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Quick overview of claim creation

A. Claim Creation

First select the Search option from the Claims drop down menu

Select search by Individuals

Select the Search field that will make it easier for you to identify your claimant:

For example, we search by name with CAL included in the name then press Enter:

Double click on the proper file or click once and then click on the Yellow folder will give you the general picture of the claimant.  You have multiple options available on your left, but since we simply want to create a new claim, we will select the List option:

The pending option will automatically be available:

You will choose to create a new Batch by clicking on the  button.

Then do it again to create a serie of claims items by clicking on the  button.

You will now be in a position to create each claim item as needed:

You will first identify the family member, type of claim, payable item to and if needed the Provider information.   

Then fill the claim information based on the actual bill received from the pharmacist, Health professional, dentist or whatever.

I

When you click  the system will automatically take all the proper adjudication decisions and provide you with the decisions:

To continue and create an additional claim item, simply click on the OK + and redo the previous steps until you have created all claims items.  After accepting the last item, simply click on Cancel to exit this option.

Once you have created the last item, the system will bring you back to your Item list in a pending Batch were you will find the resume of all the claims items that you will have processed:

Again multiple options will be available to you:

-          review or edit any item

-          print

-          write a note

-          order payment issuance

-          or exit and save as a pending batch

If Saved as a pending batch, the item will now appear in the employee Pending batches section as well as in the general Pending batches (this is the first page when entering the Search option).

If you selected to order payment issuance, the transaction will be sent to the Cheque manager module.  Obviously, you should first create all your claims and then with a single request get cheque issuance for all requested claims.

B. Issue payment

To issue payment, access the Cheque manager module in your top drop down menu:

A simplified menu will now be available to you on the left side, where we will:

• first select the Cheques payment  -  Authorization sub-option

• hold the Ctrl button and click on the payment that you wish to authorize,

then

• click on the  button.

This simple process will automatically generate all the needed activities except for the actual cheque printout that will be again generated automatically once you have placed your cheques in the printer and requested the  option.

To print the selected batch, click on the  option.

Currently you will have a “Preview option” only.  Each cheque will appear on the screen only.  We will provide you with the print option if needed.

And this is it.  The rest of the stuff is for maintenance or special situations that you will be able to explore on your own.