Claim Settings

The Claim Settings contain options that are change certain functionality when creating or editing claims. Some settings are specific only to your user while others impact all users in the customer.


Who can use this feature?

Users with access and modify permission for Practice can edit Customer Claim Settings.

Users with any access permission  for Claims can edit User Claim Settings.


Configure Claim Settings for Customer

The Claim Settings contain options that change certain functionality when creating or editing claims. Some settings are specific only to your user while others impact all users in the customer. The Claim Settings for Customer contains options that will apply to all users under the customer. 

Who can use this feature?

Users with access and modify permission for Practice can edit Customer Claim Settings. 


Real-Time Claim Submission (RTCS) Settings.

This setting gives you on-demand visibility into your claim for tens of thousands of clearinghouse edits on an individual or batch claim level. Validating claims using RTCS means less claim rework, and accelerated reimbursements so you get paid faster. Enabling this feature is highly recommended based on the benefits.

  1. Select Claim > Settings.

  2. Click the Edit button.

  3. Optional: Click the Copy Settings link to copy the current settings to another customer associated with your account. 

  4. Use the drop-down menu to determine the action that happens when a claim is set to send to insurance via clearinghouse:

    1. Automatically validate and submit the claim (Recommended): This option will give you real-time claim results along with real-time claim status.  Rejected Claims will be set to “Rejected at Clearinghouse”. Accepted Claims will be set to “Claim at Insurance”. Results and statuses will be visible within Claim Tracker.

    2. Automatically validate, but do not submit the claim: This option will allow you to obtain real-time claim results, however, claim statuses will not be updated in real time. Claim statuses will remain at “Send to Insurance via Clearinghouse” until we automatically batch process claims at 11:00 PM Eastern Standard Time. 

    3. Do not validate or submit the claim automatically: This option will disable RTCS. Claim statuses will remain at “Send to Insurance via Clearinghouse” until we automatically batch process claims at 11:00 PM Eastern Standard Time. Claim results along with claim status updates will not be available until the next day within claim tracking.

  5. Click  Save.

Fee Schedules Settings

This setting allow you to control what price is used on a charge in the event that more than one option could apply based on the fee schedules created for your customer. These changes apply to ALL fee schedules created for your customer account.

  1. Use the drop-down menu to determine the type of Fee Schedule pricing for Institutional claims based on the: HCPCS Code or Revenue Code.

    By default, the system will always use HCPCS Code prices on Institutional claims. However, if you wish to base prices for Institutional to always be based on Revenue Code prices, click on the drop-down menu and select Revenue Code.

  2. When multiple fee schedules apply to a claim based on their associations, the fee schedule used will be determined by the following order of precedence you select: Click on the association to highlight it and select the up or down arrow or right-click the association and select “move up” or “move down” to change the order of precedence. 

  3. Click Save

Configure Claim Settings for Users

The Claim Settings for User contains options that will apply to your user account.

Who can use this feature? 

Users with access permission for Claims can edit User Claim Settings. 


Claim Print Settings

This setting allow users to set the default margins to use when printing the CMS-1500 (Professional Claim) and the CMS-1450 (Institutional Claim).

Any open print tabs will need to be closed and re-opened after making changes to the Claim Print Settings. 

  1. Use the arrows to set the margins to use when printing claims on the CMS-1500 claim form.

    1. Left margin: The number in this field indicates the horizontal spacing that will be used when you print HCFA forms. To move to the right, increase the number in this field to add space to the beginning of the line. To move left, decrease the number to delete space from the beginning of the line.

    2. Top margin: The number here indicates the vertical spacing used when printing HCFA forms. To move up, decrease the number to remove space from the top of the page. To move down, increase the number to add space to the top of the page.

  2. Use the arrows to set the margins to use when printing claims on the CMS-1450 (UB-04) claim form.

    1. Left margin: The number in this field indicates the horizontal spacing that will be used when you print HCFA forms. To move to the right, increase the number in this field to add space to the beginning of the line. To move left, decrease the number to delete space from the beginning of the line.

    2. Top margin: The number here indicates the vertical spacing used when printing HCFA forms. To move up, decrease the number to remove space from the top of the page. To move down, increase the number to add space to the top of the page.

  3. Click  Save.


Claim Default Settings

Set User level Claim Default Settings by selecting Yes or No to the available claim settings:

    1. If set to Yes, a warning will pop up if you’re creating a duplicate claim.

    1. If set to Yes, a pop up will appear after a claim has been submitted using RTCS letting you know the claim was accepted by the clearinghouse.

    1. If set to Yes, the claim will be created based on the patient’s default procedure codes. Please reference our Claim Defaults Help Article.

    1. If set to Yes, the claim will be created based on the patient’s default diagnosis codes. Please reference our Claim Defaults Help Article.

    1. If set to Yes, the system will take the codes entered on the claim and set them as the patient’s default procedure or diagnosis codes.

    1. If set to Yes, the claim will populate with the patient’s default authorization information.

      If disabled, an authorization can still be copied or entered manually on the claim.

    1. If set to Yes, a pop-up window will appear if you are editing a patient’s authorization.

    1. If set to Yes, a pop-up window will appear when adding an Admission code asking if you would like to set the same value as the Principal Diagnosis code.

    1. If set to Yes, the Sales rep and an initial delivery date will display. These fields are for reporting purposes only; they are not submitted on the claim.

    1. If set to Yes, a “Chiro” column will be available to add information related to services under the Charges tab.

    1. If set to Yes, an additional column will be available under the Charges tab. Please see the Inventory Codes Help Article for more information.

    1. If set to Yes, the Homebound option will default to “Yes” for all new professional claims. This is a helpful option if most of your visits are home visits.

    1. If set to Yes, the patient's gestational age will populate from the last menstrual period field in the claim.

  1. Click  Save.