Create Claim by Encounter¶

▶ Video coming soon 2 ways: one encounter, or many

What this is for¶

Create Claim by Encounter turns encounters (visits) into claims — one at a time, or a whole batch at once. It is the last step for practices that enter and check the encounter first; see Two ways of working.

Before you start¶

Open it from the menu: Encounter → Create Claim by Encounter.
It lists only encounters that are ready to bill: those with no claim yet and not on hold. An encounter on hold never appears here — release the hold first.
It searches as soon as it opens, newest date of service first. There is no date limit until you set one.

Create a claim from one encounter¶

Find the encounter — use From Dos / To Dos, Last Name, Encounter # (CSV) or any other filter, then Search.
On the encounter, click the Create Claim icon.
The claim screen opens, filled in from the encounter but not saved yet. Check it — see Enter or edit a claim.
Click Save. The encounter's Billing Status becomes Billed and it leaves this list.

What comes across from the encounter: the patient, insurance profile, facility, every provider, the referral, the date of service and entry date, place of service, claim type, the diagnosis codes, and each line with its procedure, modifiers, units and diagnosis pointers. The Claim # is the encounter number. When the insurance profile has a primary insurance, the claim is set to go by EDI to it.

Prices come from the fee schedule

Each line's charge is taken from the practice's fee schedule, not from the encounter. A procedure with no fee there has no price — enter it on the claim before saving.

The claim screen does not open if the encounter cannot become a claim yet — for example it has no line items, or a date in the future. The reasons are listed in a Service Validation box.

Create claims from many encounters¶

Search so the list shows exactly the encounters you want to bill.
Click Create Claim for Selected. It uses every encounter the search found, on every page — there are no check boxes. Up to 1000 at once.
The Create claim screen shows the Summary: Selected encounters, Valid Encounters and Invalid Encounters, and an Error List of what is wrong with each invalid one. Click an encounter number there to open and fix it.
Optionally type a Batch Name. Every claim created in this run is tagged with that name, so you can find the batch later in Manage Claim's Claim Tags filter.
Click Create Claim. Claims are created and saved for the valid encounters only; the invalid ones stay on the list, unbilled.
Bulk Claim Create - Summary shows Total Number of Claims Created, Total Insurance Claims Billed and Total Patient Claims Billed. Click a number to see those claims in Manage Claim.

Compare the two numbers

If Total Number of Claims Created is lower than Valid Encounters, some encounters failed a last check as their claim was saved, and were skipped without a message. They are still unbilled — search this screen again to find them, then open each one and fix it, or use Create Claim on it to see what is wrong.

Unlike the single way, bulk claims are saved straight away — there is no claim screen to check first. Check the Error List, and the claims afterwards in Manage Claim.

The screen¶

Search row: From Dos, To Dos, Last Name and First Name (both match the start of the name), Patient # (CSV), Encounter # (CSV), Billing Type (All, HCFA, UB), Search and Reset. Advance Search opens every other filter — dates, demographics, providers, payer, procedure and ICD codes, billing status, tasks and tags — with the same [Any], [Empty] and [Exclude] options as Manage Claim. Order By sorts the list.

On each encounter:

Icon or link	What it does
Encounter #	Opens the encounter to edit.
Open Encounter Summary	A read-only summary in a new tab.
Edit	Opens the encounter to edit.
Create Claim	Creates the claim from this encounter — see above.
Notes	The encounter's notes.
Event Log	Who changed what on the encounter.

The two icons beside Order By switch between cards and a table.

Other buttons at the top — like Create Claim for Selected, these use every encounter the search found:

Add to Eligibility Check Queue — queues each one for an insurance eligibility check. Up to 50 at once.
CSV Export — downloads the list as a CSV file.

Common problems¶

You see	Why	What to do
An encounter is missing from the list	It already has a claim, it is on hold, or a filter is hiding it.	Click Reset. If it is still missing, open it from Manage Encounter — it is billed or on hold.
Cannot create Claim. Encounter is on hold. Release the hold before creating a claim.	The encounter was put on hold.	Release the hold on the encounter first.
Cannot create Claim. Encounter Date of Service is in the future	The date of service is after today.	Correct the date on the encounter, or wait until that day.
Cannot create Claim. Encounter has no line items.	Nothing to bill yet.	Add the procedures on the encounter.
Procedure fee is missing for … (Error List)	The fee schedule has no price for that procedure.	Add it to the fee schedule, or create that claim one at a time and enter the price.
ICD Code … is present but not mapped to any line item. (Error List)	A diagnosis code is not pointed to by any line.	Point a line at it on the encounter, or remove the code.
…only 1000 Encounters is the limit for bulk action.	The search found more than 1000.	Narrow the search — a shorter date range, for example.
There are no valid encounters to create claim	Every encounter in the batch has an error.	Fix them from the Error List, then try again.
Fewer claims created than Valid Encounters	Some failed a last check and were skipped.	See Compare the two numbers above.
Create Claim did not complete	The server did not answer in time.	Check Manage Claim for this batch before trying again. Running it again does not bill anything twice.

Watch it¶

eClaim Pilot · Billing

Create Claim by Encounter

Video coming soon