Computers in
the Medical Office
Chapter 7:
Creating Claims
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Creating Claims
Once the services a patient has received
been entered into the practice
management program, the next step is to
create insurance claims.
The insurance claim is the most important
document for correct reimbursement.
Claims communicate information about a
patient’s diagnosis and procedures and
the charges to a payer.
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Creating Claims
HIPAA standard transaction for electronic
claims is the HIPAA X12-837 Health Care
Claim or Equivalent Encounter Information
(837P).
Paper format is known as the CMS-1500
claim form.
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Creating Claims
Claims are created in the Claim
Management area of Medisoft
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Creating Claims
When the Create Claims button is clicked,
the Create Claims dialog box appears
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Creating Claims
The Create Claims dialog box contains a
number of filters claims, including
Transaction
Dates
Case Indicator
Chart Numbers Location
Primary
Insurance
Provider
Billing Codes
Amount
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Creating Claims
Once claims are created, they are listed in
the Claim Management dialog box, with a
status of Ready to Send
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Selecting/Filtering Claims
Medisoft’s List Only feature selects only
those claims that meet specified criteria,
such as:





Chart number
Date created
Insurance carrier
EDI receiver
Billing date
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Editing Claims
If any claims need to be edited, simply
highlight the claim in the Claim
Management dialog box and click the Edit
button
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Editing Claims
In the Claim dialog box, changes are made
to a claim, such as moving a transaction to
another claim
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Transmitting Claims
Claims are transmitted electronically to a
clearinghouse, or directly to an insurance
carrier
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Transmitting Claims
The clearinghouse sends a report to the
practice, to verify the claims that were
transmitted
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Transmitting Claims
The clearinghouse also sends an audit/edit
report to the practice, which lists potential
problems with claims
Corrections are made before the claims
actually reach the insurance carrier
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