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Creating a Patient Claim (US)

 To create a patient claim, you can begin from two main areas; The Patient’s Profile or from their Appointment.

From the Patient Profile

  • Search for your patient under the Patient tab.

  • Go into their Billing > Claims and click New Claim

From the Appointment:

  • Click on the Appointment on the Schedule

  • On the Appointment pane, scroll down to the Insurance Info area

  • Click on “Add” button under Primary Policy or the “Add Claim” button at the bottom on the Insurance section.

Regardless of which way you start, the process from here is the same.

  • Give the claim a name – this is internal and should be useful in identifying the claim.

If you are selecting a Health Insurance insurer (to generate a CMS1500), you will want to ensure you fill out as many of the fields as possible, including the Claim, Employee or ID number, the Policy, Group, or Plan number, and the Insurance Plan Name so that these populate in fields 1A, 11, and 11c of the Health Insurance Claim Form.

While you can always return to this later to fill in more details, you will want to complete this before you generate a CMS 1500 form or submit a claim.

  • Then click Save and you’re all set. The claim will now show up under the patient’s Claims area.

  • Or on the Appointment pane

The next step is Adding Billing Codes and Insuring a Patient Visit.

Things to Look Out For When Creating Claims

When you create a new claim for a patient, you’ll notice the Signature on File and Accept Assignment radio buttons.

These fields will be included on both CMS-1500 forms (box 13 & 27) and EDI files that you generate for submission.

These fields can be handled in each individual claim you create, or you can set up a clinic/insurer wide setting to default one or both of these fields to ‘Yes’ for all patient claims where you haven’t selected ‘Yes’ or ‘No’.

You can find that clinic wide setting by heading into Settings > Billing Settings

If you were to check off either of these settings (let’s say both for this example), then each claim on your account that doesn’t have a value inputed for these fields would default to ‘Yes’.

If you had a claim where you selected ‘No’ and have enabled the ‘Yes’ default, Jane will ignore the default and use the ‘No’ value on the CMS-1500s and EDIs that you generate.

Please Note: If you do choose to default your Signature on File to Yes, it’s important that you do obtain your patient’s signature before billing for their visits. For specific questions on the importance of when and how to obtain your patient’s signature, it’s best to contact your regulating body or college.

Interested in collecting your patient signatures using Jane’s intake form feature? If so, please have a look at the following guide document: Intake Form: Require Signature Setting