A locked claim does not restrict the addition, removal, or editing of disbursements or adjustments.
On locked claims, you can still add or edit claim user notes and change the status of the claim.
While you can change the Bill To selection, the claim insured information cannot be modified.
The Locked check box can be used in combination with security options to prevent users from unlocking and editing claims.
When printing or exporting claims, the check box will automatically check if the Automatic Lock Claims After Print or Export option is enabled in the Program Setup > Claim screen.

Additional Paperwork

If you need to include any additional paperwork information with the claim, simply use this field. Click on the EDIT button to enter up to 9 additional paperwork fields.

Ambulance Pick up and Drop off

If you need to utilize the Pick Up Location and/or Drop Off Location, simply double-click on the Location Name to access the Physician/Facility library and make your selection. This will automatically populate the address information.

Note: There is no direct relationship between the ambulance fields and the library. If you make any changes to the address in the library, you will need to manually update the claim ambulance fields.

EZClaim will only populate the address if it is completely blank and will not overwrite any existing data.

CLIA Number

The CLIA number may be entered in many ways.

Use the CLIA Number field on the claim screen.
- You may need to add this field via the Column Chooser.

To include the relevant (Billing or Rendering) entries in the Physician/Facility Library, utilize the Additional ID Numbers area.
- The CLIA number will be exported in loop 2300 of ANSI electronic claims.
- On paper claims, the CLIA number, preceded by an X4 qualifier, will be printed in box 33b (Billing) and/or box 24j (Rendering).

If needed at the individual patient level, the CLIA number can be entered under Initial Claim Values on the Patient screen.

When the program is exporting data for electronic billing, the program will look for a CLIA number in the following places and use the first one it finds:

CLIA Number field on the claim
Claim Rendering provider
Claim Billing provider

CMN Form

Note: If your claims require a CMN to be attached, you will need to add the field to the grid. The field is not normally visible.

Use the grid customization feature to add the CMN Form field. See Claim Information Grid for more information on customizing the grid.

Once the CMN is completed, you will then need to “assign” it to the service line as follows.

Tip: If you don't see the Attach CMN column, you can use the Column Chooser to add it.

EDI Note

If your payer requires, claim-level notes can be included in the ANSI 837. These notes are entered into the EDI Note field on the claim information grid.

Note: The field is not normally visible. Use the grid customization feature to add the EDI Note field. See Claim Information Grid for more information on customizing the grid.

Tip: Data entered in this field will be electronically exported in Loop 2300 Segment NTE Field 2

Insurance Type Code Override

Setting this field will override the default insurance type (set in the payer library) for this claim only.

Note: Use the grid customization feature to add the Ins. Type Code Override field. See Claim Information Grid for more information on customizing the grid.

Ignore Applied Amount

This field provides a checkbox that allows the user to disregard applied amounts. For instance, this may be necessary to conceal a patient payment made at the time of service or to hide applied amounts when submitting secondary claims.

Note: Use the grid customization feature to add the Ignore Applied Amount field. See Claim Information Grid for more information on customizing the grid.

This feature only applies to paper claims (box 29 on the 1500 form and box 54 on the UB04 form).

Last Worked Date

The Last Worked Date field is specifically designed for Workers Comp claims. It serves the purpose of exporting data into the Loop 2300 Segment REF*297.

However, it should be noted that this field does not indicate when a claim was last followed up with.

Note: Use the grid customization feature to add the Last Worked Date field. See Claim Information Grid for more information on customizing the grid.

Pricing Exception Code

This field is utilized in specific scenarios when the HCP segments are needed in the 837 file. It is used in the 2300 HCP15 segment and will only be exported if the Claim Type in the submitter/receiver library is set to Reporting.

Note: Use the grid customization feature to add the Pricing Exception Code field. See Claim Information Grid for more information on customizing the grid.

Chiropractic

Additional fields are available in the Claims grid for Chiro claims.

Manifestation Date – Loop 2300 Segment DTP Qualifier 453 Field 03
Nature of Condition – Loop 2300 Segment CR2 Field 08
Pat Condition Desc 1 – Loop 2300 Segment CR2 Field 10
Pat Condition Desc 2 - Loop 2300 Segment CR2 Field 11