Claim Edits

The Claim Edits feature allows permissioned users to edit box fields within a claim in the Submit tab. This enhancement enables billers to update claim data before submission to ensure claims are processed quickly and accurately if account configuration or claim rules cannot meet a unique billing case. 

Best Practice: We recommend institutionalizing billing requirements for automated bulk claim creation using account, service, and claim rule configurations as the primary method. Claim Edits should only be used when one-off claim content changes are needed. 

Configuration

Claim Edits will require additional configuration by a Managing Organization Admin. To enable this feature, navigate to the Managing Organization Admin > Configuration > Account Settings. From there, select Edit and toggle on Enable Claim Edits before clicking Save to complete the process.
 

Users and Permissions

Only user profiles at the Managing Organization level will be able to edit claims. Managing Organization Admins will not require additional permissions to edit claims, but Managing Organization Users will.

• 1. To enable the ability to edit claims, navigate to Managing Organization Admin > Users.
     
  2. Select the hyperlink of the user whose permissions you wish to enable. 
  3. In the profile, select Permissions, then Edit.
     
  4. Under Insurance Claims Access, update the dropdown to Edit.
     
  5. Next, toggle on Can Edit Claims.
     
  6. Select Save to complete the process. 
     

Editable Boxes

Since this feature is currently in development, the number of boxes that can be edited is limited at this time. However, as this feature develops, additional boxes will become editable and added to the list below.

• Box 4 - Type of Bill
  Box 6 - Statement Covers Period
  Box 12 - Admission Date
  Box 13 - Admission Hour
  Box 14 - Admit Type
  Box 15 - Admit Source
  Box 16- Discharge Hour
  Box 17 - Discharge Status
  Box 18-28 - Condition Codes
  Box 31 - Occurrence Codes
  Box 39-41 - Value Code/Amount
  Box 42 - Revenue Code
  Box 43 - Service Description 
  Box 44 - HCPCS
  Box 53 -Assignment of Benefits
  Box 64a - Document Control Number 
  Box 67a-q - Diagnosis Codes
  Box 69 - Admitting Diagnosis
  Box 71 - PPS
  Box 74 - Principal Procedure Code and Date
  Box 80 - Remarks
• Box 18 - Hospitalization Dates Related to Current Service
  Box 19 - Additional Claim Information (Designated by NUCC)
  Box 21 - Diagnosis or Nature of Injury or Illness 
  Box 22 - Resubmission Code and Original Ref. Number (ICN)
  Box 24b - Place of Service
  Box 24d - Procedures, Services, or Supplies
  Box 24e - Diagnosis Pointer
  Box 27 - Assignment of Benefits
  Box 29 - Amount Paid

Claim Edit Workflow

At Kipu, we understand how important it is for our clients to make even the smallest of changes quickly and efficiently. Let's review the best way to generate an editable claim within the RCM. 

• Let's review how to use the Claim Edit tool for new claims.

  1. Record and Submit the Attendance.
  2. Create the New Claims.
  3. Under the Submit Claims tab, locate the newly created claim.
     
  4. Select Edit Claim Form to open up the edit feature.
     
  5. Locate the box number of the line item you wish to change and update the information. Please note fields displayed in gray are for reference and cannot be edited using this feature.
     
  6. After inputting the desired changes, select Save Changes to finish editing the claim.
     
  7. Select Submit Claims to complete the process once all desired claim(s) have been edited. 
     

• Let's review how to use the Claim Edit tool for corrected claims.

  1. Generate the Corrected Claim. 
  2. After generating the correction, navigate to the Work Center > Insurance Billing > Submit Claims section.
     
  3. Locate the newly corrected claim and select Edit Claim Form to open up the edit feature.
     
  4. Locate the box number of the line item you wish to change and update the information.
     
  5. After inputting the desired changes, click Save Changes to finish editing the claim.
     
  6. After the edits have been made, click Submit Claims to complete the process. 
     

• If a claim needs a single line item changed but nothing else, the edit feature can be utilized by Resubmitting the claim without any changes. 

  1. Generate the resubmission using the process outlined here. 
  2. After generating the resubmission, navigate to the Work Center > Insurance Billing > Submit Claims section.
     
  3. Locate the Resubmitted Claim and Edit Claim Form to open the edit feature.
     
  4. Locate the box number of the line item you wish to change and update the information.
  5. After inputting the desired changes, select Save Changes to finish editing the claim.
  6. After the edits have been made, select Submit Claims to complete the process. 
     

Manage Edited Claims

When a claim is edited, the system will create a note detailing who edited the claim, which box was edited, and what information was added/changed. In the example below, we can see the following:

1. User Name 
2. The Box(es) Edited
3. The Claim Sequence (New, Correction, or Resubmission)
4. The Data Added/Change

In addition to creating a claim note, the system will track claim edits under User Audit Records and The Claim Submission Report, Claim Status Report (By Service Date), and Claim Status Report (By Claim.)