PRACTICE MANAGEMENT

USER MANUAL

©SOAPware, Inc. 2017

Table of Contents
Practice Management Maintenance-Setup Steps .................................................................................. 9
Important Setup Information for SOAPware Practice Management .................................... 10
Getting Setup with Gateway EDI/TriZetto -- What to Expect .................................................. 11
1. Manage Facilities (Block 24B and Block 32 and Statement 'Remit Payment To'
Address) ......................................................................................................................................... 13
2. Manage Groups/Billing Provider/ Pay To Information (Block 33) ...................................... 20
3. Provider Manager (Blocks 24J and 31) ................................................................................... 24
4. Setting Default Claim Options/Base Export Path................................................................. 27
5. PM Security Administration ................................................................................................... 31
6. CPT® Code Maintenance (Block 24D) ................................................................................... 55
7. HCPCS Maintenance (Block 24D)............................................................................................ 60
8. ICD Maintenance (Block 21) .................................................................................................... 65
9. Adjustment Maintenance * ..................................................................................................... 69
10. Custom Charges Maintenance * .......................................................................................... 73
11. Fee Schedule Maintenance (Block 24F) * ............................................................................ 76
12. Remittance Advice Remark Codes ....................................................................................... 83
13. Claim Adjustment Reason Codes ......................................................................................... 88
14. Insurance Company Manager .............................................................................................. 95
15. Contacts/Referring Physicians (Block 17).......................................................................... 104
16. Flags/Notes Category Manager .......................................................................................... 108
17. Custom Demographic Titles ............................................................................................... 111
18. Set Structured CPT Options ................................................................................................ 113
19. List Options ........................................................................................................................... 114

Updating CPT®, HCPCS, and ICD-9 codes .......................................................................................... 118

Download New Quarterly/Annual Codes ................................................................................ 119
Deleted Code Procedure ........................................................................................................... 127

Schedule Setup ....................................................................................................................................... 128

Activate Providers/Resources for a Facility ............................................................................. 129
Provider/Resource Outlining .................................................................................................... 135
Provider/Resource Recurrences * ............................................................................................ 142
Entering Facility Business Hours * ........................................................................................... 149
 Creating Holidays/Closings * .................................................................................................... 153
Creating Scheduplates ............................................................................................................... 157
Confirm Scheduled Appointments .......................................................................................... 161
Check Insurance Eligibility ......................................................................................................... 163

Menus and Toolbars .............................................................................................................................. 165

SOAPware Menu * ...................................................................................................................... 166
Billing Menu * .............................................................................................................................. 167
Scheduler Menu * ....................................................................................................................... 168
Edit Menu *.................................................................................................................................. 169
Tools Menu * ............................................................................................................................... 170
View Menu* ................................................................................................................................. 171
Help Menu* ................................................................................................................................. 172

Patient Account Overview ..................................................................................................................... 173

Looking Up a Patient Account................................................................................................... 174
Creating a New Patient .............................................................................................................. 177
Patient Information Bar ............................................................................................................. 180
Schedule Tab ............................................................................................................................... 181
Demographics Tab * .................................................................................................................. 183
Insurance Demographics Tab ................................................................................................... 185
Custom Demographics Tab ....................................................................................................... 191
Flags/Notes Tab ......................................................................................................................... 192
Ledger Tab ................................................................................................................................... 195
Family Tab .................................................................................................................................... 199
Claims Tab ................................................................................................................................... 200
Statements Tab ........................................................................................................................... 202
New Charges Tab ........................................................................................................................ 203
Locked Tabs ................................................................................................................................. 205

Scheduling ............................................................................................................................................... 208

Changing Active Facility* ........................................................................................................... 209
Navigation .................................................................................................................................... 210
Views * ......................................................................................................................................... 212
Time Increments* ....................................................................................................................... 213
 Coloring* ...................................................................................................................................... 214
Export the Schedule * ................................................................................................................ 215
Schedule Reports*...................................................................................................................... 217
Searching for Available Appointments* .................................................................................. 218
Scheduling an Appointment ..................................................................................................... 221
Moving an Appointment* .......................................................................................................... 224
Deleting an Appointment* ........................................................................................................ 226
Changing Appointment Status* ............................................................................................... 227
Scheduling Repeat Appointments ............................................................................................ 228

Transaction Entry .................................................................................................................................. 231

Work Flow- Clinical Documentation to Creating Claim ......................................................... 232
Remove Order Entry Items from Billing Statement ............................................................... 243
Post a Superbill/Billing Statement from Patient Chart .......................................................... 245
Add Default Modifier to Specific SMARText Plan Items or Order Entry .............................249
More Visit Information Claim Level ......................................................................................... 254
More Info Ambulance-Claim Level * ........................................................................................ 256
More Info Contract-Claim Level * ............................................................................................. 258
More Info Dates-Claim Level * .................................................................................................. 260
More Info File Information-Claim Level * ................................................................................ 262
More Info Additional Claim Information (Box 19)-Claim Level............................................. 264
More Info Misc Details-Claim Notes ........................................................................................ 266
More Info Misc Details-Original Reference Number/ICN ...................................................... 268
More Info Misc Details-Lab CLIA number ............................................................................... 270
More Info Misc Details-EPSDT................................................................................................... 272
More Info Misc Details-Spinal Manipulation ........................................................................... 273
More Info Misc Details-Mammography * ................................................................................ 275
More Info Misc Details-Service Authorization Exemption * ................................................. 276
More Info Misc Details-Investigational Device * .................................................................... 278
More Info Misc Details-Medical Record Number * ................................................................ 280
More Info Misc Details-Anesthesia Related Procedures ....................................................... 282
More Info Misc Details-Condition Information * ................................................................... 284
More Info Misc Details-Demonstration Project ...................................................................... 286
 More Info Misc Details-Care Plan Oversight * ........................................................................ 288
More Info Patient Tab-Claim Level * ........................................................................................ 290
More Info Property and Casualty Tab-Claim Level ................................................................ 292
More Info Providers Tab-Claim Level ....................................................................................... 294
More Info Referral/Authorization-Claim Level * .................................................................... 296
More Info Supplemental Information Tab-Claim Level * ...................................................... 298
More Info Vision-Claim Level * ................................................................................................. 300
Additional Providers Tab-Charge Level ................................................................................... 302
More Visit Information Charge Level-Dialysis and DME ....................................................... 304
Additional Information-Charge Level Drug Tab ..................................................................... 306
Add Description to NOC codes ................................................................................................. 308
Additional Information Supporting Documentation-Charge Level * ..................................309
Edit/Update Charges * ............................................................................................................... 310
Apply Payment to Patient Account in New Charges Tab * ................................................... 314
Apply Co-Pay/Pre-Pay to Visit.................................................................................................... 320
Delete a Co-Pay from visit * ...................................................................................................... 324
Spread One Payment to Multiple Dependents ...................................................................... 325

Patient Ledger ......................................................................................................................................... 327

View Charges in Ledger ............................................................................................................. 328
Create a Claim from Ledger ...................................................................................................... 330
View Personal Payments in Ledger .......................................................................................... 332
View Insurance Payment Details from Ledger ....................................................................... 334
Print Receipt/Statement by date range from Ledger ............................................................ 336
Add Charges in Ledger ............................................................................................................... 338
Add Payment in Patient Ledger ................................................................................................ 341
Print Receipt for Payment in Ledger ........................................................................................ 343
Delete Personal Payment .......................................................................................................... 347
Delete an insurance payment from visit ................................................................................. 348
Add Adjustment in Ledger * ..................................................................................................... 354
Transfer Credit Balance ............................................................................................................ 357
Refund Overpayment ................................................................................................................. 361

Payer/Non-Patient Accounts ................................................................................................................. 365

 Add a Payer/Non-Patient Account * ........................................................................................ 366
Add Payer/Non-Patient Account in Demographics * ............................................................ 368
Add Dependents to Payer/Non-Patient Account * ................................................................ 371
Change Payer/Guarantor in Make Payment dialog * ............................................................ 372

Enter Charges .......................................................................................................................................... 374

Enter Charges Manually ............................................................................................................ 375
Home Visits .................................................................................................................................. 381
Hospital/Other Facility Charges ................................................................................................ 383

Enter Payments....................................................................................................................................... 385

Add Personal Payments from Billing Menu ............................................................................ 386

Claims Manager ...................................................................................................................................... 388

General Workflow: Claims Manager ........................................................................................ 389
Step by Step Work flow-Claims Manager ................................................................................ 391
Claims Search .............................................................................................................................. 396
Filtering Claims............................................................................................................................ 398
Pending Scrub ............................................................................................................................ 402
On Hold ........................................................................................................................................ 405
Ready To Submit ......................................................................................................................... 409
Scrubber Errors-How to Correct and Rebuild Claim ............................................................. 414
Submitted Tab ............................................................................................................................. 428
Resubmit Claims Rejected by Clearinghouse ........................................................................ 429
Resubmit Claims Rejected by Payer/Insurance Company .................................................... 433
Rebuild and Resubmit rejected file .......................................................................................... 437
Omit a paid charge when refiling from Insurance Payment Posting ..................................440
Secondary Claims ....................................................................................................................... 443
Tertiary Claims ............................................................................................................................ 446
All Tab ........................................................................................................................................... 449
Export the displayed grid from the All Tab in Claims Manager ........................................... 450

Posting Insurance Payments ................................................................................................................ 451

Create Manually Posted Insurance Payment ......................................................................... 452
Introduction to Insurance Payment Posting ........................................................................... 455
Insurance Recouped Payment .................................................................................................. 461
Auto Posting of Insurance Payments .................................................................................................. 468
Clearinghouse Account Settings .............................................................................................. 469
Security for Deleting Remits .................................................................................................... 472
Download and Select Remits ................................................................................................... 473
Edit Errors ................................................................................................................................... 476
Appeal/Resubmit a Denied Claim ........................................................................................... 485
Correction/Reversal of Payments ............................................................................................ 487

Reports ..................................................................................................................................................... 489

Accessing the Report List .......................................................................................................... 490
CPT® Master Report .................................................................................................................. 491
HCPCS Master Report ............................................................................................................... 493
ICD Master Report ..................................................................................................................... 495
Custom Charges Master Report .............................................................................................. 497
Adjustment Code Master Report ............................................................................................. 498
Fee Schedule Report ................................................................................................................. 499
Dependency Report .................................................................................................................. 500
Duplicate Report ......................................................................................................................... 501
Payment Summary Report ....................................................................................................... 502
Production By Diagnosis Report............................................................................................... 505
Production by Procedure Report (by Provider, Referring Provider and/or Facility) .........507
Statement Report ...................................................................................................................... 509
Credit Balance Report ............................................................................................................... 512
Missed Charges Report ............................................................................................................. 513
A/R Patient Report ..................................................................................................................... 516
A/R Carrier Report ...................................................................................................................... 518
Insurance Payment Analysis Report ........................................................................................ 524
End of Day Report ..................................................................................................................... 526
End of Month Report ................................................................................................................. 528
End of Year Report .................................................................................................................... 530
Custom Patient Reporting ......................................................................................................... 532

Security Manager/Audit Log ................................................................................................................. 541

Security Manager ........................................................................................................................ 542
PM Accessibility in Read Only Mode .................................................................................................... 545
Billing Reports, PM Tools, and Schedule ................................................................................. 546
Patient Account Tabs in Read Only .......................................................................................... 549
Exporting Contact List ................................................................................................................ 554
Extracting Insurance Companies.............................................................................................. 556
Exporting the Pharmacy List ..................................................................................................... 558
 Practice Management
Maintenance-Setup
Steps

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Important Setup Information for SOAPware
Practice Management

Before you begin

1. Contact Gateway EDI/TriZetto to begin Enrollment Process for submitting electronic claims.

2. Each Lesson should be completed in the order they are listed.

3. Current users of SOAPware that have already setup maintenance files should check each one
for additional billing information required to complete the setup.

4. Lessons in this Chapter containing information used on the CMS 1500 form will have the
block number from the CMS 1500 form shown in parentheses in the title.

5. If a section of Billing is inaccessible to a user, go to Security setup and check the Billing
section for the User. Security is accessible by logging in to SOAPware as Administrator.

Steps for setting up billing section of security can be found by clicking the link: Billing Security
Administration

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Getting Setup with Gateway EDI/TriZetto --
What to Expect

A brief description of the Provider Enrollment process.

(Color coding is used to denote participant roles and associated activities.)

Blue = Office

Teal = SOAPware

Black = TriZetto (Formerly known as Gateway EDI)

1. Office contacts TriZetto and signs a contract with TriZetto. (Note: This can happen before
installing SOAPware CS.)

2.. Office purchases and installs SOAPware Clinical Suite and signs up for the following training
sessions in exact order:

A. SOAPware Billing Setup

B. Transaction Entry and Work flow

C. Claims Processing

3. Office completes SOAPware master setup and begins practicing with the software in
preparation for live use. (Note: This step can be done in conjunction with the steps shown
below.)

4. TriZetto will contact the Office to complete a Provider Enrollment online. TriZetto will request
provider ID numbers and Master Insurance List (MIL) from Office; provider enrollment process
will begin within two days of signed contract.

5. TriZetto will generate the Enrollment packet, and the Office is given payer enrollment packet
to complete.

6. Office returns enrollment packet originals to TriZetto and production date is estimated based
upon projected payer approval time frames. (The Office can begin sending commercial
claims as each payer approval is granted, followed by governmental approvals.)

7. TriZetto verifies accuracy and forwards payer enrollment agreements to Carriers.

8. TriZetto contacts Carriers to obtain approval dates and records dates on addendum.

9. BCBS, Medicare, and Medicaid payer approvals are obtained. The training packet, which
includes a copy of the Providers Addendum (list of Provider ID numbers and payer approvals),
training CD, and MIL is sent to the Office.

10. TriZetto will contact the Office to schedule an "install appointment."

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HIGHLY RECOMMENDED: When the Office is ready to send the first live claim file, (with real
patient claims), SOAPware recommends that the office use a one-on-one training sessionto
provide assistance from SOAPware PM experts for this first filing. A SOAPware representative
will inspect the setup of the system to ensure everything looks correct, and will also assist the
Office with creating, scrubbing and troubleshooting the first claim file. SOAPware will also help
the office prepare for their setup call with TriZetto.

11. Office sends first file with live claims to TriZetto; file is tested (two day turnaround) before
TriZetto production begins.

12. Once the Office is installed and is sending claims, the Office will be contacted to schedule
initial report training.

13. Report training is completed.

14. Two weeks after production begins, a second report/web training is offered to the Office.

15. Two week-stage web training is completed.

16. Each office is assigned to a TriZetto New Accounts Rep who will monitor their claims for first
30-60 day period in production to ensure that the claims acceptance rate is above 85%.

17. Office may request additional phone training with TriZetto and/or call/email with Support
questions at any time.

18. TriZetto Customer Service will work with the Office to correct any errors on claims
submitted. TriZetto will always be available for any insurance questions, or other questions
about the reports or errors. Anything related to the generation of claims files or errors on the
software side will be handled by SOAPware Tech Support via www.soapware.com/ticket

NOTE: TriZetto can provide an estimated time frame for payer approval in your state.
PLEASE NOTE THAT TIME ESTIMATE BEGINS AFTER GATEWAY HAS RECEIVED YOUR
COMPLETED PROVIDER ENROLLMENT PAPERWORK.

To help expedite the setup process, Office should submit completed GEDI enrollment
forms as soon as possible.

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1. Manage Facilities (Block 24B and Block 32
and Statement 'Remit Payment To' Address)

Tools -> Manage Facilities

Facility Manager

Click the Create New Facility button.

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Setup Facility Details

Steps 1-5 identifies the Place of Service-Block 32

1. The commonly known Facility Name.

2. Legal Name of the facility. (block 32)

3. Physical address of the facility. (block 32)

4. City, State and Zip of the facility. You must include 9 digit Zip Code (Block 32)

5. Clinic Phone number.

6. NPI number assigned to the facility. (Block 32a)

7. Place of Service this selection specifies the code that is placed on claims (Block 24B)
identifying the type of facility.

8. Phone number for Billing Inquiries. This number will appear on Patient Statements,
Receipts, etc. for billing questions

9. Clinic CLIA number

10. State License Number

11. Press Update to save

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Home visits

When filing electronic claims for home visits, the 5010 format requires the patient's address as
the Place of service. Gateway EDI will plug the patient's address into the file when they see that
Place of Service code 12. Certain fields in the Facility Manager will have to be completed in
order for claims with home visits to pass the scrubbing process in the Claims Manager, even
though that information will not be included in the Electronic file. Simply typing 'Home' in the
required fields will allow claims to pass the scrubber.

1. Type Home or any name for the Facility. (This name will be listed in the drop down options
for facility selection).

2. Add Full Legal Name-Home

3. Add Street-Home

4. Enter City-Home

5. State-2 digit State abbreviation

6. Zip-5-9 digit zip code

7. Add Place of Service Home-12. This place of service will prompt Gateway EDI to add the
patient's address as the Place of Service to the claim file.

Remaining fields can be left blank.

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Add Return Address for Patient Statements/Remit Payment
To Address

Remit Payment To drop down list in the Statement Processing/Reports-Statements feature is

built by adding facilities/places of service to Manage Facilities. A separate facility can be added if
patient payments are to be sent to a post office or lock box, instead of the facility street
address. The next step shows an example of a printed statement when selecting the facility in
this step to remit payment to.

Note: If uploading electronic statement files to TriZetto, do not add a second address line in the
setup. The second line will not be pulled onto the statement in the print process, resulting in
mail returns if the second line is a necessary part of the mailing address.

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Remit To Facility-Statement Example

SOAPware Statement example

Facility Scheduler Tab

This is the location for the functional details of facilities in the Scheduler. Three main sections
here: Provider/Resource Management, Business Hours Management, and Facility Closings.

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Provider/Resource Management

In this area, should be a list of licensed providers for the site. If a provider is not already in this
list, the provider likely does not have a license to the Scheduler. This area is the location to
actually activate the providers/resources that will be using the Facility.

Business Hours Management

This section allows the working hours for the Provider/Resource to be set for the facility. If the
user has multiple facilities, among which a Providers/Resource travel, set the days and hours
that each will be working at each facility each week. These times that are set up will then be
available for scheduling for each Provider/Resource.

Facility Closings

Block off the days the clinic will not be open to see patients, or is closed entirely for holidays,
etc. Notice this section applies to the overall facility regardless of the provider. To set up a new
closing, Click the Add Closing button (with the green plus sign).

Facility Additional IDs Tab

Add ID numbers for Service Facility if Insurance company requires these in addition to Facility
NPI.

Note: Leave blank unless specific payers require this information.

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1. Click on Additional IDs tab.

2. Click Add icon (green plus) and select the insurance company from the list (Tools->Insurance
Companies)

3. Enter additional ID numbers.

4. Click Okay.

Repeat for additional Payers only if required.

5. Click to edit information.

6. Update

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2. Manage Groups/Billing Provider/ Pay To
Information (Block 33)

Tools menu -> Manage Groups

Manage Groups/Pay To Information

Click Add Group button to add a new Group/Pay to information.

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Add a Group

Enter Pay To/Billing Provider information for the Clinic. Creating a Group and associating a
provider with a Group, will cause the group information to default as the Provider's Pay To/
Billing Provider information, with each insurance company. If there a specific Insurance
Company that recognizes a different Pay To (or Group) for a particular Provider, the Group
information can be overridden in the Insurance Company dialog, as needed.

It is highly recommended that you set up your Groups after your Facilities, as it will greatly
streamline your setup of insurance companies later in the setup process. Note: It is
recommended that even if a Provider in the clinic is his/her own group, you can setup a single
provider as a group. The Group information will be the default Pay To Provider for the Provider.
All in all, a group can represent a single doctor or a group of doctors. It is really just who the
billing entity is for the Provider.

1. Contact Information: Enter the basic demographic information for the group. (Name,
Address and Phone) Include 9 digit Zip Code. Note: Address must be a street address. If Pay-To
address is a PO Box, etc., that information will be entered in section 5

2. Select Person or Non Person Entity type

3. ID Numbers: Enter the appropriate ID for the group.

Indicate either the EIN or social security number and add the number.

Enter Billing NPI number.

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4. Electronic: Select Mutually Defined - ZZ for the identifier for the Submitter ID. This ID is how
TriZetto identifies who is submitting the claim file. The ID field will be your 4 digit Site ID code
provided to you by TriZetto.

Enter Billing UPIN

Enter Billing State License

5. Pay-To Address: If payment is sent to an address other than the street address in Contact
Information, enter that address here. Include 9 digit Zip Code.

6. Paper Claims Legacy ID: (Optional) Select from the drop down to indicate a particular ID/
number, if your state requires a particular ID on every claim. For instance, if your state requires
the Taxonomy Code, you can enter the taxonomy identifier and code, and the information will
go in the legacy field of every claim, along with the NPI number. If you are not aware that a
particular ID is required for every claim for your state and payer base, other than the NPI, you
may be able to ignore this field.

7. Additional IDs: When setting up a brand new system, you can ignore the Insurance
Information section, initially. You will have to have your insurance companies setup first, before
you can really take advantage of this field. Once you have finished the setup process, and need
to add additional IDs required for a particular insurance company, you can change that
information here at the group level, if needed.

- To create an additional ID for a specific insurance company (for your group), you will click
the Create New button (with the green + sign). Search for the needed Insurance Company. Click
Select.

Electronic Claims: Add the additional ID required by the selected insurance company. If UPIN
or State License is required, you can click on the '+' to automatically add the ID from step 2.

Paper Claims: If a legacy ID is required in addition to referring provider NPI for paper claims,
use the drop down to select the legacy ID Qualifier followed by the number and then Click
Save.

8. Legal Authenticator: Complete this section for exporting QRDA 1 files. Otherwise, leave
blank.

9. Save.

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Newly added Group/Pay to Provider is added to the List. Most often there will only be a single
Provider or a single group listed here per clinic. A Group can contain one to many Providers, but
a Provider can only be associated with one group.

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3. Provider Manager (Blocks 24J and 31)

Tools -> Provider Manager

Enter/edit Rendering Provider information, Link Provider

to a Group. The Misc. tab will indicate to Payers that the
Selected Group is the Billing/Pay To Provider

1. Click to highlight and Select a Provider from the list. Providers should have been added when
SOAPware was initially installed and licenses were activated.

2. Enter the Provider's demographic information, including DEA, NPI and Taxonomy numbers.

3. Click the Misc Tab to link Provider to a specific Group.

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4. Group: Click the drop down arrow to display a list of available Groups. Select the appropriate
Group to associate to the Provider.

5. Superbill Task User*: The user selected in this drop down box will be the default user
assigned tasks from the selected physician when superbills are posted.

6. Checking this check box will allow a task to be auto-created and automatically assigned (to
the user selected in step 5 above) every time a superbill is posted, without requiring the
physician to manually click to add the task each time.

*Until a specific user is selected in this drop down box, the physician will be listed as the default
user for the task created when a superbill is posted. If a group of staff members within the
clinic process superbills, post charges and create claims for each provider, and there is not one
designated person who does this for a specific provider, a generic user can be set up under
Security to which to assign these tasks. Staff members needing to see the newly posted
superbills can then simply pull up the task list for the generic user created.

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Signature Tab (Block 31)

The clinician's signature will need to be captured via a signature capture device, scanning in a
hand written signature as a picture, or even using Microsoft Paint. Save the signature in a
picture format.

1. Click the Signature tab to insert a signature for the Provider

2. Click the Select Image button to capture the image. Find the location of the stored signature
image and Click on the image. Click Open.

3. The signature will appear within the box provided to preview. If the image needs to be
increased in size, click the + button to zoom in. If the image needs to be made smaller, click the
- sign to zoom out. When first displayed, the image will default to 100% of its actual size.

4. Click Update to save signature.

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4. Setting Default Claim Options/Base Export
Path

Setup how paper and electronic claims are exported from the system.

Tools -> Billing Maintenance -> Claims Options

Paper Claim Options

1. Default Printer: Select from the drop down to set the default printer when printing paper
claims.

2. Print Full CMS Form: If not using preprinted CMS 1500 forms, check Print Full CMS form to
print the entire claim form, including the red lines (must have color printer).

3. If using preprinted CMS 1500 forms, leave blank. Only text will print.

Please Note:

Most printer manufacturers install a PCL (Printer Command Language) driver by default. This
works well if printing documents in plain text with very little formatting, e.g., a word document
on a home computer. However with the complexity of forms and page layouts, selecting a PS
(Post Script) Print Driver instead of a PCL driver is recommended. This type of printer driver will

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handle the forms information most efficiently. SOAPware recommends using a business grade
printer, or a color laser jet printer, if selecting Print Full CMS Form.

Note: Selecting Print Full CMS Form will print the front of the CMS 1500 only, and will not
include the print on the back of the form. If a payer requires the standard front and back of the
CMS 1500 form, the claim will not be acceptable.

SOAPware does not support printers/scanners. Meaning that SOAPware does not install printer
drivers or set printer configurations. Please contact an IT person for additional hardware
matters. However, it is recommend to download the most recent printer drivers needed from
the manufacturer's website. It is usually a FREE DOWNLOAD. For any issues locating the driver
needed, please contact the manufacturer directly. Be cautious of downloading drives from an
alternate source other than the printer manufacturer.

Electronic Claim Options

1. Office Contact: Enter the name of a person within the office that clearinghouses can contact
if any issues arise.

2. Office Contact Phone: Contact Phone Number.

3. Office Contact Fax: Contact Fax Number.

4. Office Contact Email: Contact email address.

5. Output Path: Specify a file location to which a copy of the claim file will be saved. Note:
Make sure that the Save Local Copy box is checked to save your claim files to a local file. If more

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than one person in the office works with claims, it is recommended that this file path be stored
in a shared file/drive to allow any computer/user to access the claim files.

6. Auto Submit: If this box is checked, electronic claim files will be automatically uploaded to
the clinic's TriZetto site. You will have to have the correct information entered in the
Clearinghouse fields in the section below to ensure this will work correctly. Leave blank if
manually uploading claim files to TriZetto.

7. Save Local Copy: Check this box if you would like to store a copy of your claim files on a local
drive/file location. If you have Auto Submit and Save Local Copy checked, files will automatically
upload to TriZetto and you will have the claim file stored in a local drive, if the file needs to be
resubmitted.

1. Name: Indicates the name of the Clearinghouse.

2. Clearinghouse ID: If using TriZetto as your clearinghouse, enter the following number in this
field: 431420764

3. Receiver Qualifier: If using TriZetto as your clearinghouse, select Mutually Defined - ZZ

from the drop down list.

4. Receiver ID: If using TriZetto as your clearinghouse, enter the following number:
431420764000000

5. User Name: Enter the 4 digit site ID. This number is assigned by TriZetto.

6. Password: This password will be given to you by TriZetto. This password is necessary in order
to auto submit your claim files using their sftp site.

7. Server: If using TriZetto as your clearinghouse, enter the following: sftp.gatewayedi.com

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8. Testing: Only check this box if you are instructed by the receiver to do so. IMPORTANT:
TriZetto prefers live claims for testing. They will manually review the file and if it passes, they
will forward on to payers.

9. Accept Assignment: Check this box if you would like to default to Accept Assignment on all
claims. Options are Yes, No, or Lab Charges Only. This can be overridden at the claim level, if
needed.

Note: Selecting Lab Charges Only will apply to electronic claims only, and will not automatically
split lab charges from other charges for paper claims. If this option is selected and a paper
claim is printed, the Accept Assignment box will default to No.

10. Click Okay to save.

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5. PM Security Administration

Tools -> Security

Billing Security options have been added for Groups, Roles and Users. Each section will
have to be completed to allow Users access to assigned areas of Billing. Click on a specified
action to allow access (green check mark), deny access (red X) or default to the user's
individual privileges (leave blank ). Clicking on Allow All button will place a check in all
boxes and Clicking Deny All will place a red X in all boxes.

Users should be added to Security Prior to assigning privileges to Billing

Security changes made will not take effect until you log out. For additional documentation
on Security see online manual

Assign Billing Security Privileges to Roles

Access to specified sections can be manually allowed or denied for each user.

Another way to assign security privileges to users is to select or create a Role, assign
accessibility to the role, and then assign that Role to a User. This will eliminate the need to go
into every section of billing for each user and repeat the process.

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1. Click on the expander node next to Roles.

2. Click on the expander node next to one of the Roles in the list. (Screenshot shows Office
Manager selected)

Billing Access

3. Click the expander node next to Billing

4. Click on Billing

5. Click inside the box next to Accessible-This will allow any user assigned the Role of Office
Manager to access the Billing Menu option

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Adjustment Maintenance

6. Click the expander node next to Billing Maintenance

7. Double Click Adjustment Maintenance

8. Click on a specified action to allow access (green check mark), deny access (red X) or default
to the user's individual privileges (leave blank ). Clicking on Allow All button will place a check in
all boxes and Clicking on Deny All will place a red X in all boxes.

Add code-Allows user to add new adjustment codes in Adjustment Maintenance dialog

Edit code-Allows user to edit adjustment codes

Inactivate code-Allows user to mark an adjustment code Inactive.

Repeat Steps 7 and 8 for each section/action under Billing.

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Claim Adjustment Reason Maintenance

Edit Note-Allow adding or editing notes.

Update Codes-Allow access to update Reason Codes.

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Claims Options

Accept Assignment-Deny access or allow user to Accept Assignment on claims.

Auto Submit-Deny access or allow user to Auto Submit claims.

Clearinghouse ID-Deny access or allow user to edit Clearinghouse ID.

Clearinghouse Name-Deny access or allow user to edit Clearinghouse name.

Default Printer-Deny access or allow user to set default printer for claims.

Office Contact-Deny access or allow user to edit Office Contact.

Office Contact Phone-Deny access or allow user to edit Office Contact Phone.

Office Contact Fax-Deny access or allow user to edit Office Contact Fax.

Office Contact Email-Deny access or allow user to edit Office Contact Email.

Output Path-Deny access or allow user to change output path.

Password-Deny access or allow user to edit password.

Print Full CMS Form-Deny access or allow user to select to print Full CMS Form.

Receiver ID-Deny access or allow user to edit Receiver ID.

Receiver Qualifier-Deny access or allow user to edit Receiver Qualifier.

Save Local Copy-Deny access or allow user to Save Local Copy of claim files.

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Server-Deny access or allow user to edit Receiver Server.

Testing-Deny access or allow user to change claim file to Test file.

User Name-Deny access or allow user to edit User Name.

CPT Maintenance

Edit code-Deny access or allow user to Edit CPT Maintenance.

Inactivate code-Deny access or allow user to mark a CPT code Inactive.

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Custom Charges Maintenance

Add code-Deny access or allow user to add a Custom Charge code.

Edit code-Deny access or allow user to edit a Custom Charge code.

Inactivate code-Deny access or allow user to mark a Custom charge Inactive.

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Fee Schedule Maintenance

Accessible-Deny access or allow user access to the Fee Schedule menu option.

Add Fee Schedule-Deny access or allow user ability to Add a new Fee Schedule.

Edit Fee Schedule-Deny access or allow user ability to make edits within the Fee Schedules.

Inactivate Fee Schedule-Deny access or allow user the ability to make a Fee Schedule Inactive.

Add Code-Deny access or allow user the ability to Add a new Code from the HCPCS/CPT list to a
Fee Schedule.

Update Code Values-Deny access or allow user to Update Code amounts.

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HCPCS Maintenance

Edit code-Deny access or allow user to edit a HCPCS code in Maintenance.

Inactivate code-Deny access or allow user to change a HCPCS code to Inactive.

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ICD Maintenance

Edit code-Deny access or allow user to edit a Diagnosis code in ICD Maintenance.

Inactivate code-Deny access or allow user to change a Diagnosis code to Inactive.

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Claim Details

Edit Owner-Deny access or allow user to change Owner/Provider in Charge Details.

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Claims Manager

Accessible-Deny access or allow user access to the Claims Manager.

Scrub Claim-Deny access or allow user to scrub claims in the Claims Manager.

Edit Claim-Deny access or allow user to edit claims in the Claims Manager.

Change Claim Status-Deny access or allow user to change the claim status in the Claims
Manager.

Rebuild Claim-Deny access or allow user to Rebuild a claim in the Claims Manager.

Generate Electronic-Deny access or allow user to generate an electronic claims file in the
Claims Manager.

Submit Claims-Deny access or allow user to submit claims in the Claims Manager.

Print Claims-Deny access or allow user to print claim forms in the Claims Manager.

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Insurance Company Manager

Accessible-Allow/Deny user access to the Insurance Company Master files/Maintenance.

Add Insurance Company-Allow/Deny user to add new insurance companies.

Update Insurance Company-Allow/Deny user to update/save insurance companies.

Remove Insurance Company-Allow/Deny user to delete/remove an insurance company from

Insurance company Maintenance.

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Insurance Payment

Accessible-Deny access or allow user access to Insurance Payment Posting.

Create Payment-Deny access or allow user to Create a new Insurance Payment.

Save Claim-Deny access or allow user to apply a payment and save that payment in Insurance
Payment Posting.

Post Payment-Deny access or allow user to post a payment in Insurance Payment Posting.

Apply Payment Details-Deny access or allow user access to add/edit Payment/Remit details in
Insurance Payment dialog.

Print Payment-Deny access or allow user access to Print Payment in Insurance Payment dialog.

Change Next Action-Deny access or allow user to edit the Next Action option in Insurance
Payment dialog.

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Patient Account

Create New Chart/Patient Account-Deny access or allow user to create a new chart or patient
account.

Allow Check Self Pay-Deny access or allow user to check the box next to self pay option on
patient account information bar.

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Patient Claims

Add On Hold/Claim Notes-Deny access or allow user access to comment in the On Hold notes
section or the Claims Notes section in the Claims Tab.

Delete Claim-Deny access or allow user to remove/delete claims in the Claims Tab.

Edit Charge-Deny access or allow user to edit charges in the Claims Tab.

Edit More Info-Deny access or allow user to edit More Info dialog in the Claims Tab.

Select CMS1500-Deny access or allow user to select/view the CMS 1500 claim form from the
Claims Tab.

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Patient Family

Add Dependent-Deny access or allow user to add a dependent to a Patient Account Family tab.

Make Payment-Deny access or allow user to make a payment in the Patient Account Family
tab.

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Patient Ledger

Add Charge-Deny access or allow user to add a charge from Patient Ledger.

Edit Charge-Deny access or allow user to edit a charge from Patient Ledger.

Delete Charge-Deny access or allow user to delete a charge from Patient Ledger.

Add Adjustment-Deny access or allow user to apply an adjustment from Patient Ledger.

Edit Adjustment-Deny access or allow user to edit an adjustment from Patient Ledger.

Delete Adjustment-Deny access or allow user to delete an adjustment from Patient Ledger.

Add Payment-Deny access or allow user to add a payment from Patient Ledger.

Edit Payment-Deny access or allow user to edit a payment from Patient Ledger.

Delete Payment-Deny access or allow user to delete a payment from Patient Ledger.

Print Receipt-Deny access or allow user to print a receipt from Patient Ledger.

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Patient New Charges

Create Visit-

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Patient Schedule

Select a Scheduplate-Deny access or allow user access to scheduplates in Schedule tab.

Add a Referral-Deny access or allow user to add a referral to an appointment in Schedule tab.

Change the Status-Deny access or allow user to change an appointment status in Schedule
tab.

Set a Recurrence-Deny access or allow user to set a recurring appointment for a patient in
Schedule tab.

Add a Resource-Deny access or allow user to add a Resource in Schedule tab.

Delete an Appointment-Deny access or allow user to delete a scheduled appointment in

Schedule tab.

Edit Resource-Deny access or allow user to edit a resource in Schedule tab.

Enter Visit Comments-Deny access or allow user to enter visit comments in Schedule tab.

Check Insurance Verification-Deny access or allow user to check Insurance Verified in

Schedule tab.

Check in a Patient-Deny access or allow user to check in a patient in Schedule tab.

Take a Co-Pay-Deny access or allow user to take a co-pay in Schedule tab.

Create a New Visit-Deny access or allow user to create a new visit in Schedule tab.

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Print a Visit-Deny access or allow user to print a visit in Schedule tab.

Patient Statements

Open Statements-Deny access or allow user access to the Statements tab in Patient Account.

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Payer Account

Edit Demographics-Deny access or allow user to edit demographics in Payer/Non-Patient

Account.

Add Dependent-Deny access or allow user to add a dependent to a Payer/Non-Patient Account.

Delete Dependent-Deny access or allow user to delete a dependent in a Payer/Non-Patient

Account.

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Reports

CPT Master-Deny or allow user access to view/print the following reports from Billing ->
Reports menu

HCPCS Master

ICD Master

Custom Charge Master

Adjustment Master

Fee Schedule Report

Dependency Report

Duplicate Report

Payment Summary

Production By Procedure

Daily Receivable Summary

Statement Report

Outstanding Insurance

Credit Balance Report

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SOAPnote Audit Report

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6. CPT® Code Maintenance (Block 24D)

Located in the Tools menu -> Billing Maintenance ->CPT Maintenance

CPT® Code Maintenance

Maintain CPT codes. Assign NDC codes, CLIA numbers to CPT codes.

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CPT® Search by Code

Begin typing the CPT code in the CPT Look up and as you type, the codes and short descriptions
are listed.

CPT® Search by Description

Begin typing the CPT description in the Short Description Look up and as you type, the codes
and short descriptions are listed.

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Create a Custom CPT® Description

1. After selecting a CPT code, Place a check mark if you wish to use the custom descriptions
when searching for this code.

2. Begin typing a short description of your choice for this selected CPT code.

Note: Only complete this section if using descriptions other than the original short descriptions
for the CPT code.

Inactivate a CPT® code

To inactivate a CPT Code, place a check mark in the Inactive box. This will not completely
remove it from the data base, but will remove it from the list. See Hide/Show Inactive CPT
Codes.

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Hide/Show Inactive CPT® Codes

If a code had been Inactivated and is no longer going to be used, it can be hidden when viewing
the Code List by placing a check mark in the Hide Inactive Codes box.

View All CPT® Descriptions

To view all descriptions associated with CPT codes in the Code List, Click the radio button next
to Full View. Included in the list will be any Custom Short, Medium or Long descriptions if the
Use Custom Descriptions is selected when Creating a Custom CPT Description .

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CPT® Effective, Modified or Deactivation Date

1. Effective date column lists the year the code is in effect.

2. Modified Date column lists the date the code was last modified.

3. When a CPT code is discontinued Deactivation Date column will list the date it was
discontinued

Note: The dates are automatically inserted.

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7. HCPCS Maintenance (Block 24D)

Tools -> Billing Maintenance -> HCPCS Maintenance

HCPCS Maintenance

Maintain HCPCS codes. Assign NDC number to specific codes to automatically populate when
the code is charged.

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HCPCS Search by Code

Begin typing the HCPCS code in the HCPCS Look up and as you type, the codes and short
descriptions are listed.

HCPCS Search by Description

Begin typing the HCPCS description in the HCPCS Short Description Look up, and as you type,
the codes and short descriptions are listed.

Create a Custom HCPCS Description

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1. After selecting a HCPCS code, Place a check mark if you wish to Use the Custom Descriptions
when searching for this code.

2. Begin typing a short description of your choice for this selected HCPCS code.

Note: Only complete this section if using descriptions other than the original short descriptions
for the HCPCS code.

Inactivate a HCPCS code

To inactivate a HCPCS and delete it from the HCPCS Code List, Place a check mark in the Inactive
box. This will not completely remove it from the data base, but will hide it from view if there is
also a check mark in the Hide Inactive Codes option.

Assign NDC Number to specific HCPCS

1. If a HCPCS requires NDC numbers, type the numbers into the NDC Number field.

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2. Determine which codes have NDC numbers assigned to them at a glance. If there is a
number in the NDC column, that number will be included on paper and electronic claims
whenever that code is charged in a patient account.

View all HCPCS Descriptions

To view all descriptions associated with the HCPCS codes in the Code list, Click the radio button
next to Full View. Included in the list will be any Custom descriptions that have been assigned to
HCPCS codes.

HCPCS Add, Effective and Inactive Date

1. Add Date column lists the date the code is added to the data base.

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2. Effective Date lists the date the code is in effect.

3. Inactive Date lists the date a code is discontinued or deleted.

Hide/Show Inactive HCPCS Codes

If a code had been Inactivated and is no longer going to be used it can be removed from the
Code List by placing a check mark in the Hide Inactive Codes box.

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8. ICD Maintenance (Block 21)

Tools menu -> Billing Maintenance -> ICD Maintenance

ICD Maintenance

Using the radio button, select to search for ICD-9 or ICD-10 codes

ICD Search by code

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Select ICD Type to search by clicking on the ICD-9 or ICD-10 radio button. Begin typing the ICD
code in the ICD Look up and as you type, the codes and short descriptions are

listed.

ICD Search by description

Begin typing the ICD description in the Short Description lockup and as you type, the codes and
short

descriptions are listed.

Create a Custom ICD Description

1. After selecting a ICD code, Place a check mark if you wish to use the custom descriptions
when

searching for this code.

2. Begin typing a short description of your choice for this selected ICD code.

3. Click Save.

Note: Only complete this section if using descriptions other than the original short descriptions
for the

ICD code.

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Inactivate an ICD code

1. To inactivate a ICD code and delete it from the ICD Code List, Place a check mark in the
Inactive box.

2. Click Save.

Note: This will not completely remove it from the data base, but will hide it from view if there is
also a check mark in

the Hide Inactive Codes option.

ICD Effective, Modified and Deactivation Date

1. Effective date column lists the year the code is in effect.

2. Modified Date column lists the date the code was last modified.

3. When an ICD code is discontinued Deactivation Date column will list the date it was
discontinued.

Note: The dates are automatically inserted when modified or updated

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Hide/Show Inactive ICD Codes

If a code had been Inactivated and is no longer going to be used it can be removed from the
Code List

by placing a check mark in the Hide Inactive Codes box.

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9. Adjustment Maintenance *

Tools menu -> Billing Maintenance -> Adjustment Maintenance

Adjustment Maintenance

Add an Adjustment

1. Click on the Green + to open the New Code Section.

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2. Type Numeric and/or Alpha Code.

3. Give the new Code a Description.

4. Click the Add button. The new Custom Adjustment code is now added to the Code List.

Inactivate an Adjustment

To inactivate an Adjustment Code and delete it from the Code List, Place a check mark in the
Inactive box. This

will not completely remove it from the data base, but will hide it from view if there is also a
check mark in

the Hide Inactive Codes option.

Adjustment Search by Code

Begin typing the Custom Adjustment code in the Code Search and as you type, the codes and
short descriptions are

listed.

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Adjustment Search by Description

Begin typing the Adjustment description in the Short Description Search and as you type, the
codes and short

descriptions are listed.

Adjustment Effective, Modified or Deactivation Date

1. Effective date column lists the year the code is in effect.

2. Modified Date column lists the date the code was last modified.

3. When an Adjustment code is discontinued Deactivation Date column will list the date it was
discontinued.

Note: The dates are automatically inserted when modified or updated

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Hide/Show Inactive Adjustment Codes

If a code had been Inactivated and is no longer going to be used it can be removed from the
Code List

by placing a check mark in the Hide Inactive Codes box.

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10. Custom Charges Maintenance *

Tools menu -> Billing Maintenance -> Custom Charges Maintenance

Custom Charges Maintenance

Add a Custom Charge

1. Click the Green + to open the New Code dialog.

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1. Type new Code using numeric and/or alpha characters.

2. Type a Short Description for the code.

3. Type a Medium Description. (optional)

4. Type a Long Description. (optional)

5. Place a check mark in the box if item or service is taxable.

6. Click Add. New Custom Charge is now added to the Custom Charges List.

Inactivate a Custom Charge

1. To inactivate a Custom Code and delete it from the Code List, Place a check mark in the
Inactive box.

2. Click Save.

Note: This will not completely remove it from the data base, but will hide it from view if there is
also a check mark in

the Hide Inactive Codes option.

Custom Charge Search by Code

Begin typing the Custom Charge code in the Code Search and as you type, the codes and short
descriptions are

listed.

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Custom Charge Search by Description
Begin typing the Custom Charge description in the Short Description Search and as you type,
the codes and short

descriptions are listed.

Custom Charge Effective, Modified and Deactivation Date

1. Effective date column lists the year the code is in effect.

2. Modified Date column lists the date the code was last modified.

3. When a Custom Charge code is discontinued Deactivation Date column will list the date it was
discontinued.

Note: The dates are automatically inserted when the code is modified or updated.

Hide/Show inactive Custom Charges

If a code had been Inactivated and is no longer going to be used it can be removed from the
Code List

by placing a check mark in the Hide Inactive Codes box.

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11. Fee Schedule Maintenance (Block 24F) *

Tools menu -> Billing Maintenance -> Fee Schedule Maintenance

Fee Schedule Maintenance

This screen shot shows the Maintenance screen after building 4 different Fee Schedules. The
Default Fee Schedule amounts will have to be manually entered, and other Fee Schedules can
be based on those fees. Aetna and BCBS AR are based on 100% of the existing Default fee
schedule. Medicare is Based on 99% of the Default Fee Schedule for this example.

Adding Codes to a Fee Schedule

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Begin by adding Procedure and HCPCS codes to the Default Fee schedule.

1. Click on the Drop Down Arrow in the Name field to open the Name(s) of existing fee
schedules.

2. Double Click on Default in the Drop Down list.

3. Click the Add Code button to open the Code Search dialog.

4. Begin typing the code and as you type, a list of codes and the Description of the codes will
display.

5. When the correct CPT/HCPCS is in the Code and Description search field, Click the Okay
button.

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6. Click the Add Code button and repeat steps 4-5 until Code list is complete with Procedure
codes and HCPCS codes most commonly used in your practice

Create a Fee Schedule by Manual Entry

Use the newly created list of codes to add a charge for each code in the Default Fee Schedule.
Make sure the Manual Entry option is selected

1. With Default Fee Schedule still selected, Click the Update Codes button in the Fee Schedule
Details to open the Default Codes Update dialog.

2. Begin typing the code.

3. Type a charge amount for the code. The Default Amount field will automatically populate
when applied.

4. Click the Apply button.

5. Repeat steps 2-4 until all codes have a fee applied and Click the Close button.

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Note: Codes will have to be added to the Code List before they can be found in the Codes
Update dialog list.

Create a Fee Schedule Based on an Existing Schedule

A Fee Schedule can be automatically priced based on a percentage of any of the existing fee
schedules.

1. Add a new fee schedule and Type a name for the schedule.

2. Click Based On Existing.

3. Select Default from the Drop down list and Type a percentage of the Default fee schedule
amount to base the new fee schedule charge.

4. Click the Add button.

5. Scroll over to the column to verify the new Fee Schedule has been added to the Code List.

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Update fees for codes added using the Manual Entry Option

Update all Fee Schedules that have been added using the Manual Entry option. If a Fee
Schedule has been added using the Based on Existing option, those steps will follow.

1. With Default Fee Schedule selected, Click the Update Codes button in the Fee Schedule
Details to open the Default Codes Update dialog.

2. Begin typing the code.

3. Type the updated fee for the code. The Default Amount field will automatically update when
Applied and Closed.

4. Click the Apply button.

5. Repeat steps 2-4 until all codes have been updated, and then Click the Close button.

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Update codes with fees Based on Existing Fee Schedules

Prior to updating fees that have been added using Based on Existing Fee Schedule option, the
Based On Fee Schedule will have to be updated by following steps in the Update fees for
codes added using the Manual Entry Option section of this manual.

1. Scroll to find the fee schedule to update and then Click anywhere inside the column. In this
example Cigna is the fee schedule selected.

2. With the Fee Schedule in the Name field of the Details section, Click on the Preview button.
The fees will change according to the percentage amount.

3. Click on Save.

Searching for a fee by code

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Search all Fee Schedules for fees applied to codes by code number.

1. Click inside the Code Search field in the Code list section and begin typing the Code. The code
is highlighted for each fee schedule displaying the fee.

Hide Inactive Fee Schedule(s)

If a Fee Schedule has been Inactivated and is no longer going to be used it can be removed
from the Fee Schedule List

by placing a check mark in the Hide Inactive Items box.

Inactivating a Fee Schedule

1. To inactivate a Fee Schedule and delete it from the Fee Schedule List, Place a check mark in
the Inactive box.

2. Click Save.

Note: This will not completely remove it from the data base, but will hide it from view if there is
also a

check mark in the Hide Inactive Codes option.

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12. Remittance Advice Remark Codes

Located in the Tools menu -> Billing Maintenance ->Remark Code Maintenance

Remittance Advice Remark Code Maintenance

Maintain Remittance Advice Remark Codes

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Search by Code

Begin typing the code in the Code Look up and as you type, the codes and descriptions are
listed.

Search by Description

Begin typing the description in the Description Look up and as you type, the codes and
descriptions are listed.

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Add Note to Remark Codes

1. Add free text notes for internal comments, information, etc.

2. Click Save

Update Codes

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Reason codes are updated quarterly and users will be notified by SOAPware News Alert when
the codes are ready to update. Click the Update Codes button to download any new, deleted or
modified remark codes. A progress bar displays during the update process.

Hide/Show Inactive Remark Codes

If a code had been Inactivated and is no longer going to be used, it can be hidden when viewing
the Code List by placing a check mark in the Hide Inactive Codes box.

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Remark Code Effective, Modified or Deactivation Date

1. Effective date column lists the year the code is activated.

2. Modified Date column lists the date the code was last modified.

3. When a Remark code is discontinued Deactivation Date column will list the date it was
discontinued

Note: The dates are automatically inserted.

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13. Claim Adjustment Reason Codes

Located in the Tools menu -> Billing Maintenance ->Claim Adjustment Reason Maintenance

Claim Adjustment Reasons

Maintain Claim Adjustment Reasons Codes

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Search by Code

Begin typing the code in the Code Look up and as you type, the codes and descriptions are
listed.

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Search by Description

Begin typing the description in the Description Look up and as you type, the codes and
descriptions are listed.

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Add Note to Reason Codes

1. Add free text notes for internal comments, information, etc.

2. Click Save.

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Update Codes

Reason codes are updated quarterly and users will be notified by SOAPware News Alert when
the codes are ready to update. Click the Update Codes button to download any new, deleted or
modified remark codes. A progress bar displays during the update process.

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Hide/Show Inactive Codes

If a code had been Inactivated and is no longer going to be used, it can be hidden when viewing
the Code List by placing a check mark in the Hide Inactive Codes box.

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Reasons Code Effective, Modified or Deactivation Date

1. Effective date column lists the year the code is activated.

2. Modified Date column lists the date the code was last modified.

3. When a Reason code is discontinued, Deactivation Date column will list the date it was
discontinued

Note: The dates are automatically inserted.

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14. Insurance Company Manager

Tools -> Insurance Companies

Insurance Company Maintenance

Add new Insurance Companies, Edit existing Insurance Companies and Associate Providers to
Insurance Companies when submitting Insurance Claims.

1. Add a new Insurance Company.

2. Edit an existing Insurance Company.

3. Delete an Insurance Company.

4. Click inside the blank grid directly below column headers and begin typing to search by
name, City, State, etc.

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Add a New Insurance Company

1. Click Add New Company icon to open Edit Insurance Company dialog.

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2. Insurance Company Information: Add Insurance Company Name, mailing address, phone
and fax (optional)

NPI: National Plan Identifier/Pay-To Plan secondary Identification (Not Implemented. Leave
blank)

Type: This will be used to determine which box to check in Block 1. on the CMS 1500 form.

Eligibility ID Qualifier: This will identify the type of Receiver ID used for checking insurance
eligibility for patients. Only a small list of payers require this information. If not required by the
payer, leave blank. See step 13 for a list of payers requiring this information and adding the
required numbers. For payers requiring a Legacy ID , use the drop down option and select
‘Prior Identifier Number - Q4’ For payers requiring a Tax ID , select ‘Federal Taxpayer
Identification Number-TJ’. There are several other options in the drop down but they’re
currently not used. If the tax ID option is selected, the Receiver ID field is automatically
populated from the Group/Billing tax ID setup in Manage Groups. Add Eligibility ID in each
provider's billing information (See Step 6)

Group Provider (Legacy)- This is for information purposes only, any Legacy Fee Schedules
previously assigned to this Payer from earlier versions of SOAPware.

Fee Schedule (Legacy)- This is for information purposes only, any Legacy Fee Schedules
previously assigned to this Payer from earlier versions of SOAPware.

Fee Schedule- Use the Drop Down option to select a Fee Schedule from the list in Fee Schedule
Maintenance, or leave blank and charges will be the amount specified in the Default fee
schedule.

3. Check the box if applicable:

Active This box will default to active. Click to remove check mark if the Company becomes
inactive/no longer a valid Insurance Company.

Show Legacy ID If checked, the Legacy numbers entered in the Company information will be
included on all claims.

Default Electronic Check box if claims for this insurance company will go to the payer
electronically. If not checked, claims will be printed on a CMS 1500 form.

Note: If a Payer/Insurance Company normally accepts only paper claims, but claims will be sent
to clearinghouse to drop to paper and forward to the Payer, see next step for setup

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Electronic Insurance Submission Setup

4. Electronic Submission Info is inserted into the Electronic Insurance files to identify Payer,
Clearinghouse and Type of claim. To automatically populate some of this information, it is
recommended that the Claims Options section be completed prior to setting up the Insurance
companies.

Note: All fields are required when submitting electronic claims. Payer ID and Receiver ID.will be
provided by your Clearinghouse.

Payer Qualifier-Identifies type of Payer ID. (For most Payers, this will be ZZ-Mutually Defined)

Payer ID-Identifies the Payer of claims submitted for this Insurance Company. (TriZetto will
provide a list of your Payer IDs)

Note: All payers that will be sent electronically to TriZetto and then dropped to paper claim by
TriZetto, will be Payer ID 00010

Clearinghouse Name-Identifies the Clearinghouse (Info entered in Claims Options )

Clearinghouse ID-Identifies the Clearinghouse. (Info entered in Claims Options)

Type - Identifies the Type of Claim

Receiver Qualifier-Identies the Receiver ID. (Info entered in Claims Options)

Receiver ID-Identifies the Receiver of the Electronic file submitted. (Info entered in Claims
Options)

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Additional IDs

5. Enter additional ID numbers if necessary for the claim processor to identify the entity.

EIN: Payer EIN

Claim Office #: Payer Claim Office Number

NAIC Code: Payer National Association of Insurance Commissioners Code

Note: Most Payers will not require this info, and if it's added into the claim when not required,
the claim will deny.

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Rendering Provider Setup for Insurance Company

The information in Provider Setup section is required when filing claims, to identify the
Rendering Provider of Service, The Pay To/Billing Provider and other identifiers as required by
each payer.

6. Click the New Provider Mapping button (Green +) to add Providers of Service to this
Insurance Company.

7. Click to highlight a Provider and Click the Add button to open the Edit Billing Information
dialog.

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Edit Billing/Pay To Information for Payer-Additional IDs

Edit Billing Information dialog is used to identify Billing/Pay To information (top portion) and
Rendering Provider of service (bottom portion). This information will be included on all claims
submitted to this Insurance Company.

8. Insurance Payment To: This section is populated with data used when setting up Manage
Groups. Verify that this is the correct Pay To information. To edit information or add additional
IDs required for this payer, click to place a check mark in the Override Group Values box.

Note: If group information is edited for select payers, the check mark must remain in the
check box before changes will be included on claims.

9. Tax ID: If the Pay To provider is an individual and payments are reported to his Social
Security number, Click SSN and type social security (Block 25)

10. Legacy ID for paper claims: When filing paper claims, if payer requires a Billing legacy
number in addition to the Billing NPI, select legacy qualifier from the drop down list and enter
the legacy ID. If not required, leave blank.

11. Electronic Claims-Additional IDs: Add additional ID numbers, if required for selected
payer. Most payers will not require this information, and if it's added to this setup when not
required, the claim will reject.

12. Pay-To Address: If Pay-To address is different than Billing Provider street address, enter
that information here. If group does not have a P.O. or lock box, leave blank.

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13. Eligibility Request Info: Some payers require a provider/group Tax ID or a Legacy ID be
included when checking patient eligibility. If required by payer, you will get a message alerting
you when checking eligibility. Enter those IDs in the Receiver ID field. The ID qualifier must also
be completed if adding a Receiver ID. (See Eligibility ID Qualifier section in step 2.) If a payer
does not require one, this section should be left blank. Below is a list of some payers that do
require a Legacy ID or a Tax ID:

Payers requiring Legacy ID

• BCBS of Arkansas
• BCBS Michigan
• California Medicaid
• Maine Medicaid
• Mercy Health Plan of Arizona
• Ohio Medicaid
• University Family Care of Maricopa
• Wisconsin Medicaid Well Woman Program

Payers requiring Tax ID

• AFTRA
• American Postal Workers Union
• American Republic Insurance
• Amerigroup, Carefirst BCBS
• Cariten Healthcare
• Cariten Senior Healthcare
• Fallon Health Plan
• Keystone Mercy Health
• Kaiser Foundation Health Plan of Northwest
• Lovelace Health Plan
• Mayo Management Services
• Mega Life
• Midwest National Life
• Physicians Mutual Insurance
• Preferred Health Systems
• Significa Benefit Services
• Texas CHIP
• Trustmark Insurance
• Writers Guild

14. Select to check eligibility using the Group/Billing NPI or the Individual/Rendering provider ID,
depending on how the provider is enrolled with the payer to check eligibility.

15. Provider Information Paper Claims Only: If this payer requires a Rendering Provider
Legacy number in addition to the NPI, use the drop down arrow to select an identifier for the ID
and then type the ID into the field. (Block 24j)

16. Provider Information Electronic Claims Only: Enter any additional IDs to be included on
electronic claims, if required by this payer for Rendering Provider.

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17. Click Save.

Delete Insurance Company Tools -> Insurance

Companies

Tools -> Insurance Companies

1. Click on the Insurance Company to be deleted.

2. Click on the Remove Company Icon (Red X). You will be prompted to verify that you want to
remove the selected insurance company.

3. You will be prompted to verify that you want to remove the selected insurance company. Yes
to delete, No to cancel

Note: Users must have security privileges to delete an Insurance company. Insurance
demographics will have to be updated for any patients that have the deleted insurance
company in their information.

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15. Contacts/Referring Physicians (Block 17)

Tools -> Contacts

Additional information in SOAPedia

Add a new Contact/Referring Physician

1. Click Add New Contact button to create a new contact.

Note: To edit an existing Contact, double click on contact name to open Edit Contact
Information dialog. To delete a contact, click on the X next to contact name.

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1. Contact Information: Complete the Contact's basic demographic information.

2. Provider Information: Enter the contact/referring physician's NPI, UPIN, State License,
Specialty and Taxonomy code. To access the list of Taxonomy Codes, Click on the link
http://www.wpc-edi.com/content/view/793/1

3. Insurance Information: If additional IDs are needed for referrals when filing with certain
insurance companies, you can enter these IDs under Insurance Information. See below steps
for adding additional IDs.

Note: Most insurance companies require only the NPI number of the Referring Provider. If the
selected insurance company requires additional IDs, proceed to step 5. If not, the Contact setup
is complete for this Referring Provider.

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Referring Provider Additional IDs

3. Click the New Insurance Mapping button in the Insurance Information section to open the
Select Insurance Company dialog.

4. Begin typing the insurance company name in the field or click on a name from the list, and
click Select to open Edit Contact ID dialog.

Note: Most insurance companies require only the NPI number of the Referring Provider. If the
selected insurance company requires additional IDs, proceed to step 5. If not, the Contact setup
is complete for this Referring Provider.

Add additional IDs

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5. Electronic Claims: Add the additional ID required by the selected insurance company. If
UPIN or State License is required, you can click on the '+' to automatically add the ID from step
2.

6. Paper Claims: If a legacy ID is required in addition to referring provider NPI for paper claims,
use the drop down to select the legacy ID Qualifier followed by the number and then Click
Save.

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16. Flags/Notes Category Manager

Tools->Flags/Notes Category Manager

Add Notes and Flag patient accounts to alert user when scheduling or opening account.

Add Category

1. Click the Add Category button

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Add Category Name, Description and Access

2. Enter a Name for the Category.

3. Add Category Description.

4. To alert users with a pop up message when opening the patient account or chart, select
those individual users or click the Select All Users box to alert all users.

5. To alert users by assigned Roles to be alerted by a pop up message when opening the
patient account or chart, you can select that Role or click the Select All Roles box to alert all
users assigned to the selected Role.

6. To alert users by assigned Groups to be alerted by a pop up message when opening the
patient account or chart, you can select that Group or click the Select All Groups box to alert all
users assigned to the selected Group.

7. Click OK to save the Category.

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Edit or Remove Flags/Notes Category

8. Click to edit selected category

9. Click to remove selected category

10. Icons can be used to edit, delete or add categories.

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17. Custom Demographic Titles

Tools -> Custom Demographic Titles

The Custom Demographics section of the chart contains the information not otherwise
contained elsewhere in the demographics area, but which may be needed in most patients'
charts. Setting the custom demographics titles has changed slightly from SOAPware 4.x.
Custom field 13 is a note or memo text box; it is used to store more information than the other
fields.

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By editing custom demographics titles, you can add additional demographic fields to SOAPware,
with names that you assign them. To modify the custom demographics headings:

1. Click Tools-Custom Demographic Titles

2. You will see a list of custom demographics text boxes. The current name of each field is
shown in an edit box where you can enter the new name.

3. Fill in as many of these fields as you wish, then click Save to save your changes.

4. Click Save, then close SOAPware and restart to see the new titles displayed.

Note: This setting will change the titles of all custom demographic fields on all patients in the
database.

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18. Set Structured CPT Options

Tools -> Options -> Structured CPT

Select Structured CPT Sub items

1. Select Sub items for the Structured CPT items when inserted in the Plan Section of the SOAP
note for documenting Encounters/Visits.

2. To exclude a sub item, click the box to remove the check mark.

3. Screenshot of Structured SMARText item within the SOAP note using the select options
above.

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19. List Options

Tools menu -> List Options

Edit Billing Related Lists (As Needed)

Billing Payment Types: Create the types of payments that are accepted in the clinic. Add any as
needed.

Financial Classes: Edit/Add any needed Financial Classes to use for tracking patients.

Schedule Appointment Status: Create any desired appointment statuses to match your clinic
work flow.

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Billing Payment Types

1. Billing Payment Types: Create the types of payments that are accepted in the clinic. Add any
as needed.

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Financial Classes

Add financial classes as needed to track patients. Determine patient's financial class at a glance.

1. Double click on a financial class item in the list, or click the Create List Item button to add a
new financial class.
2. Click Back Color and select a preset color, or click More Colors and choose a custom color.
3. Click on the Fore Color drop down and select a preset color, or click More Colors and
choose a custom color. This will edit the font of the appointment. Preview shows how the
Patent's name will display in the Patient Account Information Bar when this financial class is
selected in Demographics tab.
4. Click Save when done.

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Schedule Appointment Status

Add any appointment statues that you would like to use when tracking patient appointments.

1. Double click on an appointment status item in the list, or click the Create List Item button to
add a new status.
2. Edit the Text as needed.
3. Click Back Color and select a preset color, or click More Colors and choose a custom color.
4. Click on the Fore Color drop down and select a preset color, or click More Colors and
choose a custom color. This will edit the font of the appointment.
5. Click Save when done.

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 Updating CPT®, HCPCS,
and ICD-9 codes

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Download New Quarterly/Annual Codes

This lesson details the steps to download the latest database of CPT® HCPCS and ICD
codes. When the steps below are followed and completed, any new or revised codes will be
downloaded to your local database.

Clinical Suite Only: New codes will be automatically added to the Billing Maintenance
databases when downloaded on the SMARText Cloud library. Revised codes will also be
updated in the Billing Maintenance databases. Deleted codes will have to be inactivated
manually.

Download New Codes in the SMARText Items Dialog

When in the Chart workspace, click on the Docutainers menu and select SMARText Items (or
hit F10 on your keyboard).

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Download ICD-10 Code Updates for 2017

1. Make sure you have the "Include Cloud Library Items" box checked.
2. Type !!!2017ICD10!!! into the Find field and click on the Search (magnifying glass) button.
Once the list appears, click on the first line shown. Press down the Shift key on your
keyboard.
3. Using your mouse scroll all the way to the bottom of the list and click on the last item shown
(while still having the Shift key held down). You should see every line item selected in blue.
4. Let up on the Shift key and click the downward facing blue arrow to download, as
indicated in the image above.

If you wish, you can also download the items one-by-one or use your Ctrl key to select only the
items you need.

- Deleted ICD-10 Codes for 2017

Several ICD-10 codes were removed from the SOAPware Cloud Library effective October 1,
2016. These codes should also be removed from your local Diagnosis code library. For a list of
the codes that were deleted effective October 1, 2016, please click here.

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Download all New CPT/HCPCS Codes from SMARText Cloud
Library for 2017

1. Make sure that you have the Include Cloud Library Items box checked.
2. Enter the keyword !!!2017!!! into the Find box.
3. Click the Search button to search the entire cloud library for the new codes.
4. Select the codes individually that you wish to download by highlighting them. *Note: If you
wish to download all new codes, highlight the first code in the list, then hold down your Shift
key and scroll to the bottom and highlight the last code in the list. This will highlight all
codes.
5. Click the Download button to update (as shown in the screenshot above). If you are
presented with a dialog box asking you if you wish to replace the existing item on the
database, click Yes to update the code.

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Update Revised Codes for 2017

To download/update all codes that have been changed:

1. Type !!needsupdated-2017!! into the Find field and click on the Search (magnifying glass)
button. Once the list appears, click on the first line shown. Press down the Shift key on your
keyboard.
2. Using your mouse scroll all the way to the bottom of the list and click on the last item shown
(while still having the Shift key held down). You should see every line item selected in blue.
3. Let up on the Shift key and click the downward facing blue arrow to download, as
indicated in the image above.

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Find Obsolete Codes for 2017

To find codes from the previous year that will no longer be accepted, type !!Obsolete-2017!!
into the Find Field and click on the Search (magnifying glass) button.

To update any of the previously used codes so they contain the obsolete keyword:

1. Click the first item you would like to update. Press and hold the Control key. Click on each of
the other items you would like to update.
2. Let up on the Control key and click the downward facing blue arrow to download, as
indicated in the image above.

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PM Code Database Update (Clinical Suite Only)

As soon as items are downloaded locally from the SMARText cloud library, the codes are
brought over and made available in the Billing Maintenance Code databases. The updated and/
or new codes will show a modified date as the date that the codes were downloaded and
brought over.

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Manually Remove Obsolete/Deleted codes from Billing
Maintenance

To manually remove the inactive/deleted codes from the Billing Maintenance, go to

Tools>Billing Maintenance and select the appropriate type of code-CPT, HCPCS or ICD
Maintenance. Place a check mark in the Inactive box and click Save. This will not remove the
codes completely, but will inactivate them and remove them from the active list.

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View Inactive/Deleted Codes in Billing Maintenance

To view the inactive/deleted codes in Billing Maintenance, go to Tools>Billing Maintenance

and select the appropriate type of code-CPT, HCPCS or ICD Maintenance. Remove the check
mark in the Hide Inactive Codes box. The list will include Inactive codes and the date the code
was modified.

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Deleted Code Procedure

When a CPT®, HCPCS or ICD-9 code is deleted or no longer a valid code, it will have to be
inactivated in Tools ->Billing Maintenance-> CPT Maintenance, HCPCS Maintenance and
ICD Maintenance for the PM Code Databases.

Inactivate a code

1. To inactivate a CPT Code, place a check mark in the Inactive box.

2. Click Save and repeat for each code on your list.

This will not completely remove it from the database, but will archive it and hide it from view.

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 Schedule Setup

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Activate Providers/Resources for a Facility

Steps on how to set scheduling defaults.

To access the Scheduler, go to the SOAPware menu and click Schedule.

Add a Facility

1. Click on the Tools menu.

2. Select Manage Facilities.

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Create a New Facility

Click the Create New Facility button, to setup a new facility. If you already have a facility setup,
skip this lesson.

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Scheduler

Click the Scheduler tab to setup the clinic's defaults.

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Opening the Provider's Schedule Defaults

1. Click on a provider name.

2. Click Edit.

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Making a Provider visible for the Clinic

1. Check the box next to Visible to activate the provider for the clinic.

2. Click OK.

Set Working Hours for the Provider

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1. Click on a day.

2. Click Edit.

3. Enter the Start and End Times.

4. Check to make the Provider Available for that day, in the select clinic, if needed.

5. Click OK.

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Provider/Resource Outlining

Setup outlining blocks for Providers and Resources to streamline their time in the office.

Open the Facility Manager

1. Click on the Tools menu.

2. Select Manage Facilities.

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Edit a Facility

1. Select a Facility.

2. Click the Edit Facility button.

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Select the Scheduler Tab

Click on the Scheduler Tab.

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Select a Provider or Resource to Edit

1. Click to select a Physician.

2. Click the Edit Provider Information button.

Note: This is the same process for Resources. To Edit a Resource, just click the tab Resources
and follow the above steps.

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Open Outlining

Click on the Outlining tab.

Create an Outline

Click the Add Outline

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Set the Outline

Outline Name: Name the type of appointments that should be scheduled in the designated
time slot. (This name will show up to the left of the Schedule with the associated color, for
schedulers to have a reference for the shading.)

Outline Color: Click the drop down and select a desired color to associate with the outline and
be shown on the Schedule.

Open Time: Set the time period for the outline.

Days: Check all days that this outline and selected time will be in effect.

Note: When scheduling, these outline blocks will not prevent any other appointments from
being scheduled during the block. They are merely referential for front office staff to aid as a
guide when scheduling. You can override, if needed.

Click OK when done. Repeat this for each outline for each Provider/Resource needed.

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Activate and view the Outline shading

1. Click on the Scheduler menu.

2. Click on Coloring.

3. Select Resources.

4. Click By Outlines.

You should then see the coloring change on the Schedule and see the outline blocks you set up.

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Provider/Resource Recurrences *

Setup recurring appointments for Providers and Resources to block out their schedule in
the intervals selected and not allow any other appointments to be scheduled.

Open the Facility Manager

1. Click on the Tools menu.

2. Select Manage Facilities.

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Edit a Facility

1. Select a Facility.

2. Click the Edit Facility button.

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Select the Scheduler Tab

Click on the Scheduler Tab.

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Select a Provider or Resource to Edit

1. Click to select a Physician.

2. Click the Edit Provider Information button.

Note: This is the same process for Resources. To Edit a Resource, just click the tab Resources
and follow the above steps.

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Open Recurrence Tab

Click on the Recurrence tab.

Create a Recurrence

Click the Add Recurrence.

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Setup the Recurrence.

Appointment Time: Set the Start Time and End Time for the specific recurrence.

Recurrence Pattern: You can set the intervals for the recurrence in this area. Below are the
option:

Daily: Setup the number of day intervals between occurrences or select to have the
appointment set for every weekday (Monday - Friday).

Weekly: Setup the number of week intervals between occurrences and check the specific days
of the week for the appointment to occur.

Monthly: Create the appointment on a particular day in month intervals (for example, every
5th day of every 3rd month, with the numbers being able to be customized by you). You can
also indicate a particular day of every month for the appointment to occur.

Yearly: Indicate every Month and Day for the year year or indicate the (first, second, third,
fourth or last) (day, weekday, weekend day, Sunday, Monday, Tuesday, Wednesday, Thursday,
Friday or Saturday) of a select Month.

Range of Recurrences: Set recurrence to start by a certain date and end either after a set
number of occurrences or by a set end date.

Comments: Name the recurrence in this field. The text entered here will be what is shown on
the Recurrence from the Schedule.

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Click Save. Repeat this for each recurrence needed for each Provider/Resource needed.

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Entering Facility Business Hours *

Set up the hours of operation for a facility.

Tools > Manage Facilities

Open the Facility

1. Select the Facility.

2. Click Edit.

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Scheduler

Click the Scheduler Tab.

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Edit Business Hours

1. Click on a day of the week.

Edit the day

1. Enter the Open Time of the clinic for the specific day.

2. Enter the Close Time of the clinic for the specific day.

3. Check the box next to Is Open if the facility will be open for business on the specified day of
the week.

4. Click OK to save.

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Update the Schedule

Click the Update button to update the Schedule.

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Creating Holidays/Closings *

Set up the days the facility will be closed.

Tools -> Manage Facilities

Open the facility.

1. Select the Facility.

2. Click Edit.

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Click Scheduler.

Click the Scheduler Tab.

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Create Facility Closings.

1. Click the Add Closing button.

Edit the day.

1. Enter the Name of the closing.

2. Enter the Start and End Dates of the closing.

3. Click OK to save.

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Update the Schedule.

Click the Update button to update the Schedule.

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Creating Scheduplates

Set up facility appointment types.

Scheduler -> Manage Scheduplates

Open the Scheduplate Manager.

1. Click on the Scheduler menu.

2. Select Manage Scheduplates.

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Add a Scheduplate.

Click the Create New Template button.

Enter Scheduplate information.

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1. Type in a Scheduplate Name and Abbreviation. The abbreviation will be shown on the
appointment at a glance, and the full scheduplate name will be helpful in selecting the correct
appointment type.

2. Select a Background color to show on the appointment.

3. Select a Foreground color for the text displayed. (After selecting the background and
foreground colors, the sample text will display what the appointment will look like on the
Schedule.)

Adding a Resource.

Click the Add Resource button.

Entering Resource time.

1. Select the Resource to whom the scheduplate will apply.

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2. Enter the number of minutes needed, prior to the patient being seen by the Provider/
Resource.

3. Enter the Duration of the appointment with the resource selected. This indicates the length
of time needed with the Resource.

4. The Start Cushion indicates the amount of time needed to prepare the patient for the
Provider/Resource's time. Enter the number of minutes by typing the number or clicking the
arrows.*

5. The End Cushion allows for any follow up work related to the appointment to be indicated
and accounted. Enter the number of minutes by typing the number or clicking the arrows.*

6. Click Save.

*Both the Start and the End Cushion are designed to help prepare for the full length of the
appointment. These fields are not necessary to create a scheduplate.

Update Scheduplates.

Click Update to save the scheduplate.

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Confirm Scheduled Appointments

Confirm Appointments from Scheduler

Select Patient

1. Select day using the calendar.

2. Double click on first patient to open account.

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Change Status

2. Call Patient using information in Patient Info Bar.

3. Change Status.

4. Use arrows to navigate to next or previous account in the schedule for selected day.

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Check Insurance Eligibility

Verify Insurance Eligibility from the patient account without exiting SOAPware. The sftp
password assigned during Trizetto/Gateway EDI enrollment must be added to
Clearinghouse Options (Steps 6 and 7) before this feature is automated

Check Insurance Eligibility

1. Open Patient Account and click on Insurance tab.

2. Click Check Eligibility Button to download patient insurance eligibility. Download will begin
automatically.

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Eligibility Warnings

Note: Medicare requires the Eligibility enrollment be renewed once a year. If your renewal is
due, you will receive a message when checking eligibility, and will not receive the eligibility
results until the enrollment renewal is performed. This can be updated on the TriZetto website.
Contact TriZetto Customer service for details.

Some payers require a legacy ID or Tax ID for checking eligibility. If this message pops up when
checking eligibility, please refer to step 13 in the Insurance Company Setup. Setup Insurance
Company

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 Menus and Toolbars

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SOAPware Menu *

Provide orientation and descriptions of the SOAPware menus.

SOAPware Menu

Displays the various workspaces in SOAPware.

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Billing Menu *

Provide a description and orientation of the Billing menu.

Billing Menu

Provides access to the most commonly used billing related activities.

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Scheduler Menu *

Provide a description an orientation of the Scheduler menu.

Scheduler Menu

Provides all of the Scheduling options and functionality needed for everyday use of the
Schedule.

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Edit Menu *

Provide a description of the Edit menu.

Edit Menu

Provides common editing tools.

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Tools Menu *

Provide a description and orientation of the Tools menu.

Tools Menu

Displays all of the master dialogs for setting up and customizing the SOAPware EMR and PMS.

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View Menu*

Provide a description of the View menu.

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Help Menu*

Provide a description and orientation of the Help menu.

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 Patient Account
Overview

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Looking Up a Patient Account

Learn how to search for an existing patient from the Chart Rack.

Pull up the Chart Rack

1. Click on the Billing menu.

2. Select Patient Account.

OR

Hit Ctl + A on the keyboard.

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Search for a Patient

1. Select the type of information to search. The options are Birth Date, Chart #, Name, Phone
# and Social Security #. The default option will be Name if nothing is selected.

2. Type in a name or number to search. If looking for a patient name, the system will search by
last name.

Chart rack is re-sizable. Hover over the edge or corner of the chart rack an drag your mouse to
re-size.

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Select the Patient.

When the patient needed has been pulled up, click on the name and hit Select; or hit Enter on
the keyboard.

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Creating a New Patient

How to create a new Patient Account.

Pull up the Chart Rack

1. Click on the Billing menu.

2. Select Patient Account.

OR

Hit Ctl + A on the keyboard.

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Create a New Patient

1. ALWAYS search the existing patient database for a patient BEFORE creating a new chart. This
helps prevent duplicate charts from being created.

2. Click the Create Chart button.

Enter First and Last Name.

1. Type in First and Last Name.

2. Click OK.

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Enter Demographics

Enter demographic information as provided.

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Patient Information Bar

Show the highlights of the Patient Account Information bar.

Patient Information At-A-Glance

Allows demographic and balance information to be easily seen without having to search.

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Schedule Tab

An overview of the patent's appointment details and history displayed on the Schedule tab.

Schedule Tab - Patient Appointments

1. Visit Detail: Summary of the overall length of the appointment

2. Scheduplate: The appointment type

3. Referral: Referring Provider

4. Facility: Place of Service

5. Status: The status of the patient visit within the clinic's work flow. (This list is completely
customizable by clinic.)

6. Recurrence: Sets recurrences of the visit, if needed.

7. Resources: Allows the scheduling of one to multiple resources for one visit

8. Visit Comments: Allows miscellaneous information and visit details to be entered and stored
for the visit.

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9. Verification: Indicates the date and user who verified the patient's insurance benefits and
eligibility.

Note: If appointment is moved, or rescheduled, the verification will have to be rechecked

10. Check-In: Allows a patient to be checked in with the click of a button.

11. Take Co-Pay: Allows a patient's co-pay to be taken at the beginning of the visit.

12. Visit List: Displays all of the patient's past, current and future appointments to be displayed
in one place, to help prevent double booking an appointment.

13. Today: Immediately selects the current day's visit.

14. Print Visit: Prints out the selected visit.

15. New Visit: Creates a new appointment for the patient.

Confirming Patient Appointments

By clicking the left and right arrows for a Resource, you can move to the previous or next
appointment for that resource to confirm appointments, without ever having to go out and
back in of each appointment on the Schedule.

When you want to mark a patient as Confirmed, you can select that status from the Status drop
down as shown above and make a note in the visit columns, if you like.

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 Demographics Tab *

Patient Demographic Information

Patient Demographics

1. Patient Name: Title, First Name, Middle Initial, Last Name, Suffix
2. SSN: Social Security Number
3. Birth Date: Date of Birth is entered manually, and Age is automatically calculated.
4. Marital Status
5. Sex: Patient gender
6. Race: Important for meaningful use guidelines
7. Ethnicity: Important for meaningful use guidelines
8. Language: Important for meaningful use guidelines
9. Patient Address
10. Contact Information: Phone and Email
11. Primary Provider: Provider within the Clinic that is treating the patient
12. Referring Provider: External provider referring patient to the clinic
13. Primary Care Physician
14. Preferred Pharmacy: Default pharmacy for sending the patients prescriptions
15. Guarantor: Person/Entity that is financially responsible for the patients account and balance
16. Financial Class: Indication of the patients financial position.

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17. Student Status: Indicates whether the student is an active student
18. Notes: Enter Internal notes pertaining to patient account
19. Print: Print patient demographics
20. Add Scan: Allows documents and forms to be scanned in as part of the patients
demographic profile. (The scanned document goes next to the General tab as a reference
document.)

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Insurance Demographics Tab

Add patient insurance information to account

Patient Insurance Policies

1. Primary Insurance Policy

2. Secondary Insurance Policy

3. Change filing status: Change the policy to Primary, Secondary, Tertiary or Inactivate a policy
by dropping down and selecting from the list.

4. View: Displays details of the patient's insurance policy

5. Scanned Insurance Card(s): Display as tabs on the Insurance tab for reference

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Adding a New Insurance Policy

Click the Add New Policy button

Primary Insurance Policy Information

Type-Select policy type from drop down list. (For informational purposes only)

Company-Select from list of insurance companies. This is the listing created when setting up
insurance companies from Tools->Insurance Companies.

Policy Information

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Policy # Type-Select Member ID-the subscriber’s identification number as assigned by the
payer. (For example, Insured’s ID, Subscriber’s ID, Health Insurance Claim Number (HIC), etc.) Or
select Unique Health ID-Required if the HIPAA Individual Patient Identifier is mandated use. If
not required, select Member ID.

Policy #-Enter insurance information exactly as shown on patient's insurance card.

Payment Options

Co-Pay or Co-Insurance amounts. The amount entered in the Co-Pay can be viewed at a glance
in the patients information bar for reference.Status-Primary, Secondary,Tertiary or Inactive.

Fee Schedule-Defaults to the fee schedule selected in the Insurance Company setup.

Insured Information

This section defaults to the patient information entered in the demographics tab. If the patient
is the insured, no changes are necessary. If the insured is someone other than the patient, you
will need to enter that info here. Please see next step.

Relation to Insured is other than Self

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If Relation to insured is changed, all data from patient demographics is cleared and information
can be manually added or can be added by clicking on the Select Guarantor icon, if the insured
has been added to Payer/Non-Patient Accounts. Complete policy information exactly as it
appears on insureds ID card.

Relation-Choose the patient's relationship to the insured from the drop down list.

Is Person- Select Yes if the insured is a person or No if the insured is a non-person entity.

Name-Enter the insured information in the fields provided.

Medicare Secondary Payer Insurance Policy Setup

If patient has Medicare as a secondary policy, the Medicare Secondary Type must be specified.
This option will be added to the Secondary Policy in patient Insurance demographics tab.

Click the drop down arrow to select the appropriate code/reason Medicare is not the primary
payer

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Check Insurance Eligibility

1. Click Check Eligibility Button to download patient insurance eligibility. Download will begin
automatically. (See next step for further information on eligibility issues).

2. Click to Add Scan. For information on adding scanners, please click on the link. Scanning Set-
Up & Options.

Medicare Eligibility

Note: Medicare requires the Eligibility enrollment be renewed once a year. If your renewal is
due, you will receive a message when checking eligibility, and will not receive the eligibility
results until the enrollment renewal is performed. This can be updated on the TriZetto website.
Contact TriZetto Customer service for details.

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Some payers require a legacy ID or Tax ID for checking eligibility. If this message pops up when
checking eligibility, please refer to step 13 in the Insurance Company Setup. Setup Insurance
Company

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Custom Demographics Tab

Custom Demographics

Customizable Demographics

Allows unique patient information to be tracked and entered based on the clinic's preferences.

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Flags/Notes Tab

Patient Account: Flags/Notes

Flags/Notes can also be created, edited and viewed within the Patient Account (for Clinical Suite
customers). To open the Patient Account, Click Billing > Patient Account.

Select the desired chart from the Chart Rack and click the Select button to open the Patient
Account.

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When the Patient Account is opened, the Patient Flag! alerts window will display for authorized
Users/Roles/Groups.

Click the X in the top right corner of the Patient Flags! window, or press the ESC key to close the
window.

1. Click the Flags/Notes tab to view the patient's list.

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2. The X button will allow you to remove/delete an existing flag/note from the patient's chart/
account.
3. The Pencil icon will allow you to edit the existing flag/note.
4. The Add Note button will allow the user to add a new flag/note to the patient's chart/
account.

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Ledger Tab

A summary of the patient's financial activity.

Ledger Tab - Financial Summary

Double click on any line item to drill down and get more details.

1. Add Adjustment: Add an adjustment for the individual patient account, as needed.

2. Add Charge: Add a non-billable charge to the patient. Charges entered from the ledger will
not be billed to insurance. (All charges to be submitted to Insurance must be processed in New
Charges.)

3. Add Payment: Add a Payment on the patient's account and apply across all charges.

4. Print Receipt: Print a patient receipt on demand

5. Create Claim: Create a Claim for visits posted prior to insurance information received. If a
visit has already had claims produced, see Claims tab.

Payment lines are displayed in green shading, Adjustment lines in blue.

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Charge Details

Double click any charge line item from the ledger to view the above details:

1. Dates of Service

2. Rendering Provider

3. Procedure Code

4. Units billed

5. Charge per Unit

6. Associated Diagnosis Codes

7. Associated Modifiers

8. Miscellaneous notes applying to the charge

9. Additional/Situational details relating to the procedure/charge at the charge level

(Loop 2400)

10. Payments or Adjustments that have been applied towards the charge.

11. Totals for the Charges, Personal or Insurance Payments, Adjustments and Related
Balance

12. Miscellaneous details pertaining to the charge

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Personal Payment Details

Double click any personal payment line item from the ledger to view the above details:

1. Payer: The person making the payment

2. Payment Details: Payment method and amount

3. Comments: Any miscellaneous information pertaining to the payment

4. Applied: Shows how the payment was applied across charges

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Adjustment Details

Double click any adjustment line item from the ledger to view the above details:

1. Date: Date the adjustment was entered

2. Adjustment code

3. Adjustment Description

4. Amount: Total adjustment amount applied to the patient's charges

5. Applied: The line item view of how the adjustment was applied to each charge.

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Family Tab

View account details for dependents linked to this account.

Family Balance

1. Guarantor: View the patient's guarantor, if different than patient.

2. Add Dependents: Add dependents under the active patient to be included in the patient's
family balance.

3. Make Payment: Apply payments to multiple dependent's accounts.

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Claims Tab

View claims associated to patient account. Edit and place claims On Hold for resubmission,
if needed from this location.

Patient Claims View

1. Claims: A listing of all patient claims On Hold, Pending Scrub, Submitted or Processed.

2. Claim Details: The claim details listed in this section represent the claim that is selected in
the Claims list above.

3. Double click the line item to further view or edit charge details. Â

4. View additional claim info.

5. Patients Primary insurance Policy.

6. Patients Secondary insurance Policy

7. Manually change the Status of a claim:

On Hold: If making changes, place a check mark in the On Hold box to move a claim to that
section in the Claims Manager. The claim must be Rebuilt to include changes on the the visit.

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Processed: If you want to make the balance on a claim the patients responsibility, place  a
check mark in Processed box.

If the claim is in the Claims Manager, this will also remove it from the Claims Manager. Â

If a claim is in the Processed status, but you want to resubmit to insurance and make it
Insurance pending status, you can click to take the check mark out and resubmit claim.

8. File With: Drop down to select Primary or Secondary policy. If a secondary claim has been
generated, and the primary payer has automatically forwarded it to the secondary payer,
remove the claim from the Claims Manager by selecting the Crossover option from the list.

9. Route: Select the routing to submit claim Paper or Electronic.

10. Paper Fill: Paper claims only allow four diagnosis codes per visit. If you have more than 4
codes per visit, you will need to make a selection if you want to use the primary 4 codes and use
the fewest pages or if you want to use more than four diagnosis codes and maintain order.

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Statements Tab

View any patient statements that have been sent out and reproduce with the click of a
button. Hold patient statements if you do not want a patient to receive monthly statements.

Statements Tab

1. Double click on any statement listed to see the original statement sent.
2. If you do not want a patient to receive a statement when processing bulk statements, place
a check mark in the box.
3. Click Yes to hold statements, click No and patient will continue receiving statements.

Note: If this patient is a Guarantor and has dependents listed in the Family tab, go to each
dependent's account and repeat steps 1-3 to hold those statements.

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New Charges Tab

Transaction entry for patient charges, payments and adjustments

New Charges Tab

1. Add Charges to patient account manually.

2. More Info allows additional details necessary for maximum payment on claims.

3. Edit Charge Details by double clicking the line item.

4. Apply Co-Pay if applicable. (Co-Pays can be taken in Scheduler tab when patient arrives for
visit.

5. Add Payment across charges for the active patient.

6. Add an Adjustment to visit.

7. Select Route to file claim-Paper or Electronic. (Defaults to option selected in Insurance

Company setup)

8. Any provider Follow-up Comments or instructions entered by the provider on the billing
statement will show up here.

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9. Enter any Claim Comments to the billing staff when processing claims.

10. Specify the Follow-up Action for the charges posted.

11. Paper Fill: Paper claims only allow for four diagnosis codes per visit. If you have more than
4 codes per visit, you will need to make a selection if you want to use the primary 4 codes and
use the fewest pages or if you want to use more than four diagnosis codes and maintain order.

12. Check box to Print a receipt after posting, or click to remove check mark if no receipt is
required.

13. Post charges, payments and adjustments to the patients ledger. If Submit to Insurance is
selected and there is an active insurance policy for the patient, a claim will be automatically
generated.

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Locked Tabs

Unlocking Patient Account Tabs

Locked Tabs due to Patient Account and Patient Chart In

Use at the same time

When a patient chart is open, and a user tries to access the same patient's account while the
chart is still open, certain tabs will be locked, as shown in the screen shot here. This will prevent
any updates or changes made by one user from getting overwritten by another user. To unlock
the tabs, the patient chart will have to be closed.

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Tab/View is currently locked by another user

If a patient account is in use, and another user accesses the same patient account, you will get
an alert that the view is currently locked by another user, and certain tabs will be locked, as
shown in this screen shot.

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Unlocking a Locked Tab

To unlock a locked tab, Click on the lock icon. Lock Information dialog will display the User,
Machine and Date/Time another user was viewing this account, causing it to lock. Verify that
nobody else is currently trying to edit/add information to the patient account, and click the
Unlock button. Removing a lock may cause data loss. You will be prompted to verify that you
want to unlock the view. Click Yes or No.

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 Scheduling

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Changing Active Facility*

Changing the active facility, if a multiple site practice.

Scheduler menu -> Active Facility

Open Active Facility

1. Click on the Scheduler menu.

2. Select Active Facility.

Select the new Active Facility

1. Click the drop down menu to find the correct facility.

2. Click Select.

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Navigation

Show the various ways to move around in the Schedule.

Move Quickly between Days, Weeks, Months

1. Move back 1 day.

2. Move back 1 week.

3. Move back 1 month.

4. Move ahead 1 day.

5. Move ahead 1 week.

6. Move ahead 1 month.

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Monthly Calendar

Click the arrows to move quickly to the date needed.

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Views *

View the Schedule as Days, Weeks, Months, or Work Weeks.

Scheduler menu -> View

Select the appropriate Schedule View.

Select the view that allows the easiest and clearest view of the Schedule.

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Time Increments*

Set the time increments shown on the Schedule.

Scheduler menu -> Time

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Coloring*

Set the coloring for Appointments and Resources.

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Export the Schedule *

Export the clinic schedule.

Export the Schedule.

1. Select the Scheduler menu.

2. Click on Exports.

3. Select Export Schedule.

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Select the Facilities/Resources to Export

1. Check the boxes of the Facilities to be shown.

2. Select the Resources whose schedules need to be exported.

3. Enter the range of dates to be exported.

4. Check to include the Visit Comments on the report as reference, if needed.

5. Click Select. The file will be exported as a CSV file.

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Schedule Reports*

Access reports on the Schedule data.

Scheduler -> Reports

Print various Schedule Reports

1. Go to the Scheduler menu.

2. Click on Reports.

3. Status Report: View a summary of patients based on their appointment status.

4. Patient Report: Provides both a summary of the specified patient's appointments, but also
provides a breakdown of the time spent at each status of each appointment.

5. Print Simple Schedule: Provides a summary of the appointments scheduled by Provider.

Indicates the Time, Patient Name, Phone Number, Scheduplate, Status and visit Comments.

6. Print Advanced Schedule: Provides a summary of appointments scheduled across Facilities

and Resources. Time, Patient Name, Phone Number, Scheduplate, Status and visit Comments.

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Searching for Available Appointments*

Find Open Appointments

Scheduler menu -> Find Open Appointment

Find Open Appointment

1. Click on the Scheduler menu.

2. Select Find Open Appointments.

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Enter Basic Search Criteria

1. Select the Resource needed from the drop down menu.

2. Enter the date ranges for the possible appointment.

3. Enter the Start and End Cushions that the appointment will need to have.

4. Enter the Duration for the appointment needed.

5. Click Search.

6. If a suitable appointment has been found, select the appointment time.

7. Click Select.

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Enter Advanced Search Criteria

1. Check the Facility needed for the appointment.

2. Enter the date ranges for the possible appointment.

3. Select a preferred Scheduplate that the appointment will need to have.

4. Add a Provider/Resource to search.

5. Click Search.

6. If a suitable appointment has been found, select the appointment time.

7. Click Select.

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Scheduling an Appointment

Schedule a Patient Appointment

Double Click on a Needed Time Slot

1. The Chart Rack will be pulled up.

2. Type in the Patient Name.

3. When the correct patient is pulled up, click Select or double click the patient.

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Schedule Tab - Patient Appointments

Enter the below Appointment information, as needed:

1. Visit Detail: Summary of the overall length of the appointment

2. Scheduplate: The appointment type

3. Referral: Referring Provider

4. Facility: Place of Service

5. Status: The status of the patient visit within the clinic's work flow. (This list is completely
customizable by clinic.)

6. Recurrence: Sets recurrences of the visit, if needed.

7. Resources: Allows the scheduling of one to multiple resources for one visit

8. Visit Comments: Allows miscellaneous information and visit details to be entered and stored
for the visit.

9. Verification: Indicates the date and user who verified the patient's insurance benefits and
eligibility.

Note: If appointment is moved, or rescheduled, the verification will have to be rechecked

10. Check-In: Allows a patient to be checked in with the click of a button.

11. Take Co-Pay: Allows a patient's co-pay to be taken at the beginning of the visit.

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12. Visit List: Displays all of the patient's past, current and future appointments to be displayed
in one place, to help prevent double booking an appointment.

13. Today: Immediately selects the current day's visit.

14. Print Visit: Prints out the selected visit.

15. New Visit: Creates a new appointment for the patient.

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Moving an Appointment*

Moving an Appointment to a different time slot

Dragging and Dropping

1. Click to select the appointment.

2. With the left mouse button held down, drag the appointment to the desired time slot. The
appointment should then be placed at a new time, and the patient's appointment details
updated automatically.

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Cutting and Pasting

1. Click to select the appointment.

2. Right click on the mouse and select Cut.

3. Click the desired time slot. Right click on the mouse and select Paste. The appointment
should then be placed at a new time, and the patient's appointment details updated
automatically.

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Deleting an Appointment*

Delete a patient appointment

Delete an Appointment

1. Click to select the appointment.

2. Right click the mouse and select Delete, or hit Delete on the keyboard. (A warning will pop
up to make sure the appointment is to be deleted. Click Yes to continue or No to cancel.)

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Changing Appointment Status*

Changing an Appointment Status

Right Click to Change Appointment Status

1. Click to select the appointment.

2. Select the needed status for the appointment. (The status should be updated automatically
on the Schedule and in the patient account.)

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Scheduling Repeat Appointments

Setting up repeat appointments.

Open the Patient Account

1. Double Click the appointment, needing to be repeated.

2. The Schedule Tab will open.

3. Click Recurrence.

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Recurrence Management

Click the Create Recurrence button.

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Set the Recurrence Pattern

1. Enter the appointment time.

2. Select whether the appointment will be on a Daily, Weekly, Monthly or Yearly basis.

3. Indicate how long the recurrence will take place. Select the Start Date, as well as either the
number of occurrences for the appointment or an End Date for the recurrence.

4. Click Save. The recurring appointments should be scheduled, and the patient account
updated automatically.

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 Transaction Entry

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Work Flow- Clinical Documentation to
Creating Claim

This lesson provides a recommended work flow for

• Documenting the clinical visit and entering diagnosis and charge (CPT/HCPCS) codes
• Creating a billing statement
• Posting the billing statement to front office/billers
• Processing charges
• Creating a claim, as needed.

Note: This lesson will not be covering all of the steps/processes needed to fully document a
clinical encounter in the SOAP note. The 2 sections in the SOAP Note that will be highlighted
will be the Assessment section and the Plan section. Diagnosis codes will be entered into
the Assessment section, and CPT/HCPCS codes will be entered into the Plan section. These
2 sections will be the two key areas that will transfer to the SW Practice Management
system and primarily affect the billing/claims.

Create the SOAP note

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With the patient's chart open, in the Charts workspace of SOAPware:

1. Click on the SOAP Notes tab,

2. Click the Create Docutainer button to create a new encounter.

Enter the Diagnosis Codes for the visit (Assessment

Section)

1. Click into the Assessment section to activate.

2. There are several methods in which to enter diagnosis codes into the Assessment section.
Some of the most common methods are:

- Selecting from the SMARText Quick Access list (This list will auto-populate with the most
common diagnosis codes used by the user logged into SOAPware. To access this window, click
on the Tools menu and click SMARText Quick Access. You can drag and drop that window to pin
to an area of the chart, if desired. The list will be begin populating as you begin to use the
system. The most commonly used codes will default towards the top.)

- Typing in a descriptive word and searching the database by hitting F10 on your
keyboard.

- Creating a custom pick list of your most common diagnosis codes.

- Defaulting the codes needed into a specific template that is associated with the type of
visit.

3. Enter the needed diagnosis codes into the Assessment Section. (Sample shown in above
image.)

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Enter the CPT/HCPCS Codes for the visit (Plan section)

1. Click into the Plan section to activate.

2. There are several methods in which to enter CPT/HCPCS codes into the Plan section. Some
of the most common methods are:

- Selecting from the SMARText Quick Access list (This list will auto-populate with the most
common CPT/HCPCS codes used by the user logged into SOAPware. To access this window, click
on the Tools menu and click SMARText Quick Access. You can drag and drop that window to pin
to an area of the chart, if desired.The list will be begin populating as you begin to use the
system. The most commonly used codes will default towards the top.)

- Typing in a descriptive word and searching the database by pressing Shift + F11 on
your keyboard.

- Creating a custom pick list of your most common CPT/HCPCS codes.

- Defaulting the codes needed into a specific template that is associated with the type of
visit.

3. Enter the needed CPT/HCPCS codes into the Plan Section. (Sample shown in above image.)

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Associate diagnosis codes with each CPT/HCPCS code

1. Click the Related Dxs sub-item for each procedure (CPT/HCPCS) code entered.
2. Check the applicable diagnosis codes that relate to the procedure, as shown in the
SMARText Quick Access window.
3. Optional: If you would like to specifically order the diagnosis codes at this point, click the cell
in the Order column to indicate the number order for each diagnosis. If the order is not
specifically selected in this column, the order will default to the order in which the diagnosis
codes are displayed in the Related Dxs subitem .
4. Optional: Click on the Modifiers sub-item to associate any modifiers as needed for the
procedure.

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Create the Billing Statement

Click the View Billing Statement button.

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Optional: Add Document task for Superbill Creation

When a billing statement is created, a window will pop up to associate a task with the new
billing statement created. If you have a user in your clinic that will post these at a later time, this
task can be assigned to them at this time, if desired. The purpose of this task box is to facilitate
a method of tracking superbills that have been created and ensure that they get posted and not
overlooked, resulting in lost revenue.

1. Click Add to add a task.

2. Click Cancel to continue without adding a task.

IMPORTANT: Once the Billing Statement has been posted, this task will automatically be
removed from the assigned user's task list.

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Review the Billing Statement

1. Procedure codes are listed.

2. Associated diagnosis descriptions are displayed next to the procedure code.
3. Associated modifiers are displayed next to the procedure code.
4. Optional: To prevent a procedure from being billed, you can click the X to the left to remove
the item from the billing statement.
5. Notes can be added to relay specific information pertaining to the visit to front office/billing
staff.
6. Click the Post Superbill button to post the billing statement.

Note: The Owner listed at the top of the billing statement will be the active provider in
SOAPware when the billing statement was created. The Facility that is displayed will be the
Active Facility on the Scheduler. Both Owner and Facility can be changed on the billing
statement as needed by clicking each drop down.

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Add Document Task for Superbill Posted

1. The User selected as the Superbill Task User in the Misc tab of Provider Manager will default
to be assigned this task when the billing statement is posted. If a user has not been set in
Provider Manager, the task will default to the active provider name, but can be changed
from this dialog as needed.)
2. Click Create to add the task for the specified user.

Note: If a user has been selected as Superbill Task User, this pop-up window will not be
displayed, but a task will automatically be added to that specified user's Task List.

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Processing the Posted Billing Statement

From any location in SOAPware, the Task list can be displayed by going to the SOAPware menu
and clicking Tasks. If front office staff are processing the posted billing statements/superbills
and checking out patients, the task list can be docked within the Scheduler to allow for easy
viewing of newly posted superbills/charges. If a back office billing staff member is processing
these superbills, they can simply pull up their task list wherever it is convenient for them within
SOAPware.

1. With the appropriate user selected at the top of the task list, the newly posted superbill will
be displayed in the list.
2. To process the visit, double click the line item to open the patient's New Charges tab.

If you would like for your Task list to display the description, patient name and time modified to
the left (as is shown in the above screen), drag and drop any of the columns around as needed.

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Process/Post Visit Charges and Create Claim (As Needed)

1. Double click on the charge to review for any changes.

2. To change claim level information, click on More Info and edit as needed.
3. If a co-pay was taken when the patient checked in, you can manually apply that co-pay to the
newly posted charges by clicking Apply Co-Pay and distributing as needed.
4. If you need to take a new payment, click Add Payment.
5. If the patient has an active insurance policy, the Follow-Up Action will default to Submit to
Insurance. If Submit to Insurance is selected as the Follow-Up Action, a claim will be
created when the visit is posted. If you do not want to create a claim, select Do Not
File. Patient Responsibility from the Follow Up Action drop down.
6. If there is a Primary Insurance policy for the patient, it will be listed here. The policy can be
changed/switched to another policy if needed by clicking the drop down and changing.
7. The route of the claim will be defaulted from the Default Electronic option that was selected
in the master Insurance Company setup. If Default Electronic was checked at the Insurance
Company level, electronic claim submission will default here. If Default electronic was NOT
checked, the default claim submission method will be paper. However, the claim route can
be changed from the default at any time.
8. If there is a Secondary Insurance policy for the patient, it will be listed here. The policy can
be changed/switched to another policy if needed by clicking the drop down and changing.
9. If submitting an electronic claim for Primary and Secondary, and the claim is being sent to
Gateway EDI, Gateway will send the secondary electronically, if possible. If you need to
generate a secondary claim directly out of SOAPware without going through TriZetto, the
claim will be sent as a paper claim.

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10. Post the visit to the ledger, when finalized. If a claim is generated, it can be viewed in the
patient's Claims tab, as well as in the SOAPware Claims Manager for scrubbing and further
processing. Once the visit has been posted, the Post Superbill task will be marked as
completed on the user's task list.

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Remove Order Entry Items from Billing
Statement

Order Entry and Immunization items that have been created in Order Manager will
automatically be placed in the Plan section of the SOAP note. Order Entry items that will not
be billed to the patient account or included on the claim for the current visit can be deleted
from the Billing Statement prior to posting Billing Statement to the billing account.

Remove Order Entry items from Billing Statement Prior to

Posting to Billing Account

1. Click on the X beside the Order Entry item you want to remove.

2. Click Yes to delete, No to cancel.

Repeat for each additional Order Entry item.

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3. Post Superbill to Billing account.

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Post a Superbill/Billing Statement from
Patient Chart

Post a Superbill/Billing Statement from Chart

1. An encounter/visit should already be documented in the SOAP note section of the Patient
Chart. The date of service will default to the encounter date unless you change the date in
the sub-items in the Structured Plan item.
2. Structured SMARText items must be used in the Plan and Assessment fields as shown in the
screenshot.
3. Click to view Billing Statement.
4. Click the Post Superbill icon.
5. Message will verify the superbill was successfully posted. Click OK.

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Open Patient Account in Billing using Task Manager

If a user has been assigned as the Superbill Task User (Step 5) in Provider Manager, that user
can access the list of Posted Superbills in the Task Manager to complete the billing work flow.

Go to SOAPware in the main menu and click on Tasks to open the Task Manager.

1. Use the drop down option to select user.

2. Use the drop down option to Show Assigned Tasks.
3. Double Click on Patient name to open the patient account.

You can also open the patient account from the chart rack. See next step.

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Open Patient Account in Billing using Chart Rack

Go to the Billing menu, then click Patient Account

1. Search Chart Rack for Patient Account. This example shows search by Name. Begin Typing
patient last name until the patient is visible in the list of patients.
2. Click to highlight Patient from the Chart Rack list and then Click Select. Patient account will
open.

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View Posted charges in New Charges Tab

Patient account will open to the New Charges Tab when a Superbill has been posted to Billing.
The upper section displays Patient demographic details and Personal/Family account balances.

The Center section lists Visit details as documented in the SOAP note section of the patient
chart. Charges are added for the Procedure Codes and can be edited by Double Clicking on the
line of the charge as described in the Edit/Update Charges lesson. Payments, Adjustments and
Additional Charges can be added manually, as needed.

The bottom section allows the user to:

1. Verify Insurance policy information for patient

2. Set follow up action for the claim. If insurance information is entered in the Patient
Demographics, this will default to Submit to Insurance.
3. Select Routing for claim-Paper or Electronic. This will default to option selected in the
Insurance Company setup for the selected insurance.
4. Check as Incomplete, allowing the user to close out of the account and come back later to
finish the check out process.
5. Print a Receipt when the visit is posted to the ledger.
6. Displays Doctor Comments typed in Billing Statement Tab.
7. Type free text Comments pertaining to the claim (informational only)
8. Add personal Payment to account
9. Post transactions to Patients Ledger

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Add Default Modifier to Specific SMARText
Plan Items or Order Entry

Modifiers can be assigned to specified codes by editing SMARText Items and inserting into
the Plan section of the SOAP note. This will not automatically add modifiers to codes
manually posted to New Charges Tab in the patient's billing account, but will add the
modifier if the shortcut is selected in the patient's chart.

Create SMARText Item to include Modifier

Open patient chart and select SOAP Notes tab

1. Insert SMARText Item into the Plan section within the SOAP Note.

2. Select modifier from the SMARText Quick Access list. This modifier will be included each time
the edited SMARText Item is inserted and posted to the patient's account.

3. Right Click on the description and select Manage SMARText Items>Create SMARText Item.
SMARText Designer will open.

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Create Shortcut, Description and Keywords for Item

4. Type Shortcut. This should be anything but an actual code or procedure name, and the
edited item can be selected by typing shortcut into the Plan section and pressing the space bar
on your keyboard.

5. Type Description. This Description will be listed in the SMARText Quick Access dialog for
identification.

6. Add as many applicable keywords as necessary to be used when searching for this edited
code.

7. Place a check mark to Display Header.

8. Click Save.

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Insert Edited Item into Plan Section using Shortcut + Space
Bar

9. Type Shortcut within the green brackets in the Plan section of the SOAP Note and press the
space bar on the keyboard.

10. The edited item will populate the Plan section with the new Modifier.

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Insert Edited Item into Plan Section using SMARText Quick
Access

11. Another option for inserting the edited item into the Plan Section is by double clicking on
the item listed in the SMARText Quick Access dialog, It will be listed using the Description
specified when creating the SMARText item. Relate Dxs as usual, create Billing Statement, and
Post to billing.

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Add Default Modifier to Order Entry Item from Order
Manager

Open patient chart, right click inside the brackets in Plan section of SOAP Note and select Order
Manager.

1. Click to Create New Order, locate Order Entry Item from the list, and click Select.

2. Click on the Order and the order will be display with sub items in the middle of the Order
Manager window.

3. Clicking on the Modifier sub item will open SMARText Quick Access dialog with a list of
Modifiers to select. Place a check mark in the box next to applicable Modifier, and right click.

4. Select Manage SMARText Items>Create SMARText Item.

Continue as shown in steps 4-8 in this lesson.

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More Visit Information Claim Level

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

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More Info Dialog

1. Type: If claim is related to an accident, place a check mark in box next to appropriate type of
accident. Electronic claims allow for up to two types, CMS 1500 paper claims allow for only one
type. If two boxes are checked for paper claims, the first type checked will print on claim. To
add Illness, Injury, or Pregnancy dates, please see Dates tab

2. Special Program Codes: Special Program-Code indicating the Special Program under which
the services rendered to the patient were performed

Delay Reason-Code indicating the reason a request was delayed

3. Primary: Release of Information Signature-Code indicating whether the provider has on file
a signed statement by the patient authorizing the release of medical data to other
organizations

Signature Executed for Patient-Code indicating how the patient or subscriber authorization
signatures were obtained and how they are being retained by the provider

4. Secondary: Release of Information Signature-Code indicating whether the provider has on

file a signed statement by the patient authorizing the release of medical data to other
organizations

Signature Executed for Patient-Code indicating how the patient or subscriber authorization
signatures were obtained and how they are being retained by the provider

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More Info Ambulance-Claim Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info for Ambulance Claims

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1. Pick Up Address: Enter full address

2. Drop Off Address: Enter full address

3. Ambulance Certification: Check Y or N if applicable.

More Info Ambulance (Continued)

4. Reason for Ambulance

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More Info Contract-Claim Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

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More Info Contract Type Information

Contract Type: Select Contract Type from drop down list and complete remaining fields, as
required by payer

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More Info Dates-Claim Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

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More Info

1. Illness, Injury or Pregnancy-Select date from drop down calendar for Accident, Onset of
Current illness or Last Menstrual period. This will automatically add the date for Current IIP

2. Patient Treatment Dates-Add dates as required by payers for your specialty

3. Hospital , Disability Dates-Select dates from drop down calendars for Workers Comp- Not
Work From, Disability-Disability From/To, Hospital admit and discharge-Hospital From/To
Care-Care From/To dates

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More Info File Information-Claim Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info File Information Tab

File Information:

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Fixed Format Information

Data in fixed format agreed upon by sender and receiver

At the time of publication of this implementation, K3 segments have

no specific use. The K3 segment is expected to be used only when

necessary to meet the unexpected data requirement of a legislative

authority.

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More Info Additional Claim Information (Box
19)-Claim Level

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

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More Info Misc Details-Additional Claim Information/
Reserved for Local Use (CMS 1500 Block 19)

Please refer to the most current instructions from the applicable public or private payer

regarding the use of this field. Some payers ask for certain identifiers in this field. If identifiers
are reported

in this field, enter the appropriate qualifiers describing the identifier. Do not enter a space,
hyphen, or other

separator between the qualifier code and the number.

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More Info Misc Details-Claim Notes

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

Claim Notes (Loops 2300 NTE01, NTE02)

To transmit information in a free-form format, if necessary, for comment or

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special instruction at the Claim Level.

Text: Type free text

Type: Select type of note from drop down list

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More Info Misc Details-Original Reference
Number/ICN

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information when needed
by payers to process claims correctly. Many specialties require specific dates, certification
numbers, etc. Additional information can be added by clicking on the appropriate tabs. The
information entered here will be at the claim level and will apply to all charges within the
claim. Unless this additional information is required by the payer for your specialty, leave
blank.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Original Reference Number/ICN

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If claim submission is Replacement claim, the ICN or Original reference number will be entered
here.

1. Number: Enter ICN/Original Reference Number as shown on explanation of benefits or

rejection report.

2. Policy ID: Select payer from drop down list. This list is pulled from the insurance policy
information in patient Insurance demographics.

Note: Claim Submission must be changed to the appropriate qualifier after it's rebuilt in Claims
Manager:

Original

Corrected (Institutional claims)

Replacement (Professional claims)

Void

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More Info Misc Details-Lab CLIA number

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Lab CLIA number (Loop 2300 REF02

with X4 Qualifier)

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Lab: The Lab will default to the Facility indicated in More Info-Facility if the lab codes have been
selected to add the CLIA number to the claims during the system setup. If visits/charges are
created for facilities outside the main facility (physical address indicated in Manage Groups),
those facilities will still have to be selected in Providers tab->Service Facility, and the lab will
need to be added in Misc Details tab, as in previous versions. The CLIA number will be pulled
from the Facility Manager.

If the Facility in More Info-Facility is changed after charges are applied, the Misc Details-Lab will
also have to be changed to the correct Lab facility.

1. Click on the drop down arrow.

2. Select the lab facility from the list.

3. Click Save.

Note: If posting charges from the Billing Statement section in the patient chart, the Facility can
be selected prior to posting to billing to populate the Misc Details-Lab section.

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More Info Misc Details-EPSDT

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-EPSDT

Code: If services are EPSDT related, use drop down list and select appropriate code for visit.

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More Info Misc Details-Spinal Manipulation

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Spinal Manipulation

Nature of Condition: Select condition from drop down list

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Description: Type description

Additional Description: Type additional description

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More Info Misc Details-Mammography *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Mammography

Certification Number: Type Mammography certification number

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More Info Misc Details-Service Authorization
Exemption *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Service Authorization Exemption

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Code: Enter Exemption code, if applicable.

Allowable values for this element are:

1 Immediate/Urgent Care

2 Services Rendered in a Retroactive Period

3 Emergency Care

4 Client has Temporary Medicaid

5 Request from County for Second Opinion to Determine if Recipient Can Work

6 Request for Override Pending

7 Special Handling

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More Info Misc Details-Investigational
Device *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Investigational Device

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Exemption Number: Enter exemption number.

Required when claim involves a Food and Drug Administration (FDA) assigned
investigational device exemption (IDE) number. When more than one IDE applies, they
must be split into separate claims.

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More Info Misc Details-Medical Record
Number *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Medical Record Number

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Number: Enter Medical Record number, if applicable.

Required when the provider needs to identify for future inquiries, the

actual medical record of the patient identified for this episode of care.

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More Info Misc Details-Anesthesia Related
Procedures

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Anesthesia Related Procedures

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Procedure 1: Click to open Select Charge dialog, and search for procedure code 1.

Procedure Code 2: Click to open Select Charge dialog, and search for procedure code 2.

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More Info Misc Details-Condition
Information *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Condition Information

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To supply information related to the delivery of health care

Required when condition information applies to the claim.

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More Info Misc Details-Demonstration
Project

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Demonstration Project

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Code qualifying the Reference Identification

Identifier: Enter Reference Identification Qualifier

Required when it is necessary to identify claims which are atypical in

ways such as content, purpose, and/or payment, as could be the case for

a demonstration or other special project, or a clinical trial.

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More Info Misc Details-Care Plan Oversight *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Misc Details-Care Plan Oversight

Number: Enter number

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Required when the physician is billing Medicare for Care Plan Oversight

(CPO).

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More Info Patient Tab-Claim Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Patient Tab

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Required when patient is known to be deceased and the date of death is available to the
provider billing system.

Date of Death: Enter date of death.

Required when claims involve Medicare Durable Medical Equipment Regional Carriers
Certificate of Medical Necessity (DMERC CMN)

Weight: Enter Patients weight.

Required when mandated by law. The determination of pregnancy shall be completed in

compliance with applicable law. The “Y” code indicates that the patient is pregnant.

Pregnant: Place a check mark in box if Yes.

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More Info Property and Casualty Tab-Claim
Level

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Property and Casualty Tab

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Claim Number: This is a property and casualty payer-assigned claim number. Providers receive
this number from the property and casualty payer during eligibility determinations or some
other communication with that payer.

Contact Name: Required when the Subscriber contact is a person other than the person
identified in the Subscriber Name.

Contact Phone: Required when this information is deemed necessary by the submitter.

Patient ID Type: Select Patient ID Type or Do not Send

Patient ID: Enter Patient ID

First Contact Date: This is the date the patient first consulted the service provider for this
condition. The date of first contact is the date the patient first consulted the provider by any
means. It is not necessarily the Initial Treatment Date.

Service Facility

Contact: Service Facility Contact Information

Phone: Service Facility Contact Phone

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More Info Providers Tab-Claim Level

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Providers Tab (Use only to override Default Info)

Use drop down options to overwrite existing Providers/Facilities at the Claim level.

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Rendering Provider-Select only if rendering provider is other than the provider indicated in the
Owner field at the top. Otherwise, leave blank.

Referring Provider-If a referring provider is set up in patient demographics, it will

automatically default to the Referring Provider tab.

Primary Care Provider-Select from the drop down list only if required by payer. Otherwise,
leave blank.

Service Facility-Select from drop down list only if services are performed in a facility other than
clinic's physical location indicated in Manage Groups setup.

Supervising Provider-Select from the drop down list only if required by patients insurance
company for the services provided. Otherwise, leave blank.

Accept Assignment-To change Assignment for current visit to something other than default
selected in Claims Options, select Yes, No, or Lab Charges Only from the drop down list.

Note: Selecting Lab Charges Only will apply to electronic claims only, and will not automatically
split lab charges from other charges for paper claims. If this option is selected and a paper
claim is printed, the Accept Assignment box will default to No.

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More Info Referral/Authorization-Claim
Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Referral/Prior Authorization Tab-Claim Level

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Referral Numbers-Required when a referral number is assigned by the payer or Utilization
Management Organization (UMO)

Prior Authorization-Required when an authorization number is assigned by the payer or UMO,

and the services on this claim were preauthorized.

1. Click and type referral number below the Number column header.

2. Click on the drop down arrow and select primary, secondary or tertiary policy associated with
the number.

3. Click Save.

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More Info Supplemental Information Tab-
Claim Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Supplemental Information Tab

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1. Control Number: Enter the control number

2. Report Type Code: Select from the drop down list.

3. Transmission Type: Select from the drop down list.

4. Click Save.

Required when there is a paper attachment following this claim.

OR

Required when attachments are sent electronically but are transmitted in another
functional group rather than by paper.

OR

Required when the provider deems it necessary to identify additional information that is
being held at the provider’s office and is available upon request by the payer (or
appropriate entity), but the information is not being submitted with the claim.

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More Info Vision-Claim Level *

Billing -> Patient Account -> New Charges Tab ->More Info

or

Billing->Patient Account->Claims tab->Select claim from list->More Info

The More Info dialog consists of several tabs for additional visit information needed by
payers to process claims. Many specialties require specific dates, certification numbers, etc.
Additional information can be added by clicking on the appropriate tabs. The information
entered here will be at the claim level and will apply to all charges within the claim. Unless
this additional information is required by the payer for your specialty, do not add any
additional information.

For charge level only information, you can add information in the Charge Details by double
clicking on a specific charge in New Charges tab or when editing charges in the patient
Claims tab.

More Info Vision Tab-Claim Level

Spectacle Lenses: Select Yes or No for applicable options.

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Spectacle Frames: Select Yes or No for applicable options.

Contact Lenses: Select Yes or No for applicable options.

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Additional Providers Tab-Charge Level

Billing -> Patient Account -> New Charges Tab ->Add Charge->Provider tab

or

Billing->Patient Account->Claims tab->Select claim from list->Double click on charge line to

open Charge Details

The Charge Details dialog consists of several tabs for additional charge information needed
by payers to process claims. Many specialties require specific dates, certification numbers,
etc. Additional charge information can be added by clicking on the appropriate tabs. The
information entered here will be at the charge level and will apply to selected charges for
the visit. Unless this additional information is required by the payer for your specialty, do
not add any additional information.

Charge Details Providers Tab (Use only to override Default

Info)

Use drop down options to override existing Providers at the Charge level, only if required by
payer. For Claim level provider information, see More Info Providers tab.

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Rendering Provider-Select only if rendering provider is other than the provider indicated in the
Owner field at the top. Otherwise, leave blank.

Referring Provider-Defaults to Referring Provider selected in Demographics tab, or use drop

down list to select from Contacts Manager.

Primary Care Provider-Defaults to PCP selected in Demographics tab, or use drop down list to
select, if required by payer.

Ordering Provider-Select from drop down list, if required by payer.

Supervising Provider-Select from drop down list, if required by payer.

Purchasing Provider-Select from drop down list, if required by payer.

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More Visit Information Charge Level-Dialysis
and DME

You can add additional information on a charge level by double clicking on the Procedure in
Claim Details. This will open the Charge Details dialog. some of the tabs are duplicates of
the ones seen in the More Info section, only at the charge level instead of the Claim level.
There are other tabs that are not found in the More Info dialog because they are only used
at the charge level. The tabs found in the charge level and in More Info should only be used
for one or the other, but not both. Those will most often be required at the claim level and
entered in the More Info section.

Additional charge Information Dialysis Related

1. Double Click on a charge line item to open Charge Details.

2. Click on tabs to add required information. These tabs will add information to each individual
charge.

3. Click Save.

For information that will apply to all charges within the claim, see More Info.

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Additional charge information DME (Durable Medical
Equipment) Related

1. Double Click on a charge line item to open Charge Details.

2. Click on tabs to add required information. These tabs will add information to each individual
charge.

3. Click Save.

For information that will apply to all charges within the claim, see More Info.

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Additional Information-Charge Level Drug
Tab

The NDC code can be added from the new charges tab, prior to posting a new visit to the
patient ledger, or added from the Claims tab when editing an existing claim/visit. Double
Click on a charge line item to open Charge Details, and enter additional information at the
charge level. Click on the Drug tab.

For information that will apply to all charges within the claim, see More Info.

Additional charge information Drug Related

Prescription Date-Required when a drug is billed for this line and a prescription was written
(or otherwise communicated by the prescriber if not written).

Drug Code-The NDC number is used for reporting prescribed drugs and biologics when
required by government regulation, or as deemed by the provider to enhance claim reporting
or

adjudication processes. The NDC number is reported in the LIN segment of Loop ID-2410 only.

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The FDA issues their numbers in either a 9 or 10 digit format. CMS requires the number to be
in the 11 digit format to be compliant with the new 5010 HIPAA standards. If the

code you find on your vial is shorter in length (i.e., 9 or 10 digits), add one or more zeros to the
code to create a longer code. A majority of them only have 10 digits.

Here is where to place the extra zero:

• If the NDC code is formatted as 4-4-2, then the extra 0 goes in first position. ####-####-##
becomes 0####-####-##

• If the NDC code is formatted as 5-3-2, then the extra 0 goes in the 6th position. #####-###-
## becomes #####0-###-##

• If the NDC code is formatted as 5-4-1, then the extra 0 goes in the 10th position. ######-
####-# becomes ######-####-0#

Drug Quantity-The dispensing quantity, based upon the unit of measure as defined by the
National Drug Code.

Drug Unit-Code specifying the units in which a value is being expressed, or manner in which a
measurement has been taken.

Prescription Number-Required when dispensing of the drug has been done with an assigned
prescription number.

OR

Required when the provided medication involves the compounding of two or more drugs being
reported and there is no prescription number.

1. In cases where a compound drug is being billed, the components of the compound will all
have the same prescription number. Payers receiving the claim can relate all the components
by matching the

prescription number.

2. For cases where the drug is provided without a prescription (for example, from a physician’s
office), the value provided in this segment is a “link sequence number”. The link sequence
number is a

provider assigned number that is unique to this claim. Its purpose is to enable the receiver to
piece together the components of the compound.

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Add Description to NOC codes

New changes have been added to the Charge level for documentation of NOC NDC Codes.

Additional Description for NOC Codes (Loop 2400 Segment

SV101-7)

Additional Description - The 5010 professional claim transaction (837P) requires that when a
non-specific or Not Otherwise Classified (NOC) procedure code is used (in the 2400/SV101-2),
then a description is required in the 2400/SV101-7.

Here’s the link to the NOC codes list from CMS: http://www.cms.gov/Medicare/Billing/
ElectronicBillingEDITrans/Downloads/CMSNOCCodes.zip

Here’s the main link--once here you can scroll to the bottom to get to the zip file that has all the
codes: http://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/FFSEditing.html

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Additional Information Supporting
Documentation-Charge Level *

Add Supporting Documentation to charge, if applicable

Additional charge information Supporting Documentation

Form Code-

Form Type Code-Required when adjudication is known to be impacted by one of the types

of supporting documentation (standardized paper forms) listed in LQ01.

1. Double Click on a charge line item to open Charge Details.

2. Click on tabs to add required information. These tabs will add information to each individual
charge.

3. Select from drop down listing.

4. Click Save.

For information that will apply to all charges within the claim, see More Info.

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Edit/Update Charges *

Update/Edit Charges

Edit/Update Charges

Charges can be Corrected/Edited from several different locations within SOAPware Billing. This
example shows a new charge in the New Charges Tab

1. Double Click anywhere on the line item to Open the Charge Details dialog.

2. Click inside any editable field and make changes/corrections, as needed.

3. Click on any of the tabs to edit information for the selected charge.

4. Click the Save button to save changes

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Edit Diagnosis Code

1. To add a Diagnosis Code, Click the Add Code button and begin Typing the ICD-9 code or Click
in the Description search field and begin typing description. Click the Select button

2. Delete a code from the list by Clicking the X in front of the ICD-9 code

3. Change order of importance for diagnosis codes by Clicking on the Up and Down arrows to
the right of the code description.

Edit Modifiers

1. To add a Modifier, Click the Add Code button and begin Typing the Modifier code or Click in
the Description search field and begin typing description.

2. Click the Select button

3. Delete a Modifier from the list by Clicking the X in front of the Modifier

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Edit Procedure Codes

1. To change or add, Click to open the Select Charge dialog

2. Begin Typing the CPT code or Click inside the Description field and begin Typing a description
for the Code and select code from the list

3. Click the Select button

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Addendum added to Patient Chart when Visits are Edited in
Billing

When a visit is created in a Patient Chart and has been edited in Billing, an Addendum is
created and attached to the SOAP note section of the Patient Chart with a description of the
changes

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Apply Payment to Patient Account in New
Charges Tab *

Apply Payment to New Charges

Apply Payment to charges in the New Charges Tab at Checkout. Payments should be applied
prior to Posting new Charges to ledger. Payments can be applied to current charges and/or
previous visits from the Make Payment dialog. After current Charges are edited and verified for
accuracy, Click the Add Payment button to open Make Payment dialog.

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Apply Payment to New Charge

Payer Details Payer defaults to the Guarantor information, and can be edited to select a
different payer

1. Payment Details Manual entry. Visits are inactivated until a Payment Amount is entered.
Once an amount is typed into the field, the payment can be applied to the charges

Select method to apply Payment:

2. Disburse To automatically apply this payment, Click the Disburse button. This will post to the
oldest outstanding charge in the patient account and continue with the next oldest account
until the entire Payment amount is exhausted.

3. Pay All To apply payment to all outstanding charges on account at one time, Click the Pay All
button.

4. Pay Individual line item Charge To apply payment to current charge or selected charges,
Click the Arrow in the Applied Column. The payment amount will automatically populate the
field, and can be edited to spread the payment to other charges

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Apply Payment to Visits/Charges

5. Apply Payment to Charges.This is a screenshot of one payment applied to two different

charges. By Clicking on the arrows in the applied column, $50 was applied to each charge. As
the Payment is applied, the Remaining amount is reduced by the applied amount.

To make corrections, the Clear Applied button will remove current payments applied and reset
the Amount.

6. Click Save to return to the New Charges Tab and Post transaction to patients Ledger

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Change Payer

In the Make Payment dialog, Payer will Default to the Patient information. If someone other
than the patient is remitting payment for the account, that information can be entered here for
tracking payments/refund information, etc.

To remove the payer and add a new one, Click the X next to the Payer name.

Create a New Payer

Click + to add a new Payer or ... to search existing list of Payer/Non Patient accounts

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New Payer details

Enter Payer details and then Click the Save button

Add Payment Details

1. Enter Payment details including Payment method and amount of payment. As you type the
payment amount, the lower portion listing the patient visits is activated.

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2. If a Guarantor/Payer payment is to be applied to additional patients in the system, Click the
Add Patient button or select a dependent from the Add Dependent list

3. Apply payment amount to several charges with one click. Payment will be applied to charges
beginning with the oldest outstanding balance

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Apply Co-Pay/Pre-Pay to Visit

Apply Co-Pay/Pre-Pay to visit at check in

When a Co-Pay is taken at the time a patient checks in, it will be saved in the Unapplied Co-Pay
section in the New Charges Tab. The Screen shot in this step is how the New Charges Tab will
appear at Checkout after the Visit has been posted to the New Charges tab from the Chart
section.

1. Click the Apply Co-Pay button to open Select Unapplied Co-Pay dialog.

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Select Unapplied Co-Pay

1. Select the Co-Pay from the list of Co-Pays to be applied, by clicking to highlight.

2. Click Ok

1. Select the visit to which the Co-Pay will be applied by clicking to highlight.

2. Double click on the arrow inside the Applied column to insert the co-pay amount. To undo
any applied amount before saving, simply double click again.

3. Click the Save button to save, or Cancel to exit without saving.

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If the Disburse button is clicked, the Co-Pay will be disbursed to the oldest visit with a balance.

New Charges dialog opens. The Unapplied Co-Pay is zero, the payment is applied to the new
charge and the Balance reflects the Payment.

4. Click the Post button to post transaction to the Patients Ledger.

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Delete Co-Pay From Patient Ledger

1. Click Ledger Tab.

2. Locate the payment line item and Click the X next to the Posted date.

3. Click Yes to put the payment back into the Co-Pay Unapplied Amount and allow the user to
reapply the Co-Pay to the correct visit/charge.

No will remove the payment from the system.

Cancel will cancel the delete process and return to Ledger details.

Note: Only users with security privileges will be allow to delete a payment.

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Delete a Co-Pay from visit *

1. Click Ledger Tab.

2. Locate the payment line item and Click the X next to the Posted date.

3. Click Yes to put the payment back into the Co-Pay Unapplied Amount and allow the user to
reapply the Co-Pay to the correct visit/charge.

4. Click No to remove the payment from the system.

5. Click Cancel to cancel the delete process and return to Ledger details.

Note: Only users with security privileges will be allow to delete a payment.

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Spread One Payment to Multiple
Dependents

Pay multiple patient/dependent accounts from an Active Patient Account in the Make
Payment dialog . Click on the Make Payment button found in several sections within the
Patient Account.

Select Dependents for Payment

If the Payer shown in the Payer Details section wants to pay additional patient/dependent
accounts within the system, those payments can be applied from one dependent's account in
the Make Payment dialog. If the Payer has dependents set up in the Family Tab, they will be in
the drop down Add Dependent list. If not, the patient can be accessed by Clicking the Add
Patient button and selecting a patient from the Chart Rack.

1. Click the Drop down option to select another patient/dependent from the Payer's Family Tab.

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Apply Payment to Dependent(s)

This example shows a $100.00 payment to be distributed between 2 Patient Accounts. The
active patient will be listed first and the additional dependent(s) will be listed next.

2. Click the arrow in the Applied column on the charge line item, and type payment amount for
the first patient listed.

3. Repeat for the next patient listed. As payments are applied, the Remaining amount is
reduced until all has been distributed and the remaining is zero. The Clear Applied button will
remove all applied amounts allowing corrections to be made prior to Saving the transaction.

4. Click Save.

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 Patient Ledger

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View Charges in Ledger

View charge details from Patient Account-Ledger tab

Select a Charge to View

1. Double click on a Charge to view charge details

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Charge Details

2. View details for selected claim including Service dates, codes used when charging the service,
description of code, Units or Minutes, and charge per Unit/Minute.

3. View additional claim information by clicking on the tabs.

4. Summary of Payments and Adjustments applied to selected Charge. You can view payment
details by double clicking on the payment line(s).

5. Override charge details (paper claims).

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Create a Claim from Ledger

If a claim has never been created for charges and insurance information is later added to
patient demographics, create a claim from the patient ledger to submit to the payer.

1. Open patient account and Click on the Ledger tab.

2. Click the Create Claim button to open Create Claim dialog.

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Select Charges to create a claim

3. Click to highlight and select the visit for which you wish to create a claim.

4. If More Info needed, click to add Claim information details.

5. Click the drop down arrow to open listing of all insurance companies associated with the
patient, including active or inactive policies. Click to highlight and select the payer responsible
for the selected visit.

6. The Routing for the claim will default to the option selected in Insurance Companies setup.
You can change that routing here if you prefer to print a paper claim instead of filing an
electronic claim.

7. If you wish to open the Claims Manager after creating claim, place a check in the box.

8. Click Create button.

Claim(s) will be transferred to the Claims Manager Pending Scrub section to be scrubbed and
then submitted to the payers.

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View Personal Payments in Ledger

View details of personal payments from the Patient Ledger

<strong>Select a Payment to View</strong>

Select a Payment to View" style="image-resolution: 96dpi" data-width="941" data-

height="898">

1. Hover the mouse over a Payment or Adjustment line for 2 seconds in the patient Ledger to
view where the payment or adjustment was applied.

2. Double click on a Payment line to view details of the transaction.

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Payment Detail

Payment Detail dialog opens showing all the details of the selected payment, including the
charge to which the payment was applied, payer and payment details.

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View Insurance Payment Details from
Ledger

View Insurance Payment Details from the Ledger tab

Double Click on the Insurance Payment line item.

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Insurance Payment details dialog opens listing Claims, Claim Details and Payment Details.
Sections can be hidden or expanded by clicking the arrows. Payment notes icons are
highlighted when a comment is added. Click to expand and view note. Remittance details are
displayed at the top.

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Print Receipt/Statement by date range from
Ledger

Print a Receipt/Statement from the Patient Ledger Tab. Select by date or a date range.
Select by Posted Date or Date of Service. This report can be Previewed and/or Printed

1. Click Print Receipt button.

Select Receipt dates

2. Select date/date range for receipt.

3. Select to report by Post Date or Date of Service.

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4. Print to open Print Preview.

Print Receipt/Statement

Click the printer icon to print or select one of the other options shown on the ribbon bar.

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Add Charges in Ledger

Add Custom Charges to patient account from within the Ledger Tab. Select Patient Account
from Chart Rack and Click on the Ledger Tab

Note: Charges entered from the Ledger Tab will not be sent to the Claims Manager and
submitted to Insurance. This option is for miscellaneous items unrelated to CPT or HCPCS
charges

Add Charges in Ledger Tab

1. Click the Add Charge button. Select Charge dialog opens

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2. Begin Typing Charge Code or Search by Code number or Description. Search includes Custom
Charge Maintenance codes and CPT/HCPCS codes and must be included in the Default Fee
Schedule to populate the Charge amount.

3. Click the Select button.

Custom Charge Details

Charge Details window opens for editing. If the Charge amount is blank, the code has not been
setup in the default fee schedule. You can manually add the amount by typing the charge
amount. Click Save

View Custom Code in Ledger

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Charge is added to account ledger.

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Add Payment in Patient Ledger

Apply payment within Patient Ledger

Apply Payment to Patient Ledger

1. Click the Add Payment button to open Make Payment dialog.

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Add Payment Details

2. Type payment details.

3. Apply payment to charges:

Disburse: Will auto disburse payment (older to most current charges).

Pay all: Will auto apply Amount to all outstanding charges.

Or you can manually apply payment to selected charge by clicking on the arrow in the Applied
column (Red Arrow).

When entire amount is applied, Remaining balance will be $0.00

4. If receipt is requested place a check mark in the box next to Print Receipt and Click Save.

If errors are made, click Clear Applied to remove applied amount(s).

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Print Receipt for Payment in Ledger

Apply a personal payment from patient ledger and print a receipt. Receipt for payment now
showing more details. For this lesson, we will apply a payment made by a Payer/Non-
Patient to three separate dependents accounts from one dependent account.

Apply Payment to multiple dependents from ledger

1. Click on Ledger tab in patient account.

2. Click on Add Payment.

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Select multiple dependent accounts

3. Verify payer name.

4. Enter payment details.

5. Click Add Patient. Select dependent from chart rack and repeat for each dependent.

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Apply payment to each dependent visit

6. Click inside the grid in Applied column to apply payment to charge and repeat for each
dependent account.

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Print a receipt for personal payment made in patient
ledger

When a payment is applied to an account from the ledger, the Print Receipt after Saving will be
checked by default. If a printed receipt is not necessary, click inside the box and leave blank.

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Delete Personal Payment

Patient Account -> Ledger Tab

Open the Patient Ledger Tab and click the X on the payment line. You will be required to
Confirm Delete. Yes will Delete and No will Cancel.

Note: Users must have security privileges to delete a payment.

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Delete an insurance payment from visit

Delete and reapply a previously posted insurance payment from the patient's ledger

Deleting an insurance payment from a patient visit

Prior to deleting payment, double click on the payment line and make note of the Claim
number for reference.

1. Click the X next to the Posted date for the payment that will be deleted.

2. Click Yes to continue deleting the payment, or No to cancel.

3. Close the patient account, or press ESC key to exit.

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Go to Billing->Post Insurance Payments.

4. Click Create/Load Payment to view list of open remits.

Select Remit to edit

5. Click on the remit/post date containing the deleted payment.

6. Click Select to open the remit.

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Select Claim to edit

Note the Check amount and Remaining balance is showing as it was prior to Posting remit to
patient ledger.

7. Click Select Patient button.

8. Enter Claim number.

9. Click Select to open payment details.

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View Payment details

View details of previously applied payment.

10. Click to highlight Payment Amount and hit the delete key on your keyboard.

11. Click to highlight Provider Paid amount and hit the delete key on your keyboard.

12. Select Next Action for the claim. Note: If the claim was set to patient responsibility from
previous posting, the claim status will remain as Processed, and patient will receive a statement
on this charge, if there is a balance due. To prevent a statement from generating, you will need
to select Refile, Wait for Additional Payment, File Secondary-Paper or Crossover-Pending
Secondary. This will change the claim status to Submitted, Pending Scrub or On Hold.

13. Click Save Claim.

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Select correct Patient/Claim number to reapply payment

14.Note the remaining balance is the amount that was deleted.

15. Enter Claim/Patient account to reapply payment.

16. Click the Select button.

Reapply payment to correct claim

17. Enter payment amount.

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18. Enter provider paid amount.

19. Select Next Action for the claim.

20. Save Claim.

Print/Export Payment report and re post remit

Note the Remaining Balance is zero and the Post Payment button is activated for re posting.
Also note that the original post date will remain and this is the date that will be reflected on the
corrected patient's payment ledger

21. Print or Export and Save payment posting report.

22. Click Post Payment.

23. Click OK.

Until the remit is re posted, payments for each claim included in the remit will not appear on
the patient ledger as paid, and patient account details cannot be viewed from ledger.

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Add Adjustment in Ledger *

Located in Billing -> Patient Account -> Ledger Tab

Add an Adjustment to Patient Account from the Ledger

Select Patient from the Chart Rack and Click on the Ledger Tab to View Account Details

1. Click the Add Adjustment button to Open the Select Adjustment dialog

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Select Adjustment Code

2. Access the list of Adjustment Codes and descriptions in Adjustment Maintenance by Clicking
the Code or Description drop down arrow

3. Click to Select the applicable Adjustment in the list. This will activate the account details in the
lower section

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Apply Adjustment to Charge

4. Click the arrow on the line item to select charge to apply adjustment. The amount will default
to the charge balance amount, but can be edited

5. Type Adjustment amount in field.

6. Click the Okay button

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Transfer Credit Balance

Transfer a credit on one visit and apply to another visit.

Note: Adjustment codes will have to be set up in Adjustment Maintenance beforehand

Adjust Credit

1. Open the Ledger tab.

2. Select the visit with a credit and click to highlight.
3. Click on the Add Adjustment button.

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4. Type adjustment code .

5. Click the arrow on the line with the credit and type '-' and then the amount to transfer. In our
example we typed -2.00

The total amount in the Applied column will display in parentheses (2.00)

6. Click Save.

7. Click Add Adjustment button.

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Apply Credit

8. Select adjustment code.

9. Click arrow in Applied column on charge to apply credit, and type amount.

10. Save transaction.

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View Ledger after Transfer

View visits showing credit and debit transaction on visits, and adjustment details.

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Refund Overpayment

Refund to Patient/Insurance

Patient Overpayment

1. Open patient account.

2. Click the Ledger tab to view credit.

3. Click th Add Adjustment button

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Select Adjustment Type

1. Click on the drop down for list of adjustments.

2. Select Refund from adjustment list.

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Apply Refund Amount

1. Double click to apply the amount of the refund. Amount will default to the amount of the

overpayment. You can also click inside the grid and manually type the refund amount. (Refund
amount will be in parentheses) You will need to press the "-"/dash key before entering the
amount manually to add the amount back to the account. For example the amount as shown in
the screenshot would be entered as -65.00.

2. Click Save.

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Ledger view after refund

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 Payer/Non-Patient
Accounts

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Add a Payer/Non-Patient Account *

Go to Billing -> Payer/Non-Patient Account

Create a New Payer/Guarantor

Click on Billing from the main menu and Click Payer/Non-Patient Account to open Non Patient
Accounts Lookup.

1. Click on the Create New Payer icon.

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2. Complete payer information and Click Save.

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Add Payer/Non-Patient Account in
Demographics *

Billing -> Patient Account -> Demographics Tab

1. Open Patient account and Click on the Demographics tab.

2. Click Create a Non Patient Guarantor to open the New Payer dialog.

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Enter Payer information and click Save. Guarantor/Payer name will populate the Guarantor
field.

Add Dependents to Payer Account

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3. Click the arrow next to Guarantor name to open Guarantor Demographics.

4. Click the Family Tab. The active patient will display in the Dependent list.

5. Click Add Dependent to add additional patients to this payer if needed.

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Add Dependents to Payer/Non-Patient
Account *

Add Dependents to Payer Account

3. Click the arrow next to Guarantor name to open Guarantor Demographics.

4. Click the Family Tab. The active patient will display in the Dependent list.

5. Click Add Dependent to add additional patients to this payer if needed.

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Change Payer/Guarantor in Make Payment
dialog *

Billing -> Patient Account -> Ledger tab -> Add Payment or Billing -> Patient Account -> New
Charges tab-> Add Payment

Add Payer from Patient Ledger

1. Click the Add Payment button to open Make Payment dialog.

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Payer name will default to Patient unless a Guarantor has been specified in Patient
Demographics.

2. Click X next to current Payer name in Payer Details section of Make Payment Dialog. The field
will be cleared.

3. Click button to select a different payer from Select Payer dialog.

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 Enter Charges

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Enter Charges Manually

Visits that are not normally entered in the patient chart, such as hospital visits, nursing
home visits, etc.can be manually entered in the New Charges tab.

Go to Billing -> Enter Charges

Add a New Visit

Click the New Visit button

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More Info-Owner Information for Manual Charge Entry

More Info will default to the Active Provider as the Owner/Rendering Provider. If the Rendering
Provider of service is anyone other than the Active Provider, you can override this by clicking on
the Providers tab and selecting that provider from the drop down list. If the rendering provider
is the same as the active provider, this must be blank.

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More Info-Facility Information for Manual Charge Entry

More Info->Facility will automatically populate with the Active Facility selected in the Scheduler.
For single facility users, the work flow will not change. If visits or charges are created for
facilities outside the main facility (physical address indicated in Manage Groups), those facilities
will still have to be selected in Providers tab->Service Facility.

More Info->Owner will automatically populate with the Active Provider, and can be overridden
in the Providers tab, if applicable.

Additional claim details should be added at this time in order to be applied at the claim level, or
to all charges for this visit. Check the boxes that apply in the top section, or click on the
appropriate tabs to add information specific to the current visit. The Dates tab is shown in this
example. Hospital admit/discharge dates, injury dates, etc. can be added here.

Details are at the claim level. Information specific to the charge level should be added in charge
details.

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Enter Charges from Billing Menu

• Click the Add Charge button to Open the Select Charge dialog
• Begin typing the Charge code in the box or Click inside the Description to Search the code
data base. Click on the code from the list to insert it into the field
• Click on the Select button, or hit the enter key on your keyboard

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Add New Charge Details, including ICD-9/Diagnosis codes
and Modifiers

Charge Details dialog will open for adding/editing New Charge. If a field is not grey/inactivated,
it can be edited for corrections or changes

• Click the Add Code button to Add a Diagnosis/ICD-9 code to the New Charge. Begin Typing
the code or Click to search. When the correct code is in the field, Click the Select button or
use the Enter key on the keyboard to select a Diagnosis.
• Add a Modifier to the New Charge, Click the Add Code button. Begin Typing the code or Click
to search. When the correct code is in the field, Click the Select button or use the Enter key
on the keyboard to select a Modifier and Enter again to add another code.
• Check Omit box only if you want to exclude this charge from claim file.
• Enter additional Charge information if applicable in appropriate tab. These tabs apply to the
charge level. If information is specific to the claim level, enter that in More Info.
• The Facility will default to active facility/facility selected in More Info.
• Click the Save button to save data.

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Post New Charges to Patient Ledger

• Insurance demographics display in the lower section of the new charges tab, and the Follow
Up Action will default to Submit to Insurance. This can be changed to Do Not File-Patient
Responsibility, if you do not want to submit visit to insurance.
• The route for the primary insurance will default to the route specified in the Insurance
Companies setup. If you want to change the route, you can do that at this time.
• Mark as Incomplete to avoid accidentally posting a visit that needs additional information.
Remove check mark when complete and ready to post.
• Enter any claim comments for internal use. (Will not print on claims)
• Add a payment or apply a co-pay
• Click the Post button to apply charges to the Patient Ledger.

The Patient Ledger Tab will open and the New charge(s) will be shown in the ledger.

Note: The insurance claim is created at this point. If any changes are made to the charge(s) while the
claim is in the Pending Scrub section prior to uploading the claim to the payer, the claim must be
placed into the On Hold section and rebuilt before the changes will be applied to the claim.
Otherwise, it will be submitted the way it was at the time of posting the visit.

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Home Visits

When filing electronic claims for home visits, the 5010 format requires the patient's address
as the Service Location. Gateway EDI will plug the patient's address into the outgoing file
when receiving a claim with Place of service 12. To set up a facility, certain fields have to be
completed in order for claims to pass the scrubbing process in the Claims Manager. Setting
up a facility for Home visits, and typing 'Home' in the required fields will allow claims to
pass the scrubber.

Create a Facility for Home Visits

1. Type Home or any name for the Facility. (This name will be listed in the drop down options
for facility selection).

2. Add Full Legal Name-Home

3. Add Street-Home

4. Enter City-Home

5. State-2 digit State abbreviation

6. Zip-5-9 digit zip code

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7. Using the drop down list option, select Place of Service Home-12. This place of service will
prompt Gateway EDI to add the patient's address as the Place of Service to the claim file.

Remaining fields can be left blank.This Facility should be selected from the drop down list in
More Info when posting charges for Home visits.

Enter Charge for Home Visit

1. Click New Visit.

2. More Info.

3. Using the drop down list option, select Home for Facility, and Save.

4. Add Charges as shown in Enter Charges Manually.

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Hospital/Other Facility Charges

If services are performed in the main clinic, the facility name and address is no longer
needed at the claim level when filing electronic claims, but when filing electronic claims for
hospital or facilities other than the main clinic, the 5010 format requires the facility name
and address be included in the file for the Service Location. The facility must first be added
in Manage Facilities . Once the facility is added, the charges can be manually posted in the
New Charges tab.

Specify Service Facility

1. Click More Info and use the drop down list to select the correct Facility/Place of Service. This
will add the appropriate two digit Place of Service code to the claim file.

2. Click Providers tab and use the drop down list to select the correct Facility/Place of Service.
This will add the facility name and address to the claim file.

3. Include Hospital Admit/Discharge, Injury , Workers Comp, or other charge related dates in
Dates tab.

Click Save, and continue by Adding Charges as shown in the first lesson. Enter Charges
Manually

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Practice Management User Manual ©SOAPware, Inc. 2017 Page 384
 Enter Payments

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Add Personal Payments from Billing Menu

Main Menu -> Billing -> Enter Payments

Apply personal payments to patient accounts. Make Payment dialog can also be accessed in
the New Charges tab and the patient account Ledger. To apply Insurance Payments to
accounts, see Post Insurance Payments.

1. Click on the Enter Payments menu option to open the Chart Rack. Select a Patient from the
Chart Rack and the Make Payment dialog will open.

2. Type payment details.

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3. Apply payment to charges:

Disburse: Will auto disburse payment (older to most current charges).

Pay all: Will auto apply Amount to all outstanding charges.

Or you can manually apply payment to selected charge by clicking on the arrow in the Applied
column (Red Arrow).

When entire amount is applied, Remaining balance will be $0.00

4. If receipt is requested place a check mark in the box next to Print Receipt and Click Save.

If errors are made, click Clear Applied to remove applied amount(s).

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 Claims Manager

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General Workflow: Claims Manager

Billing -> Claims Manager

An Insurance Claim cannot be created unless insurance information has been entered in
Patient Account Insurance Demographics tab.

Open Claims Manager

To open the Claims Manager, click the Billing menu, then select Claims Manager.

Paper claims are identified by the Icon in the first column. Electronic claims are blank.

1. When a charge is posted to the Ledger from the New Charges tab, an insurance claim is
created and inserted into the Pending scrub section of the Claims Manager.
2. Claims are scrubbed and placed in the Ready to Submit section.
3. If the claim rejects for scrub errors, the claim will be placed in the On Hold section with a
reason for rejection, and will need to be corrected.
4. After a claim is edited/corrected, it must be rebuilt to apply the changes, and scrubbed
again. If a claim continues to reject when Scrubbed, repeat until the claim is error free and
moved to the Ready to Submit section.
5. When the Claims are Ready to Submit, they can be generated and uploaded electronically,
or printed on a CMS 1500 form.

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Select a single claim by clicking the claim to highlight. To select multiple claims, click on a claim and
while holding down the Ctrl key, left click on other claims to highlight. To select all claims in a section,
click on the first claim to highlight and while holding down the Shift key, click on the last claim to
highlight all claims selected.

For details on setting up print options, please see Paper Claim Options.

Column Headers

Sort Columns in each section by clicking on the column header, if needed

• Date of Service: Date of service/visit.

• Claim: Claim number used for identification and tracking. This number is automatically
assigned when the claim is created.
• Physician: Performing Provider.
• Patient: Patient name.
• Primary: Identifies patients Primary Payer.
• PRT: Primary Payer Routing (Paper claim or Electronically sent).
• Secondary: Identifies patients Secondary Payer.
• SRT: Secondary Payer Routing (Paper claim or Electronically sent).
• Amount: Total amount of claim.
• File With: Filing claim with (Primary or Secondary).
• Submission: Indicates to Payer if the claim is Original claim, Corrected claim, Replacement
claim or a Voided claim.
• Status: Status of claim (On Hold, Pending Scrub or Ready to Submit).
• Hold Notes: Hold notes gives a short description of rejection reason. This note will
automatically generate if basic claim info is missing in the Scrub process. It can also be
typed by clicking in the grid if the claim is manually placed on hold by user.
• Claim Notes: Claim notes are automatically added when a claim is set to Refile, has been
Rebuilt, etc. It can also be typed by clicking in the grid if needed.

Hold notes and Claim notes are for user reference only. Notes are not included on claims

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Step by Step Work flow-Claims Manager

Claims will need to go through the Scrubbing process to check for missing data. This
process will catch claims that are missing some basic information, such as insurance
information, patient demographics, charge information, payer information, etc.

Pending Scrub Section

Patient accounts with payer information entered into the Insurance Demographics section of
the Chart/Patient Account will automatically produce a claim when new charges are added and
the Follow Up Action is set to Submit to Insurance in the New Charges tab.Those claims will be
placed in the Pending section of the Claims Manager until they are Scrubbed and Submitted to
the payer or clearinghouse.

1. Click on the claim line to highlight.

To select random claims, Click on a Claim and while holding down the Ctrl key, left click on
select claims to highlight. To Scrub all claims in the section, click to highlight the first claim, and
while holding down the Shift key, click to highlight the last claim. This will highlight all claims
listed.

2. Click the Scrub button. Claims will be moved to the Ready To Process section.

Note the Claim number 1327 in the red box. This lesson will track that claim from Pending
Scrub to Submitting claim.

Insurance remittance/response will use this claim number in the Patient Account section of the
EOB to identify the patient.

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Scrub Errors

Claims will be moved to the Ready To Submit section unless the scrubber finds error(s) on a
claim as shown in this screen shot. Claims with errors will be moved to the On Hold section to
be edited and rebuilt. A reason for rejection will be noted in Hold Notes column.

3. Click Ok. The error dialog will continue to prompt you to click OK for each claim that has
errors until all selected claims have been scrubbed.

Open Patient Account

4. Double Click on Claim line to open patient account and make edits.

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Edit claim in Claims Tab

5. Double Click on Charges line item in error to open Charge Details dialog.

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Edit Charge Details

The scrub error said diagnosis was missing for procedure code 85025. Verify the correct charge
was selected and add/edit needed information.

6. Click Add Code

7. Begin typing code or code Description and select from list.

8. Save edits. Close account and return to Claims Manager.

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Rebuild Claim

9. Click on claim line to highlight.

10. Click the Rebuild button. Claim must be rebuilt before edits will be applied.

11. Claim will be moved to Pending section. Click Scrub.

12. Claim will be moved to Ready To Submit section.

Click Generate Electronic to select all electronic claims that are ready to submit and generate
an electronic claim file to upload to clearinghouse/payer with one click.

Click Print Claims to select all paper claims that are ready to submit and print .

Click Submit Selected to select and submit only specified/highlighted claims for printing or
uploading.

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Claims Search

Quickly find a claim within the Claims Manager Working, Submitted or All tabs by Claim
Number. Also view Total Claims in each section and Total Amount for those claims.

Search for Claim On Hold, Pending or Ready to Submit by

Claim Number. View Total Claims in each section or tab,
and Total Amount of claims

1. Locate a claim On Hold, Pending Scrub or Ready to submit by typing the claim number into
the Find Claim By Number field.

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Search for Claim in Submitted and All tabs by Claim
Number and Post Date

To search for claims that have been submitted to payers, click the Submitted tab in the Claims
Manager. (Claims in Submitted tab have been uploaded to payers, but not processed. Any claim
created will be in the All tab, regardless of status).

1. Type the claim number into Find Claim by Number field.

2. Select date range the for the claim Posted Date.
3. Click the filter button.

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Filtering Claims

In addition to Filtering Posted date, each column can be filtered to drill down and search for
specific claim types, payers, claims by provider, and other options from all tabs within the
Claims Manager.

New Filtering Options

1. Hover over the column headers to activate the filter icon.

2. Click on the icon to drop down filter options, and click on an option.

3. If additional filtering is necessary, repeat steps 1 and 2. One or more columns can be filtered
at a time.

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Filtering Results

Results for filtering by posted date 10/1/2012 to 5/28/2013, and selecting Medicare as the
Primary payer to view claims that were submitted during that date range.

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Multiple Filtering options results

Submitted claims filtered by Date Range and sorting Physician and Payer columns. Total at the
bottom of the screen includes all claims within the date range selected in the Filter Posted Date.

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Filtering Columns

1. Submitted claims filtered by Date Range and filtered Primary payer column to only list claims
with Medicare as the primary payer.

2. Total claims submitted within the date range selected in the Filter Posted Date.

3 & 4. Total for claims with Medicare as the primary payer that were submitted within the date
range selected in the Filter Posted Date.

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Pending Scrub

Claims will need to go through the Scrubbing process to check for missing data. This
process will catch claims that are missing some basic information, such as insurance
information, patient demographics, charge information, payer information, etc.

An option to Bypass Scrubber in the On Hold and Pending sections allows for claims
missing a Provider Signature, or an invalid State for Canada and Puerto Rico to proceed to
Ready to Submit. All claims must be scrubbed the first time to be certain that the only
rejections are Invalid State or Missing Provider Signature.

Pending Scrub Section

Patient accounts with payer information entered into the Insurance Demographics section of
the Chart/Patient Account will automatically produce a claim when new charges are Posted to
the Patient Ledger, and those claims will be placed in the Pending section of the Claims
Manager. Claims can be selected for Scrubbing one at a time , selected claims or all claims.

1. Click on the claim line to highlight.

To select random claims, Click on a Claim and while holding down the Ctrl key, left click on other
claims to highlight. To Select all claims in a section, Click on the first claim to highlight and while
holding down the Shift key, Click on the last claim to highlight those two and all the claims in
between.

2. Click the Scrub button. Claims will be moved to the Ready To Process section. If the scrubber
finds an error on any claims, those claims will be moved to the On Hold section with a
description of the error.

Note the Claim number 1327 in the red box. Insurance remittance/response will use this claim
number in the Patient Account section of the EOB to identify the patient.

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Scrub Errors

Claims will be moved to the Ready To Submit section unless the scrubber finds error(s) on a
claim as shown in this screen shot. Claims with errors will be moved to the On Hold section to
be edited/corrected and rebuilt. A reason for rejection will be noted in Hold Notes column.

3. Click Ok. The error dialog will continue to prompt you to click OK for each claim that has
errors until all selected claims have been scrubbed.

Bypass Scrub

If a paper claim is missing the Provider Signature, or if any claim has an Invalid State (for Puerto
Rico or Canada), you can Bypass the Scrub once you've verified that those are the only two
reasons for rejection.

1. Select Bypass Scrub from the drop down list in the Status column in the On Hold or Pending
Section

2. Rebuild

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3. Scrub claim

4. Highlight claim and Submit Selected. Claim Notes will show Bypassed Scrub with a date
stamp

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On Hold

Select Claim on Hold

After the Scrubbing Process, Claims that have error(s) will be placed in the On Hold section of
the Claims Manager where they can be edited and then Scrubbed again for any further errors
prior to Submitting to the Payer. This example lists three claims that are missing diagnosis
codes.

1. Double click on the first claim to open the Claim Details in Patient Account.

Edit Claim

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The Claim Details section allows access to all details of the claim in error to correct and Rebuild
the claim before repeat the Scrubbing process. Note the Claim number in the screenshot is 257.
A number is assigned to each claim as the claim is created for identification. That number can
be found in the Claim ID column in the Claims Manager. Editing can be done by Clicking on the
More Info button for claim information or by Double Clicking on the line of the Charge for
charge/line item corrections.

2. Double Click on the charge to access Charge Details

Charge Details

The Charge Details dialog allows for editing most charge related errors. Fields can be edited by
clicking on the drop down arrows or Clicking the buttons.

3. Edit Procedure codes, dates of service, units or charges.

4. To add a Diagnosis code, Click the Add Code button.

5. Delete/Add Modifiers

6. Click on tabs to enter additional charge information

7. Add misc. details

8. After making changes, click Save

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More Info

Tabs included in the More Info dialog allow for entering many specialty specific required items.
For details, please see More Visit Information

Rebuild Claims

After closing out of the Claims Tab, the Claims Manager will open. Repeat steps 5-8, or those
steps applicable to the errors, until all claims you wish to correct/edit are completed.

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9. Click to Select one or more corrected claim(s)

10. Click the Rebuild button. The claim(s) are moved to the Pending Scrub section to Scrub after
corrections.

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Ready To Submit

Claims in the Claim Manager that have been scrubbed and are ready to submit to the Payer
will be moved to the Ready to Submit section.

Claims Ready to Submit

1. Select one or more claims to submit to Payer.

2. To submit only the Electronic claims in the Ready to Process section, Click the Generate
Electronic button.

3. To Print only the Paper Claims in the Ready to Process section, Click the Print Claims button.

4. To submit some but not all claims, click to highlight the claims and then click the Submit
Selected button.

Note: To automatically upload claims to Gateway EDI, you must have the required
information setup in Claims Options .

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Filtering Claims Ready to Submit

Claims can be filtered by type (Paper or Electronic) to get an accurate count and charge amount
to confirm all claims have been received by the clearinghouse or to verify the correct amount of
claims have been printed.

1. Click the filter icon in the PRT column and select E to list Electronic claims only. **After totals
are recorded or electronic claims are uploaded change back to All go display remaining paper
claims.

2. Total Electronic Claims ready to submit.

3. Total Charge amount for electronic claims.

4. Total Paper and Electronic claims ready to submit.

5. Click Generate Electronic to upload all electronic claims to clearinghouse.

Important: Once claims are uploaded, follow clearinghouse instructions to immediately confirm
file was received by clearinghouse/payer and compare totals for the file.

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Printing CMS 1500 Claims using Plain paper

To print claims using plain paper, place a check mark in the Print Full CMS Form box. Using a
color printer will print the lines and blocks shaded in red. Printing with black ink only will print
the form in black and white.

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Printing CMS 1500 Claims using Pre printed forms

If using pre printed CMS1500 forms, remove the check mark from Print Full CMS Form box. This
will just print the text into the fields.

Please Note:

Most printer manufacturers install a PCL (Printer Command Language) driver by default. This
works well if printing documents in just plain text and with very little formatting, for example a
word document on a home computer. However with the complexity of forms and page layouts,
it is recommend, printing these documents on a PS (Post Script) Print Driver instead of a PCL
driver. This type of printer driver will handle the forms information most efficiently. SOAPware
recommends using any business grade printer, or a color laser jet printer, if selecting Print
Full CMS Form.

Note: Selecting Print Full CMS Form will print the front of the CMS 1500 only, and will not
include the print on the back of the form. If a payer requires the standard front and back of the
CMS 1500 form, the claim will not be acceptable.

SOAPware does not support printers/scanners. Meaning that SOAPware does not install printer
drivers or set printer configurations. Please contact an IT person for additional hardware
matters. However, it is recommend to download the most recent printer drivers needed from
the manufacturer's website. It is usually a FREE DOWNLOAD. If there is trouble locating the
driver needed, please contact the manufacturer directly. Be cautious of downloading drives
from an alternate source other than the printer manufacturer.

Thank you,

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SOAPware Support

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Scrubber Errors-How to Correct and Rebuild
Claim

If the Scrubbing process finds a claim with errors/incomplete information, a Scrub Error
message will pop up and the claim will automatically be moved to the On Hold section of
Claims Manager.

This lesson will describe the errors and list the steps to correct the error(s). The Claim will
then have to be Rebuilt to apply the corrections, and Scrubbed again. When the claim has
passed the scrubbing process, it will be automatically moved to the Ready to Submit
section.

Note: Edits/Corrections will not be applied to claims unless the Rebuild process is
performed.

Scrub Errors

Claim #1327 was scrubbed and rejected because it was missing a diagnosis code for CPT code
85025.

1. Click the OK button in the message box.

2. In the On Hold section of the Claims Manager, Double Click anywhere on the claim line to
open Patient Account.

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Patient account will open to the Claims tab with the active claim shown in the bottom section.
Corrections can be made by clicking on any of the tabs, depending on what the scrub error
indicates.

After corrections are made, Close the Patient Account, return to Claims Manager and
Rebuild claim to apply changes.

At least one diagnosis must be entered for the charges: No

Diagnosis entered for 85025

1. Double click on the line item that's missing info to open Charge Details dialog

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At least one diagnosis must be entered for the charges: No
Diagnosis entered for 85025 (continued)

2. Click Add Code in Diagnosis Codes section

3. Type code or use drop down to search by code or description

4. Click Select and Save

Close patient account and return to Claims Manager. Select claim from On Hold section and
click Rebuild.

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The Primary insured is missing part or all of their
demographics

Verify insured info

1. Find the claim getting rejected in the On Hold section of Claims Manager and Double Click
inside the grid to open Patient account. Click the Insurance tab.

2. Click View next to the insurance company getting the error

3. Check each field in the Insured Information section and verify that it matches information
exactly as it appears on insurance card, including the Patients relation to insured.

Return to Claims Manager and Rebuild claim to apply changes.

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Primary Insurance Company Missing Data

Check Insurance Company setup

1. Find the claim getting rejected in On Hold section of Claims Manager and find the Payer
name-Primary column or Secondary column, depending on filing status

2. Go to Tools -> Insurance Company.

3. Find the Insurance Company/Payer within the list and Click the Edit Icon.

4. Add missing info.

5. Click OK

For step by step Insurance Company setup instructions, click here

Return to Claims Manager and Rebuild claim to apply changes.

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Secondary Insurance Company Missing Data

Check Insurance Company setup

1. Find the claim getting rejected in On Hold section of Claims Manager and find the Payer
name-Primary column or Secondary column, depending on filing status Go to Tools ->
Insurance Company.

2. Find Insurance Company in Insurance Company Manager and Click the Edit Icon.

3. Add missing info.

4. Click OK

For step by step Insurance Company setup instructions, click here

Return to Claims Manager and Rebuild claim to apply changes.

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The Provider is missing part or all of their information

Verify Rendering Provider information in Provider Manager

1. Find the claim getting rejected in the On Hold section of Claims Manager and Check for
Provider name in the Provider column.

2. Go to Tools -> Provider Manager and verify correct info is entered in all fields.

3. Add missing data.

4. Verify Provider is linked to Billing/Group information.

5. Verify Signature is added.

6. Click Update.

If there is not a Provider shown in the Provider Column, see next step

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The Referring provider is missing part or all of the
information

Verify Referring Physician info is entered correctly in Contacts

1. Find the claim getting rejected in the On Hold section of Claims Manager and Double Click
inside the grid to open Patient account. Click the Demographics tab.

2. Check the name of the Referring Provider.

3. Go to Tools -> Contacts and select the Referring Provider from the list. Double click to Edit
Contact Information.

4. Verify Provider information is included in each required field.

5. If additional provider IDs are required, add the insurance company requiring the ID and enter
that information.

6. Click OK to save information.

Return to Claims Manager and Rebuild claim to apply changes.

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The Provider is missing all or part of the signature

Verify Rendering Provider Signature is loaded

1. Find the claim getting rejected in the On Hold section of Claims Manager and check the
Physician column to find the name of the Rendering Physician.

2. Go to Tools > Provider Manager and select that physician from the list of Providers.

3. Click on the Signature tab and make sure signature is selected. (See Provider Manager setup
in Billing Maintenance)

4. Click Update.

Return to Claims Manager and Rebuild claim to apply changes.

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The Facility is missing part or all of its information

Check Facility Setup

1. Find the claim getting rejected in On Hold section of Claims Manager and Double Click inside
the Grid to open Patient Account.

2. From the Claims tab, make sure the rejected claim is displayed in Claim Details and Double
Click to open the Charge Details.

3. Check the Facility in the Misc. Details section of Charge Details dialog as shown in the
previous step.

4. Go to Tools -> Manage Facilities and select the Facility from the list.

5. Click the Edit icon.

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Facility Information

6. Verify required information is included in each field. (Include 9 digit Zip Code)

7. If Additional IDs are required, click the Additional IDs tab and enter required information.

7. Click Update to save changes.

Return to Claims Manager and Rebuild claim to apply changes.

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Invalid State

Patient is missing part or all of their demographics: Invalid State

Primary Insured: Invalid State

Secondary insured: Invalid State

In the On Hold section of the Claims Manager, find the claim with the error and double click to
open Patient Account.

1. Click on the Demographics tab.

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2. In the Address section, correct the state format. It should be a two digit, all CAPS, valid state.

3. Click on the Insurance tab.

4. In the Primary Insurance section, click the View button.

5. In the Insured Information section, correct the State format.

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6. Click Save.

Repeat for the Secondary Insurance Policy, if applicable. Claim must be Rebuilt to apply
changes.

Note: This scrub error can also be seen if there is an invalid state format used in Manage
Facilities, Insurance Company setup, Manage Groups, and all areas where the state is
required.

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Submitted Tab

The Submitted Tab lists all claims that have been submitted to Payers. Claims can be
searched by Date Range and the information listed in the columns can be sorted by clicking
on the column headers.

Claims Manager: Submitted Tab

1. Select a submitted date range

2. Type claim number, if applicable
3. Click on the filter button
4. Double click on a claim to open the claim for editing

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Resubmit Claims Rejected by Clearinghouse

Billing -> Claims Manager -> Submitted Tab

Edit and resubmit claims that have been rejected by the Clearinghouse. Columns can be
sorted by clicking on the column headers. Additional filtering can be done by clicking on the
filter icon to specify payers, patients, claim status, etc.

Select Claim for Correction

Click the Submitted tab, filter by Date of Service, locate claim by Claim Number or Patient
Name, and double click line item to open Claims tab in Patient Account.

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Edit Claim

If rejection is for Visit information, click the More Info button.

If rejection is connected to Charge details, double click the line item in Charges section of the
Claims tab.

Repeat for each rejected claim, if applicable. For additional instructions on making corrections
to claims, please see On Hold lesson

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Scrub Corrected Claims

Click to highlight the corrected claim, or select multiple to scrub by holding down the Shift or
Ctrl key and highlighting all.

Click Scrub.

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Submit Corrected Claims

When claims have passed the Scrubbing Process, have no errors and are moved to the Ready to
Submit section, they are ready to submit to the Payer.

Select one or more claims to submit to Payer.

• To submit only the Electronic claims in the Ready to Process section, Click the Generate
Electronic button
• To Print only the Paper Claims in the Ready to Process section, Click the Print Claims button
• To submit some but not all claims, click to highlight the claims and then click the Submit
Selected button.

Note: To automatically upload claims to Gateway EDI, you must have the required
information setup in Claims Options .

Note: To correct and resubmit a claim that has been rejected by the Payer, see Resubmit
Claims Rejected by Payer/Insurance Company.

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Resubmit Claims Rejected by Payer/
Insurance Company

Resubmit a claim that has been rejected by the payer/insurance company. This requires the
Claim Frequency Type Code or Submission Type be changed from Original to another type,
and must include an original reference number or ICN.

Billing->Patient Account->Claims tab/Insurance tab/Demographics tab

Open patient account to make corrections prior to

rebuilding and resubmitting claim

After making corrections to rejected claim, click on the Claims tab. If the claim is rejected for
charge details, corrections can be made while adding the ICN/Original Reference number

1. Find the rejected claim in the Claims list and click to highlight line item and open in Claim
Details section.

2. Click the box next to On Hold to move the claim to the On Hold section in the Claims
Manager.

3. Click More Info button to Edit Claim Details.

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Add Original Reference Number/ICN In Misc Details tab

4. Number: Enter ICN/Original Reference Number as shown on explanation of benefits or

rejection report.

5. Policy ID: Select payer from drop down list. This list is pulled from the insurance policy
information in patient Insurance demographics. If the Policy information is not provided, the
claim will reject.

6. Click Save.

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Place Worked Claim On Hold

7. Place a check mark to put the claim On Hold to rebuild and resubmit.

Change Claim Frequency Type/Submission Code

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8. Rebuild claim.

9. Click to display drop down list. Select Replacement for professional claims, Corrected for
institutional claims, Void to submit a voided claim.

These codes are associated with the Claim Frequency type and are indicated in the electronic
file:

Original-1

Corrected-6 (Select for corrected Institutional claims)

Replacement-7 (Select for corrected Professional claims)

Void-8

10. Scrub claim to move it to the Ready to Submit section to be resubmitted to payer.

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Rebuild and Resubmit rejected file

Rebuild an entire claim file or multiple claims at one time to resubmit to payers.

Rebuild Selected Claims

1. Click on the Submitted tab.

2. Select Filter Posted Date range.

3. Select claims by Clicking on the first one and while holding down the Shift key Click on the last
claim. This will highlight those claims and all claims in between. Or hold down the Ctrl key and
select multiple claims one at a time.

4. Click the drop down arrow next to Rebuild Selected button and add a note for rebuild reason,
if needed. The comment will display in claim details for reference.

5. Click Rebuild Selected button.

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6. You will be prompted to confirm rebuilding the number of claims selected. Click Yes to
continue or No to cancel. Claims will be transferred to the Pending Scrub section in the
Working tab.

Scrub and Submit Rebuilt claims

7. Select claims to scrub and Click Scrub.

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8. Select claims to Submit and Click Submit Selected, or to submit all claims in the Ready to
Submit section, click Generate Electronic.

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Omit a paid charge when refiling from
Insurance Payment Posting

Omit a paid procedure from a claim when resubmitting unpaid charges to insurance.

Billing -> Post Insurance Payments

Refile only denied charges to Insurance

1. Comment Reason for denial

2. Apply payment amount to paid charge(s).

3. Set Next Action to Refile.

4. Double Click on line of paid charge(s) to open Charge Details.

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Omit Paid Charges

5. Place a check mark to Omit from Claim. Click Save.

Post Payment to ledger

Check mark will be placed in the Omit column. When claim is Rebuilt, this charge will not be
refiled to insurance.

6. Select Route for refiling claim (Paper or Electronic)

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7. Select the File With from drop down option

8. Save Claim and then Post Payment to ledger. Claim will move to On Hold section of Claims
Manager.

Rebuild Claim

Go to Billing -> Claims Manager

9. Locate claim in On Hold section

10. Rebuild Claim to save claim changes and Scrub claim

Claim is now Ready to Submit

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Secondary Claims

When posting a primary insurance payment to a patient visit/claim that has a secondary
insurance policy set up in Insurance Demographics, the Next Action will default to File
Secondary-Paper.

Secondary claims will automatically be moved to the On Hold section in the Claims Manager
once the primary insurance payment is applied to the visit and File Secondary-paper is
selected for the Next Action.

Set Secondary Claims to process

1. When posting primary insurance to a visit, verify the Next Action selected is File Secondary-
Paper.

2. Save Claim.

When the entire remit is applied to charges and Posted, the secondary claims will be located in
the On Hold section and ready to process in the Claims Manager.

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Rebuild Secondary Claim

3. Locate the secondary claim. Click to highlight.

4. Click Rebuild. Claim is moved to Pending Scrub section.

Scrub Secondary Claim

5. Click the Scrub button. Claim is moved to Ready to Submit.

Note: Paper claims can be previewed by clicking on the PDF icon in the Pending Scrub section

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Print Secondary Claim

6. Click the Print Claims button. All paper claims in the Ready to Submit section will print.

7. Click to highlight a single claim and then click the Submit Selected button. Only the
highlighted claim will print.

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Tertiary Claims

Filing tertiary claims is a manual process and should be done only after primary and
secondary claims have been processed by the payers. The quickest way to generate a
tertiary claim can be done in the Claims tab within the patient account.

Add Tertiary Policy Information

1. Click the Insurance tab.

2. Add New Insurance and select Tertiary for the Policy Status.

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Select Claim

1. Click the Claims tab.

2. Click to highlight the Claim.

3. Place a check mark next to On Hold.

4. File With should be Secondary.

5. Using the drop down list in Secondary Policy section, click to highlight the Tertiary Policy, and
close the patient account.

Rebuild Claim

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1. Open Claims Manager and click on Working tab.

2. Find claim in the On Hold section and click to highlight.

3. Rebuild claim.

Print Tertiary Claim

1. Scrub claim.

2. Print Claims.

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All Tab

The All Tab lists all claims that have been created within the selected Date of Service range,
listing the Status of each claim.

The All Tab lists all claims in the Working and Submitted tabs and the current status of the
claim. Claims can be searched by Date Range and the information listed in the columns can be
sorted by clicking on the column headers.

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Export the displayed grid from the All Tab in
Claims Manager

Use the Filtering option and create a Claims Report that

can be exported and saved in several file formats

1. Select the All tab in Claims Manager.

2. Select filtering options. This example shows Date of Service filter and Primary payer filtered
for Medicare.

3. Click View Report.

4. use drop down option to select file type for exporting or printing.

Adding the

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 Posting Insurance
Payments

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Create Manually Posted Insurance Payment

Access from the main menu -> Billing -> Post Insurance Payments

Select Payer/Insurance Company from Drop Down list of

existing Payers in the Insurance Company Maintenance

1. Use Drop Down to Select a Payer from the list

2. Type Check number shown on the Remit

3. Click the Create button

Add Remit Information as shown on EOB

4. Select Billing Provider/Pay to Information from the drop down list in the Group Section

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5. Enter Check date. This is for internal use and will not be used for any reporting date. It can be
the check date, date entered, etc.

6. Select Payment Method.

7. Select date remit is created/deposited. If applying payments from a check that was posted
previously, the deposit date can be typed here and this payment will show on the Payment
Summary to balance with your deposit for that day. To exclude it from the Payment Summary
on the Posted Date, place a check mark in Exclude Posted Only, and it will not be included when
balancing to the deposit for that day.

Note: Reporting and Patient Ledger will not display this date. It's only for informational
purposes in the payment details. The patient ledger will display payment on the Post Date. The
payment(s) will be included in the End of Day reporting on the Date Posted. If the Date Posted
is in a different month than the Check Date/Date Entered, the ledger and month end reporting
will be reported by the Post date. The Payment Posting date cannot be changed.

8. Type Check amount shown on the check

9. Click the Select Patient button

Select the Patient account for Payment

10. Type the Patient account number shown on the Remit or Click on the Chart Rack button to
search for the Patient.

11. Click Select to Open the Patient account

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View of Payment Posting window with Patient Selected for
Payment

When selecting a patient, the account number shown on the remit is the Claim number
assigned to the visit. When patient is opened, the grid will go directly to the claim number that
was entered.

After all payments have been applied and the Remaining amount is zero, the Print Payment
button will create a report listing payments applied for reference. The report can be displayed
or printed, or can be exported and saved to a file on your computer.

Refer to next lesson for applying payments to visits. Introduction to Insurance Payment Posting

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Introduction to Insurance Payment Posting

Introduction to Insurance Payment Posting

Create/Load Payment Detail is manually entered using information from the Remittance/EOB.

Patient Details Displays patient information from the General Demographics section and
Patient/Family Balances from the Patient Ledger.

Claims Lists Outstanding/Unpaid insurance claims for the Patient, the status of the Claim and
details pertaining to the claim. To include paid claims in the list, place a check mark in the box
next to Show All Claims.

Claim Details Populated with information pertaining to the claim. This section is collapsed
upon opening the claim, but can be expanded to view details.

Payment Details Breaks down the individual charges/services that are included in the selected
visit/claim. Double Click on a line item to view Charge Details.

Additional Adjustment options Allows user to add Claim Level Adjustments or Provider Level
adjustments in order to bring remit Remaining Balance to zero and activate the Post Payment
button.

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Select Claim/Visit for Payment

Outstanding claims are listed in the Claims section of the Posting window. If a claim is
highlighted, the lower section of the window displays each line item/charge that makes up the
selected claim. Details in both the Claims and Charges sections can be sorted by Clicking on
the column headers.

1. Click inside the Claim grid to select a claim for payment.

2. Details of the selected claim will display in the Payment Details section of the window.

Enter Claim Details using Remit/EOB

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The Claim Details section display various details that populate when charges are originally
posted to the account.This information is read only, and cannot be edited. Payment Details
section is manually entered using details from the EOB.

3. Type Total Payment amount for the selected claim. Note that the Remaining Balance
amount is the same as the Payment Amount and will decrease as payments are applied to the
line items. When the last transaction is applied, the Remaining Balance should be zero, and
Save Claim button is activated. An alert will pop up if an amount more than the Remaining
Balance on the check is entered, and the transaction cannot be saved.

4. Type Claim Control number from Remit for informational/tracking purposes.

5. Enter total amount that is the responsibility of the insured/patient as shown on Remit.

Apply Payment to Charges

6. Match the remit payment to the correct charge by verifying Begin and End dates, Procedure
code and Amount Billed.

7. Click on the line of the charge inside the Allowed Column and enter the amount shown on
the EOB as the Allowed amount.

Note: If applying a secondary or tertiary payment and not taking an adjustment, leave the
Allowed amount blank and click inside Provider Paid column. (Step 10.)

8. Tab to the next column and enter any amount that was applied to the deductible,
CoInsurance, etc.

9. Tab to Adjust Codes column and the total adjustment amount is displayed on the first line of
the Adjustment Codes dialog. Adjustments can be broken down by manually changing the
amounts, selecting the Adj Group and Code and tabbing to the next line, as needed. ESC to
close dialog.

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10. Tab to Provider Paid column. Type payment amount. If payment is zero, put 0 in Provider
Paid to activate the Save Claim button.

11. Tab to Remark Codes column and begin typing the code shown on the remit. As you type,
the list will sort to the code you need. When the code is highlighted, pressing the enter key will
place a check mark in the box and clear the search for the next code, if applicable. To view
Remittance Advice Remark Codes dialog, click here.

12. Notes can be added to identify specific payment/adjustment comments, if needed. Notes
can be viewed in payment details from ledger by clicking on the note icon.

13. If there are any additional adjustments that have been applied at the Claim Level, click the
ellipses button open the Claim Level Adjustment Detail and add Group, Code and Amount. Each
column has to be completed before it can be saved. Click OK to save and exit. To view further
details, click here.

14. Verify the Next Action. This will determine whether a secondary claim is generated, If the
Primary insurance crossed the claim over to the Secondary payer, and no secondary claim is
needed, or if the balance is patient responsibility.

Patient Responsibility: Claim status will change to Processed and the balance for this visit will
be moved to patient responsibility.

Crossover-Pending Secondary: A secondary paper claim will not be generated and the balance
will remain showing as pending insurance payment.

File Secondary-Paper: A secondary paper claim will be generated and placed in the On Hold
section of the Claims Manager ready to Rebuild, Scrub and Print.

File Secondary-Electronic: A secondary electronic claim will be generated and placed in the On
Hold section of the Claims Manager ready to Rebuild, Scrub and Print. Primary payment
information will be saved to the claim when it's rebuilt.

Refile: If claim is partially paid and you need to refile any unpaid charges, this option will place
the claim in the On Hold section of the Claims Manager ready to Rebuild, Scrub and Print.

Wait for Additional Payment: Claim will remain in the insurance pending status until
additional payment is applied.

15. Click Save Claim. A pop up message will verify payment was saved. Click OK.

16. When Remaining Balance is zero, or to view applied payments, click Print Payment. Report
must be printed or saved to a file prior to Posting Payment.

If Cancel is clicked, a confirmation box asks if you want to close the Patient and lose changes. If
Yes, the patient window will cancel all data entered for the active patient and close the account
If an amount is remaining on the remit, Select Patient dialog displays to choose a new patient.

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Review, Print or Save Remit Report

Generate a report to review payments applied for the active remit/check at any time prior to
posting the remit. This report can be previewed and printed, or saved to a file on your
computer for future reference. Make any corrections or edits, if needed before Posting.

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Post Insurance Payment to Patient Ledger

When the Remaining Balance in the upper section/Remit details is zero, the Remit/EOB will
need to be posted to the patient ledger and closed. If the Remit/EOB is for multiple patients/
payments, you will be prompted to select another patient and will repeat the previous steps
until the entire Remaining amount is applied.

16. Click the Post Payment button to Apply payment(s) to Patient Ledger. Payment will not be
reflected in Patient ledger until it is Posted

Note: The payment(s) will be included on the End of Day report for the Date Posted. If the Date
Posted is a different month than the Check Date/Date Entered, the ledger and month end
reporting will be reported by the Post date. The Payment Posting date cannot be changed.

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Insurance Recouped Payment

Remits that include recouped payments along with currently processed and paid claims
require 'reversing' payment amounts within the claims manager in order to balance
correctly. If payers simply request a refund, that process can be done within the patient's
ledger using adjustment codes.

Complete the Remit information in Insurance Payment Posting. Check amount should be the
actual amount of the check, and not the Payment Amount.

Select Patient by typing Claim/Account number on remit to open directly to the visit, or by
searching for patient account using the Chart Rack. Opening account by patient name will
require scrolling to locate the visit to which payment applies.

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Remove payment made in error

1. Type the amount being recouped in the Provider Paid column for the selected visit. To make
amount negative, type a dash (-) before the amount to be recouped. A negative amount will
display in parentheses as shown in the screenshot. (Adjustments taken previously will need to
be reversed as well)

2. Type the negative amount being recouped in Payment Amount.

3. To document reason for negative amount, or other details, click the drop down arrow in the
Notes column, type your comment, and click OK.

4. Save Claim to continue.

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Apply recouped amount

Note the recouped amount is added to the Remaining amount.

5. Type Account/Claim number to which the recouped amount will be applied, and Select.

6. Type payment amount.

7. Apply payment to line item(s) in Provider Paid column.

8. Select Next Action.

9 Same Claim.

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Apply Remaining Payments

10. Apply remaining transactions on remit, if applicable. This example remit has one more
payment to apply, which is the actual amount of the check.

11. Apply remaining payments and adjustments.

12. Save Claim

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Print/Save Payment

Selecting Print Payment will open the Remit Report print preview to either print or save report
in several formats for later reference, if needed.

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Post Payment

When Remaining amount is zero and Remit Report has been printed or saved, Post remit to
patient's ledger. Payments will not be reflected on reporting or accounts until the remit is
Posted.

View transaction in Ledger

Double click line item to view details.

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Hover over payment to display payment details, and double click line item to drill down to
further details and comments.

View Payment Summary

Payment Summary report will list details of transactions, but will only display the actual amount
of payment made for this remit.

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 Auto Posting of
Insurance Payments

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Clearinghouse Account Settings

Remits are generated every 4 hours by Trizetto, placed in a secure-file-transfer-protocol

(sftp) and ready to Download at your convenience. Account settings will have to be edited in
order to put that automated generation in process.

When Auto Generate Remittances is checked, any remits without a Download Date will be
included in the first download. Remits that should be verified as previously posted will have
a yellow background when viewing the downloaded remits list within SOAPware. After
verifying a remit has been posted, the remit can be deleted from the list.

Remits can also be manually selected for download, if preferred.

Log in to Trizetto Website

1. Select My Account tab.

2. Manage Product Files and Specifications.
3. Remittance Advice Settings.

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Trizetto/Gateway EDI Remittance File Settings

Place a check mark in the following options:

1. Include NPIs When Returned by Payers.

2. Auto Generate Remittances. (Leave blank if manually selecting remits to download as
needed)
3. Use TriZetto Provider Solutions Payer IDs and Names for Remittances.
4. Use Multiple File Name Options.
5. Use Check Number in File Name.
6. Use Check Amount in File Name.
7. Use Payer Name in File Name.
8. Save Changes.

• The first download will most likely contain several remits that have already been manually
posted in SOAPware. Any remits without a Download Date will be populated into the New
Remit list in SOAPware and will have to be deleted to avoid duplicate payment posting.
These remits will be listed with a yellow background if the check number and check amount
was posted in SOAPware previously.
• If preferred, remits can be manually selected and printed like always. In order to include
them in the auto remit list for posting, click the Download Selected button after placing a
check mark on the selected remits.

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Manually Download Selected Remits

If a previously downloaded remit needs to be downloaded again:

1. Using the drop down arrow, select to Search Advanced.

2. Place a check mark to Show Archived (Previously Downloaded Remittances).
3. Select one of the search options and Download Selected.
4. Open SOAPware to Billing>Post Insurance Payments>Create/Load Payment and select
Download/Find New Remits.

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Security for Deleting Remits

It is recommended that only selected users be allowed to delete remits. If a downloaded

remit is inadvertently deleted from Download or Create Insurance Payment list, that remit
can be manually selected from the clearinghouse archived remits to download again.

Security Administration

Allow or Deny selected users permission to Delete downloaded remits

1. Go to Tools>Security to locate users in the list and Expand.

2. Expand Billing and select Post Insurance Payments.
3. Place check mark or X to deny permission.
4. Close and log out to save changes.

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Download and Select Remits

Download Remits

1. Go to Billing>Post Insurance Payments and click Create/Load Payments.

2. Click Download/Find New Remits. Progress bar will appear.

When progress bar finishes,a list appears with new remittances.

Create Manual Remit

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Paper remits can be manually created and applied by typing the information necessary to
activate the Create button.

View Archived Remit

• When a remit is downloaded and posted, it can be viewed afterward by placing a check mark
in the View Archived Remits box. These remits will list with a green background and when
selected are not editable. Claims are listed in the Remit View window and details are seen as
they were originally received in the 835 file.
• Click the Print Report button to view edited payment details as they were applied to charges.
• If remit needs to be edited at a later time, the payment must be deleted from the patient
ledger and reopened for editing.

Select Remit for Posting

• Each column can be sorted by clicking on the column header.

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 • A green check mark is listed for all new remits. When a remit is Selected, check mark is
removed.
• The remit information shown is how it was returned by the payer in the 835 (ERA) file
including Check Date, Payer Name, Check Number, Payment Method, Check Amount, and
Post Method.
• Red asterisk in the Errors column indicates some of the information in the file wasn't an
exact match to the claim details in SOAPware, and will need to be corrected prior to Posting
the remit. When corrected, the asterisk is removed.
• Pink background indicates the payer ID, name, address or phone number is not an exact
match with any payers currently set up in the Insurance Companies setup. (When selected
for posting, these can be matched to a payer within SOAPware)
• Yellow background alerts that this check number and check amount has been previously
posted in SOAPware, and could possibly be a duplicate. (User must verify and delete the
remit if it is a duplicate)

Select for posting by double clicking on the remit line or highlight and click the Select button.

Failed Remits

If a remit fails and cannot be automatically applied to claim(s), the remit must be printed from
the clearinghouse website, then manually applied and posted. Failed remits are listed in the
message and will continue to show in the list with each download until the remit is created,
manually applied and Posted.

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Edit Errors

Electronic Remittance Advice files are matched to the submitted claims within SOAPware. If
the ERA returned by a payer doesn't completely match the claim information within
SOAPware, the mismatched area will be shaded pink with a tool tip to help identify the
error. Once these mismatched items are changed in SOAPware to agree with the
information on the remit, future remits for that payer/patient will match and not return
with errors.

• The Post Payment button is not enabled until all errors are corrected.
• Most errors can be corrected by Matching patients or claims that are shaded pink.
• If changes are made in patient demographics and Insurance Company setup, to match
the way they are returned on the remit, this will reduce the amount of errors for future
downloads.

Match Payer

Payers received in the 835 file are mapped to the Payer ID listed in the Electronic Submission
Info in Tools>Insurance Companies. When a claim is selected and the Payer section of the Remit
View is pink, it must be manually matched.

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1. Click the ellipses to open Select Insurance Company dialog. If several insurance companies
in SOAPware have the same 5 digit Payer ID, those payers will be listed.
2. Select the Edit icon if needed to verify the appropriate payer from the list and click Select.
3. If the correct payer isn't found in the list, place a check mark in the Show All box and scroll to
find another payer, highlight and Select.
4. If payer still isn't found, select the + icon to add a new payer.

• Highlighting and Selecting a payer from the Insurance Company list will remove the error
and enable the Post Payment button if this is the only error (pink area) on the remit.
• Editing the insurance Company name address and phone number in SOAPware to match
the remit information will reduce errors on future remits from the same payer. (This will also
change the payer information in patient insurance demographics tab)

Match Group

Some payers may be contracted with different names for providers, groups, etc. and will not
match exactly with the Pay To information as SOAPware settings and must be manually
matched.The names listed include the names received in the 835 file and as seen on the printed
remits.

4. Click the drop down arrow to select the appropriate group from the list.

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Remit View

The Remit View is a snapshot of claims and payments exactly as they are received in the
electronic 835 file and are not editable from this view. To manually edit an adjustment, double
click on the claim line. Edits will not change this snapshot.

Match Claim

If a claim line is shaded pink, the download failed to match the patient demographics or claim
and must be manually corrected.This example claim failed to match because of the policy
number was different than the one in SOAPware.

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5. Click on the claim line to claim, View Remit Errors and Match to open Patient/Claim Match
window.

The top section of the Match window payment details returned from the payer and the bottom
section is patient account information in SOAPware. If the claim is matched, this window will
open focused on that claim. Payer details show the claim was processed as secondary, and
checking the Secondary Policy# confirms the numbers are different.

6. Expand to view claim details if needed, or verify claim is correct by checking Date of Service,
Claim amount, etc. on claim line.

7. Match Claim and OK to match the selected claim with this remit. (Payment Details window
opens.)

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8. In payment details window, verify details are correct and Save Claim to save changes and
remove error alert from the Remit View.

Match Patient

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Some payers return patient names that do not exactly match the information in the SOAPware
account. If a claim error is because of a Patient mismatch that patient and claim must be
manually matched.

1. Type patient last name or the first 2-3 letters of the last name and press Enter on your
keyboard. First name search is also available by typing first few letters and then press Enter on
the keyboard. List of matches along with policy information is shown.

2. Find the correct patient in the list and Match Patient. (Payment Details window opens.)

3. Verify payment details are correct and Save Claim to remove error alert from the Remit View.

4. If unsure about a correct patient, expand to view claims that are currently pending insurance
processing and in the Submitted status, or place a check mark in Show All Claims to view claims
that are in the Processed status and after verifying the claim is a match, click the Match Claim
button.

View Claim Alerts and Warnings

Payers will deny a claim for different reasons and automatically deduct the non covered
amount from the billed amount on the remit. Warnings and alerts are added to the Remit View
enabling users to review the claim, determine the next action, and write off the adjustment or
Omit it from the Adjustment total, make corrections and resubmit the claim.

• Warnings (stop sign) are seen when a claim is in the Denied status as a warning to review
and determine if an adjustment is needed or if a claim needs to be refiled.
• Alerts (yellow triangle) are seen when a payer initiated adjustment needs to be reviewed to
verify the adjustment is correct. These alerts usually do not require action, only review.

Claims details in the remit view includes how the claim is processed (Primary or Secondary) and
the claim status to determine the Next Action. (File Secondary, Crossover, Patient Responsibility
or Refile)

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1. View Claim Errors button will list all claims for a selected claim showing with a pink
background or showing a warning or alert. This will list all errors on the selected claim.
2. Click OK to exit errors list.
3. Click to expand the claim and view charge details or select the Expand All-View Detail button
to expand all claims on the remit.

View Adjustment Reasons and Remark Codes in Remit View

4. After expanding to view details, hover mouse over the icon, Adj Codes or Remark Codes to
view the description and determine if the adjustment(s) total needs to be edited. If no editing is
required, close details and proceed to the next claim if needed.

5. If a claim fails to match, the payment amount will remain in the Remaining balance until
matched and posted. Post Payment button will not be active until all claims are matched and
Remaining Balance is zero.

6. If edits are required, double click the claim line to open payment details and edit.

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Edit Adjustments

Some adjustments are defaulted to Omit from the Adjustment Total and will have a check mark
in the Omit box. These adjustments will not be deducted from the billed amount or the charge
balance.

1. To Omit this adjustment from the adjustment total place a check mark in the Omit box.

2. To change the adjustment amount and include the new amount into the adjustment total,
change the Adj Amount, remove the check mark and ESC to close the Adjust Codes grid.

3. To include the full adjustment amount in the adjustment total and deduct from the charge
balance, remove the check mark.

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Post Remit

When a claim with warnings is opened for editing, the warning is removed and replaced with a
yellow alert reading 'Reviewed' to mark it as worked. After all errors have been removed from
the remit and the Remaining Balance is zero, the Post Payment button is enabled.

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Appeal/Resubmit a Denied Claim

Denied claims can be moved to On Hold section of the Claims Manager with a comment or
instructions for resubmitting a corrected claim or appealing the determination.

If a claim is denied and must be resubmitted, the claim can be moved to the On Hold section of
the Claims Manager until ready to work.

1. Placing a check mark in the Omit box will remove the amount from the Adj Total and the
amount will not be deducted from the charge balance.

2. Set Next Action for claim.

3. Expand the Claim Details section to add comment/instructions/reason for denial.

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4. Place a check mark in On Hold to open hold notes.

5. Type instructions and click OK. These notes will be visible in the Claims Manager Hold Notes
section.

6. Collapse Claim Details and Save Claim.

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Correction/Reversal of Payments

If a remit is returned with a payment and reversal or correction on the same remit, a red
stop sign will alert users that the claim couldn't be matched and must be manually applied.
The claim will be listed twice, and one of the claims will show as a negative amount in the
remit view.

1. Click the expander button on the claim line with the regular (positive) amount to view
payment details on the charge line(s) Double click the claim line to open for editing.

2. If the positive and negative amounts are identical, you shouldn't have to edit the negative
payment details, but will need to open and cancel to remove pink shading and enable to Post
Payment button

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3. Apply any Allowed, Deduct, CoIns, CoPay, and Late columns as shown in the remit view to the
claim and Save.

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 Reports

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Accessing the Report List

Billing menu -> Reports

Accessing the Report List

1. Click on the Billing menu.

2. Select Reports.

3. Select the report needed.

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CPT® Master Report

A report showing all CPT codes added to the database for a specified year or all years
combined.

CPT Master Options

1. Select the year of the CPT codes or check to see All Years' codes.

2. Select to sort by either the code or the description and the code.

3. Click Ok.

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CPT Master Sample

Sample CPT Master Report for all codes added to the database in the year 2010, sorted by
Code.

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HCPCS Master Report

A report showing all HCPCS codes in the database for a specified year or all years
combined.

HCPCS Master Options

1. Select the year of the HCPCS codes or check to see All Years' codes.

2. Select to sort by either the code or the description and the code.

3. Click Ok.

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HCPCS Master Sample

Sample HCPCS Master Report for the year 2010, sorted by Code.

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ICD Master Report

A report showing all ICD codes in the database for a specified year or all years combined.

ICD Master Options

1. Select the year of the CPT codes or check to see All Years' codes.

2. Select to sort by either the code or the description and the code.

3. Click Ok.

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ICD Master Sample

Sample ICD Master Report for the year 2010, sorted by Code.

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Custom Charges Master Report

A report showing all custom codes in the database.

Custom Charges Master Options

1. Check if you want to show all active codes.

2. Select to sort by either the code or the description and the code.

3. Click Ok.

Custom Charges Master Sample

Sample Custom Charges Master Report with only active codes showing.

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Adjustment Code Master Report

A report showing all adjustment codes in the database.

Adjustment Master Options

1. Check if you want to show all active codes.

2. Select to sort by either the code or the description and the code.

3. Click Ok.

Adjustment Code Master Sample

Sample Adjustment Code Master Report with only active codes showing.

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Fee Schedule Report

A report showing the fees set for each code, according to the selected Fee Schedule.

Fee Schedule Report Options

1. Select the desired fee schedule from the drop down.

2. Click Ok.

Fee Schedule Report Sample

Sample Fee Schedule Report for the Default fee schedule.

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Dependency Report

A report showing the fee schedules that have dependencies on them, and the percentage
that is being calculated for each.

Dependency Report Sample

1. The base Fee Schedule. The fee schedule(s) listed below are based on the top fee schedule.

2. The calculated fee schedule, based on a percentage of the above fee schedule.

3. The percentage of #1 fee schedule to calculate the #2 fee schedule.

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Duplicate Report

A report showing any duplicate patients in the database. Searchable by First, Middle or Last
Name, SSN, Date of Birth, or Phone Number.

Patient Duplicate Options

Search by any of the above criteria to find duplicate patients.

Patient Duplicate Sample

Sample Patient Duplicate Report searching by last name, Slim.

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Payment Summary Report

A report for showing the payments by payment type that have been entered during a
specified time period.

Payment Summary Report Options

1. Start Date and End Date: Select a date range in which to see all of the payments entered.

2. User: If wanting to run the Payment summary for a particular user, select the appropriate
user from the drop down.

3. Exclude Posted Only: Posted Only refers to payments that were only officially posted on the
current date, but have a different (previous) Entered Date. This situation would occur if you
took a pre-payment for a patient, but did not officially post the payment to their account that
day (and it remained in the patient's Pre-Pay bank), but you did deposit the check at the bank.
On the day that you do post those charges to the patient's account, if you do not want that
payment on your payment summary report (because it has already been deposited), you can
check the Exclude Posted Only box. If you would like to see those items on your Payment
summary, if you leave the Exclude Posted Only check box UNchecked, you will see those items
listed as Posted in their status. In addition, you will be able to see both the Entered Date and
the Posted Date, should any confusion arise.

4. Group by User: Checking this box will show payments entered by user (unless a specific user
has been selected already).

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Payment Summary Sample for all Users

1. The Date Range for the Payment Summary data.

2. Date Run: The date the report is generated

3. Indicates how the report is run: By User or All Users

4 & 5: Payment Types: Cash, Check, Credit Card, Insurance payment, etc.

6. Payment Status (Posted): Indicates that the payment was officially posted to the patient's
ledger during the date range specified. Refer to the Date Posted column for the item to see the
specific post date. This status will have both an Entered Date and a Posted Date. Depending on
the circumstances, in some cases, these 2 dates may not be the same.

7. Payment Status (Unapplied): Indicates any payments that were taken from the patient and
entered, but not officially applied toward any charges. (Will pertain to Co-Pays and Pre-Pays).
This status will show an Entered Date, but no Posted Date.

8. Payment Status (Nonposted): Indicates any payments that have been entered into the
system, applied to charges, but have not been posted to the patient's ledger. These payments
will be found in the patient's New Charges tab of their patient account. This status will show an
Entered Date, but no Posted Date.

9. Date Entered: The date that the payment was entered and saved for a particular patient.

10. Date Posted: The date that the payment was posted to the patient's ledger.

11. Type: Indicates the type of payment (will be a Co-Pay, Pre-Pay, or Payment).

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12. Patient Name: The patient to whom the payment was saved.

13. Account No.: The account number for the patient indicated.

14. Reference Number: Will indicate any information that was typed in as a reference for the
payment when it was taken. (Could be a check number, credit card type, etc.)

15. Amount: The amount of the payment that was stored for the patient indicated.

16. Daily Deposit lists: Payment total for each method of payment applied for the day.

17. Report Totals: Total for payment statuses.

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Production By Diagnosis Report

Generate a report that will list diagnosis codes along with the number of times the code has
been used within a specified date range. Several filtering options are available or leave
options blank for all codes used by all providers at all facilities.

Filtering Options

1. Select ICD Type 10 or 9

2. Starting Code and Ending Code letter(s) or leave blank for all

3. Date range for reporting period

4. Provider or leave blank for all

5. Check Show Inactive to include inactive providers and select provider from the drop down
option

6. Sort by ICD Code or Usage Count

7. Select Facility or leave blank for all

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Results for Selected Options

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Production by Procedure Report (by
Provider, Referring Provider and/or Facility)

A report for showing the production by code for a specified date range and searchable by
Provider, Referring Provider, and/or Facility.

Production by Procedure report will include all charges applied to a Visit in the New
Charges tab, even if they have not been posted to the Patient ledger. If you are finding
discrepancies between this report and the Month or Year end reporting, we recommend
running the Missing Charges Report to check for any Visits that have not been posted to
the Patient account.

The Amount for each Procedure listed is the amount indicated for the code in the Default
Fee Schedule. Total Amount Billed will depend on the number of Procedures charged, and
any amount that is overridden in the Charge section of Charge Details.

Production by Procedure Report Options

Search for payments entered by Date Range, Provider, Referring Provider, and/or Facility.
Provider listing includes only active, licensed providers within the practice. To list Inactive
Providers, place a check mark in the box next to Show Inactive. To report all Providers and
Facilities, leave blank.

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Production by Procedure Sample

Sample Production by Procedure Report searching by date range and selecting one Provider, all
Facilities and all Referring Providers.

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Statement Report

This Statement manager allows statements to be run both in group or individually by

patient or guarantor.

Billing menu->Reports->Statement Report

Statement Report Options

1. Minimum Balance: Set a minimum balance by which to send statements out. This will not
allow any statement to print if the balance is less than the minimal set here.
2. Group: Print batch statements by Provider or Group.
3. Patient: Print individual statements for a select Patient.
4. Guarantor: Print individual statements by a select Guarantor.
5. Date Range: The aging on charges calculates by date. Select to print and age charges on
patient statements by Date of Service or by the Date Posted.
6. Search Guarantor: Run statements in alphabetical grouping by Guarantor/Patient Last
Name Range. (A-L one week, M-Z the next week, etc.) Statements will be grouped by
Guarantor. Alpha selection should be CAPS.
7. Remit To: Select the Remit To facility for receiving patient payments. If Remit to is a PO Box,
a separate facility can be added to Manage Facilities for statements.

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 8. Notes: Enter any note that you would like to go on every statement within the batch
selected.
9. Do not show tax id: Check to not include the Tax ID on patient statements.
10. Do not show pending insurance items: Check to NOT include any charges that are
pending insurance.
11. Include Credit Balances: Check to include patient accounts with credit balances to be
included and printed in the processing.
12. Top Margin: If using any kind of perforated paper to send out patient statements and need
to adjust the margins, enter the number that matches up with your statement paper.
13. Submit Via Clearinghouse: If sending statements to Gateway EDI for them to print out and
mail for you, check this box to upload the statement batch.
14. Testing: If needing to send a test batch of statements to Gateway EDI, check this box prior
to sending.
15. Click Okay when finished to generate the statement batch.

*Note: If a patient has a personal balance but is not included in the statement batch, verify that
the Do Not Send Statements check box is not selected. This is located under the Statements
tab in the patients account.

Sample Statement

For the best fit, fold on the black line and use the #9 (3 1/8 in x 8 7/8 in) double window
envelope.

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Confirm Saving to the Database

Click Yes to save a copy of each statement in the associated patient account.

Click No to not save a copy of each statement in the associated patient account, and re-run the
statement batch.

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Credit Balance Report

A report showing all patients with credits on their accounts.

Credit Report Sample

Sample Credit Report

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Missed Charges Report

A report showing any possibly missed charges within SOAPware, by Provider. Filter report
by Start date. The report will display 3 specific areas where charges could be being missed:

1. Encounters: Any patients with encounters that do not have an associated billing
statement will be shown.
2. Superbills: Any patients with superbills that have never been posted will be shown.
3. Visits: Any patients with visits that are in the patient's New Charges tab of their Patient
Account that have not been posted to the patient ledger will be shown.

(Previously known as SOAP Audit Report)

Missed Charges Report Options

1. Select the Provider from the drop down, or leave blank to process all providers.
2. Select a Start Date.

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Missed Charges Report Sample showing Encounters
without a Superbill

1. Encounters with no Superbill created. Will indicate Encounter Date, Patient Name, Account
Number, and the associated reason for the visit (Encounter Name).

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Missed Charges Report Sample showing Non-Posted
Superbills and Visits

2. Superbills that have not been posted. Will indicate Superbill Date of Creation, associated
Patient Name and Account Number.

3. Missed Visits found in the New Charges tab of the patient account. Will indicate the Visit
Date, associated Patient Name and Account number.

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A/R Patient Report

A report showing all patient A/R, searchable by selecting a specific Guarantor or Patient,
Patient Account Number, and Filtered by either Patient or Insurance amount or Both. Also
filterable by Aging Category of Current, 30, 60, 90, 120 days or All, as well as setting a
particular dollar range for the Type or Aging.

A/R Patient Report Options

1. Create an A/R Patient report for a particular Guarantor.*

2. Create an A/R Patient Report for a selected Patient. *

3. Create an A/R Patient Report for a particular patient, by entering their Account Number.*

4. Filter your report by any or all of the below options. These categories build on one another.
The range at the bottom will search based on the specific options that are selected in both Type
and Aging. Leave all fields blank to get the full A/R reporting.

Type - Patient, Insurance, Both: Select one of these options to filter. Filter just the Patient
balance or the Insurance balance or Both together.

Aging - Current, 30 Days, 60 Days, 90 Days, 120 Days, All: Select an aging category to filter.

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 Balance Range Start and End: The amount range entered here will apply to the options
selected in Type and Aging. For example, if you wanted to filter for any Insurance balance that
has been outstanding for 120+ days that is greater than $1,000, you would select Insurance for
Type, 120 Days for Aging and enter 1,000 for the Balance Range Start.

5. Click Okay when finished.

* If these fields are left blank, the report engine will search the entire patient database, based
on the criteria entered at the bottom.

A/R Patient Report Sample

1. Each patient shown will indicate the Patient A/R breakdown with totals and the Insurance A/R
breakdown with Totals.

2. For each Guarantor (Family), there will be a total of all of the dependent's Patient A/R, as well
as the totals of all of the dependent's Insurance A/R.

3. At the bottom, there will be a total Family Balance which is a total of both the overall Patient
A/R balance and the overall Insurance A/R balance.

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A/R Carrier Report

Provides both a summary and detailed report (by patient) showing the amount of accounts
receivable pending with each insurance company (carrier).

A/R Carrier Report Options

1. Group/Provider: Select a specific provider or group by which to run the report.

2. Breakdown by Provider: If a Group is selected from the drop down and Breakdown by
Provider is checked, the report will show the group activity, broken down by the individual
providers within the Group.

3. Show Patient Details: Will provide the specific patient charges that make up each Carrier A/
R. If you are wanting a summary report of the total A/R for each carrier, leave the box
unchecked.

4. Click Ok to run the report.

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Sample Carrier A/R report, for a Group, broken down by
Provider (Summary Report)

To Run the above report:

-Select a specific Group from the Group/Provider dropdown.

-Check Breakdown by Provider.

-Leave Show Patient Details unchecked.

1. Provider/Group: The Group selected for the report.

2. The Provider Summary within the Group.

3. The Insurance Company (Carrier) A/R.

4. Indicating the total amount of A/R by aging category for claims that are filed as Primary
claims with the Insurance Company.

5. Summary data for the Provider's total Carrier A/R, being held in Primary claim
submissions and Secondary claim submissions.

6. Totals for the Provider's Carrier A/R for both Primary and Secondary Claim submissions
(when both are applicable).

7. Percentages of the Total Carrier A/R for the Provider, broken down by aging category.

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Sample Carrier A/R Report by Group, broken down by
Provider and showing Patient Details.

To run the above report,

-Select a Group from the Group/Provider dropdown.

-Check Breakdown by Provider.

-Check Show Patient Details.

1. Provider/Group: Indicates the Group that was selected for the report.

2. Provider: Information is broken down by Provider, and indicates who the below A/R is
referencing. (Shown due to Breakdown by Provider being checked.)

3. Carrier: The Insurance Company Name that the A/R is referencing.

4. Patient: The Patient charge detail that is comprising the total A/R.

- File With: (P for Primary or S for Secondary) Will indicate whether the insurance company
above was being filed with as Primary or Secondary for the particular procedure code.

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 (For Example, the above sample report would indicate that BCBS was filed with as Primary
for the code 00120 and $90 is 120 days past due.)

- CPT: the procedure code included in the claim

- Date of Service: Date of Service for the procedure code

- Submitted: The date that the procedure was last submitted/filed with insurance.

- A/R breakdown: by Current (0-30), 31-60 Days, 61-90 Days, 91-120 Days, and Over 120
Days.

5. Total: Provides the Total Carrier A/R for the patient, with the specific Insurance Company
listed above.

Sample Carrier A/R report for a Single Provider with No

Patient Details (Summary Report)

To Run the above report:

-Select a specific Provider from the Group/Provider dropdown.

- Leave other checkboxes blank (unchecked).

1. Provider/Group: The Provider selected for the report.

2. The Insurance Company (Carrier)

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3. Indicating the total amount of A/R by aging category for claims that are filed as Primary
claims with the Insurance Company.

4. Indicating the total amount of A/R by aging category for claims that are files as
Secondary claims with the Insurance Company.

5. Summary data for the Provider's total Carrier A/R, being held in Primary claim
submissions and Secondary claim submissions.

6. Totals for the Provider's Carrier A/R for both Primary and Secondary Claim
submissions.

7. Percentages of the Total Carrier A/R for the Provider, broken down by aging category.

Sample Carrier A/R report by Provider, with Patient Detail

To run the above report,

-Select a Provider from the Group/Provider dropdown.

-Leave Breakdown by Provider unchecked.

-Check Show Patient Details.

1. Provider/Group: Indicates the Provider that was selected for the report.

2. Carrier: The Insurance Company Name that the A/R is referencing.

3. Patient: The Patient charge detail that is comprising the total A/R.

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 - File With: (P for Primary or S for Secondary) Will indicate whether the insurance company
above was being filed with as Primary or Secondary for the particular procedure code. (For
Example, the above sample report would indicate that BCBS was filed with as Primary for the
code 00120 and $90 is 120 days past due.)

- CPT: the procedure code included in the claim

- Date of Service: Date of Service for the procedure code

- Submitted: The date that the procedure was last submitted/filed with insurance.

- A/R breakdown: by Current (0-30), 31-60 Days, 61-90 Days, 91-120 Days, and Over 120
Days.

5. Total: Provides the Total Carrier A/R for the patient, with the specific Insurance Company
listed above.

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Insurance Payment Analysis Report

The new Insurance Payment Analysis Report will display amounts submitted to
Insurance Companies in a selected date range, amount paid by payer, and amount
disallowed. Also included is amount paid by patient for the charge.

• Select Provider or leave blank for all

• Select Insurance Company or leave blank for all (check to Show Inactive/Deleted Insurance
Companies)
• Select Code Range or leave blank for all
• Select Date Range for charges by Date of Service

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1. Payer/Insurance Company Information
2. Patient Name
3. Filed as Primary or Secondary, Date of Service, Total amount submitted, Adjustments/
Payments and Total amount paid
4. Column Totals
5. Payer/Insurance Company Summary

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End of Day Report

Report the charges, payments and adjustments entered each day, filterable by User or
Provider.

End of Day Report Options

1. Select the date to view the transactions that took place on that day.

2. View transaction data by User or Provider.

3. Select from the dropdown whether you want data broken down and displayed by User first
and then by Provider, or by Provider first, and then by User. Or leave blank to show all.

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End of Day Report Sample

Details shown on End of Day Reporting:

1. Patient Name and date of service.

2. Procedure and Charge for procedure.

3. Personal payments.

4. Insurance payments.

5. Adjustments on account.

6. Co Pay taken for patient. The gray shaded grid indicates that the co pay was received but not
yet applied to the patient account and posted to ledger.

7. Totals by provider.

8. Grand total.

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End of Month Report

The End of Month report calculates based on the following logic:

The report aging is based on all charges that have been posted (for the provider/group
selected), and all payments and adjustments that have been posted to those charges, as of
the end of the month or the current date, which ever occurs first chronologically. Charges,
payments, and adjustments must be posted or applied in the given month to appear in the
MTD area and in the given year to appear in the YTD.

1. Select month to report.

2. Select the appropriate year.
3. Filter by Group/Provider. Leave blank to show all,
4. Select Date of Service to see the aging based on the Date of Service on each charge.
5. Select Posted Date to see the aging based on the Posted Date on each charge.

A/R Calculations (0-30 Days, 61-90 Days, 91-120 Days, Over

120 Days)

The report aging is based on all charges that have been posted (for the provider/group
selected), and all payments and adjustments that have been posted to those charges, as of the
end of the month or the current date, which ever occurs first chronologically.

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MTD/YTD Units, Charges, Payments and Adjustments

Charges, payments, and adjustments must be posted or applied in the given month to appear
in the MTD area and in the given year to appear in the YTD.

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End of Year Report

Report number of procedures, total charges, payments and adjustments by provider/group

per year.

1. Select year to report

2. Filter by Group/Provider. Leave blank to show all, select individual provider or group

3. Choose to run by date of service or by date posted to ledger

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Example of End of Year report by date of service by
Provider

1. Accounts receivable by month

2. Total procedures, charges, payments and adjustments broken down by month

3. Year to date totals

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Custom Patient Reporting

Generate reports on your patients, based on multiple criteria including demographics,

appointment/scheduling information, billing/claim data, etc. Each selection made within
any of the categories creates an AND statement. This will mean it will only pull up patients
that meet ALL of the criteria selected, as opposed to only meeting one of the criteria
selected.

Default Output Information (in Columns):

• Account Number
• First Name
• Last Name
• Address
• City
• State
• Zip Code
• Home Phone

Note: If you select multiple criteria for the report, those additional selections will be added
as columns to the output you receive, to allow you to see the values for each patient row. If
you select Unique Patients Only, you will only see the above columns listed, without the
additional criteria as columns.

Access the Custom Patient Report

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1. Click on View menu.
2. Select Reporting->Custom Reporting.

Demographic Info

Enter values for any of the demographic fields needing to be searched. Be aware that each
selection that is made creates an AND statement. (For instance, if you select a specific sex such
as female, and select an ethnicity of Hispanic or Latino, the report will pull all females in the
system that are Hispanic or Latino.) You may enter selections in any of the categories to search
multiple parameters.

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Scheduling Info

Search on any of the parameters available under Scheduling Info. Select a Facility from the drop
down before selecting a Provider/Resource and/or a Scheduplate.

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Insurance Policy Info

Select an insurance company from one of the fields available. Enter a policy type to search for
any insurance policy with a specific type assigned.

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Billing Info - Account Balance Info (Clincial Suite customers
only)

Account Balance Info will enable searching patient balances.

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Billing Info - Charges Info (Clincial Suite customers only)

The Charges Info will be searching for any codes, adjustments or visit detail that is entered
within the Patient Account. The search of these codes does not search the SMARText within the
SOAP note. It is only a search of the billing data that is billed on the patient's ledger.

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Billing Info - Claims Info (Clincial Suite customers only)

Enter any criteria to pull up patients based on their claim detail.

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Selecting Unique Patients Only

If you have entered criteria that generates multiple entries per patient (for example, running a
search on patients with appointments within a particular date range), there is an option to only
see the unique list of patients that fit that criteria. To do that, check Unique Patients Only. This
option allows you to get a true count of the number of different patients that meet the criteria.
Note: When Unique Patients Only is checked, your report will only show the default columns
for the report and will not add on the additional search criteria as additional columns.

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The preview of the report will be shown first and will allow you to export the data in multiple
formats. Any of the options listed above will be available for export. Feel free to export the
patient information to use to merge with other documents, create graphs, spreadsheets, etc.

Exported Report

This screenshot is an example of the previous report exported to an Excel spreadsheet.

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 Security Manager/Audit
Log

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Security Manager

How to view and monitor user activity.

SOAPware menu -> Security Manager

Accessing the Security Manager

1. Go to the SOAPware menu.

2. Select Security Manager.

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Viewing system activity

The Audit Log is designed to show the specific activity throughout the system and allow it to be
displayed by Date, User, Location in the system, IP Address, Section in SOAPware, or by Patient.
It will show the basic activity that was done, and if an item is clicked on, the Audit Details will
show the specific changes that were made.

1. Query the specific information that is needed.

2. A display of the line item activity performed.

3. When a line item is selected, the Audit Details will show the specific activity performed and
exactly what the changes were.

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Specific items can be viewed in the Audit Details, such as changing/adding a policy number in
Insurance Demographics.

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 PM Accessibility in Read
Only Mode

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Billing Reports, PM Tools, and Schedule
All billing reports listed below will be accessible once a site is Read Only and can be exported to
PDF or Excel from the print preview.

Custom Reporting will still be accessible in Read Only mode.

Below is the notification of the functions which will no longer be available in Read Only mode:

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PM Tools
Once a site is in Read Only view, there will no longer be access to Manage Groups from the Tools
menu. This item will be grayed out along with Security.

Manage Facilities will be accessible under Tools, but the list and options are grayed out once the
window is opened.

Although Billing Maintenance items will be accessible and editable, the edits will not be reflected
in the SOAPnotes or the billing statements.

Schedule
In Read Only mode users can view the Schedule, but they can no longer open any appointments
or charts from the schedule. New appointments and charts can no longer be created either.

The schedule can still be printed by going to: Scheduler > Reports > Print Advanced Schedule.
Select the facility providers and/or resources, select Extended Report, then enter the date range
and click Select.

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This report can be exported to Excel in the print preview.

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Patient Account Tabs in Read Only
The majority of patient account tabs will be greyed out as the Ledger is in the screenshot below:

The Print Receipt button under the Ledger tab will no longer accessible.

Flags/Notes Tab
The Flags and Notes will continue to be accessible and editable by a user if needed, but no new
flags or notes can be added.

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Claims Tab
In the Claims Tab, users will have access to the list of patient claims, but will not be allowed to
edit any claims.

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*NOTE: Any claims that need to be re-submitted after Soapware sunset can be done on Trizetto’s
website.

Statement Tab

Users will have access to the Statement Tab, and will be allowed to print any listed. SOAPware
suggests running statements the day of SOAPware sunset, and if any patient has a balance, a
Custom Code may be created in the user’s new billing software (i.e. “Balance Forward from
SW”), then the balance can be applied to the patient account in the new billing software.

*NOTE: Statements can be exported to an RTF file and opened as a Word document, which can be
edited as patient balances change. These statements can be printed and re-mailed.

SOAPware also recommends running a statement on a test patient with a .01 cent balance, exporting
the statement to an RTF file, and saving it to Word (check export watermarks). This can then be used
as a “Generic Statement” for all patients since it can be edited.

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Insurance Tab
Insurance policies will be accessible for viewing company name, policy and insured information;
however no changes can be made. All scanned images (i.e. insurance cards or photo id) and
eligibility reports will be accessible and printable, but no scanned images can be added nor can
eligibility be checked.

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Practice Management User Manual ©SOAPware, Inc. 2017 Page 553
Exporting Contact List

Print List
Go to Tools > Contacts and click Print List

In the Print Preview that displays click Export To drop down menu and select the preferred file
type.

For an editable list choose an appropriate Excel file type.

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Check the box next to Show grid lines and click OK. Rename the report and save.

This report contains only the name, specialty, city, state, and phone and fax number. Any
additional data (i.e. NPI numbers and other provider information) will need to be entered
manually into the spreadsheet.

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Extracting Insurance Companies
It is possible to copy data from the Insurance Company Manager list, which contains the name,
address, phone, city, state and zip code. This list does not contain the payer ID of the company
because this is the payer ID for Trizetto, and if a site will be using a different clearinghouse it will
not be necessary. If the site continues to use Trizetto with the new billing software, the payer
ID's will need to be manually entered into the Excel spreadsheet that can be created using the
following instructions:

Open Insurance Company List

Go to Tools > Insurance Companies

Highlight List
Click on the first insurance company to highlight it. Press and hold the Shift key while scrolling
down and click on the last insurance company so that all lines are highlighted blue.

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Copy and Paste List
On the keyboard, press "Ctrl C" to copy. Open a blank Excel spreadsheet and press "Ctrl V" to
paste.

The document can be saved and edited as needed, including adding the payer ID's manually.

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Exporting the Pharmacy List

Print Pharmacies
Go to Tools > Pharmacies and click the printer icon.

For an editable list, click the downward arrow in the Export To box of the Print Preview and
choose the appropriate Excel file type.

Check the Show grid lines box then click OK.

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Rename the report and save. This report contains only the description, name, street, city, state,
zip, pharmacy type, and phone and fax number. Any additional data will need to be entered
manually into the spreadsheet.

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