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Claim Verification

Overview

The Claim Verification program is used to:

  • properly identify the correct insured/patient from enrollment
  • properly identify the correct provider in the network
    • (optionally) set a specific contract based on matching TIN in the network, even though exact provider is not found

Usage

If any claims need verification, you will see them listed on the main program screen. A section may show for each possible claim status, where each status designates the reason the claim needs verification.

  1. Adjust the priority filter, shown in each section as column P. Priorities can be 1-10, with 1 being the highest priority. Typically, higher priority claims should be done first.
  2. Change the number of claims shown. This may be helpful if all or most of the claims showing must be skipped but have not yet been completed.
  3. If you know the exact claim number of a claim to verify, possibly from another notification such as email, you may enter it here and click the Go button to verify that claim.
  4. If you need to reprint a Reject/Return letter, use this link to do so. You will need to know the claim number.
  5. If you have any claims locked, they will show here with the options to verify them directly, or release the lock so others can verify the claim, or so you can come back to it later.
  6. Outstanding locks by you or others may show here.

Claim Status Sections

Each claim status section represents a particular reason why the claim is showing in this program. You are able to see the following columns:

P Priority level of the claim
Claim # the identifier for the claim in this system
Entry Date when the claim was entered or received EDI
Skipped By who skipped this claim - NOTE that if you hover over this name, you may see the note they left when it was skipped which contains helpful information
Notify Sender flag indicating that this claim was not able to be handled internally and is now visible to the client for assistance

After hovering over the Skipped By name to see helpful information, click the claim number to begin verifying a claim in one of the following sections:

start.txt · Last modified: 2014/05/20 10:34 by admin