Claim Info provides the essential details needed to generate claims for corresponding encounters. This information is required only if necessary for claim submission. Some fields may be mandatory based on the payor’s requirements, the nature of the patient visit, injury, or services being billed. Each field supplies specific data for the electronic and paper claims generated.
Here's how to enter Claim info:
1) From the patient encounter, click the suitcase icon to open up encounter tools.
2) Open Claim info.
3) Enter relevant details and remember to click Save!
Click for a breakdown of which fields populate each box on claim forms.
- Nature of Condition
- CMS 1500: n/a
- 837: Loop 2300, CR208
- Onset of current symptoms or illness
- CMS 1500: Box 14 - Qualifier 431
- 837: Loop 2300, DTP03 - Qualifier 431
- EPSDT Referral
- CMS 1500: Box 24H
- 837: Loop 2300, CRC03
- Acute Manifestation of a Chronic Condition
- CMS 1500: Box 15 - Qualifier 453
- 837: Loop 2300, DTP03 - Qualifier 453
- First Visit
- CMS 1500: Box 15 - Qualifier 444
- 837: Loop 2300, DTP03 - Qualifier 444
- Initial Treatment
- CMS 1500: Box 15 - Qualifier 454
- 837: Loop 2300, DTP03 - Qualifier 454
- Last X-Ray
- CMS 1500: Box 15 - Qualifier 455
- 837: Loop 2300, DTP03 - Qualifier 455
- Latest Visit or Consultation
- CMS 1500: Box 15 - Qualifier 304
- 837: Loop 2300, DTP03 - Qualifier 304
- Report Start
- CMS 1500: Box 15 - Qualifier 090
- 837: Loop 2300, DTP03 - Qualifier 090
- Report End
- CMS 1500: Box 15 - Qualifier 091
- 837: Loop 2300, DTP03 - Qualifier 091
- Dates Patient unable to work
- CMS 1500: Box 16
- 837:
- Start Date: Loop 2300, DTP03 - Qualifier 297
- End Date: Loop 2300, DTP03 - Qualifier 296
- Disability Dates
- CMS 1500: n/a
- 837:
- Start Date: Loop 2300, DTP03 - Qualifier 314
- End Date: Loop 2300, DTP03 - Qualifier 360
- Both: Loop 2300, DTP03 - Qualifier 361
- Hospital Dates related to current services
- CMS 1500: Box 18
- 837:
- Start Date: Loop 2300, DTP03 - Qualifier 435
- End Date: Loop 2300, DTP03 - Qualifier 096
- Provider Details
- CMS 1500: Box 17
- 837:
- Rendering: Loop 2310A, NM - Qualifier 82
- Ordering: n/a
- Supervising: Loop 2310A, NM - Qualifier DN
- Condition Related To: Employment
- CMS 1500: Box 10a
- 837: Loop 2300, CLM11
- Condition Related To: Auto Accident
- CMS 1500: Box 10b
- 837: Loop 2300, CLM11
- Condition Related To: Other Accident
- CMS 1500: Box 10c
- 837: Loop 2300, CLM11