Creating a Claim in iClinic

1. Introduction

This guide provides step-by-step instructions for manually creating a claim in iClinic, covering patient selection, claim creation, validation, and submission processes.

2. Accessing the Billing Section

1. Log In: Sign in to your iClinic account.
2. Open Billing: 
   • Click on the Billing Icon located on the left side of the screen.
   • A new tab will open in iClinic.

3. Starting a New Claim

1. Initiate Claim Creation: 
   • Click New to begin a new claim.
2. Select Patient: 
   • In the pop-up box, click Select Patient.
   • Enter the patient’s Last Name, First Name, or Date of Birth.
   • Click Go to search.
   • Select the correct patient from the search results.
   • Click Load Patient to proceed.

4. Entering Claim Information

1. Required Fields: 
   • Complete all fields marked with a red asterisk.
2. Provider Information: 
   • Click the Cover By dropdown and select the appropriate provider.
3. Billing To: 
   • Choose between Insurance or Self-Pay in the Bill To section.
4. Attending Provider: 
   • Select Yes or No under Billing Uses Attending Provider to specify whether the attending or covering provider appears on the claim.
5. Service Information: 
   • Ensure the following fields are filled out: 
     • Place of Service
     • Type of Service
     • Billing Address
     • Office Location
6. Visit Date: 
   • Click Today or use the calendar to select the appropriate date.
7. Claim Type: 
   • Select the appropriate Claim Type from the list.

5. Adding Diagnosis and Procedure Codes

1. ICD Codes (Diagnosis Codes): 
   • Click Search ICD.
   • In the pop-up box, enter either the diagnosis name or ICD code.
   • Click Go to search.
   • Double-click on the correct diagnosis code to add it to the claim.
2. CPT/HCPCS Codes (Procedure Codes): 
   • Click Search in Database.
   • Enter the procedure code (CPT/HCPCS) or description.
   • Click Go to search.
   • Double-click the appropriate code to add it to the claim.

6. Finalizing the Claim

1. Review the Claim: Ensure all fields are correctly filled out.
2. Create Claim: Click Create Claim to save and generate the claim.

7. Validating and Sending the Claim

1. Access the Claim: 
   • Go to the Billing List.
   • Under Options and Filters, select Claim Date and set the appropriate date range.
   • Find the claim by clicking on the patient’s name. The status should show New.
2. Validate the Claim: 
   • Click Validate.
   • A pop-up will appear, identifying any errors (e.g., missing Provider ID).
   • Address any issues, then click Continue to proceed.
3. Send the Claim: 
   • Click Send.
   • A pop-up box will appear. Choose to either: 
     • Send Electronically, or
     • Print and Send via Mail.
   • After selecting the appropriate option, click Continue.
4. Confirm Submission: 
   • Return to the Billing List.
   • Click Refresh.
   • The claim status should now display as Sending.

8. Best Practices

• Double-Check Details: Always review patient and claim information for accuracy before submission.
• Validate Regularly: Ensure all claims pass validation to avoid submission errors.
• Document Errors: Keep track of common errors for quicker troubleshooting in the future.

9. Troubleshooting Tips

• Claim Not Sending: 
  • Recheck validation for missing or incorrect data.
• Patient Not Found: 
  • Verify spelling and date of birth during the search.
• Status Not Updating: 
  • Refresh the Billing List to update the claim status.

10. Support Resources

• In-App Help: Use iClinic’s help feature for quick assistance.
• Technical Support: Contact support for system-related issues.
• Billing Department: Consult with billing specialists for claim-related concerns.

Following these steps ensures accurate and efficient claim creation and submission within iClinic.