Claims Processing

This module allows provider claims to be entered and reviewed before posting and updating other tables. Claims are verified against authorizations and contracts to make sure they are valid and also determines the total contract amount of each claim. Claims can be manually overridden if unauthorized, or rejected even if it is authorized. Claims can be entered in the following ways:

• Entered by user
• Importing HIPAA compliant 837 file
• Entered by provider through Web Based County Provider Application
• Import HCSIS Waiver file

After the Claims are reviewed, they are posted to the Master files which updates the Client Authorizations, Provider Contracts, and the Funding Table. The claims can then be interfaced to Accounts Payable for payment which prints a Remittance Advice that can be sent to the Provider with the payment.