Generating Insurance Claims

Once you have entered the patient and insurance information needed to submit a complete claim and you have entered and posted some insurance-billable charge entries, you can generate insurance claims.

In the navigation panel, you will see a section entitled Claims and within that section you will find a link to Create New Claim(s) – Professional. (If you are using the “Pro” version of the software, you will also have a link to Create New Claim(s) – Institutional. The procedure to generate institutional claims is very similar to that described below for Professional claims.) The screenshot below shows the options you can specify for your insurance run.


Include Previously Billed Items

Normally, an insurance batch would include only charges that have not yet been billed, but from time to time you may have a situation in which you want to include charge items that have already been billed. The first option, Include Previously Billed Items allows you to do exactly that.

Filter Options

You can use these options to …

  • Specify the date range of charges to be included.
  • Specify the alphabetic range of patients to be included.
  • Limit charges billed to a single rendering provider.
  • Limit Carriers to be billed to a particular Carrier Category (entered on the Carrier information screen).
  • Limit patients to just those assigned to a particular Patient Category on the Patient information screen.
  • Limit claim charges to those which you have assigned to a particular Sort Code on the Charge entry screen

Output Options

These output options can be used to adjust the way the data is presented or alter data shown in particular areas of the claim. In most cases, you will probably want to check the first two options.

The Pay-To Provider option forces the system to use the Pay-To Provider address information at the bottom of the claim rather than the default address for the designated Billing Provider (Supplier).  See Managing Billing Providers for more information.

Creating Your Claim Batch

Once you have set your filtering and output options, just click the Create Claims button to create your claims.

The Create Claims step gathers all the data needed for claim output, according to the options you have specified. When this step is complete,  the next screen will appear, on which you will specify the specific format desired by clicking the Output Claims To… button:

Select the appropriate output format for the claim batch…
… and click the Preview/Print button.

From the Preview window, you can examine exactly what is going to print before proceeding. When ready, use the Print or Quick Print buttons to send the job to your printer.

If your claim output does not line up well with your pre-printed forms, you can tweak the print position up/down and/or left/right by adding the claim form to the Reports Alignment list, with the desired adjustment values.