Creating Claim Setups

In order to generate valid paper or electronic insurance claims for a patient, you must complete a Claim Setup. The Standard version of SOS creates only “Professional” claims; the Pro version of SOS creates both “Professional” and “Institutional” claims. To input this claim setup information…

1. Open the desired Patient form.
2. Select the Care Episodes tab, just below the top panel containing the patient’s identifying information.
   
3. Now double-click the desired Care Episode in the Care Episode list panel. (The current Active Care Episode will be the highlighted if there are two or more episodes in the list).
4. On the Care Episode form, you will see one (SOS Standard version) or two (SOS Pro version) Claim Setup tabs. To generate 1500 claim forms and Professional (that is, regular outpatient service) claims, you must fill in information on a Professional claim setup form. To file UB institutional claims, you will have to provide information on an Institutional claim setup. Sections below address each type of claim setup separately.

Claim Setups – Professional

When you initialize a patient in SOS, a blank Professional claim setup is automatically created for you. Double-click that existing item in the list to open the form to review and add details. If you have experience with the CMS 1500 paper claim form, the fields on this screen form will be very familiar to you. Even though the form is organized according to the paper claim layout, the same information is needed to file electronic claims, so be sure to complete all necessary fields.

In SOS Standard, you can have only one Claim Setup per Care Episode, but there is no limit to the number of Care Episodes per patient. In SOS Pro, there is no limit to the number of Care Episodes or to the number of Claim Setups per Care Episode.

Some fields on this form are associated with user-maintained lookup lists, so if the desired selection is not in the drop list, you will have to add it to the list using the New button on the top or bottom of the specific drop list window, as below:

• Referring Provider or Other Source
  
• Service Facility
  

Claim Setups – Institutional

In the lower section of the Care Episode screen, click the Claim Setups – Institutional tab to open a list of already created institutional claim setups, if any. Double-click an existing setup, or click the New button (first button on the list’s toolbar) to create a new one.

In order to successfully submit institutional claims, you must enter appropriate information in one or more institutional claim setup forms for any patient for whom institutional claims will be filed. As you can see from the screenshot, these claim setups include a great many fields. In most cases you will be able to leave many of these fields blank. Just complete those you know to be required by the carriers for this patient.