For workspaces with the insurance claim module enabled, CMS 1500 claims can be created from billing items for services provided through appointments in Carepatron.
Note: The insurance claim module is currently only available for workspaces in the United States.
Creating a Claim from an Appointment
Open the appointment sidebar from the calendar or client overview.
Click on the individual details to view the billing items.
This view will show any claims related to the appointment and any unclaimed amounts.
In the Unclaimed amount banner, click Add claim.
A new claim will automatically be created, pulling information from the appointment.
The newly created claim will appear on the appointment.
Click on the claim to open the claim view.
Troubleshooting
If there is no claim on the appointment and no unclaimed amount, ensure at least one billing item has an insurance amount.
If the Unclaimed amount banner appears but there is no Add claim button, your workspace may not have the insurance claim module enabled.
Creating a Claim from Client Billing
Open the Client Billing page in the client profile.
From the main billing panel, select New > Claim.
Choose the unclaimed items to add to the claim.
To create a blank claim, unselect all items.
Select Create.
Creating a Claim from the Claim List
In the main navigation, go to Billing.
Select the Claims tab to open the claim list.
Click New Claim in the header.
Choose the client for whom you want to create a claim.
The client’s unclaimed items will load for selection.
Choose the unclaimed items to add to the claim.
To create a blank claim, unselect all items.
Select Create.
Adding Items to an Existing Claim
Open the claim to which you want to add items.
Expand the Diagnostic and Billing Items sections.
If the client has unclaimed items:
Select Add unclaimed items to choose items for the claim.
Otherwise, select + Add service to add a new line item to the claim.
Completing a US Professional (CMS 1500) Claim Form
Carepatron will attempt to pull relevant information when creating a new claim; however, claims must be reviewed for accuracy and completeness.
Reviewing Client Information
When creating a claim, client information is pulled automatically.
Adjust this information if necessary within the claim.
Adding Incident Information
Incident information captures details about the cause of the need for healthcare services.
Reviewing the Rendering Provider
The rendering provider(s) indicate who provided the services on the claim.
These are automatically added based on the appointment staff, but adjustments can be made within the claim.
Adding a Referring Provider
The referring provider is the healthcare professional who referred the client for services.
Selecting the Service Facility
This is the location where services were provided.
It is pulled from the appointment’s selected location but can be adjusted manually.
Selecting a Policy for the Claim
The Insurance Information section allows selection of the client’s insurance policy for the claim.
Ensure that:
The policy details are correct.
The payer details are accurate.
The services added to the claim correspond with the selected policy.
Adding Billing Information
The Billing Information tab describes the billing details required for claim submission.
These must match the billing and tax details used when enrolling with the payer.
The billing profile is selected based on the rendering provider and payer but can be adjusted if necessary.
Common Problems
Mismatched billing details or identifiers with the payer.
Adding Diagnostic and Service Details
The Diagnosis and Billing Items section describes the client’s diagnosis and the provided services.
ICD-10 Diagnosis Codes are pulled from diagnostic notes attached to the appointment.
Service Details are created from billing items in the client’s profile.
Place of Service Codes come from the appointment’s location.
Review Checklist
Ensure the Service Lines contain the correct details.
Verify that the Service Description and Coding are accurate.
Check that Diagnosis Codes and Service Line Diagnosis Pointers are correctly linked.
Add any necessary supplementary information or modifiers for services provided.
Confirm that the Amount Paid matches the already paid amount.
Common Errors
Using outdated codes.
Improper linking between diagnoses and procedures.
Missing required modifiers.
Validating a Claim
A draft claim can be validated for common errors by selecting Validate in the claim header.
The claim will be checked for common errors to ensure completeness before submission.
Submitting an Insurance Claim
Electronic submission is available for payers that have been imported from our clearinghouse. For all other payers, submission must be handled manually.
To submit an Electronic claim
Open the claim
Check the submission method is Electronic
Click Submit in the claim header
Carepatron will submit the claim to the clearing house.
Fix any additional validation errors that may be returned.
After a successful submission, the claim will show as Submitted
Our team will be able to answer any other questions you may have. Just reply via messenger through the Help channel in your workspace.