Sample CMS 1500 and UB04 Form

CMS 1500 Blank Form

CMS 1500 Sample Filled Form

Sample UB04 Form

eClaimManager Practice Management System.  For subscription, please contact vbsenthilinnet@gmail.com

Preview CMS 1500 Form

Nagata EDI Tool :  Create CMS 1500 Form using  EDI 837 Professional

EDI RESTful Web Service API

1. JSON to EDI 837 Professional Claims
2. Parse EDI 837p Message into JSON
3. Parse EDI 835 Message into JSON
4. JSON to cms 1500 Form

Medical Billing Process

Medical Billing is a Process of Submission of Bills/Claims to the Insurance Company in a specified format for the service rendered (for the treatment given) by the doctor for the patient. Why the doctors approach the insurance company for the payment? Since the Majority of patients has insurance coverage and details of such coverage are provided to the doctor before the treatment. So it is the responsibility of the doctor to send the claims to the insurance company and get paid for the treatment given.

Here is the overall medical billing process. In the later section, we will see more detail on each section.

Insurance Verification:
Process started from here and usually front desk people are doing this process. Its a process of verifying the patients insurance is active or inactive by calling insurance or through online verification. If the insurance is inactive, it does not make any sense to send the claim/bill to the insurance company to get paid. So the front office people have to make sure that patient insurance is active even before the patient appointment. If the insurance is not active, then they have to collect the fee from the patient itself(In medical billing, this normally called as Self Pay claim or Patient Responsibility claim).

Charge Entry:
Charge entry is nothing preparing the claim to be sent to the insurance company. After getting the treatment details and patient disease details from the doctor, the billing department will start preparing the claim.The claim details, that are needed to get your insurance claims processed are entered here, and includes, the face sheet of the patient, doctor details, information about the insurance coverage of the patient and billing information.

Payment Posting:
Payment posting is simply posting payments from the insurance company into the system. The insurance company sends a check along with an Statement(This is statement is called as Explanation of benefit , shortly as EOB). On the EOB the insurance company will tell you the allowed amount and the amount they paid.

Denial Management:
The insurance companies reject(deny) paying claims for a number of reasons. Incomplete claim form, inconsistent patient information, etc.The insurance company indicates the reason for the denial in the Statement. Billing department will resolve those errors and again submit the claim to the insurance company.

Here is the overall medical billing process. In the later section, we will see more detail on each section.

 

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com.

ZK + Spring Security Login form–Part 3

Implement custom UserDetailsService for spring security

ZK + Spring Security Login form–Part 2

Implement custom UserDetailsService for spring security

ZK + Spring Security Login form–Part 1

ZK MVVM CRUD with Spring 3. and Hibernate 4

ZK MVVM CRUD With Spring 3 + JPA + Hibernate 4 Entity Manager

A simple CRUD Application based on JPA.

ZK MVVM CRUD With Spring 3 + JPA + Hibernate 4 Entity Manager–Part 7

Look and Feel –> Change the default ZK CSS

ZK MVVM CRUD With Spring 3 + JPA + Hibernate 4 Entity Manager–Part 6

ZK UI Presentation layer.

ZK MVVM CRUD With Spring 3 + JPA + Hibernate 4 Entity Manager–Part 5

DAO and Service Layer for CRUD operation.

ZK MVVM CRUD With Spring 3 + JPA + Hibernate 4 Entity Manager–Part 4

Integrate Spring and Hibernate

ZK MVVM CRUD With Spring 3 + JPA + Hibernate 4 Entity Manager–Part 3

Define the persistence.xml file

ZK MVVM CRUD With Spring 3 + JPA + Hibernate 4 Entity Manager–Part 2

Create ZK Application with Eclipse and Maven.

ZK Passing Parameter between two files using MVVM–Part 2

Overview

This is the first series of articles about Passing parameter between two zul files using MVVM Design pattern.This article will focus on the how to pass values from the parent window to child window opened in modal mode.

ZK Passing Parameter between two files using MVVM–Part 1

Overview

This is the first series of articles about Passing parameter between two zul files using MVVM Design pattern.This article will focus on the how to pass values from the parent window to child window opened in modal mode.

ZK Passing Parameter between two files using MVC and MVVM

How to submit the claims after primary insurance ?

This is another interesting area where lot of automation is required in the software.

ZK Passing Parameter between two files using MVC - Part 5.

Overview

This is the fifth series of articles about Passing parameter between two zul files using MVC Design pattern.This article will focus on the How to return values from the child window (Modal) to the Calling Parent Window using sendevent.

ZK Passing Parameter between two files using MVC - Part 4.

Overview

This is the fourth series of articles about Passing parameter between two zul files using MVC Design pattern.This article will focus on the How to return values from the child window (Modal) to the Calling Parent Window.

MVVM CRUD with Spring 3.1 and Hibernate 4 and ZK - Part 5

This article focus on Delete function.