Editing Claims

This section tells you how to edit claims. Eyefinity Practice Management saves all changes that you make to a claim.

Topics include:

Editing CMS 1500 Forms

  1. Use one of the following methods to open the Edit Claim window.
    • Search for the claim. Then, select Edit Claim from the Action drop-down list.

      For more information, go to Searching for Claims.

    • Open the Claim Detail window for the claim, and click Edit Claim. If the Edit Claim button is not visible, you may need to click the On Hold button to change the claim status to On Hold for editing.

      For more information, go to Viewing Claim Details.

  2. Modify or add information to the claim, as needed.

    For more information, go to Understanding How the Claim Is Populated.

  3. To edit the referring provider information in Box 17:
    1. Locate the Referring Provider/Other source First Name field, and click the filter icon.
    2. In the search field, enter at least two letters of the outside provider’s name.

      Outside providers that match your entry are listed.

    3. Select the provider from the list.

      The provider’s First Name, Last Name, and NPI are added to the claim.

    4. Select the Provider Qualifier.
  4. To modify Services:
    1. Click + Add to add a new service.

    2. Enter the Date of Service and Procedure Code.
    3. Enter Modifiers, if needed.
    4. Enter the Diagnosis Pointer, if needed.
    5. In the Receivable text box, enter the total charge for the service or material.
    6. In the Carrier Charge text box, enter the net price of the service.
    7. In the Days/Units text box, enter the quantity of the service.
    8. In the Patient Paid text box, enter the total paid amount.

    9. To add a custom detail note, click the speech balloon icon. Select the type of note you are entering from the Note Reference drop-down list and then type the note in the Item Narrative field.

  5. To see how the information will appear on the form, click Preview CMS Form.
  6. Click Save to save your changes and return to the Claim Detail window.

Understanding How the Claim Is Populated

Claims Management autopopulates the CMS 1500 form with information you’ve recorded throughout the Eyefinity Practice Management system. You can review and modify most of the information on the CMS 1500 form through the Edit Claim window.

The table below describes which fields Claims Management uses to autopopulate the CMS 1500 form, and indicates which field on the Edit Claim window corresponds to each CMS 1500 box.

Some information that Eyefinity Practice Management imports into the CMS 1500 form may depend on whether insurance plan information overrides carrier information. In situations in which data can be extracted from different fields in Eyefinity Practice Management, all fields are listed. Contact Eyefinity Practice Management Customer Care for assistance with setting up custom attributes and overrides.

CMS 1500 Box

 Eyefinity Practice Management
Edit Claim Field		 Eyefinity Practice Management Source Field and Notes

Box1

GroupHealth

Group Health Type is a custom attribute. Contact Eyefinity Practice Management Customer Care to set it up.

Box 1a

Insured: Insured ID/SSN

Front Office > Patients > Search Patients > Insurance > Add/Edit Insurance > Insured ID

Box 2

Patient: First Name, Last Name

Front Office > Patients > Search Patients > Demographics > Name

Box 3

Patient: DOB

Front Office > Patients > Search Patients > Demographics > Date of Birth

Box 4

Insured: First Name, Last Name

Front Office > Patients > Search Patients > Insurance > Add/Edit Insurance > Subscriber Name

Box 5

Patient: Address, City, State, Zip, Phone

Front Office > Patients > Search Patients > Demographics > Address Lines, Zip/City/State, Primary Phone

Box 6

Patient: Relationship

Front Office > Patients > Search Patients > Insurance > Add/Edit Insurance > Relationship to Subscriber

Box 7

Insured: Address, City, State, Zip, Phone

Front Office > Patients > Search Patients > Insurance > Add/Edit Insurance > Address Lines, Zip/City/State, Phone Number

Box 8

N/A

N/A

Box 9

Other Insured: First Name, Last Name

N/A

Box 9a

N/A

N/A

Box 9b

N/A

N/A

Box 9c

N/A

N/A

Box 9d

Other Insured: Plan Name

N/A

Box 10a—d

N/A

N/A

Box 11

Insured: Policy Group

Front Office > Patients > Search Patients > Insurance > Add/Edit Insurance > Group Number

Box 11a

Insured: DOB, Sex

Front Office > Patients > Search Patients > Insurance > Add/Edit Insurance > Date of Birth, Sex

Box 11b

N/A

N/A

Box 11c

Insured: Group Name

Front Office > Patients > Search Patients > Insurance > Add/Edit Insurance > Group Name

Box 11d

N/A

N/A

Box 12

N/A

Eyefinity Practice Management always prints “Signature on File” and the date the form is generated.

Box 13

N/A

Eyefinity Practice Management always prints “Signature on File.”

Box 14

N/A

Eyefinity Practice Management always leaves this blank.

Box 15

N/A

Eyefinity Practice Management always leaves this blank.

Box 16

N/A

Eyefinity Practice Management always leaves this blank.

Box 17

Referring Provider: First Name, Last Name

Front Office > Patients > Search Patients > Insurance > Eligibility/Authorization > + Eligibility/Authorization >

Referring Dr. First Name

Referring Dr. Last Name

These are custom insurance attributes that are usually added only to Medicare DME. Contact Eyefinity Practice Management Customer Care to add them to a carrier. If no Referring Provider information exists for the Medicare DME plan, the provider listed on the prescription appears in box 17.

The Provider Qualifier is populated in box 17 with “DN” when a referring provider name is recorded in box 17.

Box 17a

Referring Provider: ID

N/A

Box 17b

Referring Provider: NPI

Front Office > Patients > Search Patients > Insurance > Eligibility/Authorization > + Eligibility/Authorization > Referring Dr. NPI Number

This is a custom insurance attribute that is usually added only to Medicare DME. Contact Eyefinity Practice Management Customer Care to add it to a carrier.

Box 18

N/A

Eyefinity Practice Management always leaves this blank.

Box 19

N/A

Eyefinity Practice Management always leaves this blank.

Box 20

N/A

Eyefinity Practice Management sometimes leaves this blank. However, this area is under development.

Box 21

Illness: Diagnosis Codes

When creating an order:
Front Office > Patients > Search Patients > Material Orders & Exams > + Exam/Misc. Order > + Exam > Diagnosis Codes

When reviewing an invoiced order:
Front Office > Patients > Search Patients > Material Orders & Exams > Transactions > Transaction # > Diagnosis Codes

Box 22

N/A

Eyefinity Practice Management always leaves this blank.

Box 23

N/A

N/A

Section 24

 

CMS 1500 form boxes 24A–24J are divided horizontally to accommodate the submission of 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 for reporting supplemental information. This area is not intended to allow for the billing of 12 lines of service.

Box 24A

Services: Date of Service

When creating an order:
The date the order is created in Front Office.

When reviewing an invoiced order:
Front Office > Patients > Search Patients > Material Orders & Exams > Transactions > Transaction # > Date

Box 24B

N/A

Place of Service is a custom attribute. Contact Eyefinity Practice Management Customer Care to set it up.

Box 24C

N/A

Eyefinity Practice Management always leaves this blank.

Box 24D

Services: Procedure Code, Modifier

When creating an order:
Front Office > Patients > Search Patients > Material Orders & Exams > + Exam/Misc. Order > Item Type (only shows items, does not show actual CPT codes and modifiers)

When reviewing an invoiced order:
Front Office > Patients > Search Patients > Material Orders & Exams > Transactions > Transaction # > Transaction ID > Item Description (only shows items, does not show actual CPT codes and modifiers)

Box 24E

Services: Diag. Pointer

When creating an order:
Front Office > Patients > Search Patients > Material Orders & Exams > + Exam/Misc. Order > + Exam > Diagnosis Codes

When reviewing an invoiced order:
Front Office > Patients > Search Patients > Material Orders & Exams > Transactions > Transaction # > Diagnosis Codes

Box 24F

Services: Charges

When creating an order:
Front Office > Patients > Search Patients > Material Orders & Exams > + Exam/Misc. Order > Price

When reviewing an invoiced order:
Front Office > Patients > Search Patients > Material Orders & Exams > Transactions > Transaction # > Transaction ID > Price

Box 24G

Services: Quantity

When creating an order:
Front Office > Patients > Search Patients > Material Orders & Exams > + Exam/Misc. Order > Qty

When reviewing an invoiced order:
Front Office > Patients > Search Patients > Material Orders & Exams > Transactions > Transaction # > Transaction ID > Qty

Box 24H

N/A

Eyefinity Practice Management always leaves this blank.

Box 24I

N/A

Eyefinity Practice Management always leaves this blank.

Box 24J

Rendering Provider: ID (gray line) and NPI (white line)

ID of the doctor selected on the order:
Administration > Resources > Provider Setup > + Provider > Provider Number

NPI of the doctor selected on the order:
Administration > Resources > Provider Setup > + Provider > Provider NPI

Box 25

Billing Provider: ID (cannot edit the SSN/EIN check boxes)

Administration > Resources > Provider Setup > + Provider > SSN and EIN

Box 26

Claim: Claim Number

Claims Management > Claim Management

Box 27

N/A

N/A

Box 28

Service Totals: Total Charge

Front Office > Patients > Search Patients > Material Orders &
Exams > + Exam/Misc. Order > Allow (adds only the allowances for the items on the claim)

Box 29

Service Totals: Paid Amt

Front Office > Patients > Search Patients > Material Orders &
Exams > + Exam/Misc. Order > Copay (adds only the copays for the items on the claim)

Box 30

N/A

N/A

Box 31

Rendering Provider: First Name, Last Name

The doctor selected on the order in Front Office.

Box 32

N/A

Practice Name:
Administration > Practice > Practice Information > Practice Name, Address, ZIP, City/State

Billing Name:
Administration > Practice > Claims Information > Billing Name, City/State

Box 32a

N/A

Administration > Practice > Claims Information > NPI # and Billing NPI #

Box 32b

N/A

Administration > Practice > Claims Information > Qualifier and Facility ID

Box 33

Billing Provider: Name, Address, City, State, Zip

Provider:
Administration > Resources > Provider Setup > + Provider > Provider Name and Phone

Company:
Administration > Practice > Claims Information > Company Billing Name, Company Billing Address, ZIP

Box 33a

Billing Provider: NPI

Administration > Practice > Claims Information > Billing NPI #

Box 33b

N/A

Eyefinity Practice Management leaves this blank unless you have requested for this to populate for a specific carrier. Contact Eyefinity Practice Management Customer Care to activate this functionality.

ID of the doctor selected on the order if this is activated:
Administration > Resources > Provider Setup > + Provider > Provider Number