Everything you need to know about the EZClaim Claims Screen
To easily navigate this article, use the links provided below. At the end of each section, click "Back to Top" to return to this menu.
Accessing the Patient Claims Screen
Claim Screen Fields and Navigation
Accessing the Patient Claims Screen
To access the Patient Claims screen, simply click on the Claims tab located on the left side of your screen. From there, you can double-click on the specific claim you wish to view to open the patient claim.
Claim Screen Fields and Navigation
Bill To
The Bill To dropdown displays the payers linked to the patient's record. The selected Bill To option will show information, for example: (1/2), to indicate the presence of Primary and/or Secondary payers associated with the claim.
Tip: EZClaim will automatically change the Bill To based on service line responsible parties.
Examples:
|
Current Bill To |
New RP for Service Line 1 |
New RP for Service Line 2 |
New Bill To |
|
Primary |
Secondary |
Secondary |
Secondary |
|
Primary |
Primary |
Secondary |
Primary (no change since the primary has a higher priority than the secondary) |
|
Primary |
Patient |
Secondary |
Secondary (switched to secondary because secondary has a higher priority than patient) |
|
Patient |
Secondary |
Secondary |
Patient (no change because the Patient is further down the chain than secondary) |
|
Primary |
Patient |
Patient |
Patient (notice it skipped the secondary) |
Claim Status Setting
If the Bill To setting for the claim is changed to a Secondary or Tertiary payer, EZClaim will automatically reset the status to Ready to Submit and move it to the Send Claims window for re-queueing.
However, if the Bill To payer has the Automatically Forwards Claims option enabled in the Payer Library, the Claim Status will not change.
This feature is particularly useful when the Primary Payer, usually Medicare, forwards claims to the Secondary Payer on your behalf or in certain billing scenarios where claims processed as Primary require no further action from your side.
Additionally, when auto-posting, if the 835 Claim Status indicates Forwarded to Additional Payers, the status will remain as Submitted.
Claim Information Grid
Rows
The Claim Information Grid displays all relevant information from the Physician Library, as well as any additional details pertaining to the claim.
Note: Not all fields are mandatory, and the Grid categories can be customized to include any additional fields as needed.
Click on the expander arrows to open Claim categories. Right-click the grid and select Customize Grid to add additional rows.
Drag and Drop additional row information to the Category location. For example: Accident Date would be dropped under the Date Information category.
To remove a row, drag and drop the row back to the Customization dialog box.
Categories
Additional Categories may be added to the Grid by clicking on the Categories tab in the Customization pop-up. Drag and drop the category to the grid to add it to the view.
Drag and drop a category from the view to the customization pop-up to remove it.
To add a customized Category, click on New.
Claim Status Information
The Claim Status on new claims is automatically set to Ready to Submit.
Once the claim has been Exported or Printed, the claim status changes to Submitted.
Prior Authorizations
If authorizations are available for a Patient/Payer selection, EZClaim will notify you on the charges screen.
Note: It is up to the user to select the correct authorization. See Authorization Library for more information.
There is an informational Icon to the right of the authorization selector.
If the icon appears in blue, it signifies that there is an available authorization for the claim insurance, but there is no assigned authorization number. On the other hand, if the icon appears in gray, it indicates that there is no available authorization.
Hovering over the icon shows a summary of the claims’ authorization information
To select the Authorization number, click on the 
Note: If an authorization does not appear, please ensure that the authorizing payer in the authorization library matches the bill to payer.
The list of authorizations will only display those with remaining units and/or dollars, and that are not marked as hidden. If you have exhausted all available units, the authorization will not be visible in this list. When selecting an authorization, if the <No Template> option is used to create the claim, the procedure code of the authorization will be added to the preview line.
Authorizations and Claim Templates
When selecting an authorization, if the Claim Template is set to <No Template>, EZClaim will pre-fill the service line preview row with the procedure code, modifier(s), and any other information such as charges from the procedure code library.
Note: This only applies if the template is set to <No Template>
Authorization Data Checks
EZClaim performs three authorization checks when saving a claim.
- Dates between the start and end date: If outside the date range, the following message will appear.
- Unit count is lower than Units Allowed: If the unit count is higher than allowed, the following message will appear.
- Total dollar amount below the Dollars Allowed: EZClaim first checks for the service line allowed amount value.
- If the allowed amount value is $0.00 then it will use the charge amount to determine if a warning should be shown.
Diagnosis Codes
If submitting claims electronically, up to 12 diagnosis codes may be entered.
When you hover your pointer over a diagnosis field, the description from the code library will be displayed. If you don't see a description, please ensure that the code has been entered correctly in the library.
On the Service line, you will need to enter the number (or numbers) that indicate the relevant diagnosis or diagnoses associated with the procedure code.
Note: All diagnosis codes entered on the claim must have a corresponding number on a service line.
Billing guidelines allow for a maximum of 4 diagnosis pointers per service line. For Diagnoses J10, K11, and L12, please use letters (J, K, L) instead of numbers in the Diag. # field.
Diagnosis Code Lookup
Double-click a diagnosis field to open the lookup library list. Use the ICD selector to change between the ICD-9 and ICD-10 code sets.
Another option is to use the ICD10Data.com website to look up codes -- https://www.icd10data.com/
This resource is widely used and available for free, accessible directly from your EZClaim program.
To access it, simply right-click on the diagnosis field and choose the option Lookup ICD-10 on ICD10Data.com.
Once a code has been found, click the Use button.
Add Code
The Add Code button allows you to quickly add a code to a code library without opening the full library.
Enter the code and description then click Add & Select or just Add.
