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6.
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Visits and Claims
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These are the subsections in this section: |
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Creating New Visits |
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Creating Claims |
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Printing a Paper Claim |
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Printing a Paper Claim on a Red 1500 Form |
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Sending an Electronic Claim |
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Resubmittal of an Electronic Claim |
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Claim Status |
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a. |
Creating New Visits |
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Patients & Visits tab to access the Visits sub tab and either click the plus icon or click the New Visit Wizard icon .
Adding a Visit(s)
To follow the New Visit Wizard, simply follow the instructions listed on each screen. If all the required data is not entered, an error message will appear indicating which field(s) need data before you can proceed to the next screen. The Billing Code is where the appropriate CPT® / HCPCSII code is to be entered. Click Run Crosswalk to view and select the corresponding ABC code describing the service provided. You may enter the known ABC code in the Billing Code in order to process the Crosswalk. However, you must enter the correct CPT® / HCPCSII code as the Billing Code and the ABC code as the Documentation ABC code before you go to the next screen. Enter all appropriate information in the rest of the Wizard screens and click Save.
If you choose to click the plus icon , the data fields for the Visit appear on screen. Follow the instructions in the paragraph above for the Procedure data. Enter all applicable information and click Save. You can add more Visit records as needed.
ZipClaims auto-populates claim data fields using Visit information supplied for the selected Visit. |
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b. |
Creating Claims |
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There are two ways to add Claims. You can click on Claims tab to access the My Claims sub tab and either click the plus icon or click the New Claim Wizard icon .
Adding a Claim(s)
To follow the New Claim Wizard, simply follow the instructions listed on each screen. If all the required data is not entered, an error message will appear indicating which field(s) need data before you can proceed to the next screen. Enter all appropriate information in the rest of the Wizard screens and click Save.
If you choose to click the plus icon , the data fields for the Visit appear on screen. Follow the instructions in the paragraph above for the Procedure data. Enter all applicable information and click Save. You can add more Visit records as needed.
Additional Tips
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To create a Corrected Claim, Medicaid may require a Resubmission Code. |
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In order for the provider to be paid, you must check the box next to Authorization of Payment. |
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c. |
Printing a Paper Claim |
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Once the claim has been created and saved, a line item appears on the My Claims screen showing the base information for the claim. You may either print the claim and mail it to the payer or send the claim electronically. You will only be charged once for either printing or electronic submission for a single claim, but you may print the single claim as many times necessary. If the claim is changed in any way, you will be charged for reprinting or resubmission.
To print the claim, simply click the printer icon . Validation rules are used to check for possible errors. If validation problems appear on screen, go through each point to make any necessary edits to the claim. If you have any questions about the validation problems, please contact Ultimate Customer Care at 1-866-925-2317. If the claim passes the applicable Validation rules, click Print and follow the instructions to access the paper claim. |
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d. |
Printing a Paper Claim on a Red 1500 Form |
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Most newer printers (i.e. those manufactured after 2000) are capable of printing without margins to fit on a red scanable 1500 form.
The following list is comprised of printers we successfully tested for printing these forms and that we recommend for use:
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HP Laser Jet 4 |
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HP Laser Jet 5N |
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HP Laser Jet 6P |
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Canon IR60 |
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Savin 2545 |
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Dell 1815dn |
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Dell 1720 |
Should you experience any alignment problems, verify that you have these page handling settings as default settings:
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Page Scaling: None/Off/Unchecked |
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Auto-Rotate and Center: None/Off/Unchecked |
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Choose Paper Source by PDF Page Size: None/Off/Unchecked |
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Should you further experience problems printing to the red 1500 form, please contact your printer manufacturer or vendor. |
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e. |
Sending an Electronic Claim |
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Once the claim has been created and saved, a line item appears on the My Claims screen showing the base information for the claim. You may either print the claim and mail it to the payer or send the claim electronically. You will only be charged once for either printing or electronic submission for a single claim, but you may print the single claim as many times necessary. If the claim is changed in any way, you will be charged for reprinting or resubmission.
To send the claim electronically, click the electronic submission icon . Validation rules are used to check for possible errors. If validation problems appear on screen, go through each point to make any necessary edits to the claim. If you have any questions about the validation problems, please contact Ultimate Customer Care at 1-866-925-2317. If the claim passes the applicable Validation rules, click Submit to send the claim electronically. |
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f. |
Resubmittal of an Electronic Claim |
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There are two ways to add Claims for resubmittal. You can click on Claims tab to access the My Claims sub tab and either click the plus icon or click the New Claim Wizard icon .
Changing Claim Status
To follow the New Claim Wizard, simply follow the instructions listed on each screen. Select the If all the required data is not entered, an error message will appear indicating which field(s) need data before you can proceed to the next screen. Enter all appropriate information in the rest of the Wizard screens and click Save.
If you choose to click the plus icon , the data fields for the Visit appear on screen. Follow the instructions in the paragraph above for the Procedure data. Enter all applicable information and click Save. You can add more Visit records as needed.
Additional Tips
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To create a Corrected Claim, Medicaid may require a Resubmission Code. |
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In order for the provider to be paid, you must check the box next to Authorization of Payment. |
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g. |
Claim Status |
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| In order to check the status for your claims, please contact each payer directly to access updates. |
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