Edit a Claim Submission

Search the desired claimants from any specific sub tab.

Click the desired claimant from the list.

Click the Claims button.

Select the desired submission from the drop-down.

Click Edit to display the Specific Claim Submission window for the claim submission.

A

Click to document a referral for the submission.

B

Click to copy the submission. Use when you want to use this submission as a template for a new submission. See Document a Submission for more information.

Review the submission information as desired. If the submission has not been closed, you can edit Administrator and Received Date. Choose the new administrator from the drop-down. Enter any new date directly in the field in MM/DD/YYYY format or click the calendar icon and set the date using the date picker tool.

Edit the reimbursement request information as follows

Filing

Specify whether this is an initial or final claim by checking the appropriate box.

Diagnosis

Check the box corresponding to the ICD codes you will be using for diagnosis information.

Primary ICD-9

Click the button and search for and specify the primary ICD-9 diagnosis using the Select Claim Diagnosis window.

Primary ICD-10

Click the button and specify the primary ICD-10 diagnosis. If you are using ICD-9 diagnosis codes (the ICD-9 box is checked), clicking the Primary ICD-10 button displays the Select ICD-10 Diagnosis window where you can select the corresponding ICD-10 code. If you are using ICD-10 diagnosis codes (the ICD-10 box is checked), the Select Claim Diagnosis window appears where you can search for and select the appropriate ICD-10 diagnosis. If you want to update the summary with the diagnosis, check the Update Summary box.

Secondary ICD-9

Click the button and search for and specify the secondary ICD-9 diagnosis using the Select Claim Diagnosis window.

Secondary ICD-10

Click the button and specify the secondary ICD-10 diagnosis. If you are using ICD-9 diagnosis codes (the ICD-9 box is checked), clicking the Secondary ICD-10 button displays the Select ICD-10 Diagnosis window where you can select the corresponding ICD-10 code. If you are using ICD-10 diagnosis codes (the ICD-10 box is checked), the Select Claim Diagnosis window appears where you can search for and select the appropriate ICD-10 diagnosis. If you want to update the summary with the diagnosis, check the Update Summary box.

Summary Diagnosis

Displays the diagnosis you selected above when you check the Update Summary box.

Amount Requested

Enter the reimbursement request amount here.

Current Reserve

Current reserve. Populated by ESL Office based on your claimant selection.

Update Reserve

If desired, modify the reserve in this field.

Description

Provide a description for the reserve update here by clicking the button next to the field and specifying the reason from the Select Reason window.

Advance / Simultaneous Reimbursement

Specify whether the policy provides for advance or simultaneous reimbursement by checking the corresponding box.

Diagnosis Date

When the diagnosis was made. Enter the date directly in the field in MM/DD/YYYY format or click the calendar icon and set the date using the date picker tool.

Date Last Charge Incurred

When the last charge was incurred. Enter the date directly in the field in MM/DD/YYYY format or click the calendar icon and set the date using the date picker tool.

Large Case Management

Specify whether or not the claim falls under large case management by checking the corresponding box.

Manager Approval Required

Specify whether manager approval for the claim is required by checking the corresponding box.

Legal Complaint

Specify whether or not there is a legal complaint by checking the corresponding box.

Litigation

Specify whether or not there is litigation by checking the corresponding box.

Assignment Date

When the claim was assigned. Enter the date directly in the field in MM/DD/YYYY format or click the calendar icon and set the date using the date picker tool.

Auditor

Click the button and specify the auditor, if any, from the Auditor window.

Status

Claim status. Populated by ESL Office.

Enter any desired comments in the Comments text area. If you want to add any documentation to the submission, click the Attachment button and locate the desired document.

Click Save.