Enterprise Comp Search Claims &Claim Details

Transcription

1 Enterprise Comp Search Claims &Claim Details Care mc May 2012

2 Table of Contents About Search Claims & Claim Details... 3 Instant Search... 3 Claim Note View... 4 Document View... 4 Favorites... 5 View Favorites... 5 Search Claims... 6 Searching Tips... 6 Advanced Search... 7 Viewing Claim Information... 8 Case... 8 Claim... 9 Patient... 9 Employer Insurer Adjuster Multiple Claims Details Notes Treatment Medical Bills Claim Payment History Document View Flow View Grid View Drug History Claim Details Page Layout Summary Information Claim Info Injury RTW Financials Contact Info Reference Links Care mc Page i CorVel Corporation

3 Service(s) ICD9s CM Savings Physician Facility Attorney Assigned RTW Plan Treatment Calendar Drug History Medical Bills Claim Payment History Hospital View Documents Claim Financials Liability BI Investigation Profile Litigation Profile Liability Claim Safety Liability PD Claim Witness List Action Items Care mc Page ii CorVel Corporation

4 About Search Claims & Claim Details CorVel provides industry leading services on an integrated platform called Care mc. Care mc provides access to in depth information about the claims CorVel services. There are several ways for Claims Professionals to access information about claims in Care mc : 1. Find information with Instant Search 2. Use Favorites to flag frequently visited claim records 3. Look up information with Search Claims Instant Search Use Instant Search to quickly find claim records. To search enter a claim number or claimant name in the text box at the top right of the Care mc screen. Results appear instantly and narrow as you type. Hover to highlight a claim record. Click anywhere on a highlighted record to open Claim Details for that claim. Care mc Page 3 CorVel Corporation

5 Click View to open related Notes or Documents. Claim Note View Document View Care mc Page 4 CorVel Corporation

6 Favorites ENTERPRISE COMP SEARCH CLAIMS & CLAIM DETAILS Use Favorites to flag claim records you return to frequently. Follow these steps to flag a claim record as a Favorite: 1. Look up the claim in Instant Search or Search Claims. 2. In Instant Search, highlight and click a claim record to open Claim Details 3. In Search Claims, click in the Details column on the results grid 4. Click the star in the Summary Information section. A yellow star indicates the record is flagged as a favorite. View Favorites Click Favorites in the top right corner of the Care mc screen to view a list of claim records flagged. The Favorites window opens Click a Claim Number to open Claim Details for that claim record Click to remove a claim record from your Favorites list. Care mc Page 5 CorVel Corporation

7 Search Claims ENTERPRISE COMP SEARCH CLAIMS & CLAIM DETAILS The Claims tab contains tools to help manage claims efficiently by reducing paperwork and effectively connecting claims professionals. Click the Claims tab to access Search Claims. To search in Search Claims, type all 9 digits of the claimant s SSN or any two of the following: At least 2 characters of the Claimant First Name At least 2 characters of the Claimant Last Name At least 2 characters of the Employer Name At least 4 digits / characters of the Customer Claim Number At least 4 digits of the claimant SSN A 4 digit year For example: 2011 When finished, click Search. Searching Tips To optimize search performance, enter as much information as possible in order to narrow the search and return results faster. You can type partial entries, such as Sm for Smith When you initiate a search, Search Claims looks for Caremc claims and bill review claims that match your criteria, and eliminates duplicates. Caremc claims are pulled by Open Date, and bill review claims by Last Date of Service. Enter a valid date range. The date range defaults to 6 months. Claims associated with bills in the bill review system will be returned if the last service date is within the Cases Date Range. Otherwise, if you are searching for a case management claim, use the open date of the claim when entering your Cases Date Range. The date range cannot be greater than one year. Care mc Page 6 CorVel Corporation

8 Advanced Search Click Advanced Search to find claims by CorVel Case Number, Adjuster Last Name and Claim Status. At least 2 numbers of the CorVel Case Number At least 2 characters of the Adjuster Last Name Claim Status All, Active, Closed or Active Click Search. A list of matching claims appears. Use the hyperlinks to display case details (described on the following pages). Details display in a new window. Note To sort a display column, click the header for the column you want to sort. If more than one page of records is found, a page turner appears at the bottom of the page: Care mc Page 7 CorVel Corporation

9 Viewing Claim Information Search Claims displays claim information as it is available on the selected claim: Based on HIPAA rules, in order to view Medical Bill Images, clients must fall under one of the following categories: Any worker s compensation (WC) insurance carrier or third party administrator (TPA) Employers: only self-insured, self-administered Case Click the Case hyperlink to display basic information about the patient and case. Care mc Page 8 CorVel Corporation

10 Claim Click on a claim number to open Claim Details. ENTERPRISE COMP SEARCH CLAIMS & CLAIM DETAILS The Claim Details page is described later in this guide. Patient Click the Patient hyperlink to view the Patient Profile. Care mc Page 9 CorVel Corporation

11 Employer ENTERPRISE COMP SEARCH CLAIMS & CLAIM DETAILS Click the Employer hyperlink to view the Employer Profile. Enterprise Comp customers include the letters EC after the Employer name. Insurer Click the Insurer hyperlink to view the Insurer Profile. Care mc Page 10 CorVel Corporation

12 Adjuster Click the Adjuster hyperlink to view the Adjuster Profile. ENTERPRISE COMP SEARCH CLAIMS & CLAIM DETAILS Multiple Claims The Multiple Claims link alerts you to additional claims in Care mc. Click Yes to open the multiple claims list. Click an underlined Claim Number to open Claim Details for that claim Details Click to open the Claim Details page. Care mc Page 11 CorVel Corporation

13 Information visible in this page is based on the type of claim you are working with. The Claim Details page is described later in this document. Notes Use the Notes link to see all notes entered for the claim. Use the Date Range search to view notes for specific dates. To add a note, see Details, Adding Notes. Care mc Page 12 CorVel Corporation

14 Treatment ENTERPRISE COMP SEARCH CLAIMS & CLAIM DETAILS Click the Treatment link to view a color coded calendar of treatments associated to the claim. The Treatment Calendar is described in the Claim Details section of this document. Medical Bills Click the link in Medical Bills to view details about bills attached to the claim The Medical Bills viewer is described in the Claim Details section of this document. Care mc Page 13 CorVel Corporation

15 Claim Payment History The Claim Payment History link opens the Payment History. ENTERPRISE COMP SEARCH CLAIMS & CLAIM DETAILS Click the Claim Payment History link to view information about payments made on a claim. Document View Displays documents associated with the claim. There are two ways to look at documents in Document View: Flow View and Grid View. Flow View Flow view displays thumbnails of each document in a carousel viewer. Use the scroll bar and search features to sort through multiple documents. Click an image to open it in the document viewer. Flow view is the default view setting. Click Switch to Grid View to see documents in Grid View. Care mc Page 14 CorVel Corporation

16 Grid View Use the Claim Documents Grid view to see a list of documents associated with the claim. Click an underlined Document link to view the document. Use Search to find specific documents attached to the claim. You can search by: Date Document Added Description Document Type All or Standard Document Sensitivity All, High, Med, Low Drug History Click Rx to view the patient s drug history including Service Dates, Descriptions and Prescribing MD. Drug History is also found in the Claim Details page for bill review claims. Care mc Page 15 CorVel Corporation

17 Claim Details The Claim Details page is designed to provide in depth information and additional tools to help you manage claims. There are several ways to open the Claim Details page for a claim. The most common methods are: 1. Highlight and click a claim listed in Instant Search results 2. Click a claim number link in the Search Claims results grid 3. Click in the Details column of the Search Claims results grid Page Layout There are four main sections of the Claim Detail Page: 1. Reference Links A list of information to select from. Your selection appears in the body of the page under the Summary Information section. 2. Action Item Shortcut links to add additional services to the selected claim. Click a service to open a new Request for Service form for that service. 3. Summary Information Additional claim details organized under tabs for convenience 4. Reference Information The information that appears in this section is based on your Reference Link selection. Summary Information The information in Summary Information is organized under a series of tabs to make finding critical information fast and easy. Information contained in the Summary Information tabs is read only and is organized as follows: Care mc Page 16 CorVel Corporation

18 Claim Info Injury RTW Care mc Page 17 CorVel Corporation

19 Financials Contact Info Reference Links The Reference links on the Claim Detail page allow you to view additional claim detail in a variety of areas. Service(s) The first Reference link listed in Claim Details for a Case Management claim is Services. When selected, the Reference information appears in a grid format under the Summary Information section. The grid shows all open and closed services on the claim. You can view invoiced and un-invoiced Case Notes and other information about each service. Care mc Page 18 CorVel Corporation

20 Service(s) - Referral Detail Click the Referral Date link to view the original Request for Service form. The Case Management window displays the information entered into the original Request for Service. The Request for Service form is read only and cannot be changed. Service(s) - Case Workers Click the Case Workers icon to view a list of people assigned to the case. A single case can have multiple people assigned to it. The person that entered the referral is assigned to the case automatically. Care mc Page 19 CorVel Corporation

21 Service(s) - Case Notes Click the Case Notes link to view notes for invoiced entries by CorVel case managers. Notes that have not been invoiced are visible in the Diary Notes screen. Service(s) - Diary Notes Click the Diary Notes icon to view all notes for invoiced and un-invoiced entries. Care mc Page 20 CorVel Corporation

22 Adding Claim Notes To add a note to claim, fill in information at the top of the screen: Note Sensitivity Select Low, Medium or High Note Type Select Claim Notes Note Category Select Client on-line Comment. Note Enter your note in the text box. Click Add The note appears in the list. From here you can review or add additional notes. To change the Note View level, click Claim Level or Case Level. Service(s) - Create Cover Page Click the Create Cover Page icon to enter information and print a fax cover sheet. Complete the empty sections in the Create Cover Page form. Patient and claim information are populated automatically. When you are finished, click the Create Cover Page button at the bottom of the form. Care mc Page 21 CorVel Corporation

23 The fax cover page opens as an Adobe PDF file. You must have the Adobe Acrobat Reader installed to view the file. You may print the cover page and / or save the file to your computer. Services(s) Invoices Click the link in the Invoices column to see a list of invoices created for the case. Care mc Page 22 CorVel Corporation

24 Service(s) Document View Click the Document View icon to see a list of documents attached to the case. Click a Document link to open and view the image file. ICD9s Use the ICD9s reference link to view the ICD-9 information for the claim. The Origin column indicates where the ICD-9 is pulled from: BR (Bill Review) or CM (Case Management). Care mc Page 23 CorVel Corporation

25 CM Savings Use the CM Savings reference link to view savings entered on Case Management claims. Physician Use the Physician reference link to view the physician information for the claim. The Origin column indicates where the Physician is pulled from: BR (Bill Review) or CM (Case Management). Facility The Facility link lists clinics and private medical facilities linked to the claim. Attorney Assigned Use the Attorney Assigned reference link to view any attorneys assigned to the claim. Care mc Page 24 CorVel Corporation

26 Click the Type link to open the Attorney Profile. RTW Plan Use the RTW Plan reference link to view the Return-to-Work plan, if any, for the patient/claim. Click the Date Entered link to drill down into the RTW Profile Click the RTW Restrictions link to view additional detail Care mc Page 25 CorVel Corporation

27 Treatment Calendar The Treatment Calendar displays the number of incidents per category and allows you to drill down into the bill information. Treatment types are based on the bill type selected in CorVel s Bill Review system: Legend PT CHI Hospital Medical Multiple DME RX Non-Medical Bill Type Physical Therapy Chiropractic HO and HI Other outpatient bill types Multiple bill types for services provided on the same day Durable Medical Equipment only Pharmacy only all other bill types Care mc Page 26 CorVel Corporation

28 Drug History The Drug History reference link lists the patient s drug history including Service Dates, Descriptions and Prescribing MD. Medical Bills The Medical Bills reference link appears on Bill Review claims. Use this link to view all bills associated with the claim. Payment Search Payment Search allows you to filter bills by First Service Date Range, Payee TIN, Bill Type, Bill Number and Check Number. To see all bills, click Clear then Search First Service Date of Range The Date Range defaults to the last 90 days Payee TIN (Tax Id Number) Bill Type Select from the drop down Bill Number Check Number Click Search. Care mc Page 27 CorVel Corporation

29 Total Payments Totals are displayed at the top of the screen, summarized by bill status. Bill Status The totals for charges, reductions, and allowed amounts are displayed at the top of the screen by Bill Status. Colored icons represent the bill status types as follows: - Open Bills - Pending Bills - Approved Bills Payment Information The payment information table displays all bills associated with the claim listed by bill number, and ordered by bill date. You can view bill images, attachments, and the EOR. Bill Images To view the bill images, click the icon in the Bill Images column for the bill you would like to view. - Bill images with no medical records or other documents attached - Bills with images and attachments If no icon appears in the Bill Images column, the bill has no images available. Care mc Page 28 CorVel Corporation

30 Use the toolbar at the top of the view window to manipulate the image, as necessary. Hover your mouse over each button to see a description of what the button can do (the Zoom In and Zoom Out, and Rotate buttons may be most useful for images that are hard to read or rotated). Click the Print icon to print the image. Note If you make any changes to the image, you may be prompted to save the changes. The Save button will not save the image. To save the image, re-launch it from the Bill Information grid and choose Save. Care mc Page 29 CorVel Corporation

31 Bill Information - EOR To view the EOR, click the icon in the Explanation of Review column. The EOR opens in Adobe Acrobat reader (PDF) format). You can print the EOR or save the file to a directory and it, as usual. Use the Next Page and Previous Page arrows in the toolbar to see all pages of the EOR (the number of pages displays in the status bar). Care mc Page 30 CorVel Corporation

32 View / the Bill Images / EOR Use the link at the top of Payment Information to View or Bill Images or EORs from Care mc. You can check the boxes on the right of the bill list to select specific documents to view or send When you click View/ the Bill Images/EOR the export form opens. Select PDF Viewer to view multiple images. The image viewer opens when you click Submit. Select and type in a recipient Address to send images via . Images are sent according to CorVel Secure Messaging policies. The recipient may need to retrieve an encrypted to open the message. Select a Document Type, choose whether to Exclude Payment Summary, and select the grouping of documents you want to Process When you click Submit, a confirmation message appears at the bottom in red. Care mc Page 31 CorVel Corporation

33 Bill Information - Bill Tracker Click the bill. icon to open the Bill Tracker window and view information about the turnaround time for the Bill Tracker provides a quick summary of the bill s history, including status dates for OPN, PIN, SBK, PAP, APP, and INV statuses. Bill Tracker also includes check number if a check was written and invoice number if the bill was invoiced. If the bill has been approved, the approver s initials and the Approver Type tell whether the bill was approved by the customer or by a CorVel Bill analyst. If the bill was sent back, the bottom of the window includes the most recent Send Back comments. If the bill was extracted, the bottom of the window lists the dates and the results of each attempt to extract the bill. Claim Payment History The Claim Payment History reference link lists payment information. Care mc Page 32 CorVel Corporation

34 Hospital The Hospital reference link lists any Bill Review hospital data associated with the claim. View Documents Click the View Documents Reference link to view documents attached to the claim. Care mc Page 33 CorVel Corporation

35 Claim Financials The Claim Financials reference link provides information about reserves and payments for a claim. Reserves & Payments Click Reserves & Payments to see a summary of current payments, reserves and incurred for each major expense category. Last Reserve Change shows the date of the last posted reserve change Pending Reserves shows a checkbox if any reserve changes are pending but not yet posted. Pending reserve changes can be deleted or changed. Click Detail next to any Category to see additional information about posted payments. Care mc Page 34 CorVel Corporation

36 Reserve History Click Reserve History to see a list of reserve changes posted for each major expense category. You can filter the list to show only certain types of reserve changes: All shows all reserve changes (different types of changes are described below) Captured reserve changes imported from a prior carrier or TPA Manual reserve changes initiated by CorVel claims staff System reserve changes initiated by CorVel claim systems Uncheck Include Payments (Y/N) to exclude payments from the list. Care mc Page 35 CorVel Corporation

37 Subrogation/Recovery Click Subrogation/Recoveries to see recovered amounts for claims under subrogation. Any information regarding subrogated parties, and other information entered in the claim system is also shown here. Liability BI The Liability BI reference link lists information about bodily injury (BI). Care mc Page 36 CorVel Corporation

38 Investigation Profile The Investigation Profile reference link lists information about Police and/or other investigating agencies. Litigation Profile The Litigation Profile reference link lists information about attorneys, counsel, and legal dispositions. Liability Claim Safety The Liability Claim Safety reference link includes information about the injured worker, accident, and insurance coverage. Liability PD The Liability PD reference link includes information about property damage (PD). Care mc Page 37 CorVel Corporation

39 Claim Witness List The Claim Witness List reference link contains information gathered from witnesses. Action Items The Action Items links appear under Reference Links on Case Management claims. These links allow you to select additional services for the claim. Each link takes you to the appropriate screen or form to select the service. Claim information is automatically populated into the new screen or form. The Case Management Services links open a new Request for Service form under the Referral tab. The fields included on the form are tailored to the service requested. For additional information, refer to the Request for Service User Guide. Care mc Page 38 CorVel Corporation

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