Claims Journal

(Topic Last Updated On: 06/07/2018)

Accounting > Claims Journal

The Claims Journal screen is launched by clicking the Claims Journal menu item on the Accounting menu. This screen is designed to give users quick access and very detailed information into Claims and Service Line details. Similar to the Balance Journal, but specific to Claims and Service Lines. From this screen, patient or Payer specific Claims and Service Lines can be retrieved and reviewed in very granular detail. Service Line activities can be viewed using the 'Billing Service Line Activities' application window that is launched from this screen using the 'Service Line Activity' button. The 'Search Criteria' fields operate in the same fashion as they do on the Claims Generator screen. This screen is incredibly useful for billing and accounting personnel that need to review Claims and Service Line details when dealing with 3rd Party Payment discrepancies.

Field Descriptions

Patient Only

This field appears in the 'Patient - Filter By' section of the screen and is selected by default when the screen is initially launched. With this radio button selected, only Claims associated with the patient ID entered in the 'Patient ID' field, will display in the 'Claims' grid.

Entire Filter

This field appears in the 'Patient - Filter By' section of the screen. With this radio button selected, the "Payer/Payer Category', 'From Date', To Date', and 'Services' fields become available to enter in more specific search criteria.

Patient ID

This field will auto-populate the selected patient's ID when the screen is initially launched. This field is used to retrieve Claims for a specific patient by entering in the patient ID, selecting the patient from the 'Patient ID' dropdown field, or using the advanced 'Patient Search' pop-up window, by clicking the ellipsis button to the right of this field.

Show Only Outstanding Claims

This checkbox field is checked by default. With this option checked, only claims with an outstanding unpaid balance will appear in the grid. Unchecking this option will include Claims in the grid that have been paid in-full from the Batch Payments screen.

Payer/Payer Category

This field contains a dropdown menu of Payer/Rate Groups or Payer Categories. The radio button options ('Payer' or 'Category') to the right of this field, dictate which type of items are displayed in the dropdown menu. Payer Categories can be added and edited from the 'Payer Category' Code Table on the Administration menu. Payer Categories are associated to Payer/Rate Groups from the Payer/Rate Groups screen. Only items that were active within the selected 'From Date' and ' To Date' date range will display in the dropdown.

From Date

This field contains a calendar date selection menu used for entering or selecting the first Date of Service (DOS) for Service Lines included in the Claim.

To Date

This field contains a calendar date selection menu used for entering or selecting the last Date of Service (DOS) for Service Lines included in the Claim.

Services

This field displays a checkbox list of all Billable Services associated with the selected Payer or Payer Category that have an 'Effective On' and/or 'Effective To' date that falls within the selected 'From Date' and ' To Date' date range. By default, all Services listed will be selected (checked). To better filter the search results, users can check only desired Services from the list.

Claims Grid Columns

Claim ID

This column displays the system reference ID, assigned to the Claim as it is generated using the 'Claims Generator' screen.

Patient ID

This column displays the 'Patient ID' associated with the displayed Claim.

Patient Name

This column displays the full name of the patient associated with the displayed Claim.

Srv. Start

This column displays the earliest 'Service Start' date associated with the Service Line items within the Claim.

Srv. End

This column displays the latest 'Service End' date associated with the Service Line items within the Claim.

Chrg. Units

This column displays the total number of charged units for all Service Lines within the Claim.

Chrg. Amt.

This column displays the total charged dollar amount of all Service Lines within the Claim.

Clm. Units

This column displays the total number of claimed units for all Service Lines within the Claim.

Clm. Amt.

This column displays the total claimed dollar amount of all Service Lines within the Claim.

Outstanding

This column displays the total dollar amount of the unpaid balance against the Claim.

Payer

This column displays the Payer/Rate Group associated with the Claim.

Status

This column displays the current Claim status ('Submitted' or 'UnSubmitted'). Like on the 'Claims Generator' screen, the 'Claims' grid groups Claims by the status of 'Submitted' and 'Unsubmitted', displaying a total number of items (Claims) for each grouping.

Last Submit Date

This column displays the last date the Claim was submitted for billing using the Billing Export screen. This column only applies to 'Submitted' claims.

Service Line Grid Columns

(Service Line Column Divider)

The Service Lines column header bar contains a unique Column Divider tool that can be moved (left-to-right) along the Service Line column headers. This tool is used to 'freeze' the columns in the grid. Single-click and drag the Column Divider to the desired column position. All columns to the Left of the divider will remain in place as the horizontal scrollbar is moved.

Service Line ID

This column displays the system generated reference ID number assigned to the Service Line.

Service Name

This column displays the Billable Service Name associated with the Service Line.

Service From

This column displays the first Date of Service (DOS) for the Service Line.

Service To

This column displays the last Date of Service (DOS) for the Service Line.

Procedure Code

This column displays the 'Procedure Code' for the Service Line as defined on the Billable Services screen.

Modifier

This column displays the 'Proc. Modifier' for the Service Line as defined on the Billable Services screen.

Charged Amount

This column displays the total charged dollar amount for the Service Line.

Charged Units

This column displays the total number of charged units for the Service Line.

Claimed Amount

This column displays the total claimed dollar amount of the Service Line.

Claimed Units

This column displays the total number of claimed units for the Service Line.

Outstanding Third Party Amount

This column displays the total dollar amount of the unpaid Third Party balance against the Service Line.

Service

This column displays the Service Line's Billable Service as configured on the Billable Services screen.

Service Type

This column displays the Billable Service Type for the Service Line as configured on the Billable Services screen.

Rendering Provider

This column displays the Rendering Provider associated with the Service Line as configured on the Billable Services screen.

Command Buttons

(Patient Search)

This ellipsis button is located to the right of the 'Patient ID' field. Clicking this button opens the advanced 'Patient Search' pop-up window. This window is used to help search for and select a patient using patient specific identifying information. The selected patient ID will display in the 'Patient ID' field.

View claims

After entering a Patient ID and/or making all desired 'Search Criteria' selections, clicking this button will retrieve Claims and Service Lines matching the criteria selections and display them in the grid.

Clear Criteria

Clicking this button removes all previously retrieved Claims from the grid and resets all 'Search Criteria' selection fields.

Select All

After a 'From Date' and 'To Date' has been selected and a 'Payer/Payer Category' has been chosen, clicking this button will select all Billable Services listed in the 'Services' field. By default, all Services will be selected (checked) once they appear in the field after the Payer/Payer Category has been selected.

UnSelect All

Clicking this button will deselect any selected Billable Services listed in the 'Services' field. By default, all Services will be selected (checked) once they appear in the field after the Payer/Payer Category has been selected.

Expand All

Once Claims are retrieved into the 'Claims' grid, clicking this button will expand all Claims, displaying their associated Service Lines below each Claim in a Service Line grid.

Collapse All

Once Claims are retrieved into the 'Claims' grid, and all or some of the Claims have had the Service Line grid expanded, clicking this button will collapse all of the Service Line grids leaving only the Claims displaying in the grid.

Service Line Activities

This button becomes enabled after retrieving Claims into the grid, expanding the Claim, and selecting a Service Line record. Clicking this button launches the Billing Service Line Activity 'Always on Top' application window. This window provides the user with very detailed information on the activity against a Claim's Service Lines. *See the Billing Service Line Activity topic for more information.

Clicking this button closes the Claims Journal screen.

Procedures

How to Retrieve Claims and Service Lines
1.) Using the 'Search Criteria' fields, make the desired selections to retrieve specific Claim(s) and Service Line details. 2.) Once all desired selections have been made, click the View Claims button. 3.) Claims matching the specified 'Search Criteria' selections will display in the 'Claims' grid. 4.) Locate the desired Claim in the grid and click the '+' button to the left of the Claim record to display the Service Lines associated with that Claim. To collapse the expanded Service Lines grid, click the '-' button to the left of the Claim record. 5.) To expand all displayed Claims in the grid, click on the Expand All button. To collapse all displayed Service Line grids, click on the Collapse All button. 6.) To clear all retrieved Claims from the gird and reset all 'Search Criteria' fields, click on the Clear Criteria button.

How to Review Service Line Activity
1.) Using the 'Search Criteria' fields, make the desired selections to retrieve specific Claim(s) and Service Line details. 2.) Once all desired selections have been made, click the View Claims button. 3.) Claims matching the specified 'Search Criteria' selections will display in the 'Claims' grid. 4.) Locate the Claim containing the desired Service Lines to be reviewed in the grid. Click the '+' button to the left of the Claim record to display the associated Service Lines. 5.) Located and select the desired Service Line from the grid. Click the Service Line Activities button or simply double-click the Service Line Item from the grid. 6.) The Billing Service Lines Activity 'always on top' application window will open. *See the Billing Service Line Activity topic for more detailed information.

Considerations

Export to Excel

Once Claims are retrieved into the 'Claims' grid, the displayed results can be exported into an Excel file and saved to the users computer. Right-click anywhere within the grid to have the 'Print/Export' dialog box appear:

This feature is available in almost every grid within the Methasoft application. Click the 'Export to Excel' option to have the displayed Claims and Service Lines exported into an Excel file and saved to the designated folder on the computer.