Cataract Post Op Claim Processing

Each insurance company has requirements for billing claims. The information below is an example of data input on the invoice. If your carrier has different requirements, please contact support for assistance. 

See Cataract Post Op Bilateral Claim Processing, for detailed instructions. The right and left eye must be submitted on separate invoices. 

Instructions

There are multiple areas of the system that need to be accessed and/or updated to complete the claim processing.

Surgeon's NPI

1. The surgeon's NPI must be displayed in box 17b of the HCFA. Ensure the surgeon's NPI is updated within Admin.
2. Access Admin > Vendors/Partners > External Providers > open the provider > Provider IDs.
3. In the field for NPI ensure there is data, add data if needed.
4. Click 'Save & Close.'

Invoice

1. Access Accounting > Invoices > search for and open an invoice.
2. Single click on the line item to update. 
3. In the Invoice Item Detail modal, input the surgery date in the Service Dates fields.
4. Ensure the diagnosis listed matches the surgeon's diagnosis, add the required modifiers.
5. Click 'Save.' See Example
6. Access the Additional Claim Info tab.
7. For cataract co-mgmt claims, in the "(17) Referring Provider" field, select the surgeon from the dropdown menu. Note: Ordering Provider is only required for DME.
8. In the "(19) Local Use" field, input the date you assumed care and relinquished care date (90 days after surgery). Note: This link to a 90 days calendar may be helpful in determining the relinquished care date. 
9. In the Initial Treatment Date field, located within the Electronic Claim Codes section, input the surgery date. See Example
10. Click 'Save.'
11. Click 'Authorized.'
12. Access the Claim History tab.
13. Click the submit icon.