WinFlexOne v6.30 Claims Entry Documentation

Transcription

1 The claims entry screen has been enhanced to provide easier access and visibility to the claim processor s preferences and for ease of use. From the Main Menu of WinFlexOne select Process Claim 2007 MHM Resources LLC 1

2 Select New Claim Session 2007 MHM Resources LLC 2

3 Click on Additional Information menu item Account Info Employee Memo Company Memo Click on Additional Information expansion arrow, or press Alt + i Company Memo Employee Memo Account Information 2007 MHM Resources LLC 3

4 Click on Options menu item. Cursor Sequence o Exclude Service Stop Date o Exclude Rejected Amount o Exclude Date Received Click on User Preferences expansion arrow, or press Alt + o Cursor Sequence o Exclude Service End Date o Exclude Rejected Amount o Exclude Date Received 2007 MHM Resources LLC 4

5 On New Claim o Goto Employee ID o Goto Claim Type o Goto Service Start Date o Goto Amount o Goto Transaction Date WinFlexOne 6.30 On new claim go to o Employee ID o Claim Type o Service Start Date o Amount o Transaction Date 2007 MHM Resources LLC 5

6 Running Total o Enable Running Total o Reset Total Upon Changing Employee ID o Reset Total (Shift + Del) Enable Batch Total Enable Date Received Flag Claim on Hold Enable Batch Total Enable Running Total o Reset on Employee Change Enable Date Received Flag Claim On Hold 2007 MHM Resources LLC 6

7 Duplicate Checking o On Exiting Claim Amount Field o On Saving Claim Duplicate claim check o Never o On Save o Leaving Amount Field o Save or Leave 2007 MHM Resources LLC 7

8 Claim Type Alert Level Claim type alert level 2007 MHM Resources LLC 8

9 Press F4 to list all claims within a the batch Click the Claims in Batch expansion arrow or press F MHM Resources LLC 9

10 Notice that new claim entered may be a duplicate of a previously entered claim. Notice that new claim entered may be a duplicate of a previously entered claim MHM Resources LLC 10

11 Notice that selected employee has claim(s) on hold within the system. NOTE: Flag Claim On Hold must have been selected under the Options menu in order to view this notification. Notice that selected employee has claim(s) on hold within the system. NOTE: Flag Claim On Hold must have been selected under the Other User Preference menu in order to view this notification MHM Resources LLC 11

12 Rejection Letter popup when rejection amount is entered into Rejected field. NOTE: Rejection letter must exist in the specific employer master file. Rejection Letter popup when rejection amount is entered into Rejected field. NOTE: Rejection letter must exist in the specific employer master file MHM Resources LLC 12

13 Notice that selected employee has a debit card. Notice that selected employee has a debit card MHM Resources LLC 13

14 Sample claims entry screen Batch ID Claim ID Running Total Batch Total Company Employee Employee SSN/ID Claim Type Service Date o Start Date o End Date Sample claims entry screen Batch ID Batch Total Running Total Claim ID Employee SSN/ID Company Name Employee Name Claim Type Service Start Date Service End Date 2007 MHM Resources LLC 14

15 Sample claims entry screen (Continued) Amount o Claimed o Rejected Transaction Date Date Received (Optional) Reference Info Provider Sample claims entry screen (Continued) Claimed Amount Rejected Amount Transaction Date Received Date (Optional) Reference Information Provider 2007 MHM Resources LLC 15

16 Sample claims entry screen (Continued) Claim Status o On Hold o Reason for On Hold Sample claims entry screen (Continued) Claim Hold Reason o Once a claim hold reason has been selected, the claim will be marked as On Hold without clicking any On Hold box MHM Resources LLC 16

17 Sample claims entry screen (Continued) EOB Memo (only appears if employer has EOB Memo text. o Has EOB o Full Message Has EOB must be clicked if claims operator has adequate substantiation, or claim will automatically be placed On Hold. Sample claims entry screen (Continued) EOB Memo (only appears if employer has EOB Memo text. o Has EOB o Full Message Has EOB must be clicked if claims operator has adequate substantiation, or claim will automatically be placed On Hold MHM Resources LLC 17

18 Sample claims entry screen (Continued) New Save Cancel Delete Process ICE Forms Close Sample claims entry screen (Continued) New Save Cancel Delete Process ICE Forms is now a separate button on the Claim Options menu. See ICE Form Documentation for ICE Form entry instructions MHM Resources LLC 18

19 What s new or different? F3 is no longer used for Look Up Claim F3 is utilized for Employee Search. Reset Total (Shift + Del) is no longer available to reset a running total within a single claim. Operator does not receive dropdown list of claim types when entering claim type. Operator need not click an On Hold box to place a claim on hold. ICE Form processing is through separate menu item on Claims Options menu MHM Resources LLC 19