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Insurance History Tab - Create Claim Button

Overview:

In ChiroHD, the Insurance History tab features a button formerly labeled "New Bill," which has now been renamed "Create Claim." This button is designed to bypass the standard claim validation process and is intended for use by billing experts. It is important to understand the functionality and risks associated with this button to avoid misuse in your regular billing workflows.


Purpose of the "Create Claim" Button:

The "Create Claim" button allows users to create a claim that can intentionally bypass the main validation process but still performs important checks (e.g., for diagnosis codes and billing providers). This option is specifically intended for billing professionals who understand when and why they need to bypass validation for specialized reasons.


Who Should Use the "Create Claim" Button:

This button should only be used by billing experts such as insurance billers or billing companies. These users may have a specific reason to bypass validation temporarily. However, this should never be an office's everyday workflow when creating claims, as skipping validation could lead to billing errors that may affect claims processing.

Important Note:

  • Do not make the "Create Claim" button part of your regular workflow.

  • Always follow the regular billing process via the Insurance tab on the home screen, which ensures proper validation and fewer errors.


Key Validation Errors:

Even when using the "Create Claim" button, there are two critical validation checks that cannot be bypassed:

  1. Missing Diagnosis Codes (DX Codes): Claims without a valid diagnosis code cannot be created.

  2. Missing or Invalid Billing Provider: Claims must have a valid billing provider associated with the services rendered.

If these errors are present, ChiroHD will block the creation of the claim until the issues are resolved.


Process for Creating Claims Without Validation:

If you choose to use the "Create Claim" button:

  1. Review and fix any errors flagged by the system (e.g., missing DX codes or billing providers).

  2. Once the errors are corrected, you can proceed to create the claim.

  3. After creating the claim through the Insurance History tab, you must manually send the claim via the Insurance > Claims History tab (either to the clearinghouse or print it as a paper claim).

This process includes additional steps compared to the regular billing workflow to ensure that only qualified billing experts use the "Create Claim" feature.


New Bill with All

This is the bulk version of the Create Claim button on that same screen.

Sometimes you need to submit a completely fresh claim for every charge on a patient's Insurance History — not a corrected resubmission, but a brand new one.

New Bill with All lets you do that in one click instead of toggling each charge individually.

Note: Only charges with no payment applied are included. Already-paid lines are skipped automatically. This button is only visible to users with Insurance permissions.

Use Cases for New Bill with All

  • The patient's insurance payer changed and the original claims need to be resubmitted to the new payer.

  • The original claims were never received by the payer and you need a clean submission.

  • You need a completely fresh claim for all charges rather than a corrected resubmission.


Best Practices:

  • Avoid using the "Create Claim" button unless absolutely necessary.

  • Always use the Insurance Dashboard and follow the standard claims process for most billing tasks.

  • Ensure that your billing team understands the implications of bypassing validation and uses this feature only in rare, specific cases.

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