The Detail Claim window displays detail claim information. Each claim has one or more detailed claim items associated with it. The claim items display in the list box at the bottom of the window.
Claim total dollar information displays in the upper right of the window. The system calculates the dollar amounts automatically based on the amounts found on the detail claim items. Enter these dollar amounts only on the Detail Claim Item window.
Add new claim items to the claim item list by selecting the Add Lines button. The Selected Lines button displays details about a selected line in the Claim Item group box
The All Lines button is used to browse or update all of the claim items shown in the Claim Item group box.
Claim Information Group Box:
Claim Type: Select the provider radio button if the provider submitted the claim or the case person radio button if the person submitted the claim.
Batch Number: This field displays the unique system assigned batch identification number that included this claim. The batch number contains the Julian date plus the worker number plus the time (using the 24-hour clock)
Claim Number: This field displays the unique claim identification number assigned by the system.
Office Number: This field displays the unique office number of the DHHS office associated with this claim. The actual name of the office will be displayed after this field.
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In the add or update mode only, select the search arrow to go to the Office List window to find the appropriate office. |
Claim Totals Group Box:
Submitted Amt: This field displays the total dollar amount of this claim submitted by the claimant.
Amt Not Paid: This field displays the total reductions to the submitted claim.
FICA: This field displays the total federal tax withheld from the claim.
Bkup Withholding: This field displays the amount of Backup Withholding deducted from the claim.
Aprv Pmt Amt: This field displays the amount approved for payment to the claimant
Provider Group Box:
Number: Enter the unique provider identification number
Name: This field displays the provider name associated with the entered provider ID number.
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In the add or update mode only, select the search arrow to go to the Search Organization window to find the appropriate provider. |
Date Group Box:
Billing: This field displays the billing date shown on the bill
Received: This field displays the date the DHHS office received the bill
Claim Items Group Box:
Line: This column displays the line numbers of the claim items associated with this claim.
Vers: This column displays the version number of the claim items associated with this claim
Status: This column displays the status of the claim items.
Last: This column displays the last name of the person associated with this claim item.
First: This column displays the first name of the person associated with this claim item.
Freq: This column displays the frequency with which the service is provided to the person identified in the claim item.
Svc Begin: This column displays the first date the service is provided for the person identified in the claim item.
Svc End: This column displays the last date the service is provided for the person identified in the claim item.
Service Type: This column displays the type of service being provided for each claim item.
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Select the Add Lines button to go to the Detail Claim Item window to add additional lines to the claim. |
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Select the Selected Lines button to go to the Detail Claim Item window to update or browse the selected claim item lines from the claim item group box. |
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Select the All lines button to go to the Detail Claim Item window to update or browse all of the claim items from the claim item group box. |
NFO4071H
(12-2011)