Use this tutorial to enter a transportation claim line item on the Transportation Claim Entry page.
Complete the following steps to perform this tutorial:
Display the Transportation Claim Entry page.
Enter the details of the claim line item in the following fields:
In Auth #, enter an authorization number and press the Enter key on your keyboard.
In Patient Acct., enter the patient account number.
In Travel Date, enter the date on which the travel occurred. For more information about entering dates, see the Calendar Controls topic.
EI Code displays the EI identification number and description.
In Provider, select the service provider from the drop-down list.
In Units, enter the total number of units charged for the claim. You can enter up to 4 numeric digits in this text box. 1 unit equals 15 minutes of service time, 1 item, 1 mile, or 1 trip (as applicable).
Unit Conversion displays the current unit conversion where 1 unit equals 15 minutes of service time or 1 item (as applicable).
In Prior Auth #, enter the previous authorization number.
In Amount Submitted, enter the dollar amount of the claim.
In Amount Received, enter the dollar amount of the claim that has been received.
In Units, enter the total number of units charged for the claim. You can enter up to 4 numeric digits in this text box. 1 unit equals 15 minutes of service time, 1 item, 1 mile, or 1 trip (as applicable).
In Last FR Source, select the source from the drop-down list.
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NOTE: Click the DMA Notification button to add a DMA notification. For more information, see the Tutorial: Add a DMA Notification topic. Click the Overrides button to add a claim override. For more information, see the Tutorial: Add a Claim Override topic. Click the EOB button to add a document to the document library. For more information, see the Tutorial: Add a Document to the Document Library topic. |
The Claim Detail table contains all line items that have been added for the claim. The table contains the following data:
Edit allows the editing of a claim entry. Click the 
icon to refresh the page and display information about the row selected in the table.
District displays the name of the district.
EOB File allows the viewing of a document in the document library. Click the 
icon to view the attached document.
Authorization # displays the identification number for the authorization.
Service Date displays the date the service is or was provided.
EI Code displays the EI identification number and description.
Units displays the number of units for which the provider is billing. 1 unit equals 15 minutes of service time.
Charges displays the charge for the line item.
Delete contains a link to remove the item.
Claim Total Charges displays the total dollar amount of all claims of this type.
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NOTE: Asterisks (*) indicate which fields are required on the page. If required information is missing, an error message displays at the top of the page after saving the data. |
Click Add to add up to five claim line items of this type to the claim.
Click Submit.
Version 1.6
