EZClaim Advanced 7 Manual

Transcription

1 EZClaim Advanced 7 Manual Last Updated: February 3, 2010 Copyright 2008 EZClaim Medical Billing Software EZClaim Advanced Contents 1

2 This page intentionally left blank 2 Contents EZClaim Advanced

3 Contents Part 1 Getting Started Support Resources on page 4 Top Support Questions on page 5 Installing EZClaim on page 6 Registration on page 8 Backing Up and Restoring Patient Data on page 9 Moving the Program to another Computer on page 12 Advanced Quick Start on page 14 Printer Adjustment on page 25 Part 2 Electronic Billing Electronic Claims Using the ANSI 837 Format on page 29 EDI File Analyzer on page 47 Reading EDI Reports on page 49 Additional ANSI 837 Screens on page 52 ERA ANSI 835 File - FAQ on page 59 Posting ANSI 835 ERA Files on page 61 Secondary ANSI 837 Claims on page 70 Electronic Claims Using a Print Image on page 75 Part 3 Additional Features Libraries on page 82 Find Patient on page 96 Patient/Insured Info Screen Features on page 100 Physician/Diagnostic Info Screen Features on page 102 Payers/Other Info Screen - Features on page 105 New Charges Screen - Features on page 107 Printing Claims on page 115 Entering Payments and Adjustments on page 117 Secondary Paper Claims on page 120 Claim Archives on page 124 Part 4 Advanced Features and Modules Advanced Program Features on page 127 Program Options on page 138 Reports on page 147 Networking EZClaim on page 153 Troubleshooting on page 158 EZClaim Advanced Contents 3

4 Support Resources Free Self Help Support Tools Self help support tools can be found within the program and on the web at F1 Press the F1 key on the keyboard when using the program to access the help system. Online EZAnswer Search for issues using key words. Good for error messages or general questions. Online Discussions Ask specific questions regarding all aspects of EZClaim programs. EZClaim support personnel monitor discussions. Manuals and Support Documents Download updated manuals and additional support documents not included with software package. View Tutorials pertaining to the use of EZClaim. Support Questions? See our Top Support Questions on page 5. Example: Too many users in the system. Search the Help File EZClaim provides an extensive Help file that may answer your question. To use the Help file follow these steps. 1. Click on Support/Help on the menu bar. 2. Select Help Topics. 3. Select a topic in the Contents tab list box, the Index tab list box, or use the Search tab if available. 4. Click on Display button or press the Enter key. Most help screens will also provide links for further information regarding the chosen subject. Click on the underlined link for further information. Clicking on the Print button will print out the help topic information. EZClaim Paid Support Please contact EZClaim at for information regarding our Paid Support options. 4 Support Resources EZClaim Advanced

5 Top Support Questions There are too many users message on page 159 Moving the Program to another Computer on page 12 How do I register EZClaim? on page 8 How do I adjust my printer to work with EZClaim? on page 25 How do I change the date format? on page 145 How do I backup my Patient and Claim data? on page 9 How do I print the black and white 1500 form? on page 116 How do I print line item descriptions? on page 111 How do I enter payments? on page 117 Why are all my services printing on one line? on page 104 How do I print patient statements? on page 151 How do I bill secondary paper claims? on page 120 For additional support questions and information please refer to the EZClaim web page at EZClaim Advanced Top Support Questions 5

6 Installing EZClaim Program Setup from CD How do I install EZClaim? 1. Insert the EZClaim CD. 2. If the setup program does not run automatically, click on the Start button and select Run. 3. Type in d:\setup (d: being your CD-ROM drive letter). 4. Press Enter or click on the OK button. 5. Follow the on-screen directions (basically keep clicking the Next button). Upgrading: If you are upgrading to a new version, do not uninstall your current version, simply install the software with the new CD. Your data will remain but the program will be updated. We suggest backing up your data before installing new versions. See Backing Up and Restoring Patient Data on page 9 for more information on backing up your data. Network Installation or Installing Additional Users See Network Installation or Installing Additional Users on page 154 for instructions. Opening the Program for the First Time 1. Double Click on the EZClaim Icon on your Desktop (If an EZClaim icon was not automatically installed on your desktop, see Creating an Icon on your Desktop on page 7). Or, if you do not have an EZClaim icon on your desktop, click on the Start menu button and select Programs and then EZClaim. 2. Click the Next button to move to the Provider Information screen. On this screen, enter data in all fields you want to be automatically filled each time you add a new patient. If you do not want data to be prefilled or will fill it in later, leave this page blank. 3. Click the Next button to move to the Registration screen. IMPORTANT: If you do not register at this time, the program will run for 30 days without registering. If your trial period expires, you WILL NOT lose your data. Simply register the software to gain full access. Trial Users To continue using the program in Trial mode, click the Finish button to complete the program setup. 6 Installing EZClaim EZClaim Advanced

7 Registered Users Enter your registration number and key code into the fields then click Finish. The program will give a confirmation box describing the program and modules that have been registered. Creating an Icon on your Desktop Normally, the setup program will create an icon labeled EZClaim Program on your desktop. If, for some reason the icon is not created, use the following steps to make one. 1. Go to the Start menu>programs>ezclaim 2. From the Dropdown menu right click on EZClaim Program 3. Select Send To 4. Click on Desktop (create shortcut) Proof of Purchase - Registration Number Your Registration number and Key Code is your proof of purchase. You will need this information if you contact EZClaim. Please keep these numbers on file. Updating EZClaim To check for free online updates, go to Support/Help on the EZClaim menu bar and select Check for Updates. Once on the EZClaim updates page, you will see a notification if an update is available for your program. Click on updates to take you to the updates page. Follow the instructions for updating your EZClaim program. EZClaim Advanced Installing EZClaim 7

8 Registration How do I register EZClaim? Menu Location: Support/Help > Registration During the trial period, this box will show every time you open the EZClaim program. If you are in trial mode, click OK to continue. If you have a registration number and key code, enter the numbers into the fields and click OK. You will receive a confirmation message. The registration number and key code are stored with the database. If you move the program to another computer, once the data has been restored, your program will be registered. During the trial period, all EZClaim modules are available and the database is licensed for 5 users. You have 30 days or 150 uses before the trial period expires. You will not lose data if the trial period expires. 8 Registration EZClaim Advanced

9 Backing Up and Restoring Patient Data Menu Location: File > Backup Utilities How do I backup my Patient and Claim data? Backing Up To a CD You cannot backup directly to a CD ROM drive. To backup to a CD, you must backup the data to your hard drive first (i.e. C:\Backup.zip) then use your CD burning software to burn the backup file to a CD. When using the Restore feature, the user can Restore their backed up data directly from the CD containing the Backup file. Use the Browse button to locate the Backup file and click Restore. Backing Up Data EZClaim will backup all patient and claim data including all Libraries and any memorized claims you may have in your program. Using the Backup feature does not back up the EZClaim Program, only data entered into EZClaim. To reinstall the EZClaim program, use the EZClaim CD or download the EZClaim program from the web page, To Backup Data: 1. Go to File on the menu bar, select Backup Utilities, then Backup. 2. Enter the file name that will contain the backup data or use the Browse button to select the backup location. (By default, the Backup location will read A:\Backup.zip for backing up to a floppy disk.) EZClaim Advanced Backing Up and Restoring Patient Data 9

10 3. Write down and keep file name for use when restoring data. 4. Click on the Backup Now button. 5. Once data is completely backed up a confirmation message will be displayed. Ex: The Data has been backed up to: 6. Note: Data can also be backed up to any type of disk drive. You may be asked to insert additional disks if all the data will not fit onto a single disk. 7. Once data is completely backed up a confirmation message will be displayed. Ex: The Data has been backed up to: (Path and File name) Viewing a Backup File EZClaim does not support the viewing of a backup file. You can confirm the backup file by performing a restore. Backup File Details The backup file is a ZIP compression file (not a zip disk file). You must use a ZIP compression utility such as WinZip ( or other disk compression utility to view the contents of the file. To view the contents of the EZData.mdb file, which holds your entire patient and claim data, you must use Access 2000 or higher (do not convert the database to a version higher than Access 2000). You cannot view patient, claim or note templates or auto fill libraries directly. Restoring Data EZClaim Restore feature will restore all patient and claim data previously backed up. 10 Backing Up and Restoring Patient Data EZClaim Advanced

11 Note: Unless you have moved or want to move your data files, you should restore the data to the folder C:\Program Files\EZClaim To Restore Data: 1. Go to File on the menu bar, select Backup Utilities and then Restore. 2. Enter the file name that contains the backup data or use the Browse button to select the location of the backup file. If using the Browse button, double click the file name to enter it into the Restore field. 3. Click on the Restore Now button. Moving Data Files to a Server To move your data files from your local computer to a server computer: 1. Backup your data using the above instructions. 2. Restore your data using the above instructions but click the Browse button for the field labeled Restore data to the following folder and select a location on the server. EZClaim Advanced Backing Up and Restoring Patient Data 11

12 Moving the Program to another Computer How do I move EZClaim to another computer? Step 1 - Install Program on Second Computer 1. Install the program on your second computer 2. Using your original installation CD, install the program onto the new computer. If you cannot locate your CD, you can download the full version of EZClaim Advanced from our website at (Just fill in the required fields and you will be allowed to download the installation file to install EZClaim on your new computer.) 3. Confirm correct installation by running the program and viewing the sample patient. Step 2 - Backup Data from First Computer. 1. Go to File on the menu bar, select Backup/Restore Utilities, then Backup Data. 2. Enter the file name that will contain the backup data or use the Browse button to select the backup location. (By default, the Backup location will read A:\Backup.zip for backing up to a floppy disk. If your computer does not have a floppy drive, select another location using the Browse button.) 3. Write down and keep file name for use when restoring data. 4. Click on the Backup Now button. Step 3 Restore Data to Second Computer 12 Moving the Program to another Computer EZClaim Advanced

13 1. Go to File on the menu bar, select Backup/Restore Utilities and then Restore Data. 2. Confirm the file name. If needed, click the second Browse button to locate the backup file. Double click the file name to select it. 3. Click on the Restore Now button. EZClaim Advanced Moving the Program to another Computer 13

14 Advanced Quick Start EZClaim Tutorials Watch several short movie on entering patient data into EZClaim Advanced. Go to EZClaim Tutorials at to view. ANSI 837 Electronic Submission For information on submitting claims using the ANSI 837 file format, refer to Electronic Claims Using the ANSI 837 Format on page 29. EZClaim Free Web Updates To check for free online updates, go to Support/Help on the EZClaim menu bar and select Check for Updates. Once on the EZClaim updates page, you will see a notification if an update is available for your program. Click on updates to take you to the updates page. Follow the instructions for updating your EZClaim program. Data Entry Tips Do not use words such as Same None or N/A. Use only valid data in fields. Do not use MR., MS. or other prefixes. Do not use DR. MD, OD etc. Providers are identified by their NPI or provider numbers only. 14 Advanced Quick Start EZClaim Advanced

15 Do not use any special characters such as hyphens, commas, apostrophes, etc. unless required by your insurance carrier. EZClaim Advanced Advanced Quick Start 15

16 Step 1 Payer Library EZClaim suggests entering this data before entering Physician Library and patient data. Menu Location: Tools > Payer Library Add Payer Information to Library 1. Enter name and address of Payer. 2. Enter Payer ID if submitting electronic claims. (Payer ID s are provided by your insurance company or clearinghouse.) 3. Click on the Add button. 4. Payer information is now listed in the box below. 5. To Edit payer information, highlight the payer, click on Edit and then Add/Save. 6. Note: Additional data entry may be required for electronic claims. Step 2 Physician, Organization and Facility Library Click the Tools menu and select Physician/Facility Library Setting up the Physician Library correctly is very important for error free claim submission. Once the entries are completed in the library, they will be selected on EZClaim s data entry screens. EZClaim recommends entering this information before entering patient data. 16 Advanced Quick Start EZClaim Advanced

17 Entering Billing Provider Information (Box 33 on CMS 1500 form) 1. Enter the Name of Provider, Agency or Business in Full Name Required field. 2. For billing provider data select Billing as Classification. 3. Select Entity Type as Person or Non-Entity Type if Agency or Business name. 4. Enter Organization name or Last Name and First Name if person. 5. Enter Address information. 6. Enter Individual or Group NPI number. 7. Enter Tax ID Type using the dropdown arrow and then enter number. 8. If required, enter additional ID Numbers such as Medicaid or BC by first selecting the Payer by clicking in the blank line. Using the dropdown box select ID Type and enter ID numbers required by the Payer. Note: As of May 23, 2008 Legacy numbers are not required for most insurance companies. 9. Click on Save. EZClaim Advanced Advanced Quick Start 17

18 Entering Rendering Provider Information (Box 31 on CMS 1500 form) If the Billing provider has entered a Group or Group NPI entry, the provider may also require a Rendering Provider entry for their Individual NPI/ Provider number. 1. Enter the First and Last name in the Full Name (Required) field. This is the name you will see when selecting an entry. 2. Select Rendering as Classification. 3. Select Entity Type. 4. Enter Last name and First name. 5. Enter NPI number. 6. If required, enter additional ID Numbers by first selecting the Payer by clicking in the blank line. 7. Click on Save. Entering Facility Information Enter Facility if required. 1. Enter Facility Name. 2. Select Facility Classification 3. Select Entity Type. 4. Enter Name and Address information. 5. Click on Save. 18 Advanced Quick Start EZClaim Advanced

19 Entering Referring Provider Information 1. Enter Name. 2. Select Referring as Classification 3. Select Entity Type. 4. Enter Last and First names or Organization name. 5. Enter NPI number of Referring Provider. 6. Click on Save. Provider Information - Optional Menu Location: Tools > Options > Provider Information Note: Information entered into the Provider Information screen will automatically be entered on each new patient form. Enter only information you want automatically entered on each patient form. Note: When you change information on this screen, it will not change current patient data, only new patient data entered. If you are billing for multiple providers, it is probably best to leave most of this screen blank and use the Patient Template feature instead. See: Patient Templates - New Patient Using a Template on page 127 Provider Specialty is used only for electronic billing and is not printed on paper claims. EZClaim Advanced Advanced Quick Start 19

20 Step 3 Patient/Insured Info Screen Field Requirements for General Data Entry (Additional fields may be required by your insurance company) Follow these recommended guidelines. Do not use DR. MR. MS. or other prefixes. Providers are identified by their NPI or provider numbers only. Do not use words such as Same None or N/A. Use only valid data in fields. Patient Information Name, Address, City, State and Zip Date of Birth Patient Gender Patient Relationship to Insured. Claims sent to Medicare are always marked Self. Insured ID number. Assignment of Benefits Indicator and Release of Information Indicator. (EZClaim Fields: Patient Sig on File and Insured Sig on File.) Print Current Date Or - Enter a date or checkmark in the check box. 20 Advanced Quick Start EZClaim Advanced

21 Insured Information: Note: If the Patient is the same as the Insured, use the Copy button to enter data in Insured fields. Insured ID number, Date of Birth, Gender Insured s Policy Group or FECA Number if required. Printing the Form and Data If you are printing on the red pre-printed 1500 forms, make sure the box (bottom right) is unchecked. If checked, a black and white 1500 form will be printed along with the data. Step 4 Physician/Diagnostic Info Screen Date of Current: This is the Default Date of Current field. Enter a date in this field if the date is used for all charges for this patient. If this date is for current charges only, enter Date of Current on the Charges Screen. This field is required by Medicare. Referring Provider: Name and NPI#: Use dropdown arrow to select Referring Provider information. Physician/Supplier Name: Box 33 on the Use the dropdown arrow to select the Physician/Organization name previously set up in the Physician Facility Library under Tools > Physician Library. EZClaim Advanced Advanced Quick Start 21

22 Patient Account No: Go to Tools>Options> General Data Entry to set the option for automatic entering of a Patient Account Number or enter an Account Number of your choosing. Accept Assignment: Check Yes or No Physician Signature: Check to print out Signature on File in Box 31 Print Date: Check to print date on claim. Facility Information: If required, use dropdown arrow to select Facility Information previously set up under Tools>Physician/Facility Library. Rendering Provider: If required, use dropdown arrow to select Rendering Provider information previously set up under Tools > Physician/Facility Library. For paper claims, this information will print in Box 24j of the 1500 form. Carrier Area: Click on Click to select Payer button to select a Payer previously set up in the Payer Library, Tools > Payer Library. For printing, this information will print on the top right of your 1500 form. Payers and Others Info Screen Optional Note: This screen is primarily used for ANSI 837 electronic submission. Refer to Electronic Claims Using the ANSI 837 Format on page 29 for additional information. 22 Advanced Quick Start EZClaim Advanced

23 Step 5 New Charges Screen Diagnostic Codes Enter DX codes in Diagnostic Codes boxes. Enter Diag Code Line # on Service Line. Data Entry Click on the dates of the calendar to enter service line dates. Continue entering required service line data. Multiple Modifiers Enter multiple modifiers as GP 25 or GP25. Do not enter as GP*25. Place of Service Codes: Below are the most commonly used codes. 11 Office 12 Home 21 Inpatient Hospital 22 Outpatient Hospital 23 Emergency Room - Hospital 31 Skilled Nursing Facility 32 Nursing Facility 34 Hospice 41 Ambulance - Land 42 Ambulance - Air or Water 51 Inpatient Psychiatric Facility 55 Residential Substance Abuse Treatment Facility 56 Psychiatric Residential Treatment Center EZClaim Advanced Advanced Quick Start 23

24 81 Independent Laboratory 99 Other Unlisted Facility Situational: Rendering Provider and Facility Information If required, use dropdown arrow to select Rendering Provider previously set up in the Physician/Facility Library. If required, use dropdown arrow to select Facility previously set up in the Physician/Facility Library. Note: DME Companies do not usually require Rendering Providers. Leave the rendering provider fields blank. Step 6 Printing Claims and Adjusting your Printer Printer Adjustment on page 25 Printing Claims on page 115 Printing Single Claims Claims can be printed one at a time from the Charges screen by clicking the button. Batch Printing To print a batch of claims, click the File menu and click Select Claims to Print. Click to highlight the claims to print then click If you want to print a black and white 1500 form, check the box. 24 Advanced Quick Start EZClaim Advanced

25 Printer Adjustment Menu Location: File > Printer Adjustment How do I adjust my printer to work with EZClaim? IMPORTANT: You must use an original, pre-printed CMS-1500 form. Do not use a copied or faxed CMS-1500 form. Also, if you are using an ink-jet or laser printer, you must use the single sheet CMS-1500 forms. Do not use the multi-part continuous feed forms in a laser or inkjet printer. EZClaim will work with any printer that Windows 95 (or above) can handle. Follow the steps below and your forms will print out correctly. Note: After setting printer values you must click on OK to set values 1. Click on File on the menu bar and then Printer Adjustment. 2. Load your printer with CMS-1500 forms. 3. Click the Print Test Page button. 4. Following Printer Adjustment instructions, change values until the X is positioned in the center of the Medicare check box at the top of the CMS-1500 form. (Suggestion: Continue using the same form until adjusted) 5. When adjustment is correct, click on OK. EZClaim Advanced Printer Adjustment 25

26 Troubleshooting Printer Adjustments Printing problems can be frustrating. Every printer has different issues. The following trouble shooting tips try to address the common printing issues, why they happen and what can be done to fix them. Make sure you are using the latest version of EZClaim. Over time based on customer experiences, we may make minor adjustments to the printing system. Your issue may have been addressed in later releases. Click the Support/Help menu > Check for Updates. Try 11pt or 10pt Courier New Font. If the data is close but still on the lines in some places, you can try a smaller font. File menu > Printer Adjustment. If Box 33a and 33b numbers are printing on the line, make sure you are using 'Normal Spacing' for the 'Bottom Margin Setting.' Both 'Tight Spacing' and 'Smaller Font' will force the numbers to move up and print on or above the line. Vertical Adjustment may be used as well (see below). The date is printing on the hash marks. This is normal if using a 4 digit year in the format MMDDYYYY. Most insurance companies want a 4 digit year and if so, it must be in the MMDDYYYY format. Data prints good on the top of the form but is too low or high on the bottom of the form. Check the Vertical Adjustment. Most users can have a setting of 0 in this field. If a value is required, it is usually between - 25 and 25. The Black and White form is faint or too light. Review the following article INFO: Printed 1500 form is too light and/or blurry 85 If you are still having trouble getting the form lined up, the following step by step instructions should help. 26 Printer Adjustment EZClaim Advanced

27 1. Update your software to the latest release. Open EZClaim, Click Support/Help > Check for Updates. Follow the onscreen instructions. After the software has been updated, continue with the following steps. 2. Confirm you are using the correct claims for your printer. If you are using a laser or inkjet printer, you need the single sheet laser forms (do not use claims with 'holes' on the sides). If you are using a dot matrix printer, you should be using the pin feed forms (the claims with 'holes' on the sides). 3. Click the File menu, select Printer Adjustment and set the following values: - Up/Down = 0 - Left/Right = 0 - Bottom Margin = Normal Spacing - Carrier Area Adjustment Up/Dn and L/R are both = 0 - Vertical Shift Adjustment = 0 - Font Setting = 12pt Courier New 4. Click the OK button to save the settings. 5. Load your printer tray with red pre-printed claim forms. - Do not use photo-copied forms - Do not manually feed claims into the printer - Do not load a single sheet into the tray 6. Load a patient to use for testing. - Be sure the 'Print Form and Data' box is UNCHECKED (lower right corner). - It helps to have the 'Medicare' box checked (top left corner) to match our samples. 7. Click on a Charge tab that you will use for testing (don't use the New Charges tab). 8. Print the one claim 3 times in a row to check for consistency. We are looking to see if the paper feeds through the printer consistently. Look for the X in Box 1 on the form. Is the X very close to the same position on all three claims? If the X is not positioned the same every time, changing EZClaim settings will not work. The printer must print the X in the same place every time for claims to print correctly If the claims are not consistent, check the following: - Is the paper tray fully loaded with claims - Are the claims tight within the tray or is there room for the forms to slide around EZClaim Advanced Printer Adjustment 27

28 - Are the claims 'sticking' to one another because of static If you are not able to consistently position the data on the claims, you may need to look for another printer. 9. Using your 3 consistently printed claims as a guide, determine which way the claim needs to be moved. Here is an example from our printer. All 3 X's are very close to the same position. Based on the current X location we determine it needs to move right and up: 10. Click the File menu and select Printer Adjustment. 11. Based on your samples, enter the appropriate values. - The Up/Down, Left/Right values are in.01 of an inch. 6 = 1/16 of an inch 12 = 1/8 of an inch 25 = 1/4 of an inch - In our example, we measured how far the X needs to move up and over and determined it need to move up and over 1/8 of an inch so Up/Down and Left/Right will be set to Click OK to save the settings. 13. Print your claim again. Look at the print and see if additional adjustments need to be made. - In our example, it still wasn't perfect so we switched to Up/Down = 10 and Left/Right = 15 Carrier Area Location Adjustment Menu Location: File > Printer Adjustment If you are using windowed envelopes it is recommended you use claim form envelopes. It may be necessary to adjust the carrier area to print out correctly for the envelope window. Adjust the Carrier Location in the Printer Adjustment box, File>Printer Adjustment>Carrier Locations. 28 Printer Adjustment EZClaim Advanced

29 Electronic Claims Using the ANSI 837 Format EZClaim can meet all of your Electronic billing needs. Contact EZClaim for additional information and pricing or visit our web page at Electronic Claims Support If you are billing directly to the insurance company, we strongly suggest purchasing our EDI Support package. Call for details on our EDI Support package. (877) Program Updates and Tutorials Before you begin to enter patient data check for updates to your program. To check for updates go to Support/Help on the EZClaim menu bar and select Check for Updates. See Updating EZClaim on page 7 for additional instructions. View ANSI 837 Quick Start tutorial at Note: Entering the following data will result in ANSI 837 errors! Do not use words such as Same None or N/A. Use only valid data in fields. Do not use MR., MS. or other prefixes. Do not use DR. MD, OD etc. Do not use decimal points in DX codes. Unless required by your insurance carrier, do not use any special characters such as hyphens, commas, apostrophes, etc. Use 5 digit zip codes unless 9 digits are required by the payer. Submitter/Receiver Information Step 1 1. Go to Tools > Options > Submitter Information 2. Do not enter Pay to Provider unless required by your insurance company. EZClaim Advanced Electronic Claims Using the ANSI 837 Format 29

30 3. Click on Submitter/Receiver to open your Submitter/Receiver Library. 4. To Edit an entry, highlight the entry on the left, make changes and then click on Save. 5. To Add a new library entry, click on New, enter all required data and then click on Save. 6. When finished, click on Save and then Close. Required Fields Library Entry Name - Enter a name to identify the library entry. 30 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

31 Export Format - Choose the export format from the drop down list. Submitter Type - Use the drop down box to choose a Person or Non-Person type. Submitter Name - Enter the name of the person or company submitting the file. Submitter Identifier Enter the EDI submitter number provided by the insurance carrier that identifies the submitter of the file. Contact your insurance carrier for your EDI submitter ID#. Contact - Enter the name of the contact person. Telephone Number - Enter the phone number of the contact person in this format, Receiver Name - Information is provided by your insurance carrier. Interchange Receiver ID (ISA08) - Information is provided by your insurance carrier. Receiver ID (NM109) - Information is provided by your insurance carrier. Test/Production Indicator - Enter either TEST or PROD. Receiver Code (GS03) - Information is provided by your insurance carrier. Situational Fields NOTE: Do not enter Situational fields unless required by insurance carrier or errors will be generated! Strip extra characters from ID fields Usually checked, uncheck only if the insurance company requires a dash in your Tax ID# for electronic claims. Sender ID Enter only if a different number than the Submitter ID number. Sender Code Enter only if different number than the Submitter ID number. Password Do not enter unless required by your insurance company for electronic claims. Acknowledgment Requested - Usually left checked. Zip Export File Usually left unchecked unless requested by your insurance company. Payer Library Step 2 This information must be entered before entering Physician/Facility Library data. EZClaim Advanced Electronic Claims Using the ANSI 837 Format 31

32 Menu Location: Tools > Payer Library Add Payer Information to Library 1. Enter name and address of Payer. 2. Use dropdown arrow to select Ins.Type Code. 3. Required: Enter Payer ID number. (Contact your Insurance Carrier for Payer ID# s) 4. Click on the Add/Save button. 5. Payer information is now listed in the box below. Physician, Organization/Facility Library Step 3 Click the Tools menu and select Physician/Facility Library Setting up the Library correctly is very important for error free claim submission. Once the entries are made in the library, they will be selected on EZClaim s data entry screens. This information must be entered before entering patient data. General Physician Library Information Classification Use dropdown arrow to select classification type. The classification determines in which list the name will appear. For example, if you select Billing, the name will only show in the Billing 32 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

33 selection drop down (Box 33 on the 1500 form). Entity Type Person is an individual provider. Non- Entity is an Organization, Agency, Company etc. Specialty Code is not used. Notes, Fax and is used for your reference only. To edit a current entry, click the name, make the changes and click the Save button. Under Additional ID Numbers you must click in the blank line to bring up dropdown selection arrows. Entering Billing Provider Information (Box 33 on CMS 1500 form) 1. Enter the Name of Provider, Agency or Business Name. 2. Select Billing as Classification. 3. Select Entity Type as Person or Non-Entity Type if Agency or Business name. 4. Enter Last Name and First Name or Organization name. 5. Enter Address information. EZClaim Advanced Electronic Claims Using the ANSI 837 Format 33

34 6. Enter Individual or Group NPI number. 7. Using the dropdown arrow, select Tax ID Type and enter number. DO NOT ENTER SPECIALTY (TAXONOMY) CODE UNLESS REQUESTED BY INSURANCE COMPANY. ERRORS WILL BE GENERATED. 8. Enter Additional ID numbers only if required by your insurance company. Select Payer by clicking in the blank line. Continue entering ID Type and either the providers Individual or Group ID Number. (If entering a Group number, see Rendering Provider data entry below.) 9. Click on Save. Entering Rendering Provider Information (Box 31 on CMS 1500 form) If the Billing provider has set up a Group or Group NPI entry, the provider must also have a Rendering Provider entry for their Individual NPI/ Provider number. 1. Enter First and Last name. 2. Select Rendering as Classification. 3. Select Entity Type. 4. Enter Last and First name. 5. Enter NPI number. 6. Using the dropdown arrow, select Tax ID Type and enter number. 34 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

35 7. Enter Additional ID numbers only if required by your insurance company. Select Payer by clicking in the blank line. Continue entering ID Type and provider s Individual PIN#. 8. Click on Save. Entering Facility Information 1. Enter Facility information only if different than the Billing Provider information. (Box 33 of the 1500 form.) 2. Enter Facility Name. 3. Select Facility Classification 4. Select Entity Type. 5. Enter Name and Address information. 6. Click on Save. Entering Referring Provider Information 1. Enter Name. 2. Select Referring as Classification. 3. Select Entity Type. 4. Enter Last and First names or Organization name. 5. Enter Additional ID numbers only if required by your insurance company. 6. Click Save. Patient/Insured Info Screen Step 4 IMPORTANT: Not all fields are required for electronic submission. Below is a sample of the data that is USUALLY required. The most common codes are provided below. EZClaim Advanced Electronic Claims Using the ANSI 837 Format 35

36 Field Requirements Follow the guidelines below when entering data for electronic billing. EZClaim will format the fields (such as date formats) correctly when generating the export file. Do not use words such as Same None or N/A. Use only valid data in fields. Do not use DR. MR. MS. or other prefixes. Patient Information Required: Name, Address, City, State and Zip Required: Date of Birth Required: Patient Gender Required: Patient Relationship to Insured. Claims sent to Medicare are always marked Self. Situational: Insured Group Name - Required only if the insured payer identification includes a Group or Plan name. Required: Assignment of Benefits indicator and Release of Information indicator. (EZClaim Fields: Patient Sig on File and Insured Sig on File.) Required: Patient Signature Source. Note: B or C are the codes most often used. B - Signed signature authorization for CMS1500 Block 12 and 13. C - Signed CMS-1500 claim form on file. M - Signed signature authorization form for Block 13 on file. S - Signed signature authorization form for CMS-1500 block 12 on file. P - Signature generated by provider because the patient was not physically present for services. Required: Print Current Date Or - Enter a date or checkmark in the check box. Insured Information Required: Insured ID#, Date of Birth, Gender Situational: Insured s Policy Group or FECA Number Required only if the subscriber s insurance policy includes a Group or Plan Number. Other Insured Information Situational: Other Insured Information Enter secondary data only if submitting a secondary insurance for this claim. Enter secondary information in Box 9a-9d, 36 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

37 Other Insured information. Note: Enter secondary insured s ID# on the Payer/Other Info tab. Physician/Diagnostic Info Screen Step 5 Field Requirements Required: Organization/Physician billing information, (Box 33). Use the dropdown arrow to select the Physician/Organization name previously set up in Physician/Facility Library. Required: Patient Account No. EZClaim will automatically send a Patient Account Number if the Patient Account Number filed is blank. Required: Accept Assignment indicator. Yes or No Required: Physician Signature on File indicator. NOTE: Do not enter Situational fields unless required by insurance carrier. Situational: Date of Current This is the Default Date of Current field. Enter a date in this field if the date is used for all charges for this patient. If this date is for current charges only, enter Date of Current on the Charges Screen. This field is required by Medicare. Situational: Referring Provider Name and ID#: Use dropdown arrow to select Referring Provider information. Situational: Facility Information: Do not enter facility information unless Facility data is different from Billing information. Use dropdown to select Facility Name. EZClaim Advanced Electronic Claims Using the ANSI 837 Format 37

38 Situational: Rendering Provider: Enter Default Rendering Provider if required by your insurance company. Payers and Others Info Screen Step 6 Enter Payer Information Situational: Usually not required. Do not enter situational information unless required by your Payer or errors will be generated. Patient Member ID Usually left blank. Subscriber SS# - Usually left blank. Patient Weight Usually left blank. Patient Height Usually left blank. Selecting Payers 1. Click on the Click to Select Primary Payer button. 2. Select by highlighting the Payer and click OK. 3. Required: Use the dropdown arrow to select Primary Claim Filing Indicator. 4. DO NOT enter additional information unless required by insurance company. Secondary Payers 1. Click on the Click to Select Secondary Payer button. 2. Highlight 'Payer', click OK. 3. Required: Use the dropdown arrow to select Claim Filing Indicator. 4. Required: Enter ID# of secondary insurance holder. 38 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

39 Note: To delete a Payer on Payer/Others Info screen, click on the Clear Primary or Clear Secondary button. Notes To include notes with your ANSI file check the Include Notes with EDI file checkbox. New Charges Screen Step 7 Data Entry Tips Diagnostic Codes Do not use decimal points in Diagnostic codes unless required by your insurance company. Most all will reject claims if decimal points are used. Date Formats EZClaim formats all dates correctly when generating ANSI files. There is no need to enter dates in a special format when performing data entry. Multiple Modifiers Enter multiple modifiers as GP 25 or GP25. Do not enter as GP*25. Place of Service Codes: Below are the most commonly used codes. See manual for full listing. 11 Office 12 Home EZClaim Advanced Electronic Claims Using the ANSI 837 Format 39

40 21 Inpatient Hospital 22 Outpatient Hospital 23 Emergency Room - Hospital 31 Skilled Nursing Facility 32 Nursing Facility 34 Hospice 41 Ambulance - Land 42 Ambulance - Air or Water 51 Inpatient Psychiatric Facility 55 Residential Substance Abuse Treatment Facility 56 Psychiatric Residential Treatment Center 81 Independent Laboratory 99 Other Unlisted Facility Exporting Claims Step 8 Electronic Claims! On the Menu bar Selecting the Submitter/Receiver Entry 1. Go to Electronic Claims 2. Using the Format dropdown, select the type of file being submitted. Ex: For all ANSI files the ANSI 837 would be selected. 3. Using the Submitter/Receiver dropdown, select the correct Submitter/Receiver information for the file being submitted. (See Step 1 if the Submitter Library has not been previously set-up.) Note: Clicking on the button to the right of the drop down will open the full Library. 40 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

41 Selecting and Exporting Claims 1. If needed, sort claims by filters. Ex: Put checkmark in the Ready for EDI checkbox. 2. Click the Select All button to select all claims showing. Note: To select a series of claims, click the first claim then hold down the SHIFT key and click the last claim. To select individual claims, hold down the CTRL key, and click on the names. 3. Once claims have been selected, click on the Analyze button to analyze the file before submitting to the insurance carrier. If errors are found, return to patient record and update data. To view the full analyzed file hold down the Ctrl key and click the Analyze button. 4. Return to Electronic Claims dialog box and click on the Export and Send button. 5. In the Save As dialog box, click the Save In dropdown arrow and select C: drive or a location of your choice. 6. By default, file name will be Claimdat.txt. The file name Claimdat should be changed for each submission. Some providers use a Filename based on the date of submission. EX: txt. IMPORTANT: If your payer uses a specific file location and file name, be sure to follow the payer s instructions. EZClaim Advanced Electronic Claims Using the ANSI 837 Format 41

42 7. Click on the Save button. Please note the full Path and Filename of your batch file. 8. If you would like a printed Submission report, click Yes to print report. (Submission Reports are saved and may be accessed by going to File on the menu bar>reports>submission Reports.) 9. In the Send Exported Claims dialog box, enter transmission telephone number or Web page address if submitting over the Web and click Go. 10. Once connected, follow payer s instructions for entering Logon ID and Password. (Below is a sample Bulletin 42 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

43 Board system. Your Payer may use a different system.) 11. When asked to Send file, click on Send File on the menu bar of the Terminal program. 12. Using dropdown arrow select Modem protocol for transmission. We suggest using ZModem protocol for uploading files. (Check your Payer s Bulletin Board instructions for modem requirements.) 13. In Send File dialog box enter Filename by right clicking in the box and selecting Paste, or enter filename manually. 14. Click Send. 15. Follow payer s remaining instructions. Re-Exporting Claim Data Step 9 1. Selecting Previously Submitted Claims EZClaim Advanced Electronic Claims Using the ANSI 837 Format 43

44 2. Click on the Show Previous Batch button. 3. Double click on the previous batch of claims to view. 4. Select by highlighting all claims or individual claims to reexport. 5. Click on the Export or Export and Send button. 6. Re-export claims. EZTerminal - Retrieving Reports Step 10 Menu Location: File > Terminal Program 44 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

45 Use EZTerminal to dial into the Payer s computer. Once connected you can access all the features of the Payer s Bulletin Board System. (BBS) Using the EZTerminal Send File Feature 1. Go to File on the menu bar, select Terminal Program. 2. Confirm the correct phone number and modem by clicking on Setup. 3. Click on Connect. 4. Once connected use features of Payer s BBS to navigate screens. 5. When sending file, click Send File on menu bar and enter the Filename by right clicking and choosing Paste. Select Protocol. Use ZModem or choose alternate protocol by clicking on dropdown arrow. 6. When finished click the Hang Up button Using the EZTerminal Receive File Feature The following are general instructions for retrieving response files. Your Bulletin Board System (BBS) may have different requirements. Tip: When viewing the list of files to download on the BBS, use EZTerminal s Print Page menu item to print the page of filenames. This helps if searching for the downloaded file. 1. Log into BBS using the carrier s BBS instructions 2. Navigate to the download section. EZClaim Advanced Electronic Claims Using the ANSI 837 Format 45

46 3. At some point you may be asked to select a protocol. We suggest using ZModem protocol. 4. Select the file to download. (If there are additional files, you may have to repeat process) 5. Click the Receive File item on the EZTerminal menu bar. A receive box will appear. 6. Use the Browse button to choose the location for saving the file, we suggest saving files to the Desktop for easy retrieval. 7. Select ZModem 8. Click on the 'Receive File' button. 9. When asked if you would like to Analyze file select yes. NOTE: If you are using Hyper Terminal or Web based submission you must use the EZClaim Analyzer to analyze your reports. Go to the downloaded file, right click on the file, choose Send To and then EDI Analyzer. 10. Print error report. 11. If Windows opens a box asking which program to use when opening the file, scroll down and choose 'WordPad' or Notepad If you are using Hyper Terminal or Web based submission you must use the EZClaim Analyzer to analyze your reports. In EZClaim, click the Tools menu, select EDI File Analyzer, then click the Browse button to find the downloaded file. Once selected, click the Analyze button. 46 Electronic Claims Using the ANSI 837 Format EZClaim Advanced

47 EDI File Analyzer Menu Location: Tools > EDI File Analyzer The EDI File Analyzer will read electronic files and reformat them into a form that is easily readable. Different electronic file types will have different formats. Here is a list of formats that are compatible with the EDI File Analyzer. Compatible Formats ANSI 278 Authorization File ANSI 835 Electronic Remittance Advice ANSI 837 Electronic Claim File ANSI 864 Status file returned by DMERC Region B ANSI 997 Functional Acknowledgement Availity EBR Raw Data File United HealthCare Medicare Part B and DMEPOS Electronic Claim Reject Report Analyzing a File There are three ways to analyze a file: 1. Clicking the Analyze button on the Electronic Claims screen prior to exporting an ANSI 837 claim file. 2. When downloading of files from a payer s BBS the analyzer is automatically run on the downloaded file. If the file is not recognized, the analyzer will open the file in Window s Notepad. 3. Manually selecting a file for analyzing. Analyzing Electronic Claim Files Menu Location: Electronic Claims! EZClaim Advanced EDI File Analyzer 47

48 Select the claims that you would like to analyze and click the Analyzer button. If errors are found, a report showing the location of the error and where to fix them in EZClaim will be shown. If no errors are found, a message box will pop up saying no errors found. Analyzing Downloaded EDI Files When files are downloaded with the Terminal Program built into EZClaim ( EZTerminal - Retrieving Reports Step 1 on page 44), the program will ask if you want to analyze the file. Select Yes. The analyzed file will appear in Window s Notepad. Manually Analyzing EDI Files If an EDI file already exists, you can manually analyze it with the EDI File Analyzer. 1. Click the Tools menu and select EDI File Analyzer. 2. Click the Browse button to select the file. 3. Click the Analyze button. Re-Analyzing an EDI File The EDI File Analyzer shows the last 20 files analyzed. If you downloaded a file and analyzed it but don t remember where it was saved, you can use the EDI File Analyzer to view the file. 48 EDI File Analyzer EZClaim Advanced

49 Reading EDI Reports If you have downloaded an EDI file and it has not been analyzed by EZClaim, you can manually analyze it by right clicking the file, selecting Send To then EDI File Analyzer. An analyzed 997 report will look like the sample below. If the analyzer does not know what kind of file it is, the analyzer will give you the option of opening the file with Notepad. More information found in EDI File Analyzer on page 47 Once you have submitted your claims, the first report you will receive is a 997 Report. The 997 is usually available the day claims were submitted. This report will tell you if you have the required ANSI 837 data entered and you will see the following toward the bottom of the file: Transaction Set Acknowledgement Code: A - Accepted Functional Group Acknowledgement Code: A Accepted About 3 days after an accepted 997 you will have a more detailed report on every claim submitted. Accepted Report Sample Date and Time Analyzed: 2/16/2004 3:10:19 PM Analyzing File: C:\\o2555.o2555 Analyzed Results Saved To: C:\\o2555.o2555.analyzed.txt Detail Level: All ISA Header Information ISA*00* *00* *ZZ*00522 *ZZ*O2555 *040216*1357*U*00401* *0*P*:~ Interchange Sender ID: Interchange Receiver ID: O2555 Interchange Date: Interchange Time: 1357 Interchange Control Number: Usage Indicator: Production GS Header Information GS*FA*00522*O2555* *1502*1*X* Application's Sender Code: Application's Receiver Code: O2555 Group Control Number: 1 Transaction Set: 997 Transaction Set Control Number: Transaction Set Acknowledgement Code: A - Accepted Functional Group Acknowledgement Code: A - Accepted Number of Transaction Sets Included: 1 Number of Received Transaction Sets: 1 EZClaim Advanced Reading EDI Reports 49

50 Number of Accepted Transaction Sets: End of Output Rejected Report Sample When trying to determine errors with ANSI 837 files, there are three pieces of information required, the Loop, the Segment, and the Field number. With those three pieces of information, you can use EZClaim s ANSI 837 Reference guide available online at to determine where in EZClaim the information is located. If you receive a Rejected Report you will need to refer back to your analyzed file of your submitted claim batch. Most insurance companies do not provide the necessary Loop information. Follow these steps to decipher the Analyze and print the Using your analyzed file, find which line number has the error. Date and Time Analyzed: 11/12/2003 3:36:13 PM Analyzing File: C:\Program Files\EZClaim\997P315.A Analyzed Results Saved To: C:\Program Files\EZClaim\997P315.A.analyzed.txt Detail Level: All ISA Header Information ISA*00* *00* *ZZ* *ZZ*C0MBQ *031111*1217*U*00401* *0*P*:~ Interchange Sender ID: Interchange Receiver ID: C0MBQ Interchange Date: Interchange Time: 1217 Interchange Control Number: Usage Indicator: Production GS Header Information GS*FA* *ABCDE* *1217* *X*004010X098A Application's Sender Code: Application's Receiver Code: ABCDE Group Control Number: Transaction Set: 997 Transaction Set Control Number: Segment ID Code: SBR Submitted File Line Number: 15 Loop Identifier Code: 2000B Position in Segment: 9 Data Element Reference Number: 1032 Data Element Syntax Error Code: 7 - Invalid code value Current Value: MP 50 Reading EDI Reports EZClaim Advanced

51 Segment ID Code: SBR Submitted File Line Number: 25 Loop Identifier Code: 2320 Position in Segment: 9 Data Element Reference Number: 1032 Data Element Syntax Error Code: 7 - Invalid code value Current Value: C1 Transaction Set Acknowledgement Code: R - Rejected Transaction Set Syntax Error Code: 5 - One or More Segments in Error Functional Group Acknowledgement Code: R - Rejected Number of Transaction Sets Included: 1 Number of Received Transaction Sets: 1 Number of Accepted Transaction Sets: EZClaim Advanced Reading EDI Reports 51

52 Additional ANSI 837 Screens These screens are only available with the Enhanced ANSI 837 module. Ambulance Chiropractic DME/CMNs Ambulance Location: Charges Screen > Ambulance Button This screen is only available to customers who purchase the Enhanced ANSI 837 module. Ambulance Trip Information To enter information about an ambulance trip, open the ambulance information screen. Click on the Ambulance button. Enter codes into dialog box. 52 Additional ANSI 837 Screens EZClaim Advanced

53 Transport Codes: I Initial Trip R Return Trip T Transfer Trip X Round Trip Transport Reason Codes: A Patient was transported to nearest facility for care of symptoms, complaints, or both. B Patient was transported for the benefit of a preferred physician. C Patient was transported for the nearness of family members. Condition Indicators: 01 Patient was admitted to a hospital 02 Patient was bed confined before the ambulance service 03 Patient was bed confined after the ambulance service 04 Patient was moved by stretcher 05 Patient was unconscious or in shock 06 Patient was transported in an emergency situation 07 Patient had to be physically restrained 08 Patient had visible hemorrhaging 09 Ambulance service was medically necessary 60 Transportation Was To the Nearest Facility Round Trip Purpose Description A free form description to clarify the purpose for the round trip ambulance service. Stretcher Purpose Description EZClaim Advanced Additional ANSI 837 Screens 53

54 A free form description to clarify the purpose for the usage of a stretcher during ambulance service. Box 32 If printing paper claims, information for Box 32 on the CMS can be entered into this field to facilitate pickup location information without having to enter data into the Physician/Facility library. Chiropractic This screen is only available to customers who purchase the Enhanced ANSI 837 module. Click on the Chiropractic button. Enter codes necessary to supply information related to the chiropractic service rendered to a patient. Click the Copy Previous Values button to copy the values from the previous claim for this patient. Treatment Number CR2 01 The number this treatment is in the series. Total Number of Treatments in this Series CR2 02 Enter number. Number of Treatments this Month CR2 07 The number of treatments rendered in the month of service. 54 Additional ANSI 837 Screens EZClaim Advanced

55 Time Period for this Series CR2 06 The time period involved in the treatment series. Units CR2 05 Use dropdown to select the number of units. Subluxation Level Codes CR2 03/04 The beginning and ending level of subluxation. C1 Cervical 1 C2 Cervical 2 C3 Cervical 3 C4 Cervical 4 C5 Cervical 5 C6 Cervical 6 C7 Cervical 7 CO Coccyx IL Ilium L1 Lumbar 1 L2 Lumbar 2 L3 Lumbar 3 L4 Lumbar 4 L5 Lumbar 5 OC Occiput SA Sacrum T1 Thoracic 1 T10 Thoracic 10 T11 Thoracic 11 T12 Thoracic 12 T2 Thoracic 2 T3 Thoracic 3 T4 Thoracic 4 T5 Thoracic 5 T6 Thoracic 6 T7 Thoracic 7 T8 Thoracic 8 T9 Thoracic 9 Acute Manifestation Date This date is exported into the DTP*453 segment in loop 2300 of the ANSI 837 file. Nature of Condition CR2 08 Code indication the nature of a patient s condition. A Acute Condition C Chronic Condition EZClaim Advanced Additional ANSI 837 Screens 55

56 D Non-acute E Non-Life Threatening F Routine G Symptomatic M Acute Manifestation of a Chronic Condition Complication Indicator CR2 09 A Y value indicates a complicated condition; an N value indicates an uncomplicated condition. X-Rays Available CR2 12 A Y value indicates X-rays are maintained and available for carrier review; an N value indicates X-rays are not maintained and available for carrier review. Patient Condition Description 1 & 2 CR2 11/11 This is a free form description to clarify the related data elements and their content. Limit to 80 characters per field. DME/CMN This screen is only available to customers who purchase the DMERC module. When sending claims to one of the 4 DMERC regions, it may be necessary to attach electronic CMNs to service/product line items. EZClaim allows a user to attach a CMN to the claim and the CMN will be attached ONLY to line items that have a check in the CMN box. When entering a new claim, EZClaim will remind you to attach a CMN if the CMN box is checked but no CMN has been attached. Copying Previous CMNs If you check the CMN box on a service line and a CMN is not currently attached to this claim, EZClaim will prompt to copy the previous CMN to this claim. This prevents having to enter the CMN information again. 56 Additional ANSI 837 Screens EZClaim Advanced

57 Attaching a CMN to a Claim 1. Click on the Attach CMN screen. 2. Select by highlighting the CMN for this claim and click the OK button. 3. Enter Data into the CMN screen. The CMN screens represent Section B of the CMN. Please note the Length of Need, Initial Date, and Signed Date are all required fields. EZClaim will not let you close the CMN screen until those fields are entered. Printing CMNs How do I print CMNs? Once service lines have been entered onto a claim, you can print a CMN. Click the Attach CMN Form or the button labeled with the CMN name (i.e. Hospital Beds CMN ). EZClaim Advanced Additional ANSI 837 Screens 57

58 There will be a Print button available to print the CMN. The CMN printed will contain both sides of the CMN form. Section A Patient Name Data is pulled from the Patient information on the left hand side of the Patient/Insured Info screen (Box 1a, 2, and 5 on the CMS-1500). Section A Supplier Name Data is pulled from the Physician/Supplier information on the bottom left of the Physician/Diagnostic Info screen (Box 33 on the CMS-1500). Section A Place of Service Data is pulled from the first service line s place of service value. Section A HCPCS Codes Data is pulled from the CPT/HCPCS column on the charges screen. IMPORTANT: Only HCPCS codes from service lines that have the CMN box checked will print in this area. Section A Patient DOB, etc Patient DOB, and Sex is pulled from the patient info on the Patient/Insured Info screen. Height and Weight is pulled from the Patient Height and Patient Weight fields on the Payers/Other Info screen. Section A Physician Name and UPIN Data is pulled from the Referring/Ordering drop down box on the Physician/Diagnostic Info screen, the UPIN from the ID of Referring Physician field. The address and phone number are pulled from the physician s entry in the Physician Library. Note: Narrative Other information may be printed depending on CMN selected and information required. Up to 10 service lines of information can be printed. The CPT/HCPCS and Units information is pulled from the service lines. The Description, Charges, and Allowed Amounts are pulled from the Procedure Code Library. 58 Additional ANSI 837 Screens EZClaim Advanced

59 ERA ANSI 835 File - FAQ Q: What is an ERA? A: An ERA is an Electronic Remittance Advice file. It is the information you would usually receive on a paper EOB, in an electronic format. It is called an ANSI 835 file. Q: How do I receive the ANSI 835 files? A: If you have enrolled with your insurance carrier, your 835 file will be available from the Bulletin Board System (BBS), web page or FTP program. EZClaim/MedAvant customers contact your EDI representative. Q: Will I be able to receive an ANSI 835 file from all insurance companies? A: Check with your insurance company about receiving ERA s. Not all insurance companies return an ANSI 835 file. Q: How soon will I receive an ANSI 835 file? A: If you have enrolled with the payer to received ANSI 835 files, the ANSI 835 file should be available within approximately two weeks. Verify with your insurance company. Q: How do I view and then post payment information from an ANSI 835 file? A: EZClaim has a feature that allows you to analyze your 835 file, apply payments into EZClaim and run reports on the ANSI 835 file. See instruction below for Downloading and Posting payments. Q: Can I print the ANSI 835 file in an EOB format? A: Yes, when you analyze an 835 file through EZClaim s EDI File Analyzer, under Reports, you can choose Print EOB. Glossary Please refer to data entry instructions for entering the following information. Adjudication date - The date of payment or denial by the primary payer. Claim Adjustment Reason Code - The code identifying the detailed reason the adjustment was made. Allowed Amount/ Approved Amount The Allowed/Approved is the maximum amount the payer will for pay for a specific EZClaim Advanced ERA ANSI 835 File - FAQ 59

60 service. This amount may be reflected on the Primary payer EOB. Contractual Contractual Obligation (CO) is the difference between the billed amount and the allowed amount determined by the Primary payer. This amount is reflected on the Primary payer EOB. CAS If required, the CAS segment is used to report the adjustment reason codes and amounts when submitting claims to a secondary payer. Payer Paid Amount - The amount paid by the primary insurer 60 ERA ANSI 835 File - FAQ EZClaim Advanced

61 Posting ANSI 835 ERA Files If you receive ANSI 835 files back from the payer, the EDI File Analyzer can post the payment data back into EZClaim or into an Excel Spreadsheet. Only primary payments, secondary payments, and adjustments will be processed. The trace number of the 835 file will be entered into the Payment Reference field ONLY if the reference field is blank. If the reference field already has data entered, it will not be overwritten with the trace number. If the 835 payment amount does not match a payment already entered, the current payment WILL NOT be overwritten. If the service line already has a zero (or negative) balance, the payment and adjustment data will not be transferred. We suggest backing up your database before importing payment data. WHY?: Once you have Applied Payments you cannot make adjustments and re-apply payments without restoring from your backup! If you need to adjust your Options settings you can restore your database from the backup, adjust your settings, and reapply your payments. Once you have applied payments and verified the information you are ready to analyze your next ERA Limitations when Importing ANSI 835 Files The EDI File Analyzer will only process claims with the following Claim Status Codes: 1 Processed as Primary 2 Processed as Secondary 4 Denied 19 Processed as Primary, Forwarded to Additional Payer(s) 20 Processed as Secondary, Forwarded to Additional Payer(s) All other claims will be ignored The EDI File Analyzer will only process adjustments with the following Group Codes: EZClaim Advanced Posting ANSI 835 ERA Files 61

62 CO Contractual Obligations Adjustments will be entered into the Contract Adjustment field on the Payments window. OA Other Adjustments Adjustments will be entered into the Other Adjustment field on the Payments window. The Adjustment reason code will be entered into the Adjustment Code field. PI Payer Initiated Reductions Adjustments will be entered into the Other Adjustment field on the Payments window. The Adjustment reason code will be entered into the Adjustment Code field. PR Patient Responsibility No amounts are entered. The line items balance will be changed to Patient Responsibility. Group Code CR (Correction and Reversals) will be ignored. Claim Level Adjustments are ignored. All service line payment and adjustment information will be shown on the report even if they were ignored during the transfer process. Step 1 Download the ANSI 835 File Before downloading the ANSI 835 file, clear your EZClaim screen by clicking on New Patient. If the program is Multiuser, all other users must be out of EZClaim. Return to the Bulletin Board System (BBS), Web page or FTP program where the claim file was submitted. Follow insurance carrier instructions for downloading your electronic remittance advice file, sometimes referred to as an 835 file. If using EZClaim s EZTerminal program, you will receive the message Do you want to Analyze this file after the file has been downloaded. Always select Yes. NOTE: This screen will also give you the location (Path and Filename) of the downloaded file. Please note the filename and location. Use the features of the 835 Claim Payment Advice dialog box to view Reports, select Options, and Apply Payments. 62 Posting ANSI 835 ERA Files EZClaim Advanced

63 Step 2 - (Optional) Run Report To preview how payments will be applied before importing the payments into EZClaim, click on the Run Report button. The reports will show how payments will be applied. Denied claim adjustments are not processed the claim is simply marked as Denied. You will also get this report after you have exported to EZClaim. Note: If you preview the report before you apply payments, it will display the warning message Not Transferred because you have not applied payments into EZClaim. Select Close when you are done previewing the report. Click one of the Quick Report buttons to view the report or you can manually select criteria to limit the data shown on the report. All Data - This report will show all data from the downloaded 835 file. Denied Claims Only - This report will only show denied claims. Adjustments Only - This report will only show claims with adjustments Items With Transfer Warnings This report will only show claims with Transfer Warnings. Print EOB This option will print your 835 file in an EOB format. Print Report This will print the report. EZClaim Advanced Posting ANSI 835 ERA Files 63

64 Preview Report - You may print or preview the report you have selected. Clear All Criteria - Used to re-set report criteria. To preview Reports using Custom Criteria, use the dropdown arrows to select Claim Status and/or Adjustment Reason Codes and/or Transfer Warning Message. Click on Preview Report or Print Report button. Claim Status - You may select up to two claim status codes for the report. Adjustment Reason Codes - You may select up to four individual adjustment codes for the report. Transfer Warning Message You may select one warning message. Warning Messages on Report Not Transferred This is shown when the payment or adjustment has not been transferred. An item may not be transferred because it had a status or code that is ignored (see below). Mismatched Payment/Adjustment Entered This is shown when a payment or adjustment exists in EZClaim but does not match the amount in the 835 file. Service Line Already Paid This is shown when the service line already has a balance of $0.00 (or a negative balance). Option Set to Skip Adjustment This is shown when the adjustment has been skipped because the option was set to not apply the adjustment. Click the Options button on the ANSI 835 screen to view import options. Could Not Find Service Line This is shown when the service line to apply the payment or adjustment could not be 64 Posting ANSI 835 ERA Files EZClaim Advanced

65 found. The Analyzer will attempt to find the service line by matching the Claim ID, procedure code, and date. Step 3 (Optional) Options Click on the Options button to select options for posting payments. Place a check next to the adjustments to apply and click the Save and Close button. When viewing the transfer report, you will see Option Set to Skip Adjustment next to any adjustment that was not set to transfer. The Correction and Reversals is not enabled since the EDI File Analyzer will not transfer those adjustment types. CO - Contractual Obligations - Adjustments will be entered into the Contractual Adjustment field on the Payments and Adjustments window. CR Correction and Reversals - Will not be processed. OA - Other Adjustments - Adjustments will be entered into the Other Adjustments field on the Payments and Adjustments window. The Adjustment reason code will be entered into the Adjustment Code field. PI - Payer Initiated Reductions - Adjustments will be entered into the Other Adjustments field on the Payments and Adjustments window. The Adjustment reason code will be entered into the Adjustment Code field. EZClaim Advanced Posting ANSI 835 ERA Files 65

66 PR - Patient Responsibility - No amounts are entered. The line items balance will be changed to Patient Responsibility. See Entering Payments and Adjustments for more information on balance responsibility. Ask To Assign a Value to Payment Reference 2 - Check if you want specific information in the Reference 2 field on the Line Items Payments screen. When you click Apply Payments Into EZClaim, a dialog box will come up asking you to enter the information. Optional Setting Contractual Obligation Codes If the insurance company is returning ANSI 835 adjustments that are group coded as Contractual Obligations but should be Payer Initiated Reductions, you can enter Contractual Obligation reason codes into the Optional box. Only the reason codes found in the box will be categorized as contractual adjustments, all others will be categorized as Payer Initiated Reductions. Note: Claim Level Adjustments are ignored but all service line payment and adjustment information will be shown on the report even if they were ignored during the transfer. Step 4 Apply Payments into EZClaim Click on the Apply Payment into EZClaim button. Once payments have been applied, you will have the option of printing a report from the Reports dialog box. Note: If you do not run your report at this time you will not get accurate payment information when you run it later. When you run it later all your report warnings will indicate Not Transferred. Denied claims will be set as Denied in the Claim Status drop down on the Charges screen. Step 5 (Optional) Verify Payments From the Charges screen go to the Line Item Payments dialog box to verify payments. 66 Posting ANSI 835 ERA Files EZClaim Advanced

67 Step 6 (Optional) Save Data to Excel Note: To save data to an Excel spreadsheet for further review, click on the Save Data to Excel button. You will now be able to view the information received in an 835 Remittance file. Use the bottom scroll feature to view all data. Using the features of Excel, review or manipulate data. Step 7 - Analyzing or Re-Analyzing an Existing File Manually Analyzing EDI Files If an EDI file already exists, you can manually analyze it with the EDI File Analyzer. 1. Click the Tools menu and select EDI File Analyzer. 2. Click the Browse button to select the file. 3. Click the Analyze button. Re-Analyzing an EDI File Note: Although you are able to view a previously analyzed file, you will NOT be able reapply payments. To reapply payments, see below. The EDI File Analyzer shows the last 20 files analyzed. If you downloaded a file and analyzed it but don t remember where it was saved, you can use the EDI File Analyzer to view the file. EZClaim Advanced Posting ANSI 835 ERA Files 67

68 If an EDI file already exists or you have downloaded a file and analyzed it but don t remember where it was saved, you can use the EDI File Analyzer to view the file. Re- Applying Payments 1. Restore your database from your backup file. 2. Go to Tools>EDI File Analyzer, highlight your file and click Analyze. 3. Make any adjustments and re-apply your payments. Importing Authorizations from an ANSI 278 File If you receive ANSI 278 files, the EDI File Analyzer can populate the Authorization library with the data or export the data to Excel for analysis. For more information on authorizations, see Authorization Library on page 89. To Import Authorizations 1. Click the Tools menu and select EDI File Analyzer. 2. Click the Browse button to select the file. 3. Click the Analyze button. The following window showing the analyzed results will appear. 68 Posting ANSI 835 ERA Files EZClaim Advanced

69 4. To save data to Excel for further analysis, click the Save Data to Excel button. 5. To import the authorizations into EZClaim, click the Import Auths into EZClaim button.once the import is complete, you will receive a confirmation showing the results. EZClaim Advanced Posting ANSI 835 ERA Files 69

70 Secondary ANSI 837 Claims IMPORTANT! A COMMERCIAL INSURANCE COMPANY CANNOT BE BILLED ELECTRONICALLY AS STRAIGHT SECONDARY CLAIMS. Payer Library Step 1 Tools > Payer Library Required: Insurance Type Code. Use drop down box to select the appropriate Insurance Type Code. Required: Payer ID # s Both Primary and Secondary Payer s MUST have correct Payer ID numbers and Insurance Type Code entered! 70 Secondary ANSI 837 Claims EZClaim Advanced

71 Patient/Insured Info Screen Step 2 Required: Other/Secondary insurance information. (Box 9 a- d on the 1500 form) Required: Other Insured s Name - Enter Other Insured s Name (LAST FIRST) Situational: Other Insured s Policy or Group Number - Enter Other Insured s Policy or Group Number NOT the secondary Insured s ID see Step 3 for entering the insured s secondary id. Required: Other Insured s Date of Birth - Enter Other Insured s Date of Birth and Sex Required: Insurance Plan or Program Name - Enter Insurance Plan or Program Name Payers and Others Info Screen Step 3 Situational: Usually not required. Do not enter situational information unless required by your Payer or errors will be generated. Patient Member ID Subscriber SS# Additional ID Patient Weight Patient Height Responsibility Sequence Note: Confirm that both the Primary and Secondary payer s Provider ID numbers have been entered in Physician Library under Additional ID Numbers. EZClaim Advanced Secondary ANSI 837 Claims 71

72 Note: Confirm that both Primary and Secondary Payer ID s have been entered in the Payer Library and the Insurance Type Code selected. Payer ID s should be displayed in parentheses in front of the payer. If your payer ID s are not displayed please review Step 1 Payer Library. Your secondary claim information will NOT be sent with the claim if Payer ID and Ins Type Code data has not been entered!! Selecting Payers Required Information 1. If not previously selected, click on the Click to Select Primary/Destination Payer button. 2. Select by highlighting the Primary Payer and click OK. 3. Using the dropdown arrow select Primary Claim Filing Indicator. 4. Click on the Click to Select Secondary/Other Payer button. 5. Select by highlighting the Secondary Payer and click OK. 6. Using the dropdown arrow select Sec Claim Filing Ind. (Secondary Claim Filing Indicator) 7. Required: Enter Secondary Insured s ID number in Other Insured ID field. 72 Secondary ANSI 837 Claims EZClaim Advanced

73 8. DO NOT enter additional information unless required by insurance company. Charges Screen Step 4 1. Required!!: Click in the Applied Amt field to open the Line Item s Payment window. 2. Enter an insurance payment. Even if the primary insurance did not pay on the claim, you MUST enter a payment line item even if the amount is $ Confirm that the Responsible Party is set to Secondary Insurance. 4. Close Line Item Payments dialog box. 5. Required: If an Allowed Amount is on the Primary EOB, click on View Other Fields and enter the allowed amount into the Allowed Amt field. 6. Required: When you are finished entering your payments, check the Bill Secondary checkbox on the Charges tab. 7. Your claim is now ready for submission or printing. Be sure to check the Ready for EDI check box. (There is an option in the Tools > Options > Data Entry Service Line tab that you can check to automatically check the EZClaim Advanced Secondary ANSI 837 Claims 73

74 Ready for EDI box when you check the Bill Secondary Box.) 74 Secondary ANSI 837 Claims EZClaim Advanced

75 Electronic Claims Using a Print Image EZClaim can meet all of your Electronic billing needs. Contact EZClaim for additional information and pricing or visit our web page at Frequently Asked Questions Print Image Using the data which has been previously set up in the Payer Library, enter the name and address of the insurance company who is responsible for payment of this claim in the Carrier Area (bottom left corner on Physician/Diagnostic tab). The term Path and Filename tells us where in the computer a document is located. Ex: C:\claimdat.zip, tells us that a file called claimdat is located in the user s C: drive. Entering Patient Data for Print Image Submission Please refer to the complete EZClaim Manual for initial instructions on setting up patient files. The information below is specific to entering patient data for electronic submission using a Print Image file format. IMPORTANT: Before you begin, claim data must have been previously set up in the Payer Library and the Physician/Facility Library. See Payer Library on page 82, Physician, Organization and Facility Library on page 94. Patient/Insured Info Screen Step 1 IMPORTANT: Please refer to the file specifications provided by your Clearinghouse to determine which fields are needed and the proper codes to use. Do not use MR., MS., or other prefixes Do not leave a space between two parts of a last name. Ex: O Leary not O Leary, MacDonald not Mac Donald. Date formats should be MMDDYY OR MMDDYYYY. Currency format should be DD CC. (For setting defaults see Printing Options page 143. Enter the name and address of the insurance company who is responsible for payment of this claim in the EZClaim Advanced Electronic Claims Using a Print Image 75

76 Carrier Area (Bottom left corner on Physician/Diagnostic tab). Physician/Diagnostic Info Screen Step 2 Physician/Supplier name: (Box 33) Using the dropdown arrow select the Physician information which has been previously set-up in the Physician/Facility Library. Facility: If required, use the dropdown arrow to select the Facility/Organization, (Box 32). Account Numbers: Check with your clearinghouse to determine if Account numbers are required. For auto account numbers go to Tools>Options>Data Entry-General. Carrier Area 76 Electronic Claims Using a Print Image EZClaim Advanced

77 Use the Click to Select Payer button to select Payer previously set up in the Payer Library. Go to Tools>Options>Payer Library to set up Payer Library. New Charges Screen Step 3 Enter the diagnosis code reference number (POINTER) into the Diag Code Line # column. Do not use the actual diagnosis code in this box, only pointers. If payer accepts more than one pointer per service line, use single digits separated by commas or right next to each other (i.e. 123). For EPSDT Indicator or Family Planning column (Box 24H on the CMS-1500), use two characters (Y or N) to dictate the EPSDT Indicator and Family Planning Indicator Example: If EPSDT is No and Family Planning is Yes, then enter NY If EPSDT is Yes and Family Planning is Yes, then enter YY If the column is left blank, 'No' is assumed. Enter charges and other service line information. Codes used for electronic submission: Below are the most common Place of Service codes. Contact your insurance carrier for additional codes. Place of Service: 11 Office EZClaim Advanced Electronic Claims Using a Print Image 77

78 12 Home Unassigned 21 Inpatient Hospital 22 Outpatient Hospital 23 Emergency Room - Hospital 24 Ambulatory Surgical Center 25 Birthing Center 26 Military Treatment Facility 31 Skilled Nursing Facility 32 Nursing Facility 33 Custodial Care Facility 34 Hospice 41 Ambulance - Land 42 Ambulance - Air or Water 50 Federally Qualified Health Center 99 Other Unlisted Facility Exporting Claims Step 4 Once the patient and claim data has been entered into the EZClaim program you are now ready to generate your file for electronic transmission. Transmitting Claims using the Export button. Note: Click on the column headings to sort the list using the data in that column. To customize the width of a column heading, position the cursor on the line between the column headings. When the 78 Electronic Claims Using a Print Image EZClaim Advanced

79 cursor becomes two arrows left click and move column right or left. 1. Click Electronic Claims! on the menu bar to open the Electronic Claims dialog box. 2. Select Print Image or Print Image w/claim ID from the Export Format dropdown box. 3. Check Zip File checkbox if required by your processor. 4. Select by highlighting, the claims for export. If a claim is not appearing in the dialog box, uncheck the checkbox Only Show Claims Not Exported. To select a series of claims, click the first claim then hold down the SHIFT key and click the last claim. 5. To select individual claims, hold down the CTRL key, and click on the names. 6. Click on the Export button. 7. In the Save As dialog box, click the Save In dropdown arrow and select C: drive or a location of your choice. 8. By default, File name will be claimdat.txt. It is recommended that the File name be changed for each transmission. Limit file name to 8 characters. You may use the date of submission as a File name. Ex: txt. 9. Notes: DO NOT use / - * etc. in file name. IMPORTANT: If your payer or clearinghouse uses a specific file location and file name, be sure to follow the clearinghouse or payer s instructions. EZClaim Advanced Electronic Claims Using a Print Image 79

80 10. Click on the Save button. Please note the full Path and Filename of your Print Image file. 11. If you would like a printed exported claims report, click Yes to print report. (You can reprint exported claim reports by going to File on the menu bar > Reports > Submission Reports.) 12. Your file is now saved to the location you chose and to your clipboard. Transmitting Claims Step 5 Method 1 - If submitting claims using Clearinghouse communication software: 1. Open clearinghouse communication software. 2. Follow clearinghouse instructions. 3. When asked to enter path and filename, right click in the box and select Paste or enter manually. Method 2 - If submitting Web based claims or dialing directly into the Clearinghouse computer follow the instructions for Selecting and Exporting Claims except select the Export and Send button. Export and Send Button If you do not see the Export and Send button, you may be using an export format that does not allow you to export and send. Make sure your export format is correct. 1. In the Send Exported Claims dialog box enter Web address or telephone number of clearinghouse. 2. Click Go. 3. Once connected, follow payer s instructions. 4. When asked to enter filename, right click in blank field and Paste. 80 Electronic Claims Using a Print Image EZClaim Advanced

81 Re-Exporting Claim Data Print Image Step 6 Mistakes are easy to make. If the claim is rejected for some reason, you will most likely need to re-submit the claim. Selecting Previously Submitted Claims 1. Select Electronic Claims on the Menu bar to open the Export Claims for Electronic Billing dialog box. 2. Click on the Show Previous Batch button. 3. Select by highlighting previous batch of claims to resend. Click on OK. 4. Select by highlighting all claims or individual claims to reexport. 5. Click on the Export or Export and Send button. 6. Re-export claims. Sorting the Claim List To sort the data in a specific column, click on that column heading. Note: To customize the width of a column heading, position the cursor on the line between the column headings. When the cursor becomes two arrows left click and move column right or left. EZClaim Advanced Electronic Claims Using a Print Image 81

82 Libraries Payer Library Menu Location: Tools > Payer Library To open the payer library, click on the Tools menu and select Payer Library. Add Payer Information to Library 1. Enter name and address data. 2. Click on the Add/Save button. 3. Payer information is now listed in the box below. To prevent the insurance address from printing on claims check the Suppress address when printing claims checkbox. Edit Payer Information in Library To edit information in the Payer Library follow directions below. 1. Select by highlighting Payer to Edit from the list in the Payer box. 2. Click the Edit button or double click the payer. 3. Edit information 4. Click the Add/Save button 5. Payer information is now listed in the box below. Delete Payer Information from Library 1. Select by highlighting the Payer to be deleted 2. Click on the Delete button. 3. If the payer is in use, you will have the opportunity to view a report showing the usage of the payer. If you 82 Libraries EZClaim Advanced

83 select No to view the report, a delete confirmation will appear. If you click Yes to delete, the program will clear the payer from any patient records then delete the payer. Payer s can not be undeleted so use with care. Library List Report Sample Report Library Usage Report Sample Report Procedure Code Library Menu Location: Tools > Code Libraries EZClaim allows the user to set up and maintain multiple code libraries. By entering the codes most often used, you can have a code reference within your program. When entering data on individual forms, if the field is marked with a *, you can press Alt-, rt. Click or F7 to bring up the correct code list. EZClaim Advanced Libraries 83

84 Entering codes into the Procedure Code Library Menu Location: Tools > Code Libraries 1. Go to Tools on the menu bar and select Procedure Code Library. 2. Enter the Code, Charge and any other applicable information. 3. Click on the Add button. The Code will now be added to the list. Field Descriptions Code Required Enter the procedure code. Modifier Optional Enter the modifier for the procedure code. Charge Required Enter the charge amount for the procedure code. Allowed Optional Enter the allowed amount. This field will be entered into the Allowed Amount column for each service. If you do not need to track allowed amounts, leave this field blank. Adjustment Optional Enter the adjustment amount. This data will be entered into the Contract Adjustment field when entering services on the Charges screen. Product Code Optional If you require different charges or different modifiers for the same procedure code, you must use a product code. NDC Code Optional If entered, the NDC code will automatically be entered into the line item notes area preceded with N4. This follows the 1500 data entry guidelines for NDC drug codes. 84 Libraries EZClaim Advanced

85 CMN Req Optional If you are a DME company doing electronic billing, you can check this box to designate this procedure code as requiring a CMN to be attached. When the procedure code is entered on the charges screen, the CMN check box will be checked automatically. Description Optional If you would like to have descriptions printed on statements, enter them here. Descriptions are used when performing key word searches during code lookup. Category Optional Use this field if you would like to categorize the codes. This field is only used in the Procedure Code report. Sub-Category Optional Use this field if you would like to sub-categorize the procedure codes. This field is only used in the Procedure Code report. Automatically enter the patient s copay Optional If this is a procedure code that requires a co-pay, check this box and the program will automatically enter the patient s co-pay (if entered on the Payers/Other Info tab). Product Code What are product codes used for? EZClaim s procedure code library uses the combination of the Procedure code and Product code to determine a unique entry. If you need entries with different modifiers, charges, descriptions, etc, you can enter a unique product code for the entry. If a product code is not used, the current procedure code entry will be overwritten. During data entry, the procedure code field would have the format PROCEDURE/PRODUCTCODE. When you use the Code Lookup tool (F7), the procedure code/product code will be entered automatically. The product code is not printed on a claim form nor sent electronically. It s used strictly in EZClaim to determine the proper charges and descriptions. Companies that use generic procedure codes find the product code very useful for entering items into the library. Procedure Code Report Click the Report button to print a report of all the procedure codes in the library. Specialized Code Libraries If you have a need to use different charges for the same procedure codes, you need to use the specialized code EZClaim Advanced Libraries 85

86 library feature. This feature allows you to maintain multiple libraries, each with its own unique name, codes, and charges. Adding a Specialized Code Library 1. Click the drop down arrow at the bottom of the Code Library window and select New. 2. Enter the name of the new library and click OK. 3. Enter the Code, Charge (if applicable) and Description. See Libraries on page 82 for entering codes. Using Different Code Libraries for Different Patients To assign the Specialized Code Library to a specific patient, follow the directions below: 1. Set up the Specialized Code Library. 2. Select the Patient from the Find Patient list to assign a specialized code library. 3. Go to Payer/Others Info screen for that patient. 4. Click on Misc. Patient Data tab at bottom of screen. 5. Using the Code Library drop down arrow, select the new library name. Deleting One or More Codes 1. Go to Tools on the menu bar and select Procedure Code Library. 2. Select the entry you want to remove to highlight. If multiple codes need to be deleted, click once on the first code, hold the Shift key on the keyboard and click the last code to be deleted. This will highlight all the codes in between. The Ctrl key can also be used to select individual codes for deletion. 3. Click the Delete button. Importing and Exporting Procedure Codes Menu Location: Tools > Procedure Code Library You can import and export your code libraries. Both import and export work only with tab delimited text files. We do not support converting codes into the correct format. The following shows the format a text file must follow to be imported into the code libraries: Code{TAB}Charge{TAB}Allowed{TAB}Adjust{TAB}Description{TAB }Product Code{TAB}Modifier{TAB}Category{TAB}Subcategory 86 Libraries EZClaim Advanced

87 The best way to see the format is to manually enter some codes, and then export them. Other Code Libraries Menu Location: Tools > Code Libraries The libraries available are: Adjustment Codes Diagnostic Codes Modifiers Place of Service The type of data stored depends on which library you select. All libraries store the code and a description. Setting Up Your Code Libraries Menu Location: Tools > Code Libraries 1. Go to Tools on the menu bar and select Other Code Libraries. 2. Using the Drop Down arrow select the code library you want to manage. 3. Enter the Code, Charge (if applicable) and Description. 4. Click on the Add button. The Code will now be added to the list. Editing or Deleting an Entry Menu Location: Tools > Code Libraries EZClaim Advanced Libraries 87

88 1. Go to Tools on the menu bar and select Code Libraries. 2. Select the Library from the drop down bar you want to Edit or Delete a code from. 3. Select the entry you want to remove or edit and highlight. 4. Click on the Edit or Delete button. 5. If editing a code, click on the Add button after making changes. Importing and Exporting Other Codes Menu Location: Tools > Code Libraries You can import and export your code libraries. Both import and export work only with tab delimited text files. We do not support converting codes into the correct format. The following shows the format a text file must follow to be imported into the code libraries: Column 1 is the code, followed by a tab, followed by the description in column 2. For example: Code1{TAB}Description1 Code2{TAB}Description2 The best way to see the format is to manually enter some codes, and then export them Accessing the Code Libraries 88 Libraries EZClaim Advanced

89 Options for Accessing the Code Library When you are entering data in fields that use a code library, you have the following options for accessing the Code Library. 1. Click on Alt-L to bring up the Code Library. 2. Right click in a box and choose Code Library. 3. Click on the function key, F7. Using the Code Lookup (F7) 1. When the Code Library dialog box is opened, the list is sorted by Description, to sort by code number click on the Code heading. 2. Highlight code you want to use. Double click on code or click on OK. Code will be entered into field. Note: To search for a code by description, enter keyword into Search for field. The program will remember the column you last sorted by for the next time the code lookup box is opened. Authorization Library EZClaim Location: Tools> Authorization Library The Authorization Library is used to store and track patient authorizations. Setting up the Authorization Library. Note: To set up the Authorization Validation feature go to Tools>Options> Data Entry-Service Lines. Enter a check mark in the Validate authorizations when saving a new claim 1. Use the drop down arrow to select a patient. EZClaim Advanced Libraries 89

90 2. Use the drop down arrow to choose the Rendering physician which has been set up in the Physician/Facility Library. If a Rendering provider is not used, leave blank. 3. Enter additional information. If you use product codes (see Procedure Code Library on page 83), make sure the correct product code is entered into the Product Code field. EZClaim uses both the procedure code and product code when calculating Authorization usage. Procedure Code Usage If the authorization is for multiple types of procedures, you can use the * character as a wild card. For example, if 98* is entered into the procedure code field, all procedures that start with 98 will be used when calculating the number of units used for a single authorization. 90 Libraries EZClaim Advanced

91 Using the Authorization Library 1. Go to the Charges Screen. 2. Click on the button to the right of the Prior Authorization No. box. Note: Do not just type in Authorizations. The Authorizations must be selected from this box in order to count down the number of Authorizations This will bring up the Authorization Library. 5. Select and then double click the Authorization number to enter into the Charges Screen. 6. Authorization number is now entered on the Charges Screen. Default Authorization Entering a DEFAULT authorization on the Physician/Diagnostic Info screen. EZClaim Advanced Libraries 91

92 CAUTION: This will be a default value and will be used for all charges for that patient. If you do not want to use a default authorization, enter the authorization on the Charges screen. 1. Select the Physician/Diagnostic Info tab. 2. Click on the button to the left of the Default Prior Authorization No. box. This will bring up the Authorization Library. 3. Select and then double click the Authorization number to enter into the Default Authorization Number field. 4. Default Authorization number is now entered and will be used for all dates of service for this patient. Authorization Report Sample Authorization Report NOTE: Authorization information entered on charges screen must match information in Auth Library for correct calculations. Note: If you use product codes in service lines, the product codes must match those used in the Authorization library. The authorization report will show how many units have been used, how many were allowed and how many remain. 92 Libraries EZClaim Advanced

93 Auto Fill Libraries Menu Location: Tools > Auto Fill Libraries EZClaim automatically maintains AutoFill libraries for certain fields. As you enter patient data, EZClaim remembers your entries so when you start to enter the same data again, EZClaim will finish the typing for you. AutoFill features are included on the following fields: City, State, Zip Employer's Name or School Name Insurance Plan Name or Program Name Editing and Deleting Auto Fill Libraries Menu Location: Tools > Auto Fill Libraries Occasionally you will need to Edit or Delete an entry and you can do so by opening the AutoFill Library. 1. Go to Tools on the menu bar and select Auto Fill Libraries. 2. Using the drop down arrow select which library you wish to Edit or Delete. EZClaim Advanced Libraries 93

94 3. All entries in that library will be shown in the lower box. 4. Highlight which entry you want to Edit or Delete. 5. To edit entry, click on the Edit button and then make any changes or corrections to entry. 6. Click on the Add button, corrected entry will be added in the lower box. 7. To Delete an entry, highlight the entry and click on the Delete button, entry will be removed from library. Note: To turn off the Auto Fill feature go to Tools > Options > Data Entry tab and Uncheck the Automatically complete the fields you type checkbox. Physician, Organization and Facility Library Setting up the Library correctly is very important for error free claim submission. Once the entries are made in the library, they can be selected on EZClaim s data entry screens. This information must be entered before entering patient data. Click the Tools menu and select Physician/Facility Library For data entry instructions refer to the following Quick Start Guide - Step 2 Physician, Organization and Facility Library on page 16 ANSI 837 Data Entry - Physician, Organization/Facility Library Step 3 on page Libraries EZClaim Advanced

95 Print Image Data Entry - Physician/Diagnostic Info Screen Step 2 on page 76 Additional Features of the Physician Library Library List Report Library Usage Report Notes Section Enter general notes about the Physician/Facility here. They are for your reference only. EZClaim Advanced Libraries 95

96 Find Patient Find Patient Button (F4) Clicking on the Find Patient button will bring up a Patient List Dialog box. Use this Dialog box to: Select a Patient Delete a Patient Make a Patient Inactive Make a Patient Active Move a Patient to Another Group Copy a Patient to Another Group Sort Patient by Name Sort Patient by Account # Sort Patient by Insured ID# Note: In order for a patient s name to appear in the Patient List, their name must be entered in the Patient s Name field (field #2) of the CMS-1500 form. Sorting Patients by Name, Patient Account or Insured ID Selecting a Patient 96 Find Patient EZClaim Advanced

97 Option 1 1. Click on the Find Patient button (or press F4). 2. Using the dropdown arrow select an Individual Group or All Groups. (For information on setting up groups see Patient Groups on page 129.) 3. Highlight a Patient within the group and click OK. This will take you to the group selected. 4. To sort the patient list enter the first few letters of patient s last name. Double click on patient s name, press Enter or click the OK button to open patient record. Option 2 1. Click New Patient (or press F2) to clear the screen. 2. Enter the first few letters or the full name of a patient s last name. Note: You must have correct Group selected. 3. Press F4 or click the Find Patient button. The computer will search for the person s last name and list only the patients that match the name entered. 4. Use the arrow keys and press Enter to load a patient from the list. Press the Escape key to close the box. Deleting a Patient 1. Click the Find Patient button to open the patient dialog box. 2. Select by highlighting the patient/patients name you want to delete. 3. Click the Delete button. EZClaim Advanced Find Patient 97

98 You also have the option of deleting the patient currently showing on the screen by going to Patient on the menu bar and choosing Delete Patient. WARNING: Deleting a patient will delete all data associated with the patient including all claim data. Marking a Patient Inactive If a patient is no longer active but you want to save their file for later use, you can mark the patient inactive. 1. Open patient dialog box by clicking on the Find Patient button. 2. Highlight patient/patients you want to mark as Inactive. 3. Click on the Make Inactive button. Patients marked Inactive will not be listed in the Patient List dialog box. To view the entire patient list, even if they are inactive, uncheck the box labeled Show Active Only. Marking a Patient Active If a patient needs to be re-activated, you need to mark them as active. 1. Open patient dialog box by clicking on the Find Patient button. 2. Uncheck the box labeled Show Active Only. 3. Highlight patient/patients you want to mark as active. 4. Click on the Make Active button. Copying Patients to another Group 1. Open the Find Patient dialog box by clicking on the Find Patient button 2. Choose which patient or patients (see instructions for choosing multiple patients at bottom of dialog box) you wish to copy and click on the Copy to Another Group button 3. In the Select New Group dialog box choose which group you would like to copy the patient to and then click on OK Note: This feature will copy patient data only, it will not copy claim data. Moving Patients to another Group 98 Find Patient EZClaim Advanced

99 1. Open the Find Patient dialog box by clicking on the Find Patient button 2. Choose which patient or patients (see instructions for choosing multiple patients at bottom of dialog box) you wish to copy and click on the Move to Another Group button 3. In the Select New Group dialog box choose which group you would like to move the patient data to and then click on OK 4. Note: This feature will move all patient and claim data to the new group. EZClaim Advanced Find Patient 99

100 Patient/Insured Info Screen Features The Patient/Insured info screen represents the top half of the CMS-1500 form. See Advanced Quick Start on page 14 for more information. Patient and Insurance Balances Both the patient and insurance balances are shown on the Patient/Insured Info screen at the bottom. Reminder Note This is a 50 character field to enter notes that can be seen when viewing the patient record. It is not printed nor exported. Patient Notes 100 Patient/Insured Info Screen Features EZClaim Advanced

101 Holds approximately 65,000 characters Inserts Date and Time Save a screen as a Template Print out Notes Save Notes Patient/Claim Notes Report (see File>Reports) Patient Notes Report (see File>Reports) Note Templates Click on New Patient. Click on Patient Notes button. Enter data for Template. Click on Save as Template. Enter Name for Template. Click on Save button. Using Note Templates When working in a patient record Click on Patient Notes button. Click on Load Notes Template. Select by highlighting desired template. Click OK. EZClaim Advanced Patient/Insured Info Screen Features 101

102 Physician/Diagnostic Info Screen Features The Physician/Diagnostic Info screen represents the bottom half of the CMS-1500 form, except for the Charges area. Note: Use dropdown arrows when selecting data that has been previously set-up in the Physician/Facility Library. The Physician/Diagnostic Info tab includes many Default data entry fields. See information below for working with Default fields. Default Values What are Default Values? Often patients have the same codes for each date of service. Enter into Default fields on the Physician/Diagnostic Info tab only data that is used for every charge for this patient. Ex: Place of Service. For patient data to be applied to specific charges, enter data on the Charges Screen. Once you have entered Default data on the Physician/Diagnostic Info screen, it will be automatically entered on the New Charges screen. Default Date of Current Enter Date of Current on this screen only if date would remain the same for every charge for this patient. If not, enter Date of Current on the Charges screen. Default Hospital Dates Related To Current Services Enter dates in this field if dates would remain the same for 102 Physician/Diagnostic Info Screen Features EZClaim Advanced

103 every charge for this patient. If not, enter Dates on the Charges screen by clicking on the view other fields button on the charges screen. Referring/Ordering Physician Use the dropdown arrow to select Referring Provider information previously set up in the Physician/Facility Library. Default Facility Name and Address Use the dropdown arrow to select the Facility information previously set up in the Physician/Facility Library. Default Rendering Provider - If submitting claims using the ANSI 837 file format see Physician/Diagnostic Info Screen Step on page 37 for entering Rendering Physician information. Claim Form Default Values Find the Claim Form Default Values section located in the middle of the Physician/Diagnostic Information screen. Enter into the Default section only those codes that remain the same for every date of service for this patient. Ex: Place of Service, Type, etc. For codes applied to specific charges enter data on the charges screen. Then when you are entering charge data on the New Charges screen, click on the dates of the calendar and the default values will automatically be entered. Code Lookup F7 When you are entering data in a code field marked with an asterisk *, a Code library is available. See Accessing the Code Libraries on page 88. Print Date If the Print Date checkbox is checked it will print the date the claim form is printed or exported. If the Bill Date of the charges screen is blank this date will become the Bill Date EZClaim Advanced Physician/Diagnostic Info Screen Features 103

104 of the claim. To change the Bill Date see New Charges Screen - Features on page 107. Print Options for Individual Claims Note: These features will affect only the current patient information showing on the screen. To set Print Options as defaults for all patients, go to Tools > Options > Default Print Options. Why are all my services printing on one line? Summarize Claim Line Items If the carrier requires line items to be summarized, place a check mark in this box. Check this box only if you need all dates of service to print out on one line. Date Format This feature gives the option of changing date formats for an individual claim. This would be used if an individual insurance company required a specific date format different from your default settings. To change Dates of Service format click on the Advanced Print Options button on the Physician/Diagnostic Info tab. Currency Format Some carriers require different currency formats. This option will allow the user to select from two different currency formats. Advanced Print Options The advanced print options button allows you to change print options for the current patient only. Carrier Area Text entered into the Carrier area box on the Physician/Diagnostic Info tab, will print out in the very top white portion of the CMS-1500 form. You can use this area to print the address of the insurance company for mailing purposes. The payer selected here will also be shown as the Primary/Destination Payer on the Payers/Other Info tab. 104 Physician/Diagnostic Info Screen Features EZClaim Advanced

105 Payers/Other Info Screen - Features For information on using the Payers/Others Info screen for Electronic submission of claims see Payers and Others Info Screen Step on page 38. Co-Pay Amt or Percent If the patient has flat rate co-pay or a percentage co-pay, enter it here. Percent values are 1 to 100 and override any flat rate co-pay entered. During payment entry, EZClaim will calculate the percentage based on the charge amount. See Entering Payments and Adjustments on page 117 for more information. Lock Patient Record to Prevent Accidental Changes Use this check box to lock a patient record (the first three tabs) to prevent accidental changes. This causes the fields to be ready only. Once checked, the active field will be gray instead of yellow and you will not be able to make changes to the record. Entering New Insurances Only one primary and one secondary payer can be stored with a patient record. All claims for that patient record will use those insurances. If you have a patient that has changed insurances, make a copy of the patient and change the payer for this new record. This new copy of that patient will be used for new claims. There will be two patients with the same name but have different internal account numbers. EZClaim Advanced Payers/Other Info Screen - Features 105

106 Once the patient claims are paid for the old payer, you would then be able to mark that patient with the old payer as inactive. Misc Patient Data See Procedure Code Library on page 83 for additional information on using the Procedure Code Library Name field. The External ID field is used when transferring data to and from other programs. It should not be modified by the user. If the Class and Sales Rep fields were used with the discontinued EZLink module. 106 Payers/Other Info Screen - Features EZClaim Advanced

107 New Charges Screen - Features EZClaim makes it easy to generate a claim form and the user is given various options for data entry. (See Program Options on page 138) Using the Calendar to Enter Dates of Service Using the mouse, click on a date shown in one of the calendar months. The date, and any data you have entered in the Default line will be automatically entered on the service line. Continue clicking dates for each date of service. If you are entering more than 6 dates of service EZClaim will print out as many forms as needed for each individual claim. Note: If the calendar month you need for entering dates is not showing on the screen, click on the Previous Month or Next Month button located under the calendar months. If you need to change any information on a line item, click on the text to be changed and type in the new information using the tab button to move to the next field. To delete a complete service line, click on the Del button to the left of service line to be deleted. Entering Line Items Manually You can also enter line item data manually by clicking in the grid, entering the information, then pressing enter or use the arrow keys to move down to the next line. By changing the EZClaim Advanced New Charges Screen - Features 107

108 data entry options, (See Data Entry options under Tools>Options>Data Entry) you can set the Enter key to move the cursor down or across the grid. EZClaim will warn if a future date is entered into the system. Selecting Multiple Dates of Service To enter multiple dates of service at one time click on the first date of service. Hold down the Shift key and click on the second date of service. Selecting a Date Range using the Control key To select multiple dates of service summarized on one service line. 1. Click on the first date of service. 2. Hold down Ctrl key and click on second date of service. Selecting a Date Range and Changing Units using the Shift and Control keys To select multiple dates of service summarized on one service line and updating the number of units. 1. Click on the first date of service 2. Hold down the Shift and Ctrl key and click on second date of service. Enter the From Date only using the Alt key Hold the Alt key while clicking the calendar. This will enter the From date only leaving the To date blank. Quick Report This drop down lists all the reports available in EZClaim, select a report to print and click the printer icon. The report will print showing the data of the current claim only. This feature is very useful for printing patient statements or patient receipts. Claim Status To the left of the Notes button is the claim billed status. This allows for Unbilled, Submitted, Resubmitted, Accepted, Denied, and Other statuses to be applied to the claim. When a claim is printed or exported, the status will automatically change to Submitted or Resubmitted. When running reports, you can use the Claim Status criteria to only show claims with certain status values. 108 New Charges Screen - Features EZClaim Advanced

109 Diagnostic codes EZClaim provides two options for entering Diagnostic codes. 1. If the diagnostic codes remain the same for each date of service, enter codes in Physician/Diagnostic screen for Default data entry. 2. If the diagnostic codes do not remain the same for each date of service, enter codes in the New Charges screen. If diagnostic codes have been entered on the Physician/Diagnostic Information screen, these codes will automatically be entered on the New Charges screen (but allow you to modify if needed). To enter diagnostic codes for this claim, enter codes in Diagnostic Codes line. IMPORTANT: The diagnostic codes found on the Charges screen are the codes that are printed or exported. If you need to change the diagnostic codes, be sure to change them on the Charges screen. Prior Authorization Number If Prior Authorization Number has not been entered on the Physician/Diagnostic Information screen, enter Authorization Number you want associated with these charges. Ready for EDI Check this box if the claim is ready to send electronically. Marking a Claim as Permanent Once a claim has been printed or sent electronically, check this box to lock the claim to prevent accidental changes. A claim marked as permanent can still have payments entered. Simply uncheck the Permanent check box to make changes to the claim. Marking a Claim as Paid You can keep track of claims that have been paid by checking the Paid check box on each claim screen. If you want to mark more than one claim as paid, click on the Claim Archives (see Claim Archives on page 124) button and select all claims to be marked as paid by using the shift or ctrl key, then click the Mark as Paid button. Also see Entering Payments and Adjustments on page 117. Once a claim is marked Paid, it will be locked to prevent accidental changes. Simply uncheck the box to make changes to a paid claim. EZClaim Advanced New Charges Screen - Features 109

110 Bill Date (used to calculate on aging reports) EZClaim will automatically populate this field if the claim is exported or printed. You may manually enter another date if you need a specific date. EZClaim will use this date for aging reports. Bill Secondary By checking this box, when a claim is printed or exported, the primary and secondary data will switch. See Secondary Paper Claims on page 120 for more information. Next Patient and Previous Patient buttons To bring up a blank New Charge screen for the next patient click on the Next Patient button. To return to the previous patient claim, click on the Previous Patient button. Clearing Print and Export Date Stamps To clear a print and/or export date stamp, click the date with the mouse and a box will appear asking to Reset the Print Status or Reset the Export Status. Click the appropriate button to clear the date stamp. Use Insurance Charge Balance on Printed Form To show Insurance Balance only on Printed form put a check mark in this box. Tabs Once service line item data has been entered on the charge screen, a tab listing the beginning date of the claim will be at the top of your form. Each new claim will generate a tab. 110 New Charges Screen - Features EZClaim Advanced

111 Additional Fields on the Charges Screen By clicking the >> View Other Fields button on the charges screen, you can view additional fields available at the claim level. Click the << Hide Other Fields button to view the normal charges screen. Line Item Descriptions How do I print line item descriptions? The new 1500 form allows for descriptions to be printed above the service line data. To enter descriptions, click the >> View Other Fields button on the Charges screen. This will switch the grid to allow descriptions to be entered. EZClaim Advanced New Charges Screen - Features 111

112 To return to the previous grid view, click the << Hide Other Fields button. The description printing will start above the dates of service. The form will handle about 63 characters. Guidelines for entering line item descriptions can be found on the nucc.org web site. Service Lines The service line grid shows the additional fields available for data entry. You should not enter data into these fields unless required for electronic billing. Most of these fields can be accessed through the Payments and Adjustment window. Archived Check this box to Archive the claim. The claim will still remain in the database but will be hidden from view. For more information on archiving claims, see Claim Archives on page 124 Totals on Last Page Only If a claim consists of 7 or more service lines and you would like the total charges to show on the last claim form only, click on the >> View Other Fields button to check this box. Multiply Charge by the Units when Calculating Totals Do not use this check box when submitting claims electronically! It is used for special paper billing purposes only. Date Last Seen 112 New Charges Screen - Features EZClaim Advanced

113 Enter the date last seen if required for electronic billing. Each charge screen can have a different Date Last Seen Other Date and Qualifier If an additional date is needed for this claim in the ANSI 837 electronic billing file, you can enter the date and qualifier. Both the date and qualifier need to be entered for the DTP segment to be exported. QB Invoice # This field was used with the discontinued EZLink module. Other Additional Fields Supervising Physician Used in electronic billing only. Ordering Physician Used in electronic billing only. Claim Adjustments Used in electronic billing only. Claim Delay Code Used in electronic billing only. Resubmission Code Used in paper and electronic billing. Original Ref No. Used in paper and electronic billing. Claim Notes To keep notes about service line data, click on the Notes button on the charges screen. Claim Templates What are Claim Templates? Claim Templates allow a user to save a group of charges then recall them at a later time. This is very useful for billing multiple procedures performed on the same day. For example, if the same two or more services are performed every time on the first visit, the user can save those services under the name Initial Visit. When another patient comes in for an initial visit, the user can bring up the Initial Visit template, select a date and the claim is complete. Saving a Claim Template EZClaim Advanced New Charges Screen - Features 113

114 1. Enter the line items to save for the template and click the Save button. 2. A box will open asking for the name of the claim template. 3. Enter a name and click the Save button. When naming the template, do not use the following characters: \ / : *? "<>> Opening a Claim Template 1. Use the dropdown arrow to select claim template previously set-up. 2. Select a date from the date selection dialog box. 3. Once a date is selected, the saved procedures are added to the services items. 4. Each template is added to the current services so it is possible to bring up multiple templates onto one claim. Deleting a Claim Template 1. Select Claim Template to delete. 2. Click on Delete icon. Previewing Claim Template Data Click on the Preview button to preview Claim Template data. Deleting Claims Click on the Claim Archives button, select by highlighting claims to be deleted and then click on the Delete button. Click on Claims on the Menu bar, select Delete Claim. Go to the Charges screen of claim to be deleted, hold down Ctrl-D to delete claim. 114 New Charges Screen - Features EZClaim Advanced

115 Printing Claims Printing claims from Charges screen When finished entering line items on the Charges screen, click the Print 1500 button. The individual claim will be printed. Printing multiple claims How do I print more than one claim? To print out multiple claims: 1. Go to File on the menu bar, then Select Claims to Print. 2. Highlight claims to be printed and click on the Print button. 3. The claim list can be sorted by clicking on any of the column headings. 4. If claims have previously been printed they will not show up in the list. 5. To see claims previously printed, uncheck the Only Show Claims Not Printed box. This allows the user to re print any claims in the system. 6. If the Print Form checkbox is checked, that will override whatever is selected for an individual claim. Use the Group drop down box to select a different group to print. You can also use the All Groups selection to print all claims. Printing a CMS-1500 form along with Data EZClaim Advanced Printing Claims 115

116 How do I print the black and white 1500 form? To set this option as your default setting go to Tools > Options > Default Print Options. To override the default setting for an individual form, check or uncheck the Print Form & Data box at the bottom of the Patient/Insured Info screen. This will override your program default setting. Printing out the CMS-1500 form without the Charge Line Items For new patients: 1. Go to Tools on the menu bar. 2. Select Options and then Default Print Options. 3. Put a check in the box If any dollar amount is zero, leave blank. 4. Go to the New Charges screen. 5. In the first blank service line enter a 0 in the charge field. 6. Print claim. For a current patient: Load the patient using the Find Patient button. Click the Physician/Diagnostic tab. Click the button labeled Adv Print Options. Put a check in the box If any dollar amount is zero, leave blank. 5. Go to the New Charges screen. 6. In the first blank service line enter a 0 in the charge field. 7. Print claim. 116 Printing Claims EZClaim Advanced

117 Entering Payments and Adjustments How do I enter payments? Entering Payments and Adjustments Note: For Auto Posting ANSI 835 files see Posting ANSI 835 ERA Files on page Select the claim for entering payments from Claim Archives or by clicking on an existing Charges tab. 2. Click in the Applied Amount box on the service line for which you want to enter a payment. This will bring up the Line Item Payments dialog box. The cursor will be placed in the payment type field. The field will be set corresponding to the responsible party. If the responsible party is set to primary insurance, then the selection would be Insurance Pmt. 3. Enter the type of payment, the amount, any reference or notes the click the Add button or Alt-A to add the payment line. 4. Click on Next Service Line button or Enter to enter data for additional service lines. 5. The total amount paid on each claim will be entered into the Applied Amount box on the service line. Entering Percentage Amounts Percent amounts can be entered into the amount fields to speed data entry. If the total charge was $110.00, entering 25% would enter an amount of $ Patient Amount Due Enter into this field the amount due by the patient at the time of service or to be billed on a statement. This field is only required if you are printing patient statements and would like EZClaim Advanced Entering Payments and Adjustments 117

118 to collect a patient payment (such as a copay before the insurance has paid). The Patient Amount Due can not be less than the patient payment amount. This rule only applies if the Patient Amount Due is not zero. If a copay amount due has been entered on the Payers/Other Info tab, a button will appear with the amount. This makes it easy to enter the patient amount due. See the Payers/Other Info Screen - Features on page 105 for more information. Payment Types There are 5 payment types available: Insurance Pmt (Primary Insurance Payment) Sec Ins Pmt (Secondary Insurance Payment) Contract Adj Patient Pmt Other Adjustment Reference 1 Enter any reference information you would like to keep for this payment Reference 2/Deposit # Enter additional reference information for the payment. Some customers use this field to track deposit slip numbers. Reason Code You can track each adjustment (or payment) using reason codes. This field is normally only used with Other Adjustments but can be used with any payment type. Reason codes are maintained in the Adjustment Codes library using the Other Code Libraries on page 87. Payment Note Each payment can have a note attached. These notes are for your reference and are not printed on the statements. Balance Responsible Party This field determines the party responsible for the balance of the line item. This is a very important field in calculating balances printed on a patient statement. When a service 118 Entering Payments and Adjustments EZClaim Advanced

119 line is first entered, this field is set to Primary Insurance. After the primary insurance payment has been entered, the field will switch to Patient (or Secondary if the patient has secondary insurance). When printing Statements, EZClaim uses this field to determine if the patient has a balance due. If the patient does not have a balance due, the patient statement will be blank. See Patient Statements on page 151 for more information on statements. If the patient has no primary insurance set, this field will be set to Patient when the service line is entered. Responsible Party Change Date This date field is used to calculate the aging on patient statements and the AR report. This feature allows EZClaim to calculate aging very accurately based on the date the balance switched from one party to another. Add and Go To Next Service Line Click this button to move to the next service line payments. Pressing the Enter key on the keyboard is the same as clicking this button. This makes it easy to cycle through each service line and enter payments. Printing Patient Statements To go directly to the Patient Statement s report, click on the Reports button, top right, on the Charges screen. Select Statement from report list. You may also access the Patient Statements by going to File on the menu bar and selecting Reports. See Patient Statements on page 151 for more information on statements. EZClaim Advanced Entering Payments and Adjustments 119

120 Secondary Paper Claims How do I bill secondary paper claims? The EZClaim program has the ability to automatically flip claims from Primary to Secondary. Once a claim has been processed by the primary payer and the claim needs to be submitted to a secondary payer, place a check next to the Bill Secondary check box. With the Bill Secondary box checked, the printed, exported and bill date switch to show the secondary status. The claim will now print or export as a secondary claim. How data is switched for secondary billing When printing or exporting secondary claims, the claim data is pulled from the following fields: The secondary payer shown on the Payers/Other Info tab is printed at the top of the CMS-1500 Box 1: The insurance type code set in the payer library is used to determine which box is checked. If Ins Type Code is "MP" then Medicare is checked If Ins Type Code is "MB" then Medicare is checked If Ins Type Code is "MI" then Medicare is checked If Ins Type Code is "MC" then Medicaid is checked If Ins Type Code is "GP" then Group is checked If Ins Type Code is "HM" then Group is checked If Ins Type Code is anything else, then Other is checked 120 Secondary Paper Claims EZClaim Advanced

121 Box 1a: Other Insured ID field on the Payers/Other Info screen. Box 4: Other Insured s Name on the Patient/Insured Info screen. Box 9: Insured s Name Box 9a: Insured s ID Number + Insured s Policy Group or FECANumber Box 9b: Insured s DOB and Insured s Sex Box 9c: Insured s Employer s Name or School Name Box 9d: Insurance Plan or Program Name Box 11: Other Insured s Policy or Group Number Box 11a: Other Insured s DOB and Other Sex Box 11b: Other Employer s Name or School Name Box 11c: Other Insurance s Plan Name or Program Name Box 17a, 17b, 24I, 24J, 32a, 32b, 33a, and 33b ID numbers are printed based on the ID numbers found in the physician library. EZClaim Advanced Secondary Paper Claims 121

122 Sample Primary Claim This is a sample claim to show where fields are moved for printing secondary claims. It is not a proper claim and should not be used as a guide for medical billing. 122 Secondary Paper Claims EZClaim Advanced

123 Sample Secondary Claim This is a sample claim to show where fields are moved for printing secondary claims. It is not a proper claim and should not be used as a guide for medical billing. EZClaim Advanced Secondary Paper Claims 123

124 Claim Archives Claim Archive Button (F5) Clicking on the Claim Archives button will bring up a Claim List Dialog box. The Claim List Dialog box lists all the claims stored in EZClaim. Use this Dialog box to: Quickly find a claim to view Filter Claim List Edit Claims Delete Claims Mark Claim as Permanent Mark Claims as Paid Archive Claims Sort Claims by Column Headings Note: To customize the width of a column heading, position the cursor on the line between the column headings. When the cursor becomes two arrows left click and move column right or left. Opening a Claim Double click a claim to open the Charge screen. Filtering the Archive Claim List You can filter the list by any combination of 3 options: Claims Not Printed 124 Claim Archives EZClaim Advanced

125 Claims Not Exported Claims Not Permanent Claims Not Paid Claims Not Archived Edit a Claim To edit a claim from the Claim list, select by highlighting a claim and click on the Edit button. Mark Claim as Permanent Select claims by highlighting and click the Mark Permanent button. Marking a claim as Permanent will prevent changes being made to the claim. Mark Claim as Paid How do I keep track of claims that have been paid? EZClaim is not an accounting package but it does allow you to track payments and print aging reports. To help keep track of claims that have been paid, it offers the ability to mark claims as paid. See Entering Payments and Adjustments on page 117 for additional information. To mark multiple claims as paid: 1. Open the Claim Archives dialog box. 2. Select the claims to mark and click the Mark as Paid button. Note: that you cannot mark a claim that is being edited. Archive Claims Select by highlighting the claims to Archive. Click on the Archive button. To prevent Archived claims from appearing in the Claim List check the Not Archived checkbox. To unarchive a group of claims, highlight the claims to unarchive, hold the Ctrl key on the keyboard and click the Archive button. You can also unarchive a single claim by unchecking the Archived button on the Charges screen. See Additional Fields on the Charges Screen on page 111. Deleting Claims To delete more than one claim 1. Click the first claim in the list to delete. 2. Hold down the shift key and click on the last claim to delete. EZClaim Advanced Claim Archives 125

126 3. Click the Delete button located at the right of the window. Note: To select random multiple claim forms, hold down the Ctrl key and highlight each claim to delete, click on Delete. Warning: You cannot delete a claim that is currently showing on the screen. Enter New Claim Charges Button F6 Clicking on the Enter New Claim Charges button will bring up the Patient List dialog box. Select by highlighting a patient for entering new charge data and click on OK. This will take you to a new charge screen for the selected patient. 126 Claim Archives EZClaim Advanced

127 Advanced Program Features This section explains the advanced features of EZClaim: Patient Templates - New Patient Using a Template What are Patient Templates? Patient templates allow the provider to pre-fill data into any field (except for the New Charges screen) of the CMS-1500 form. For information on Claim Templates, see Claim Templates on page 113. If you bill to multiple insurance companies or bill for multiple doctors, patient templates can be very helpful. For example, for BC/BS patients, you could have a BC/BS template set up that has the insurance company s address information, providers PIN#, etc. already entered so when a new patient is being billed, you can start with the BC/BS template then fill in the patient name and address. If you bill for multiple doctors, you could have a template for each doctor. Making a New Patient Template Menu Location: Patient> Make a New Patient Template 1. Click Patient on the menu bar, and then Make a New Patient Template. 2. Enter a name to identify the template. Ex: Dr. Jones or BC/BS etc. 3. The name EZTEMPLATE will be in the Patient last name field and the name of your template will be in the Patient first name field. DO NOT MODIFY THE FIRST OR LAST NAME. The first and last name is used by EZClaim to track the template. 4. Enter data into any field you would like pre-filled (except the Charges screen). 5. Click the New Patient button to save the template and clear the screen. Using Patient Templates EZClaim Advanced Advanced Program Features 127

128 Menu Location: Patient > New Patient using a Template 1. Click the New Patient Using a Template button (F3). 2. Select a template from the list. 3. Click the OK button. 4. Enter your new patient data. Editing a Patient Template Menu Location: Patient > New Patient using a Template 1. Click the New Patient Using a Template button. 2. Select the Template you would like to edit. 3. Click the Edit button. 4. Make any changes needed. 5. Click the New Patient button save the template and clear the screen. Deleting Patient Templates Menu Location: Patient > New Patient using a Template 1. Click the New Patient using a Template button. 2. Select the template you would like to delete. 3. Click the Delete button. 4. Click the Yes button on the confirmation message box. 5. Click the Cancel button to close the Template List. Apply Template to Patient Menu Location: Patient > Apply Template to Patient If a patient record already exists, you can still apply a template to the record. The program will only enter data into fields that are blank. If needed, you can check the 128 Advanced Program Features EZClaim Advanced

129 Overwrite current data when applying template check box to overwrite the current data with the template data. Patient Groups Menu Location: File > New Group What are Patient Groups? EZClaim Group feature gives the user the option of separating patient data into different groups. Each Group allows you to store the following information separately. Patient and Claim Data Name (also the group name) All Provider Information All Submitter Information Code Libraries Note: If you would like to use the same Code Library with every group you set up, go to menu Tools > Options > Data Entry and check the box labeled Use the same code libraries for all groups. All other information such as print options, data entry options and auto-fill libraries, is common to all groups. This feature is useful if you are billing for multiple providers and you want to keep each provider s data separate. Some people like to group patients by their insurance company. Setting Up Groups Menu Location: File > New Group You are now ready to set up your groups. 1. Go to File on the Menu bar, choose New Group. 2. Enter the name you will use to identify the group. 3. If you are setting up more than one group, repeat this process. Selecting Groups Menu Location: File > New Group EZClaim Advanced Advanced Program Features 129

130 1. Open the Find Patient dialog box by clicking on the Find Patient button. 2. Using the dropdown arrow select which patient Group you want to work in. If the selected Patient Group does NOT have a patient listed, go to File on the Menu bar>open Group. 3. Highlight a Patient from that group and click OK. 4. The Group you are currently working with will be noted at the top of the EZClaim program. Deleting Groups Menu Location: File > New Group 1. Go to File on the menu bar and choose Open Group. 2. Select the group you want to delete. 3. Click on the Delete button. Warning: This will delete the Group and all patients and claims within this group. Copying Patients to Another Group Program Location: Find Patient Button 1. Open the Find Patient dialog box by clicking on the Find Patient button. 2. Choose which patient or patients (see instructions for choosing multiple patients at bottom of dialog box) you wish to copy and click on the Copy to Another Group button. 3. In the Select New Group dialog box choose which group you would like to copy the patient to and then click on OK. 130 Advanced Program Features EZClaim Advanced

131 Note: This feature will copy patient data only, it will not copy claim data. Moving Patients to Another Group Program Location: Find Patient Button 1. Open the Find Patient dialog box by clicking on the Find Patient button. 2. Choose which patient or patients (see instructions for choosing multiple patients at bottom of dialog box) you wish to copy and click on the Move to Another Group button. 3. In the Select New Group dialog box choose which group you would like to move the patient to and then click on OK. Note: This feature will move all patient and claim data to the new group. Changing Group Name Menu Location: File > New Group 1. Go to Tools on the Menu bar and then Options. 2. Select Provider Information. 3. Change the Name field to the new name. Recurring Claims Claims entered into the system can be set to recur any number of times. When the program is opened, EZClaim can check for any claims that are due to be entered and automatically enter the claims. Creating a Recurring Claim Menu Location: Claim > Make this Claim a Recurring Claim 1. Navigate to the claim that you would like to recur. Click the Claims menu and select Make this Claim a EZClaim Advanced Advanced Program Features 131

132 Recurring Claim. 2. The Create Recurring Claim window appears with the default settings to recur every 1 Month for 1 year. Adjust the dates and frequency as needed. Click Save and Close to save the dates to the database. If needed, you can add or remove individual dates using the Add Date and Delete Selected Date buttons. 132 Advanced Program Features EZClaim Advanced

133 3. The claim screen will show the recurring time frame under the patient s name. 4. To edit the schedule, click with the mouse on the time frame text to bring up the Edit Recurring Schedule window. You can add or remove dates with this window. 5. If you remove or add dates, the recurring time frame for the claim will change to Custom recurring schedule. Processing Recurring Claims Menu Location: Claims > Review and Enter Recurring Claims When EZClaim is opened, it will automatically check for recurring claims that are due. To change this option, click the Tools menu, select Options, then click the Data Entry General tab. Uncheck the Check for recurring claims that are due when opening program. EZClaim Advanced Advanced Program Features 133

134 To processes the claims, select the claims for processing and click the Enter Selected Claims button. You will receive a confirmation on the number of claims processed. Other Features Show All Recurring Claims Regardless of Due Date By default, EZClaim will only show the recurring claims that are due. By checking this box, all recurring claims that have not been processed will be shown. Select All Use this button to check the boxes for all claims showing. Deselect All Use this button to uncheck the boxes for all claims showing. Close Closes the window without processing claims. Delete Selected Entries Removes recurring claims from the schedule. Does not delete claims from EZClaim. Finding Claims By Claim ID Menu Location: Claim > Find Claim by ID Keyboard Shortcut: Ctrl-F5 Enter the Claim ID and press Enter or click the OK button. EZClaim will open the claim matching the ID. 134 Advanced Program Features EZClaim Advanced

135 By Patient 1. Click Find Patient 2. Double click the Patient s name 3. Click the desired Charges tab to show the claim. Claim Archives See Claim Archives on page 124 for more information. Finding Patients Using the Find Patient Dialog Box Menu Location: Patient > Find Patient Keyboard Shortcut: F4 Main Screen: Find Patient F4 button See Find Patient on page 96 for more information on using the Find Patient dialog box. By Patient Last Name 1. Press F2 to save the current screen and start a new patient. 2. Enter the last name of the patient. 3. Press F4 to open the Find Patient dialog box showing the matching patients. 4. Select the patient to edit. By Insured s ID Menu Location: Patient > Find Patient by Insured s ID Keyboard Shortcut: Ctrl-F4 Enter the complete or partial insured s ID number and click OK or press Enter. The Find Patient dialog box will open with the matching patients. Select the correct patient and click OK. EZClaim Advanced Advanced Program Features 135

136 By Patient Account Number Menu Location: Patient > Find Patient by Account Num Keyboard Shortcut: Shift-F4 Enter the complete or partial account number and click OK or press Enter. The Find Patient dialog box will open with the matching patients. Select the correct patient and click OK. Finding Payments Menu Location: Claim > Find Payments by Reference 136 Advanced Program Features EZClaim Advanced

137 Enter a reference into Payment Reference 1 or 2 and press Enter. All matching payments will be listed. Double click the payment to open the Claim and Payment window to view the payment detail. Use a * character as a wild card. For example to find all the payments with references beginning with 4, enter 4* into the reference field. EZClaim Advanced Advanced Program Features 137

138 Program Options Data Entry Service Lines Menu Location: Tools > Options > Data Entry Service Lines Once you begin to enter your patient data you may need to change some of the data entry features. Use this screen to customize your data entry features. EZClaim has set the most common options. Checking additional options will apply to all new claims. Options may be selected at any time. Additional clicks on a date adds additional dates of service instead of removing the dates. Checked: When you click the same date twice, another service line item will be added. Unchecked: When you click the same date twice, the service line item will be removed. Pressing the Enter key moves the cursor down on the line item grid instead of across the grid. Checked: When you press the Enter key when entering service line items into the service line grid, the cursor will move to the right. 138 Program Options EZClaim Advanced

139 Unchecked: When you press the Enter key when entering service line items into the service line grid, the cursor will move down. This is useful if you need to change a column of data. When changing the number of units, update the charge. Checked: When you change a unit value, the charge will be multiplied. Unchecked: When you change a unit value, the charge will remain the same. Automatically enter the charge stored in the code library after entering the CPT Procedure Code. Checked: When you enter the procedure code, the charge will be automatically entered. Note: The function only works if you have entered Procedure Codes in the code library. See Procedure Code Library on page 83, for additional information on entering codes. Automatically check that Paid check box if the claim has a zero balance. Checked: When entering payments, if the claim has a zero balance, the Paid check box will automatically check and the paid date will be entered. Enter Paid Date Checked: When the Paid check box is checked either by the program or the user, the current date will automatically be entered into the paid date field. Enter payments to zero claim if manually checking the Paid check box Checked: If you click the Paid check box, the program will ask if you want to enter insurance payments to zero the claim. Automatically check the Permanent check box when the claim is printed or exported. Checked: When a claim is printed or exported, the permanent box will be checked. When a claim is marked as permanent, it prevents users for making changes to the claim. Payments can still be entered. Automatically check the Ready for EDI box. EZClaim Advanced Program Options 139

140 Checked: When starting a new claim, the Ready for EDI check box will be automatically checked. The Ready for EDI is a claim status used when listing claims for electronic billing. Unchecked: When starting a new claim, the Ready for EDI check box will not be checked. Use Ctrl-Click to open the Payments box when clicking the Applied Amt cell. Checked: You must use the Ctrl key to open the Payments box. Unchecked: Clicking the Applied Amount cell on the charges screen will open the payments window. Copy previous payment date and reference when moving to next line. Checked: When entering payments, clicking the Next Service Line or pressing enter will copy the payment date and reference fields to the next service line. This prevents repetitive data entry. Unchecked: No data will be copied to the next service line when entering payments. Automatically Enter Payment Date. Checked: The payment date will automatically enter the current date when entering a payment. Unchecked: No date will be entered (unless copied from the previous payment). Save payment data with claim templates. Checked: When you make a claim template the payment data will be saved with the template. Unchecked: Claim templates will save the service data and charge information only. Confirm when deleting line items. Checked: A dialog box will ask if you are sure you want to delete the line item. Unchecked: The line item will be deleted without confirmation. Validate authorizations when saving a new claim. Checked: If an authorization is entered on a new claim, a validate will be performed to make sure the number of units and dates are valid for the entered authorization. Authorizations are not checked on previously entered claims. 140 Program Options EZClaim Advanced

141 Show Notice when X units are remaining. Enter the minimum number of units that are allowed for an authorization before a reminder pops up when a claim is saved. Automatically check the Use Insurance Balance on Printed Form check box for new claims. Checked: If checked and the claim has payments entered, only the charges will be used to calculate the Balance. Confirm CMNs when saving the claim. Checked: If checked, when the claim is saved, EZClaim will confirm that a CMN is attached if the service line s CMN box is checked. Check the 'Ready for EDI Box' when checking the 'Bill Secondary' box. Checked: If checked, when checking the Bill Secondary check box, the Ready for EDI box will be checked also. Data Entry General Features EZClaim has set the most common options. Checking additional options will apply to all new claims. Automatically complete the fields as you type (only works on selected fields) EZClaim Advanced Program Options 141

142 Checked: EZClaim will remember your entries and automatically finish entering the data. Use the same Code Libraries for all groups Checked: EZClaim will use the same code library for all groups you have set up. Unchecked: EZClaim will use separate code libraries for each group you have set up. Show the Balance Due on charges tab Checked: The Balance Due amount will be shown on the Charges tab and in Claim Archives. Unchecked: Only the Date will be shown on the Charges tab and in the Claim Archives Automatically Enter a Patient Account Number Checked: Will automatically enter Patient Account Number on Physician/Diagnostic Info tab. A starting account number can not be set. Check for claim follow up dates that are due when opening program If follow-up dates are entered into the Follow-up date field on the Charges screen, the program will show a report showing any claims due for follow-up when opening the program. Show Backup reminder when closing program Checked: When the program closes, it will check to make sure the data has been backed up within the past 7 days. Check for recurring claims that are due when opening program If recurring claims are due for entry. The program will open the Recurring Claims window and allow you to review and process recurring claims. Hide the word Charges on the charges tab Checked: The work Charges will not be shown on the charges tab. This helps if you have many charge tabs and would like to see more tabs without scrolling. Show warning if entering a future date Checked: If a future date is entered on any date field, EZClaim will show a warning. 142 Program Options EZClaim Advanced

143 Check for an existing patient record when entering a new patient Checked: The program will check to see if the patient already exists when you enter the first and last name. This helps prevent duplicate entries. Default Print Options Menu Location: Tools > Options > Default Print Options There are several options for customizing how data is printed out on your CMS-1500 forms. Any changes made to the following options will not change the settings of current patient data. Any changes made will be used when entering new patient data. To override the default settings for an individual patient, see General Date Format and Advanced Print Options on the Physician/Diagnostic Info Screen Features on page 102. If any dollar amount is zero, leave blank (don t print zero s). Checked: EZClaim will not print dollar fields that are zero, the space will remain blank. If the Amount Paid (Box 29) is zero, leave Amount Paid and Balance Due (Box 30) blank (don t print zero s). EZClaim Advanced Program Options 143

144 Checked: EZClaim will not print anything in Box 29 or Box 30 if Box 29 (Amount Paid) is zero. Leave Box 30 (Balance Due) blank. Checked: EZClaim will not print anything in Box 30 (Balance Due). This setting overrides any other settings. Print the CMS-1500 form along with the data. Checked: A black and white CMS-1500 form will be printed along with the data. Unchecked: Only the patient and claim data will be printed. Note: Check with the insurance company where you are submitting claims to find out if they will accept a black and white CMS-1500 form. Print EZClaim s Claim ID along with the Patient Account Number in Box 26 of the CMS-1500 form. Checked: A random patient account number will be entered in Box 26. Print Invoice Number Will print the Invoice number on the Claim screen instead of the patient account number. This also causes the invoice number to be exported in the ANSI 837 in the CLM01 field. Automatically check the Totals on Last Page Only box when creating a new claim This option checks the Totals on Last Page Only option on the claim screen when creating a new claim. Currency Format Some insurance companies require different currency formats. You can select from the following formats. To select a different currency format for an individual form see Print Options on the Physician/Diagnostic Info Screen Features on page 102. If you entered $80.50 for the amount, the following applies: Format Printed DD CC DDCC 8050 Date Format Options 144 Program Options EZClaim Advanced

145 How do I change the date format? General Date Format for Printing Some insurance companies require different date formats. You can select from the following formats. To select a different date format for an individual form see Print Options on the Physician/Diagnostic Info Screen Features on page 102. If you entered 2/8/57, the following applies: Format Printed MM DD YY MM DD YYYY MMDDYY MMDDYYYY Box 24A (Date s of Service) Format Select Same to have the service date format match the general date format. Otherwise, select a different date format for Dates of Service by selecting a new format from the drop down bar. Note: If you have entered a 4-digit year in the program and it switches back to 2 digits, your Windows Regional settings have the M/D/YY display setting. To change the setting open the Windows Control Panel>Regional Settings>Click the Date tab>change the Short Date Style field to M/D/YYYY. Submitter Information The information on this tab is used ONLY for Direct Electronic submission of claims. See Electronic Claims Using the ANSI 837 Format on page 29 for additional information on filling in the Submitter Info. Security Use this tab for entering your Security settings. IMPORTANT: IF YOU DO NOT REMEMBER YOUR PASSWORD YOU WILL NEED TO CONTACT EZCLAIM FOR A DATABASE RECOVERY. A FEE WILL BE CHARGED. EZClaim Advanced Program Options 145

146 1. Enter Password on the Security tab and then Confirm password. 2. When opening the program a dialog box will appear asking for the password. 3. Enter Password, click on OK. 4. To disable the Password feature, go to the Security tab and Delete the password. Note: If your do not remember your password contact EZClaim for a database recovery. A fee will be charged. 146 Program Options EZClaim Advanced

147 Reports Menu Location: File > Reports Opening the Report Dialog Box Click the File menu and click the Reports menu item. This will open the reports dialog box and list all the available reports and criteria settings. You can also press F8 to open the reports window. EZClaim provides standard reports to help manage and print information from EZClaim. Since EZClaim is based on an Access 2000 database, you can use other report writers to build your own custom reports. See the Custom Reports on page 152 for more information. Additional Downloadable Reports are available online. Click the Additional Downloadable Reports link to see the downloadable reports. Previewing Reports If you are not sure which report will meet your needs, select a report and then click on the Preview button before printing. Report Criteria EZClaim reports allow you to limit data by selecting a date range, selecting a single patient and so on. Each set of EZClaim Advanced Reports 147

148 criteria is explained below. Please note that not all criteria are used on all reports. Once a report is selected, criteria may be disabled if the report does not use it. Current Claim Only Check Box This option will only appear when the Reports button has been clicked from the Charges screen. Use this option when you want to print data from the current claim only. Commonly used with the Patient Receipt report. Do Not Use Date Range Check Box Check this box if a date range is not desired. The AR report would not normally use a date range since you would like to see all claims that have not been paid. Date Range Select a date range by entering two dates or click the date selection buttons to use a calendar to select the From and To dates. Date Range Source Select the date range source from his drop down box. The most popular date range is Date of Service but you may need to see the claim list for claims printed between a certain date range. In this case, you would select the Printed Date as the date range source. Some reports are based on a Transaction date. The transaction date is the date the transaction took place. A date of service would be the transaction date for a charge. A patient payment date would be the transaction date for the payment. The Patient Ledger is a good example for using a transaction date. By setting a transaction date range source, you can see all the transactions that happened within a certain time period. Facility Each unique facility is listed in the Facility drop down box. If you would like to limit the report data to a certain facility, select the facility from the list. The facility located on the Charges screen is used to determine the data shown on the report. Primary Payer Select a Payer to limit data to that payer only. 148 Reports EZClaim Advanced

149 Patient Each patient name is listed in the Patient drop down. You also have the option of selecting All Active Patients or All InActive Patients. If you would like to limit the report data to a patient, select an item from the patient list. Group You have the option of selecting data from all the groups or selecting one or more groups for the report. Claim Status Use these criteria to limit claims that have a certain status. One example would be to select a status of Not Printed then print the Claim List report. This would show claims that have not been printed. Responsible Party for the Line Item Balance This criteria is used to shows line items that are the responsibility of Patient, Primary Insurance, or Secondary Insurance. One example would be to select Patient then print the Patient Visits report. This would show only the line items (and balances) that are due by the patient. Procedure Code and Diagnostic Code This criteria is used to filter any report to a certain procedure code or claim diagnostic code. Enter the procedure code or diagnostic code to include on the report. Wild card characters such as * (for 0 or more characters) or? (for a single character) may be used. For example, entering 90* would include all procedure codes that start with 90 such as and Printing and Previewing Reports Once a report has been selected, click the Print button to print the report or click the Preview button to preview the report on the screen. During preview, you can click the print icon on the toolbar to send the report to your printer. Exporting If you would like to view the report data in another program, EZClaim gives you the option of exporting the report data into a variety of formats. Once the report is selected, click the Export button. The export box has two sets of options. The first is the export format. From the Format drop down, EZClaim Advanced Reports 149

150 select the export format. From the Destination drop down, select the destination. Click the OK button to export the file. Report Descriptions Below are descriptions and special issues for some EZClaim reports Accounts Receivable Report Uses data from all claims that have not been archived. Lists all patients even if they have a zero balance. To show only the patient s with a balance, change the Claim Status criteria to Not Paid. The balance can be the responsibility of the Patient, Primary Insurance, or Secondary Insurance. The date used to calculate aging is calculated by looking at the following fields. If the field is blank, it moves to the next available date in the following order. o Claim Bill Date o Claim Printed Date o Claim Exported Date o Service Date o Current Date Other Adjustments Shows the amounts of all other adjustments. Groups by the Adjustment Code, Payer, and Procedure Code. Patient Ledger Shows all transactions between a date range. Both charges and payments are included. Shows the patient demographics, billing provider, and rendering provider. Shows a running balance and is sorted by date of service. Patient Visits Not Authorized Shows services without an authorization number OR have dates that fall outside the authorized time period OR procedure codes that are not included with the authorization number. Procedure Code Summary Groups by procedure code and gives number of times the procedure code was used along with total units, total charges, total amount paid. 150 Reports EZClaim Advanced

151 Production Report Use this report to show the production of individual rendering providers. Shows Charges, Payments, Other Adjustments and Contract Adjustments by Rendering Provider. This is a summary report that shows the totals of each group. Allows for scrolling down to see the individual transactions. Referring Provider Patient Count Shows the referring providers name, the number of patients referred, claim count, total charges, total applied payments. You can scroll down to see the patients referred by the Dr., then scroll down further to see the actual line items. Submission Reports When claims are exported for electronic billing, EZClaim offers the option to print a submission report. If the report is not printed at the time of export, the submission report can be printed using the report dialog box. Reprinting a Submission Report: Click the File menu and click Reports. From the report list, select Submission Report. Click Print, Preview or Export. From the Previous Submission Reports dialog box, select the exported file name to print. 5. Click the OK button to print the submission report. IMPORTANT: If claims have been deleted or modified after exporting, the submission report will not reflect the actual data in the exported file. Patient Receipt Formatted the same as the Patient Statement but shows all transactions even if the patient does not owe any money. Commonly used with the 'Current Claim Only' check box option on the report screen. Patient Statements How do I print patient statements? Statement Report Shows the balance due by the insurance and patient. There are a couple rules used when printing reports. EZClaim Advanced Reports 151

152 A statement will only print if there is a balance due by the patient. Even if the claim has a balance due, the statement may be blank because no line item balances are the responsibility of the patient. See Entering Payments and Adjustments on page 117 for more information on setting the responsibility of the balance. The date used to calculate aging is calculated by looking at the following fields. If the field is blank, it moves to the next available date in the following order. o Responsible Party Change Date (found on the payments and adjustments window) o Claim Bill Date o Claim Printed Date o Claim Exported Date o Service Date o Current Date Service Line items will only print if there is a patient balance due on any claim (Charges screen) not marked as paid. This could be either a patient amount due (CoPay) or the line item balance is set to patient responsibility. See Entering Payments and Adjustments on page 117 for more information on setting the responsibility of the balance. All line items from the unpaid claims will print even if the line item balance due is $0.00 as long as one line item with a balance is marked as the patient responsibility. Claims marked as Paid will not print. Claims marked as Archived will not print. If a Patient Amount Due is entered, it will show as the patient balance no matter what the balance responsible party is set to. This is so people can bill patients for the patient amount due before they receive payment by the insurance company. Custom Reports Since patient and claim data is stored in an Access 2000 database, it is possible to write custom reports with a third party report writer. We suggest using either Access or Crystal Reports to design custom reports. Please note that we do not provide support on custom report designs. 152 Reports EZClaim Advanced

153 Networking EZClaim License Requirements EZClaim requires a user license for each additional person accessing the database. Contact EZClaim to purchase additional user licenses. Overview When operating with multiple users, EZClaim maintains a list of users and patients currently being edited. Record locks are maintained by EZClaim, not the database. Each time a user loads a patient, the patient s ID is stored in a record lock table and the patient is locked until the user loads another patient or closes the software. Number of Users There is a suggested limit of 5 licensed concurrent users. Due to computer speed and database access speed, there may be a performance limitation to the number of concurrent users. Limitations Certain features of EZClaim have the possibility of editing multiple records during a single procedure. Listed below are features in EZClaim that cannot be used when more than one person is in the system. Backup and Restore Electronic Billing Select Claims to Print Please make sure all other users have exited EZClaim before using one of the above features. Backup Considerations Multi-User operation increases the possibility of corrupted data due to increased chances of computer crashes and network communication problems. It is our recommendation that the database directory be backed up every day. EZClaim cannot responsible for lost or corrupted data. Repairing and Compacting Database If the database becomes corrupted, you can use the compact and repair utility in the Database Maintenance program. Click the Start menu, select Programs, EZClaim, Utilities, and then Database Maintenance. This opens the EZClaim Advanced Networking EZClaim 153

154 utility and locates your database. Choose the Compact and Repair function and click Next. Confirm that the correct database is listed then click the Compact and Repair button to repair your database. Upgrade Considerations When upgrading the software to a new release, it is very important that each user is upgraded to the same release. The database structure may be different and upgrading only one workstation may cause other workstations to work incorrectly. Network Installation or Installing Additional Users Overview 1. Share the EZClaim database directory containing the EZData.mdb database. 2. Configure EZClaim on the second computer to connect to the shared drive, sometimes referred to as pointing the program to the shared database location. Important: Installation Checklist Be sure you have permissions to install software on the computer. Make note of the shared database directory location: Make sure the database directory is accessible from the new computer. Use the 'My Computer' icon to navigate to the share location. Confirm that you have read/write permissions to the directory. Ask your network administrator to determine the permissions. During the installation process, you are asked for the directory of the program files and the database files. When the installation dialog says The application s database will be installed in the following directory make sure to enter your shared directory determined above. This installation procedure must be performed on each workstation. 154 Networking EZClaim EZClaim Advanced

155 Instructions 1. Share the EZClaim database. a. Install EZClaim on the main computer making sure to install the database into the correct location. b. Share the directory containing the EZClaim database. The path for the database on the main computer will normally will be C:\Program Files\EZClaim\EZData.mdb. * See: Instructions for setting up a shared directory for the EZClaim database ( KBID=218) 2. Configure EZClaim on the second computer to connect to the shared drive. a. Map a drive to the shared location above (Example: Z\EZData.mdb). See: Instructions for mapping a network drive ( KBID=633) b. Install EZClaim on the second computer, making sure to select the mapped database location created in previous step. c. If EZClaim is already installed and open, you can use Ctrl-Alt-O to set the previously EZClaim Advanced Networking EZClaim 155

156 mapped location. EZMonitor Location: Start > Programs > EZClaim > Utilities > Multi-User Monitor The Multi-User Monitor (EZMonitor) will monitor EZClaim usage and patients loaded. The program is set to automatically refresh the screen every 10 seconds. You can change the refresh rate by entering the number of seconds between each refresh. F5 Manually refreshes the screen. F10 Exits the program. The database file is shown at the bottom of the screen so you can determine that the correct database is being monitored. EZMonitor connects to the current EZClaim database. 156 Networking EZClaim EZClaim Advanced

157 Unlocking Patient Records If a user s computer crashes, it is possible that a patient record remains locked. If this happens, you can manually unlock all patient records by following these steps: 1. Click the Windows Start menu button then select Programs. 2. Select EZClaim then Utilities, then Database Maintenance. 3. Check the Clear Record Locks in Database option. 4. Click Next. 5. Click OK to the confirmation message. The record lock table is now cleared and other users can proceed to open the program. Opening Another Database This utility is provided in case the program AND database has been installed on a local workstation and the user needs to open a database located in a shared directory. 1. Make sure all users have exited the program. 2. Open EZClaim Medical Billing Software. DO NOT LOAD A PATIENT. 3. Press Ctrl-Alt-O on the keyboard. 4. From the Open dialog box, navigate to the shared database directory and select the EZData.mdb file then click Open. 5. Exit EZClaim and re-open. The new location will be remembered by EZClaim. EZClaim Advanced Networking EZClaim 157

158 Troubleshooting The troubleshooting section is here to help fix problems with opening or operating the program. Please try the following steps before calling technical support. Database Maintenance Start Menu>Programs>EZClaim>Utilities This maintenance utility will allow you to perform the following functions: Backup the database Restore the database Compact and repair the database Unlock any patient or user records in the database Opening the utility: 1. Make sure all users have exited from EZClaim before using any of the utilities. 2. Click the Windows Start menu button, select Programs, EZClaim, Utilities, and Database Maintenance. 3. Select the procedure you would like to perform then click the Next button. 4. Follow the on screen instructions. 5. Once the procedure is complete, the program will close. 158 Troubleshooting EZClaim Advanced