How to Submit Medical Claims

Sensei Cloud supports the electronic submission of primary medical claims for practices that use Sensei Cloud's Medical Billing feature.

For more information, see:

• Sensei Cloud Medical Billing
• How to Add a Medical Insurance Policy
• How to Use CPT® Codes for Medical Billing
• How to Bill a Dental Procedure (CDT) Code on a Medical Claim
• How to Add or Edit an Insurance Payer
• How to Manage Claims for a Location

To submit medical claims:

1. From the Location tab, select Claims > Claims Management.
2. In the Filter list, select Medical, and any other relevant filters to refine the list.

   For each claim, the Claim Number, Status, Type, Provider, Last Updated date, Payer, Plan, Patient Name, and Billed and Paid amounts are displayed. You can sort the list by any of these columns.

   Note: Claims that require action display an Alert icon in the Status column.

3. Select a claim to view the summary and update the claim as needed.
   -- If needed, click Edit ICD10 Codes to add ICD10 medical diagnosis codes to procedures included in the claim or modify any existing ICD10 codes that were entered at the time of posting.
   -- You must click Edit Addl Info for medical claims to define any additional information to be included with the claim record before submission. The status of the claim remains at Needs Info until you review and then submit the claim.
   Note: Be sure to confirm the details for the procedures included in the claim at the bottom of the Additional Claim Information window. Verify the POS (place of service), Days/Units, etc., and update if needed. The Days/Units field must contain an entry greater than zero to prevent the medical claim from being rejected.
   
   -- You have the option to include a referring provider on paper and electronic medical claims under Item 17. Referring Provider Information. Select the checkbox and select a Referral Source.
   
   Note: Only referral sources that are both active and have an NPI number defined in their referral source record will be available for selection in the drop-down list.
   -- Enter any additional claim information under Item 19. Claim Remarks. When this option is selected, you can select a Qualifier and then type the necessary information.
   
   See Adding Additional Claim Remarks for more information.
4. Click Save Changes & Submit to submit the claim, or click Save Changes to save your changes and submit the claim at a later time.
   Note: If you save your changes, you can go back at a later date and click on the claim to open the summary, and then click Submit Claim.

Note: Subsequent medical claims can only be submitted via paper.

Note: You can use SPRNT as the generic Payer ID for printed (paper) medical claims.

You can also: 

• Search claims by: Patient, Policyholder, Claim ID, and Procedure codes (CDT code and nomenclature).
• Filter the list by: Type, Status, Providers, Payers, and Date.
  Note: The claim Type is assigned automatically when the claim is generated: Svc (statement of actual services), Pre-Auth (request for pre-authorization), COT (continuation of treatment for orthodontic services), Ortho (initial claim for orthodontic treatment).
• Elect to display only claims that are Cancelled, Pending Review, or Awaiting Attachments.
• Manage claims from the Patient tab by selecting Insurance > Claims Management.

Adding Additional Claim Remarks

To add additional information to a medical claim:

1. Select the medical claim from the Claims Management screen (Patient > Insurance > Claims Management or Location > Claims > Claims Management).
2. Click Edit Addl Info.
3. Select Item 19. Claim Remarks.
4. Select a Qualifier, and then type the necessary information.
   
   Tip: Hover over the  icon to learn more about entering Qualifiers. 
   Note:
   -- The Information field allows you to type up to 71 characters (including spaces and the characters of the selected Qualifier).
   -- You can include multiple qualifiers by first entering the text for the Qualifier you selected from the drop-down list, adding three spaces, and then entering the next Qualifier code (in ALL CAPS), followed by the additional information, without an additional space after the Qualifier. 
5. Click Save Changes & Submit to submit the claim, or click Save Changes to save your changes and submit the claim at a later time. The claim remarks are included on both paper and electronic claim forms.