Industrial Account Invoice Billing
The first step in industrial account and invoice billing is adding your patients to ProviderSuite. Here are all the fields that are available to be populated for patient demographics.
From Billing > Select Setup at the Top of the page > Select Patients and the following screen will be available to add a patient.
Patient Info
The basic information required to record the details on the Patient Info screen is First Name, Last Name, Gender and Date of Birth. The following is a brief explanation of each field on the Patient Info tab:
Note: All the tabs in Billing are separated into different sections with the related features displayed under the appropriate sections for easy navigation.
The following are the sections available on the Patient Info tab:
General Information
Patient Details
Guarantor
Discount Types
Phone Detail
Age
Signature Status
Other demographic info.
General Information
Field | Description |
SSN | Enter the social security number of the patient. |
Referral Source | By default, in a new practice, this section is blank. Please contact support if your referral source drop-down is blank. Select the referral source from the drop down menu. |
First Name | Enter/Type the first name of the patient. This is a mandatory field, or the basic information needed to record Patient Info details. |
Middle Name | Enter/Type the middle name of the patient, if any. |
Last Name | Enter/Type the patient’s last name. This is a mandatory field, or one of the basic information needed to record Patient Info details. |
Suffix | Enter/Type additional information about the person, like letters that indicate the position held by the individual, or educational degree, accreditation, office, or honour. |
Alias/Nickname | Enter/Type the patient’s nick name, pet name or any specific name used to address the person. |
Address 1 | Enter/Type the first line of the patient address. |
Address 2 | Enter/Type the second line of the patient address. |
City | Enter/Type the name of the patient’s city. |
State | Select the patient’s state using the drop down menu. |
Zip | Enter/Type the patient’s zip code. |
Pri Care Prov | Select the primary care provider from the drop down menu. |
Referring Provider | Select the referring provider from the drop down menu. |
Patient Details
Field | Description |
Account | By default Automatically Assign Account number checkbox is selected under Setup - General. The system will automatically assign account number for the patient. The account number can be manually changed, if necessary. |
Marital Status | Select the marital status of the patient from the drop down menu. |
Chart | Enter the chart number. If the old patient chart number needs to be cross referenced to the new system, the chart number needs to be entered in this field. This is entered only for informational purpose. |
Gender | Select the patient’s gender by clicking on the required radio button. This is a mandatory field, or one of the basic information needed to record Patient Info details. |
Employment Status | Select the patient’s employment status from the drop down menu. |
Employers | Select the employer from the drop down menu. The employers section allows to search from the employers existing list or add new employer details. To edit, or add a company, use the buttons to the right of the company drop down. Click |
Guarantor
Field | Description |
Relationship to Patient | Select the guarantor’s relationship with the patient using the drop down menu. The options available in the drop down menu are:
|
Guarantor | Select the guarantor from the drop down menu. Click |
Phone Detail
Field | Description |
Home Phone | Enter/Type the patient’s home phone number. |
Work Phone | Enter/Type the patient’s work phone number. |
Mobile Phone | Enter/Type the patient’s mobile phone number. |
Other Phone | Enter/Type the patient’s alternative or additional phone number. |
Fax | Enter/Type the patient’s fax number. |
Enter/Type the patient’s email address. | |
Pt consents to receiving statement and/or appt reminders by email | Receive statement and reminders by email. Click the Pt consents to receive statement and/or apt reminders by email checkbox. Currently this box is for informational purposes only and does not control any statement settings. |
Age
Field | Description |
Date of Birth | Enter the patient’s date of birth. This is a mandatory field, or one of the basic information needed to record Patient Info details. |
Years | Enter the age, i.e., numbers of years. For example if the patient was born on 01/01/1990, then as of 07/03/2016, enter 26 in the Years field. |
Months | Enter the number of months if any. For example if the patient was born on 01/01/1990, then as of 07/03/2016, enter 2 in the Months field. |
Deceased | Click the deceased checkbox if the patient is deceased. The Date Deceased field gets highlighted; enter the deceased date in the appropriate field. |
Signature Status
Field | Description |
Signature on file | Click the Signature on File checkbox, if the signature of the patient is available on file. Signature on file refers to the signature of the patient or an authorized person, authorizing the release of any medical or other information necessary to process the claim. This is also used to request payment of government benefits to self or to the party who accepts the assignment. |
Date | Enter the date of the signature recorded on file. |
Other demographic info
Field | Description |
Ethnicity | Select the patient ethnicity from the drop down menu. The options available are:
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Race | Select the patient race from the drop down menu. Select Other, if none of the options match the patient’s race. |
Language | Select the patient language from the drop down menu. Click the Needs interpreter checkbox, if the patient requires an interpreter. Click the Military Veteran checkbox if the patient is a retired military veteran. |
The next step for Industrial Account Invoice billing is to add Company info that can be updated into the patient demographics page and used for creating charges during claim entry.
To set up and record Company Info
This is a simple database which allows you to record general information about the company, and record Industrial account information. Using this option, you can add a new client record or edit an existing record.
Navigate through the Setup tab, and click Companies as shown below.
The Company dialog box is displayed as shown below.
The highlighted tabs are the common tabs applicable to both General Info and the Industrial Account Info.
Field | Description |
New | Click New to record details of a new company |
Open | Click Open to access the details of the existing company. Click Open and select the required company and click OK. |
Save | Click Save to save the details of the company information entered. |
Previous | Click Previous to access the previously accessed company information. |
Next | Click Next to access the previously accessed company information. |
Delete | Click Delete to permanently remove the details of a company. |
To set up and record a New Company
General Info tab is displayed by default. The following are the sections available under this tab:
General Info
Contact Person Info
Workers Comp Info
General Info
Field | Description |
Company Name | Enter/Type the name of the company in the provided text box. |
Address 1 | Enter/Type the first line of the company address. |
Address 2 | Enter/Type the second line of the company address. |
City | Enter/Type the name of the city where the company is located. |
State | Select the state where the company is located from the provided drop down menu. |
Zip | Enter/Type the company’s zip code. |
Phone | Enter/Type the company’s phone number. |
Fax | Enter/Type the company’s fax number. |
Contact Person Info
Field | Description |
First Name | Enter/Type the first name of the person representing the company in the provided text box. |
Middle Name | Enter/Type the middle name of the person representing the company. |
Last Name | Enter/Type the last name of the person representing the company. |
Suffix | Enter/Type additional information about the person, like letters that indicate the position held by the individual, or educational degree, accreditation, office, or honour. |
Phone | Enter/Type the phone number of the person representing the company. The format for entering the extension number is X1234. |
Navigate through the Setup tab, and click Companies.
The Company dialog box is displayed.
Click Industrial Account Info tab as shown below.
The following are the section available under Industrial Account Info tab:
Company is an Industrial Account
Service Type Contact Info
Service Type Contact Person
Click the Company is an Industrial Account check box to highlight the following tabs. If the Company is an Industrial Account is unchecked, all the subsequent tabs are greyed out.
Enter/Type the account number.
Select the required Service Type from the drop down menu. If the service type is not selected, the subsequent tabs are greyed out. The two options available under service type are:
Physical Exam
Drug Screening
Select Physical Exam, the Copy Data From menu displays the following options:
Company Address
Drug Screening Address
Select Drug Screening, the Copy Data From menu displays the following options:
Company Address
Physical Exam Address
Select the required options and click Copy. The subsequent field’s information is copied from the selected source.
OR
Manually enter/type each field as shown below.
Field | Description |
Address 1 | Enter/Type the first line of the company address. |
Address 2 | Enter/Type the second line of the company address. |
City | Enter/Type the name of the city where the company is located. |
State | Select the state where the company is located from the provided drop down menu. |
Zip | Enter/Type the company’s zip code. |
Phone | Enter/Type the company’s phone number. |
Fax | Enter/Type the company’s fax number. |
Field | Description |
First Name | Enter/Type the first name of the service type contact person in the provided text box. |
Middle Name | Enter/Type the middle name of the service type contact person. |
Last Name | Enter/Type the last name of the service type contact person. |
Suffix | Enter/Type additional information about the service type contact person, like letters that indicate the position held by the individual, or educational degree, accreditation, office, or honour. |
Phone | Enter/Type the phone number of the service type contact person. The format for entering the extension number is X1234. |
Patient Demographics Update on Company Info
Make sure to go back into the patient demographics screen and add these company details and industrial account details for each patient so when you get to the charge entry screens you have all the details necessary.
Billing Applet Claims
In this section, we will discuss entering claim information into the Billing module.
IMPORTANT
Navigation within the Billing applet to move from one field to the next works best by hitting Tab on the keyboard. The application functions by providing additional information when Tab is used for navigating.
Claim General tab is divided into following sections:
Patient and Providers
Claim Payer Information
Claim ID
Relevant Dates.
The following is the Claim General screen:
Click | To |
View the unpaid open claim details of the patient. The Open Claim feature does not get highlighted until a patient is selected. | |
Clear the existing information that is displayed and enable to record new claim details of the patient. | |
Delete a claim which has not yet been released. A claim which has been released cannot be deleted. | |
Place an existing claim on hold. | |
Void a claim which has already been released. A claim which is not been released cannot be voided. |
Field | Description |
Displays information for the last patient that had a claim saved. | |
Patient Name | Displays the name of the existing patient. |
Patient Transaction History displays the details of the claim. Select the required patient for the patient’s transaction history details to be displayed. | |
Claim Notes allows to enter any notes regarding the patient’s claim into the system. Enter the necessary notes in the provided text box and click Save. The saved notes are displayed in the section below as shown above. | |
A/C # | Enter the account number to find a patient, or tab to the last name field, type in the last name and hit Enter. The Patient Search dialog box opens, which enables to search the patient by entering one of the fields mentioned or the required patient can be selected from the list at the bottom of the form.
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Facility | From the drop down menu, select the required facility, where the services were furnished. |
Provider | Select the required provider from the drop down menu. Selecting a provider with an asterisk (*) next to the provider name, are called the mid-level providers or practitioners. These practitioners need a supervisor or a medical doctor’s supervision, hence the Supervising Provider field is highlighted and the required supervisor needs to be selected from the drop down menu. |
Referring Provider | Referring Provider is the provider who sent the patient to another provider for services. Select the required referring provider from the providers that have already been added to the practice’s list in the drop down menu. A new Referring Provider can be added to the list by clicking the |
Ordering Provider | Ordering Provider is the provider who requests items or services. Select the required ordering provider from the drop down menu. A new Ordering Provider can be added to the list by clicking the |
EDI Exception Alert | Shown to all users when the provider that is on hold for at least one EDI service is selected as billing on Claim-General. |
**** FOR INVOICE BILLING MAKE SURE TO SELECT “6. Industrial Account”
The fields in the Claim Payer Information are automatically populated based on the details entered in the Patient and Providers section. From Setup -> General -> Core Information if you check Use visit numbers and Use additional A/C#s, you will be able to assign a claim with two additional fields on Claim-General: the visit number and the additional patient A/C#.
Field | Description |
Other A/C# | Enter an Other patient account number (Other A/C#), if one is available. |
Visit# | Enter a Visit #, if one is available. This number can be found of the system generated encounter form. |
Field | Description |
Claim ID | Enter the claim identification number in the provided text box and click GO. The claim details of the patient is displayed. |
Change Claim Status | If you have an incorrect rejection, or the payer has agreed to reprocess your claim, you can use this button to update the claim and mark it as being ‘confirmed’ without resaving it. |
Claim History and Preview | Allows to view the claim history of the patient and also allows to view the preview of the claim. |
Condition Related Employment | Check the Condition Related Employment checkbox if the patient condition was related to employment. |
Case# | Enter the case number related to the condition related to employment. |
Auto Accident | Check the Auto Accident checkbox if the patient condition related to an auto accident. |
State | From the drop down menu, select the state in which the auto accident took place, |
Other Accident | Check the Other Accident checkbox if the patient condition is related to some other accident. |
NOTE: Condition Related Employment, Case#, Auto Accident, State and Other Accident are the text boxes available on the insurance claim form. |
The claim forms are filled per the claim form used by the insurance companies, some using the old form 1500 (08-05) and some using the new 1500 (02-12).
1500 (02-12)-New Form
This is the new claim form sent to the insurance companies. The information entered is recorded in the patient details. The details required for the new claim form include:
Field | Description |
Current | Select the qualifier for the current date from the list and enter the date of current illness, injury or pregnancy. The following qualifiers are available for the Current date field:
|
Other | Select the qualifier for Other date and enter the date. The following qualifiers are available for the Other date field:
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Return | Enter the return date for this patient. |
Unable to work from | Enter the first date that the patient was unable to work, if this is required by the employment related insurance. |
Unable to work to | Enter the last date till which the patient was unable to work, if this is required by the employment related insurance. |
1500 (08-05)-Old Form
This is the old claim form sent to the insurance companies. The information entered is recorded in the patient details. The details required for the old claim form include:
Field | Description |
Current | Enter the date of illness (first symptom) or injury (accident) or pregnancy. |
Last Seen | Enter the date the patient was last seen or consulted. |
First Consult | Enter the date of the first consult with this patient. |
Return | Enter the return date for this patient. |
Similar Symptom Date | Enter the date of any recorded similar symptoms, not required by Medicare. |
Unable to work from | Enter the first date that the patient was unable to work, if this is required by the employment related insurance. |
Unable to work to | Enter the last date till which the patient was unable to work, if this is required by the employment related insurance. |
The following is the Claim Details screen:
Field | Description |
ICD-9 | If the date of service of the claim is before October 1st 2015, then the ICD 9 code needs to be selected. |
ICD-10 | Select the nature of the patient compliant from the required ICD 10 codes. This field is a searchable field, for example: If the patient is suffering from cough, type in cough in the description field, and select the appropriate code from the search results. The search results are sorted by their relevance to the entered text: - Diagnoses which contain the whole entered search text in the beginning – on the top. - Diagnoses which contain the whole entered search text - below. - Diagnoses which contain all words from the entered search text – in the bottom. The search starts only if at least two characters are entered. |
Last Diagnoses | Displays the information of the three last diagnoses codes, the ICD codes, the diagnosis date and the charges incurred for the services. You can add individual diagnoses from the grid by double clicking on the code. |
Use GEMs | Opens the GEMs Search dialog box which converts the outdated ICD 9 codes to the current ICD 10 codes. |
EPSDT | Check the EPSDT checkbox if the claim is an EPSDT claim. |
Anesthesia | Check the Anesthesia checkbox if the claim is an anesthesia claim. |
Dental | Check the Dental checkbox if the claim is a dental claim. |
NOTE: EPSDT, Anesthesia and Dental are further explained in the document, under their respective headings. | |
Condition C’s | Conditions C’s are codes which are entered as per the claim. |
Line | The line number is automatically displayed, based on the number of claim details entered into the system. For example, 1 is displayed in the Line box, for the first claim details recorded for the patient. Once the details entered are saved, the line automatically reflects 2, for the second claim details to be entered. |
Service From | Is the date the patient consulted the doctor, the date entered here automatically updates all the necessary dates pertaining to the claim. |
Service To | Enter the Service To date, if the patient consulted the doctor on different dates. The Service To date can be the same as Service From date. |
CPT | The treatment provided to the patient by the doctor is CPT, select the required CPT code from the drop down menu. If a CPT code entered is not available in the Practice’s list, the system will allow the code to be added when you hit tab to move to the next field. |
POS | Facility is selected on the Claim General screen, each facility has a place of service ID. Based on the selection made on the Claim General screen this field on Claim Detail screen gets populated automatically. |
Modifiers | Modifiers are used to elaborate more on the CPT codes selected, to provide insurance companies more detail. Multiple modifiers can be entered by typing in the code without interruption. For example: Type the first code 25, and continue typing the next code 45 and so on. The Modifier box automatically adds a comma between 25 and 45 differentiating the codes. |
Diagnosis Pointers | Enter the line numbers of the ICD9 and ICD10 codes that relate to the CPT code. If multiple ICD9 and ICD10 codes relate to the CPT code, enter all the related line numbers with no spaces (e.g. ABC for ICD9 code lines 1, 2 and 3). |
Drug | Check the Drug checkbox to enable the NDC field, NDC is the National Drug Code Each NDC that is selected is linked to a certain CPT code, and the list of available NDC codes will be populated accordingly after the CPT code is selected. Click Click Manually added NDC codes will be marked up with gray background, while common NDC codes will not be marked up. Manually added NDC codes are available only within the practice they had been added in. Common NDC codes cannot be modified via the Edit NDC action. When any common NDC code is edited, a new custom code is added instead of changing the common NDC code. |
Emergency | Allows to add an emergency flag-------Need clarification |
Charge | Charge is calculated based on the CPT code entered as per the fee schedule, this amount can be manually entered, overriding the fee schedule. |
Units | The units by default is always selected as 1, this can be manually changed by entering the required number of units. |
Remarks | Refers to box 19 on the claim form, therefore box 19 needs to be entered in this field. |
Hospitalization Dates | If the Place of Service (POS) is a hospital, the hospitalization dates field needs to be entered, i.e., the Admit and Discharge date. |
Enter the necessary fields and click Save, and the line will automatically change to number 2, allowing new claim details to be recorded. To modify existing claim details, highlight the required line, make necessary changes and click Save as shown below.
Claim-Final tab is used to add any patient co-payments received at the time of service, as well as any other authorization codes that may be required.
The main sections on the Claim Final screen are:
Patient Payment: The patient payment section is used for a patient that makes a co-payment. A co-payment can be entered in one of three ways:
Cash
Check
Credit/Debit Card
Other: used to enter additional details regarding payment apart from the payment options mentioned above.
Field | Description |
Payment Type | To enter payments, select the appropriate payment type:
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Print Receipt on Saving | Check the print receipt on saving checkbox to enable print for receipt on saving. |
Field | Description |
Prior Authorization | Enter the prior authorization number issued by the payer for this claim submission. |
Referral | Enter the referral number for the claim. Data entered here will be printed in the claim form for GA Medicaid. |
Medicaid Resubmission Code | Enter the resubmission code for Medicaid claims. |
Original Reference | Enter the original reference number for this claim. |
Other Claim ID | Select the qualifier for the Other Claim ID and enter the Other Claim identification number. |
Additional Claim Information | Check the additional claim information checkbox to enter the additional information about the claim. |
Local Use | The claim can be reserved for local use. |
Lab Work | Check the Lab work checkbox if there was an outside lab work associated with this claim. |
Lab Charge | Enter the amount charged for the lab work. |
Patient is Pregnant | Check the Patient is pregnant checkbox if the patient is pregnant or keep it cleared if otherwise. |
Patient Weight (grams) | Enter the weight of the patient measured in grams. (Billing Applet will convert this to pounds as required for electronic claims data). |
Field | Description |
Attachment Report Type Code | Value in the dropdown identifies the type of attachment. |
Transmission Code | Options are BM for By Mail and FX for Faxed documents. |
Identification Code Qualifier | Required when Transmission code is BM or FX the value is AC by default. |
Attachment Control # | A value assigned by the provider to uniquely identify the attachment. |
Release saves the claim and releases it per the debtor that need to be recorded. These recorded claims are saved in the required statuses and will reflect on the Today’s tab. Once a day these claims stored in their respective statuses are sent to our clearinghouse partner.
There are five ways to save a claim in the Billing Applet:
Release as Voided: This option is displayed when an existing claim is loaded and only for practices with enabled Allow Sending Claims to EDI with a Voided setting. This releases the claim with a Claim Frequency Code of 8.
Save as Pre-Released: This is used for claims that are incomplete or claims that have all the claim information, but may be missing the provider number for the payer.
Save for Review: This is used to place claims in the For Review bucket and is useful in situations when the user may be undergoing training. This allows those claims to be identified as requiring review prior to release.
Save for Client Review: Claims saved to this status can’t be released without moving the claim to another pre-released status first.
Save for Billing Approval: Claims saved to this status can be
To Create invoices
Change the selection from Print Invoices to Create Invoice Data
Invoice Date will default to today
Move the Industrial accounts to the right for the companies that you want to create invoices for (Select all plans to create invoices for all uninvoiced plans)
Under Invoice Data Parameters, Select Create invoices for unvinvoiced claim for the industrial accounts selected above
Click Create Data
To Print Invoices
Change the selection to Print Invoices for the Industrial Accounts Selected below.
Leave the Industrial accounts to the right for the companies that you want to create invoices for (Select all plans to create invoices for all uninvoiced plans)
Verify the correct printer is selected.
Click Print.
The invoices get printed.
Industrial Accounts Claim List
Like the regular claim list, this shows claims by Date of Service (DOS), but only for industrial accounts. It has information on the charges, payments, balance and Invoice Number and date.
Industrial Accounts Invoice Detail
This will show you the list of individual claims that make up an invoice, and requires that you input the invoice number. If you do not have this run the next report which is the Ind account invoice summary.
Industrial Accounts Invoice Summary
This report is by date range and is created by invoice date. You can also specify the company by which you would like to report. The report shows the company name, invoice number, invoice date and the total invoice amount. The invoice number is the link that will take you to the invoice detail report for that individual invoice. You can then use the "back" button in your navigation section to bring you back to the summary.
Industrial Accounts Outstanding Claims
This report lists all outstanding claims for industrial accounts, showing the company name, patient name , date of service (DOS), claim ID, amounts charges, paid, balance, and the invoice number and date.