Detailed descriptions to follow.

3. Once you have finished editing the options, click "Save."

Processed Files

In order to prevent the duplicate processing of files, the HIPAA Claim Master can move or delete files after they have been processed. Since the HIPAA Claim Master program can be launched by the Window's scheduler (see Running the Application via Scheduler), it is important to either move or delete processed files, so that they will not be picked up again. You have the choice to either do nothing, move the processed files to a specific folder or delete the files:

Tip: This option is not recommended.

Log

Update

Print Additional Pages

There may be additional pages with data that have no representation on the standard forms.

This option determines whether the additional pages with either COB information or segments with additional information that have no representation on the standard forms should be printed on either paper or image files. This option helps you save paper. If you only need the main claim form, there is no need to print 2 extra sheets.

If you only need the main claim form, there is no need to print these two (2) extra sheets, in this case, leave the following options unckecked to save your paper.

Document Color

This section of the setup window is concerned with the output colors. You have the choice to render the form in red or in black. The form background can be set to red to make the form visually more appealing and to allow the use of a color filter for OCR software. The color can be selected for the following media:

Note: The data is always black.

Outbox Directory Path

Define the destination folder where the result files will be stored.

You can set regional and other user-specific options that do not apply to all users. Follow the instructions below.

Present on Admission (POA) information is now often required by insurers to exclude "hospital infections" from coverage. These are diseases that are acquired by the patient after admission to the hospital and often cause high costs and even death. In the SQL export the POA codes are colon separated from the diagnosis codes. If this causes problems, you can deselect this here. With the introduction of ICD-10 it is important to save the version of ICD codes that are in the claim to the database. Since it is intrinsically linked to the Diagnosis code we decided against creating another set of fields. It would mean creating another 80 or so fields for POA and ICD version. Instead we opted to concatenate the ICD version qualifier and the POA indicator with Diagnosis Code qualifier separated by a colon (:)

Z77.22:Y:ABK with the diagnosis code in first position, followed by the POA indicator 'Y' and the ICD-10 qualifier

Example: J151::ABF Here the POA code is committed

Example E8600:Y:ABN

Example L01.03:ABJ Only the ICD version qualifier is added to the diagnosis code

This way of connecting diagnosis information with POA and ICD codes is bi-directional, meaning if you create 837 files from database, then the above example is the way to do it. Internally HIPAA Claim Master will parse out the information and assemble the respective HI segment within all applicable rules.

Field locator 43 will be populated with the procedure code description in case such code is in SV2 segment

The introduction of the National Provider ID (NPI) brought new claim forms. All three types of claims now have a form that contains the NPI. The HCFA-1500 became the CMS-1500, the UB92 was replaced with the UB04 and the ADA 2006 replaced the earlier versions.

You can choose which forms to use and it will give you the choice to either print the form and the data or to suppress the form, so that only the data appears. This is important if you want to print on pre-printed forms or use OCR to read the data.

 

They are described further below.

 

Auto Form Selection

Check this option to automatically select the forms. The system selects the forms based on the following logics. If NPI is present in Billing Provider's information, then choose new Forms with NPI, otherwise use forms pecified below.

Tip:We recommend to activate this setting. Older Pre-NPI claim files will then be displayed in the old forms while newer files with NPI will be rendered in the new forms.

 

Dental, Professional, Institutional Claims

Select the forms for the following claims:

Specify the following settings:

EDI files are often hard to read, especially if they have no carriage returns and line feeds to put each segment on a line of its own.

The EDI Editor available in the HIPAA Claim Master replaces all element separators with a star "*", all sub element separators with a colon ":" and all segment separators with a tilde "~" even if the original file uses different delimiters.

Tip: Changing EDI files can be a tricky undertaking. You should be experienced in the format of the 837 and understand that an 837 claim file could be a legal document that should not be altered without the consent of the originator.

 

To Open EDI Editor

To access the EDI Editor, select the "EDI Editor" option under "View" menu item. 

The "EDI Editor" menu

 
Alternatively, you can click on the "EDI" icon on the toolbar to invoke the EDI Editor.

This option is only enabled when you have opened an EDI file.

The "EDI Editor" button

The following screen will appear:

The EDI Editor window

 

To Cut, Copy, Paste

When you right-click anywhere in the text, a context menu will appear with typical test edit options such as cut, copy and paste.

Context menu

 

To Find and Replace

The "Find" and "Replace" utilities work as in a common text editor. To use them, right-click somewhere in the document and then from the displayed context menu select the "Find" or "Replace" command. Alternatively, you can press Ctrl F simultaneously on your keyboard to bring the text search utility.

The "Find" pop-up

Pressing Ctrl H simultaneously will bring up the Replace utility.

The "Replace" popup

To Save the Changes

As long as you don't save, there will be no changes to the file.

If you make changes to the file, the "Save" button becomes enabled and you can save any changes. The HIPAA Claim Master will further work with those changed files, so you don't have to open the file again.

Notice: Changing EDI files can be a tricky undertaking. You should be experienced in the format of the 835 and understand that an 835 claim file could be a legal document that should not be altered without the consent of the originator.

The "Save" button

 

EDI relies on transaction code sets. These codes represent longer explanations and descriptions.

At the onset of EDI one of the main design ideas was to make the EDI files as short as possible and to allow different languages to use the same descriptions by reducing long verbose explanations to 2-3 byte long codes. Computer storage was incredibly expensive and making any file larger than it absolutely had to was considered wasteful.

The code sets are stored in the file codesets.xml in the Configuration subdirectory:

Windows XP: C:\Documents and Settings\All Users\Application Data\HIPAAsuite\HIPAA Claim Master\Configuration\
Windows 7, Vista: C:\ProgramData\HIPAAsuite\HIPAA Claim Master\Configuration\

The Configuration folder in Windows 7

Tip: The folder is hidden.

 

To view/edit transaction code sets in HIPAA Claim Master, follow the instructions below.

F to P

Q to Z

 

The following screen-shot illustrates how to select the "Patient Location" code set for display. 


The "Patient Location" sub-menu

The "Patient Location" code set configuration window

 

 

Adding a New Row

To add, click on the last row. Now you can see the indicator in the first grey field.


The indicator

Click the field again to enter to the Edit mode. Now you can enter the text.

Note: Only after you leave this row, the changes will take place.

 

Deleting a Row

To delete, click the left margin. This action will highlight the whole row.

Highlighting a row by clicking the left margin

Now press the <DELETE> key on your keyboard.

 

Editing the Row

To edit, click two times the cell you want to change. Make your changes. Clicking or moving outside this cell overwrites the cell contents with the new value. To make these changes permanent, click the 'Save' button.

Notice: Don't forget to save the changes by pressing the 'Save' button.

The HIPAA Claim Master can keep a log entry for each file that gets processed. This feature is especially helpful when the HIPAA Claim Master is run through automated processes. The log is essential in tracking errors and documentation.

 

Enabling Logging

To enable logs, check the "Keep a log of every file proccessed" checkbox under Setup  Options   Log.

The "Keep a log of every file processed" check-box

 

To record the errors only in the log, check the "Record errors only in log" box displayed in the "Log" section.

The "Record errors only in log" check-box

 

Accessing Logs

Follow the instructions below to access the log files for your HIPAA Claim Master.

Click Logs  Daily Logs in the main menu.

The "Log" menu

If there is a log file for the current day, it will be displayed. If not, the page will be blank. You can navigate to each date with the calendar control on top of the page.

 

Log files are simple text files, one for each day that are stored in date hashed folders. Alternatively, access the Logs folder in the following directory:

Windows XP: C:\Documents and Settings\All Users\Application Data\HIPAAsuite\HIPAA Claim Master\Logs
Windows 7, Vista: C:\ProgramData\HIPAAsuite\HIPAA Claim Master\Logs

The directory structure for the daily logs

Tip: The folder is hidden by default. But if you type in the address in the top bar of the Windows explorer, you will find that it exists. Or you can change the explorer settings to show hidden files and directories.

 

Tip: The ProgramData folder contains all your application data, like program settings, user data, etc, for all of the installed programs on the computer. The ProgramData folder holds the same files that were contained in the \Documents and Settings\All Usersand \Documents and Settings\All Users\Application Data folders in XP.

 

For each day that the HIPAA Claim Master is used (If logs are enabled), there will be a log file which carries the name in the filename.

Within the directory, find a folder for the year you are looking log for. Then find a sub-folder for the necessary month with files for each day. Double-click a file which has the name equal to the necessary date. The log will look like this:

The daily file log

 

This entry is for a problem free file. Out of this entry you will get:

 

An entry with errors might look like the following:

The second entry shows a database export problem. The message contains details that allow tracking of the problem. In this case a carriage return was in the file between the 2 and the 4.

The HIPAA Claim Master stores the amount of claims processed per month. These usage statistics are needed for a per-claim licensing model.

Follow the instructions below to access the statistics in your HIPAA Claim Master.

Click Logs  Statistics in the main menu.

The "Statistics" menu

The following screen will display.

The "Claim Printer Usage Report" window

The screen shows the number of claims processed in total and by year and month. The data is stored as an encrypted key in the registry.

Clicking the "Send Usage Report for Billing Purposes" button creates an email that contains this report and sends it to HIPAAsuite. The per-claim licensing model depends on this report for billing purposes. If you have the unlimited Licensing Scheme, you do not need to worry about this function.

If you want to print to a printer other than the computer's defined default printer, you will need to select the desired printer.

Note: The HIPAA Claim Master Version 4.0 onwards does not need anymore third party software for the creation of image files. Older versions of the HIPAA Claim Master needed to have the Peernet Tiff Image Printer  or PDF Image Printer driver installed.

 

Follow the instructions below.

Go to File  Select Printer in the main menu.

The "Printer" window will appear. Select the necessary printer.

Selecting the Printer for output on paper

Though you do not have any documents in your print queue, click on "Print" to select this printer for future output.