For Claim creation the process starts with Demographics entry and insurance verification. Either
through scanning documents to our billing team or having it shipped in packages we collect all
the information necessary to generate an encounter: demographics, insurance information, and
ICD/CPT codes.
Once the information is retrieved the claim can be created using two methods:
- Manual Claim entry: Claims are created directly into the PM system from a route slip or super bill. Before any claim is generated verification is done for patient’s insurance eligibility. At the time of ICD/CPT entry various online tools will be used to insure correct coding is done with modifiers, units, and charges.
- Auto generation: Claims are automatically created directly from the appointment scheduler. ICD/CPT codes, modifiers, and units are entered into individual patient appointments along with Demographic information and patient insurance details. If any copayments are posted into the appointment details they are directly transferred into the encounter. At the end of the auto generation process auditing of the newly created claims can still be done before submission.