2nd Edition, ClaimGear Case Study Workbook

CLAIMGEAR STUDENT TRAINING


Introduction

Welcome to ClaimGear! On this website is a step by step process with video clips that will assist you in learning about the:

  1. ClaimGear Case Study Workbook
  2. Student Portal
  3. ClaimGear (billing software)

Anytime you see this video icon, click on it to watch a video clip for that step. The video clips will require earphones or speakers.

Step 1

Understand that there are two softwares.

  1 - The ClaimGear Case Study Workbook contains claims that may be entered into the ClaimGear billing software.
  2 - A second software is used to keep track of your assignments and to score claims. This second software is referred to as the "Portal" and is at this website: https://claimgear.collaboratemd.com.

Step 2

Review the ClaimGear Case Study Workbook. You need to read the following chapters, in this order:

  1. Front matter – either Degree or Diploma.
  2. ClaimGear Student User Manual.
  3. Which ever section you are completing for this module.
  Sections: Sections:
• Front matter - Degree • Rocky Shore • Sunset Springs
• Front matter – Diploma • West Point • Maple Hills
• ClaimGear Student User Manual • Crown Valley • Hidden Cities

Step 3

Learn the ClaimGear software.

Note: these video clips correlate with the ClaimGear Student User Manual included in your workbook, beginning on page 19.

Topic

Page #

Video Clips

Open ClaimGear 25-28

Main Page - System Tab
   
Register the Access Key Code
27
Print the Schedule

   
Schedule Appointments 29-32

Four Steps to Schedule an Appointment
Schedule a Follow-up Visit
Print the Schedule

   
Patient Registration 33-40
Review the Buttons
Review the Tabs
Add a New Patient (if you did not schedule an appointment)
Find an Existing Patient (if you scheduled this patient an appointment)

1 Patient tab
  • Enter the patient registration information
  • How to inactivate a duplicate patient account
  • Defaults
  • Referring/PCP
  • Emergency Contact
Add the Insured(s)
  • 2 Insured Tab [for the primary insured (Payer 1 fields)]
    • Add Payer 1 and Payer 2
    • Add the Insured’s Employer
    • Add a New Payer into ClaimGear
  • 3 Other Insured Tab
    • Add Payer 3
4 Misc. Info. Tab
  • If any insured information changed, be sure to update it on claim side
  • If illness/accident/injury is provided on patient registration form, enter it here
Save Your Work

   
Claim Entry – CMS-1500
form for Rocky Shore, West Point, Maple Hills, Sunset Springs, and Hidden Cities
41-48
Review the Buttons
Review the Tabs
How Many Claims Per Patient?
Add a New Claim to a Patient
Find an Existing Claim

1 Claim Tab
  • Review of the claim tab fields
    • * Fields that are defaulted from the patient registration process
    • ** Fields that need to be completed
  • Verify your selected provider
  • Verify or select a referring/PCP provider
  • Verify form version (CMS-1500)
  • Authorization #: add authorization number and click Copy Authorization To Claim button
  • Claim complete?
2 Charges Tab
  • Add ICD/Dx/diagnoses codes
  • Enter in procedures/charges with dates of service, units, modifiers, and prices
  • Enter in co-payment made at time of service
3 Additional Info Tab
  • Injury related to employment, auto accident or other accident
  • Date of onset of illness/accident/injury
  • Unable to work from date
  • Hospitalized date
  • Last menstrual period date
5 Activity Tab
Save Your Work and Print the Claim

   
Claim Entry - UB-04 form for Crown Valley Hospital 49-59
Review the Buttons
Review the Tabs
How Many Claims Per Patient?
Add a New Claim to a Patient
Find an Existing Claim

1 Claim Tab
  • Review of the claim tab fields
    • * Fields that are defaulted from the patient registration process
    • ** Fields that need to be completed
  • Verify your selected provider
  • Verify your referring/PCP provider
  • Uncheck "Always auto-calculate totals"
  • Verify form version (UB-04)
  • Authorization #: add authorization number and click Copy Authorization To Claim button
  • Claim complete?
2 Charges Tab
  • Add ICD/Dx/diagnoses codes
  • Enter in Procedures/Charges with dates of service, HCPCS, rev codes, units, and prices
3 Additional Info Tab
  • Required Fields for In-Patient Claims
  • Required Fields for Out-Patient Claims
  • Additional Info Bottom Tabs
    • Diagnosis Tab
      • Required fields for In-Patient and Out-Patient claims
    • Procedure Tab
    • Value Tab
5 Activity Tab
Save Your Work and Print the Claim

   
Payment Posting 60-67
Review the Tabs
Enter in Patient Co-payment (in the 1 Line Item Posting Tab)
Enter in EOBs (in the 3 EOB Posting Tab)
  • Claim Payment Screen
  • Other Functions
    • Retrieve Any EOB to View or Edit
    • Edit Any Payment Posting
    • Auto-Calculates Your Posting
    • Add Multiple Patients From the EOB
    • Delete an EOB Entry
  • Save the EOB
Delete/Review any Transaction (in the 6 Transaction Maintenance Tab)

   
Portal 68-70
Log into the Portal
Log in to the Portal While Logged into ClaimGear
Understand the Assignment Details Provided (including the icons)
Control Assignments with the Green Ball

   
Score Your Work
71-77
Expand to See the Errors
Rescore
Print a Scoring Report
Details at the Top of the Scoring Report
What Do These Errors Mean?
  • Biller's Goal
  • "Charge Not Found" Error
  • "Claim Not Found" Error
   
CMS-1500 Specs 78-83
CMS-1500 Claim Form
ClaimGear CMS-1500 Specs

   
UB-04 Specs 84-90
UB-04 Claim Form
ClaimGear UB-04 Specs

   
Generate Reports 91-95
Six Suggested Reports
Running a Report
Print Reports
EOB Breakdown
94-95
Cross-Reference the Report with your Written EOB Breakdown Answers

   
Add Payers 96-97
Create a Payer to Submit Electronically
Create a Payer Manually to Submit by Paper

   
Add Referring and Primary Care Physicians 98
 
Tools 99
 
Logout 100-1001
Log Out of ClaimGear
Exit ClaimGear
Log Out of the Portal
   

Step 4

Here are video clips that provide an example of how to complete five random patients in ClaimGear.

  1. How to complete patient Steven Allsop (pages 113, 120, 214, 241) from the Rocky Shore section. Rocky Shore section begins on page 105.

  2. How to complete patient Blake Freestone (pages 283, 307, 367, 368, 369, 399) from the West Point section. West Point section begins on page 275.

  3. How to complete patient Shirley Burgess (pages 283, 315, 346, 388) from the West Point section. West Point section begins on page 275.

  4. How to complete out-patient Kurt Chipman (pages 421, 434, 471, 510) from the Crown Valley section. Crown Valley section begins on page 413.

  5. How to complete in-patient Jennifer Anderson (pages 421, 431, 468, 506) from the Crown Valley section. Crown Valley section begins on page 413.

Step 5

Review the Portal chapter that discusses scoring beginning on page 71, and the Specs chapters on page 78 or 84 (or see the videos in step #3).

Here are video clips on how to score the five previously entered patients (step #4).

  1. How to score patient Steven Allsop (pages 120, 214, 241) from the Rocky Shore section. Rocky Shore section begins on page 105.

  2. How to score patient Blake Freestone (pages 307, 367, 368, 369, 399) from the West Point section. West Point section begins on page 275.

  3. How to score patient Shirley Burgess (pages 315, 346, 388) from the West Point section. West Point section begins on page 275.

  4. How to score out-patient Kurt Chipman (pages 434, 471, 510) from the Crown Valley section. Crown Valley section begins on page 413.

  5. How to score in-patient Jennifer Anderson (pages 431, 468, 506) from the Crown Valley section. Crown Valley section begins on page 413.

Step 6

There is a ClaimGear Student Achievement program. If you complete all claims included in the workbook, achieving 100% on each claim/section, you are entitled to a Certificate of Achievement. If you achieve this status, inform your instructor to contact ClaimGear Support for your certificate.




ClaimGear is a product of CollaborateMD. For more information on the commerical PM version, visit www.collaboratemd.com

Copyright (c) 2008-2009 CollaborateMD. All videos and content on this site are copyright of CollaborateMD and use is exclusively for Corinthian Colleges. Any other reproduction or distribution is strictly prohibited without the express written consent of CollaborateMD.