Editing Claims

This section explains how to edit claims in AcuityLogic Billing. AcuityLogic saves all the changes that you make to a claim.

Topics include the following:

  1. Search for a claim. See Searching for Claims.
  2. Open the Edit Claim window by using one of the following methods:
    • From the Action drop-down list for the claim, select Edit Claim.
    • Open the Claim Detail window for the claim, and click Edit Claim. See To open the claim detail window.
  3. Modify the claim if necessary. See To understand how a claim Is populated.
  4. To add or modify services:
    1. Perform one of the following actions:
      • To add a service, click + Add.
      • To modify a service, edit the information in the fields.
    2. In the Date of Service field, enter the date of service.
    3. In the Procedure Code field, enter the procedure code.
    4. In the Modifier fields, enter modifiers if necessary.
    5. In the Diagnosis Pointer field, enter the diagnosis pointer if necessary.
    6. In the Receivable field, enter the receivable.
    7. In the Carrier Charge field, enter the net price of the service.
    8. In the Days/Units field, enter the quantity of the service.
    9. In the Patient Paid field, enter the total paid amount.
  5. If the claim is for a carrier that uses the EDI 837 billing mode, add a note for a service as follows:
    1. In the Actions column, click the Message icon next to a line item.
    2. From the Note Reference drop-down list, select a note type.
    3. In the Item Narrative field, enter the note. The note can contain up to 80 characters.
    The note and comment appear on the EDI segment of electronic claim submissions. The note and comment do not appear with the procedure in box 24d of the CMS 1500 form.
  6. To delete services:
    1. In the Actions column, click the Delete icon next to a line item.
    2. In the confirmation message, click OK.
  7. To save your changes and return to the Claim Detail window, click Save.

AcuityLogic Billing autopopulates the CMS 1500 form with information you have recorded throughout AcuityLogic. You can review and modify most of the information on the CMS 1500 form from the Edit Claim window.

The following table describes the fields AcuityLogic uses to autopopulate the CMS 1500 form and specifies which field in the Edit Claim window corresponds to each CMS 1500 box.

Some fields on the CMS 1500 form are autopopulated only if you add specific custom attributes to a carrier in AcuityLogic Admin. Custom insurance attributes appear as fields in a patient’s eligibility details for that insurance carrier in AcuityLogic POS.

Additionally, some information that AcuityLogic imports into the CMS 1500 form may depend on whether office information overrides company information and whether insurance plan information overrides carrier information. Insurance and company overrides are set up in AcuityLogic Admin.

CMS 1500 Box AcuityLogic Edit Claim Field AcuityLogic Source Field

Box1

Claim and Carrier Information section > Group Health
  • Carrier:
    AcuityLogic Admin > Insurance drop-down list > Carrier > Carrier Code > Group Health Type
  • If the plan overrides carrier settings:
    AcuityLogic Admin > Insurance drop-down list > Plan > Plan Name > Group Health Type

Box 1a

Claim and Carrier Information section > Insured’s ID Number
  • If the SSN is the insured ID:
    AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > SSN
  • If the insured ID is not the SSN:
    AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > Subscriber/Insured ID

Box 2

Patient Information section > First Name, M.I., Last Name

AcuityLogic POS > Patient > Select Patient > Profile tab > First Name, MI, Last Name

Box 3

Patient Information section > Date of Birth

AcuityLogic POS > Patient > Select Patient > Profile tab > Birth Date

Box 4

Insured Information section > First Name, M.I, Last Name

AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > First Name, MI, Last Name

Box 5

Patient Information section > Address, City, State, Zip, Phone

AcuityLogic POS > Patient > Select Patient > Profile tab > Address Lines, Zip, City, State, Primary Phone #

Box 6

Insured Information section > Relationship to Patient

AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > Relationship to subscriber

Box 7

Insured Information section > Address, City, State, Zip, Phone

AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > Address Lines, Zip, City, State, Phone Number

Box 8

(08/05 Version) Patient Information section > Marital Status

(02/12 Version) N/A

(08/05 Version) When you print the CMS 1500 form, AcuityLogic always selects “Other” for marital status, and does not select any check box for employment status.

(02/12 Version) AcuityLogic always leaves this blank.

Box 9

Other Insured Information section > Relationship to Patient

N/A

Box 9a

N/A

N/A

Box 9b

(08/05 Version) Other Date of Birth, Sex

(02/12 Version) N/A

(08/05 Version) N/A

(02/12 Version) AcuityLogic always leaves this blank.

Box 9c

N/A

N/A

Box 9d

Other Insured Information section > Other Insured Plan Name

N/A

Box 10a

N/A

N/A

Box 10b

N/A

N/A

Box 10c

N/A

N/A

Box 10d

N/A

N/A

Box 11

Insured Information section > Policy Group

AcuityLogic POS > Patient > Select Patient > Insurance tab > Add/Edit Eligibility > Insured Policy Group

This insurance custom attribute must be added to the carrier in AcuityLogic Admin.

Box 11a

Insured Information section > Date of Birth, Sex

AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > DOB, Sex

Box 11b

N/A

(08/05 Version) AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > Employer

(02/12 Version) AcuityLogic always leaves this blank.

Box 11c

Claim and Carrier Information section > Plan Name

AcuityLogic POS > Patient > Select Patient > Insurance tab > Carrier/Plan > Plan

Box 11d

N/A

This box is automatically populated based on your responses to 9a–9d.

Box 12

HIPAA Signature on file

AcuityLogic prints “Signature on File” and the date you enter in the Date Signed field.

Box 13

N/A

AcuityLogic always prints “Signature on File.”

Box 14

N/A

AcuityLogic always leaves this blank.

Box 14 Qual.

N/A

AcuityLogic always leaves this blank.

Box 15

N/A

AcuityLogic always leaves this blank.

Box 15 Qual.

Box 16

N/A

AcuityLogic always leaves this blank.

Box 17

Patient Health Condition section > Referring Provider First Name, Referring Provider Last Name

AcuityLogic POS > Patient > Select Patient > Insurance tab > Add/Edit Eligibility >

  • Referring Dr. First Name
  • Referring Dr. Last Name

These insurance custom attributes must be added to the carrier in AcuityLogic Admin. These fields are usually added to claims for Medicare DME carriers only.

The “DN” qualifier is populated in box 17 when there is a referring provider name recorded in box 17 (02/12 Version). If necessary, you can select the “DK” qualifier from the Provider Qualifier drop-down list in the Edit Claim window.

With Release 3.6, format changed to first name followed by last name, and the CMS 1500 displays no punctuation except hyphens.

Box 17a

Patient Health Condition section > Referring Provider ID

N/A

Box 17b

Patient Health Condition section > Referring Provider NPI

AcuityLogic POS > Patient > Select Patient > Insurance tab > Add/Edit Eligibility >

  • NPI#

This insurance custom attribute must be added to the carrier in AcuityLogic Admin. This field is usually only added to Medicare DME.

Box 18

N/A

AcuityLogic always leaves this blank.

Box 19

N/A

AcuityLogic always leaves this blank.

If you do not use the VSP interface, you must manually process VSP Coordination of Benefits (COB) claims on eyefinity.com, and you must enter the following text in Box 19 (Additional Claim Information) on each claim:

secondary COB claim patient resp exam $XX.XX retinal screening $YY.YY

Where

  • XX.XX is the dollar amount of the patient's responsibility.

  • YY.YY is the dollar amount billed for retinal screening. Include retinal screening in Box 19 only if it is part of the claim.

Box 20

N/A

AcuityLogic sometimes leaves this blank. However, this area is currently under development.

Box 21 ICD Ind.

N/A

AcuityLogic evaluates claim diagnosis codes and enters a 9 for ICD‑9 codes and a 0 for ICD‑10 codes. If you send insurance claims electronically, the ANSI 5010-formatted data includes automated identification of ICD‑9 and ICD‑10 codes.

Note: ICD‑10 codes will not be implemented until October 1, 2015.

Box 21 A–L

Diagnosis Information section fields
  • When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Exam > Diagnosis Code (A‑L)
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Transactions tab > Transaction # > Diagnosis Codes (A‑L)

Note: ICD‑10 codes will not be implemented until October 1, 2015.

Box 22

Claim Supplemental Information section > Resubmission Code, Original Resubmission Ref.

Box 23

Claim Supplemental Information section > Prior Authorization Number or CLIA Number

To enter your office’s CLIA (Clinical Laboratory Improvement Amendments) number, in the Claim Edit window, select CLIA in the Prior Authorization Number Qualifier drop-down list.

The CLIA number is set up in the Billing Information window in AcuityLogic Admin. See Setting Up Office Information.

Section 24

Services Rendered section fields

CMS 1500 form boxes 24A–24J are divided horizontally to accommodate the submission of both the NPI number and another proprietary identifier during the NPI transition and to accommodate the submission of supplemental information to support the billed service.

The top area of the six service lines is shaded and is the location for reporting supplemental information; it is not intended to allow for the billing of 12 lines of service.

Box 24A

Services Rendered section > Date of Service
  • When creating an order:
    The date the order is created in AcuityLogic POS.
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Transactions tab > Transaction # > Date

Box 24B

N/A
  • Carrier:
    AcuityLogic Admin > Insurance drop-down list > Carrier > Carrier Code > Place of Service
  • If the plan overrides carrier settings:
    AcuityLogic Admin > Insurance drop-down list > Plan > Plan Name > Place of Service

Box 24C

N/A

AcuityLogic always leaves this blank.

Box 24D

Services Rendered section > Procedure Code, Modifier
  • When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Item Type (shows only items; does not show actual CPT codes and modifiers)
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Transactions tab > Transaction # > Transaction ID > Item Description (shows only items; does not show actual CPT codes and modifiers)

Box 24E

Services Rendered section > Diagnosis Pointer
  • When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Exam > Diagnosis Codes (A‑L)
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Transactions tab > Transaction # > Diagnosis Codes (A‑L)

Box 24F

Services Rendered section > Carrier Charge
  • When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Price
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Transactions tab > Transaction # > Transaction ID > Price

Box 24G

Services Rendered section > Days/Units
  • When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Qty
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Transactions tab > Transaction # > Transaction ID > Qty

Box 24H

N/A

AcuityLogic always leaves this blank.

Box 24I

N/A

AcuityLogic always leaves this blank.

Box 24J

Services Rendered section > Rendering Provider ID, Rendering Provider NPI
  • ID of the doctor selected on the order:
    AcuityLogic Admin > Company drop-down list > Company Setup > Add. Carrier Att. > Provider Mgmt > Provider Number
  • NPI of the doctor selected on the order:
    AcuityLogic Admin > Company drop-down list > Company Setup > Employees > Last Name > National Provider ID

Box 25

Billing Information section > Federal Tax ID #
  • Company:
    AcuityLogic Admin > Company drop-down list > Company Setup > Company > EIN
  • If the office overrides company settings:
    AcuityLogic Admin > Company drop-down list > Company Setup > Offices > Office # > Billing Information > Billing EIN

Box 26

Billing Information section > Patient Account #

AcuityLogic Billing > Claim Management

Box 27

N/A

N/A

Box 28

Billing Information section > Total Charge
  • When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Allowance (adds only the allowances for the items on the claim)
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Allowance (adds only the allowances for the items on the claim)

Box 29

Billing Information section > Amount Paid
  • When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Copay (adds only the copays for the items on the claim)
  • When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Copay (adds only the copays for the items on the claim)

Box 30

(08/05 Version) Billing Information section > Balance Due

(02/12 Version) Billing Information section > Balance Due
  • (08/05 Version) When creating an order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Balance (adds only the balances for the items on the claim)
  • (08/05 Version) When reviewing an invoiced order:
    AcuityLogic POS > Patient > Select Patient > Orders tab > Order Pricing > Balance (adds only the balances for the items on the claim)

(02/12 Version) AcuityLogic always leaves this blank.

Box 31

Billing Information section > Rendering Provider ID

The doctor selected on the order in AcuityLogic POS.

Box 32

Service Facility Information section fields

Location Name:

  • AcuityLogic Admin > Company drop-down list > Company Setup > Offices > Office # > Office Legal Name
  • If the Office Legal Name field is blank:
    AcuityLogic Admin > Company drop-down list > Company Setup > Offices > Office # > Name

Location Address:

  • AcuityLogic Admin > Company drop-down list > Company Setup > Offices > Office # > Address, City, State, Zip Code

Box 32a

Service Facility Information section > NPI
  • Carrier:
    AcuityLogic Admin > Insurance drop-down list > Carrier > Carrier Code > Service Location NPI (CMS Box 32a)
  • If the plan overrides carrier settings:
    AcuityLogic Admin > Insurance drop-down list > Plan > Plan Name > Service Location NPI (CMS Box 32a)

Box 32b

Service Facility Information section > Facility Qualifier, Facility ID

AcuityLogic always leaves this blank.

Box 33

Billing Provider Information section fields
  • Company:
    AcuityLogic Admin > Company drop-down list > Company Setup > Company > Billing Provider Fields
  • If the office overrides company settings:
    AcuityLogic Admin > Company drop-down list > Company Setup > Offices > Office # > Billing Information > CMS Box 33 Fields

Box 33a

Billing Provider Information section > NPI
  • Company:
    AcuityLogic Admin > Company drop-down list > Company Setup > Company > National Provider Id
  • If the office overrides company settings:
    AcuityLogic Admin > Company drop-down list > Company Setup > Offices > Office # > Billing Information > Billing NPI

Box 33b

Billing Provider Information for atypical providers.

  • AcuityLogic leaves this blank unless you've requested that this be populated for a specific carrier. Contact AcuityLogic Support to activate functionality.
  • ID of the doctor selected on the order if this is activated:
    AcuityLogic Admin > Company drop-down list > Company Setup > Add. Carrier Att. > Provider Mgmt > Provider Number
  • To enter an identifier manually, in the Claim Edit window, select an option in the Other ID Qualifier drop-down list and enter an alphanumeric value up to 15 characters in the Other ID field. On the CMS form. the qualifier you select is prepended to the value you enter.

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