View Claims/Charge Summary and Detail

Use to search for a specific claim number (or all claims for a patient number) within EDI to follow up and ensure the claim is paid in a timely manner. 

This task shows how to navigate to Claims (Charges) Summary and Detail using Inquiry. Claims Summary and Detail can also accessed from several reports and Claim Attachments. Labels and tabs displayed depends on where Charge Detail is accessed and if you are a GM or non-GM client.
  1. Click eStatus.
  2. Click Inquiry
    The Claim/Charge Summary screen appears displaying the last ten claims searched, or null if there isn't a recent claim search.
  3. To search for a specific claim, at Identifier, select to search by ClaimID (Group Management (GM) customers only), Charge Number (GM only) Claim Number, or Patient Identifier.
  4. At Search, enter the value (patient's account number or claim number) for the selected Identifier.
  5. Select Search (action button).
    The Claim Summary appears with the search results.
  6. Click the Claim/Charge number to view the details or update the status.
    The Claim Detail screen appears with the information panel displaying Patient, Payer, Claim/Charge , Physician and Security (if setup) information on the left. Claim History, Associated Files, View 837 Claims, and Upload Attachments (if purchased and non GM only) appear as tabs to the right.
  7. Select Update Status to update the status of the claim.
  8. With the Claim History tab selected, click the chevron next to expand he row and view Edit Detail and Report Information if applicable. If Report Information exists, the file name displays as a hyperlink to click on and view the report.
  9. Click the Associated Files tab to view a list of available claim or remit files associated with the claim such as the file history and available downloads. If applicable, Associated Claim Attachment File details also displays (history, associated files, and downloads).
  10. Select the chevron next to the file name to view detailed claim, remit , or attachment file information. Remit files also include the Check Summary.
    The Downloads section provides links to download both the original claim file and the translated claim file associated with the claim.
  11. Click View 837 Claims to view details of the translated claim in a table layout format organized by the Segment Name and data contained in the loops.
  12. Click Primary Payments to view the charge level payments showing the paid amount and adjustment amount and the reason for the adjustment. This tab will not display if the primary claim is pending or if claim is paid.
  13. Click Remittance Information to view associated check number, check date, allowed amount, claim-and charge level payment amounts, billed amounts, line number, payment status, associated adjustments and explanations, and claim EOBs. This tab does not display if payment hasn't been received.
  14. Click Upload Attachments to upload and view claim attachments.
    note: This tab is available if your organization purchased the Claim Attachments module and are a non-GM client. Group Management clients may access Claim Attachments, if purchased, from the Claim Attachments module.
  15. Click CSI Response (if enabled at your site) to view available responses. Clicking the inquiry date displays claim level and service level details.
  16. Select Return to Recent List, to return to Claim Inquiry displaying the recently searched claims.