Assessing is disabled, the Multiples, Claimed Units, and Amount will no longer be calculated by Accuro and can be manually entered.

Please refer to the Physician's Manual to understand which Multiples and Claimed Units to submit.