Regional Area

Clicking on the "Claims" menu item in the global area opens the regional area specific for the claims pages. As long as the user remains in the "Claims" global area, the regional area remains open and visible. The user has direct access to the information/control items displayed in this area, regardless of the content of the current local area. The regional area for claims has four functions: it contains a claims quick search, it contains a claim lines quick search, it allows an operator to open the Enter Claim page in order to enter a new claim and it provides access to other pages that show counters, medical cases and authorizations.

Claim Quick Search

Entering a new search criterion and executing a search will automatically put the focus back on the Claims Search Result page dynamic tab (local area). In the event that the Claims Search Result page tab had been closed, it will reopen. The search result area displays the results of the quick search, overwriting the results of a possible previous search. In effect, there can be no more than one Claims Search Result page tab open at any time. Note that if the search result returns exactly one claim the applicable claim page is directly opened, depending on the status of the claim:

Entry → Enter Claim page
Change → Change Claim page
Manual Pricing → Manual Pricing page
Manual Pricing Adjudication → Manual Pricing Adjudication page
Manual Benefits → Manual Benefits page
Manual Adjudication → Manual Adjudication page
any other status → View Claim page (also opened when the user has no access to the above mentioned pages)

The quick search offers the following search criteria ('Code' is selected by default):

Table 1. Claim Quick Search
Criterion	Remark
Code	Search on claim code.
Serviced Entity Code	Search on serviced person or object code.
Serviced Entity Name/Description	Search on serviced person last name or object description.
Entity Ref	Search on provider person or object reference.
Claim Ref	Search on provider reference.
Servicing Provider	Search on service provider (provider) code.
Service Facility	Search on location provider (provider) code.
Billing Provider	Search on claimant provider (provider) code.
Billing Relation	Search on claimant relation (relation) code.
Prior Auth No	Search on authorization code.
Claim Set	Search on claim set code.

This part of the quick search functionality follows the standard layout, for example, a menu box for the search criteria and a free text field for the key value. In addition to these two standard controls, a From date and a Through date are also enter-able as criteria. A claim meets the quick search criteria if

(1) the specified criterion is a match and

(2) the claim start and end date lie within the specified period. Claims that have no start/end date should not be found if a from and/or through date are specified.

Note that it is not allowed to search without criteria or use wildcards in the first position.

The quick search area also holds a button that opens the advanced search. Clicking this button will

(1) re-open or re-focus on the Claims Search Result tab and

(2) expand the advanced search area situated in the local area of the Claims Search Result page.

The title of the quick search is Claim Search. This serves to clarify that the quick search is on claims, as the regional area also provides access to other pages that show counters, medical cases and authorizations.

Claim Line Quick Search

Entering a new search criterion and executing a search will automatically put the focus back on the Claim Lines Search Result page dynamic tab (local area). In the event that the Claim Lines Search Result page tab had been closed, it will reopen. The search result area displays the results of the quick search, overwriting the results of a possible previous search. In effect, there can be no more than one Claim Lines Search Result page tab open at any time. Note that if the search result returns exactly one claim line the applicable claim page is directly opened, depending on the status of the claim.

The quick search offers the following search criteria ('Claim Code' is selected by default):

Table 2. Claim Line Quick Search
Criterion	Remark
Claim Code	Search on claim code.
Serviced Entity Code	Search on serviced person or object code. Note that the search includes persons or objects that are inherited from claim level if not specified on the claim line.
Serviced Entity Name/Description	Search on serviced person name or object description. Note that the search includes persons or objects that are inherited from claim level if not specified on the claim line.
Provider	Search on provider (provider) codes. Matched against the benefits provider, pricing individual provider and pricing organization provider.
Procedure	Search on procedure codes. Matched against all three claim line procedures.

This part of the quick search functionality follows the standard layout, e.g. a menu box for the search criteria and a free text field for the key value. In addition to these two standard controls, a From date and a Through date are also enter-able as criteria. A claim line meets the quick search criteria if (1) the specified criterion is a match and (2) the claim line start and end date lie within the specified period.

Note that it is not allowed to search without criteria or use wildcards in the first position.

The quick search area also holds a button that opens the advanced search. Clicking this button will (1) re-open or re-focus on the Claim Lines Search Result tab and (2) expand the advanced search area situated in the local area of the Claim Lines Search Result page.

The title of the quick search is Claim Line Search. This serves to clarify that the quick search is on claim lines, as the regional area also provides access to other pages that show counters, medical cases and authorizations.

Regional Area

Claim Quick Search

Claim Line Quick Search

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