Solo Practice Claim Entry System Model:C1A1A170 Version 1.01 Copyright (c) 1992-1995 Com1 Software Development Com1 Software, Inc. P.O. Box 482 Hudson, Ohio 44236 (216) 653-3771 IMPORTANT NOTICE: This computer program is protected by copyright law and international treaties. Any unauthorized reproduction or distribution of this program or any portion of it may result in severe civil or criminal penalties, and will be prosecuted under the maximum extent possible under the law. This program, and all support programs and documents are provided "AS IS" without warranty of any kind, either expressed or implied, including and not limited to the implied warranties of merchantability and fitness for a particular purpose. In no event shall Com1 Software Inc.,or Com1 Software Development be liable for any damages arising out of the use or inability to use this program, support programs or documentation. All prices and other information is subject to change without notice. This program is to be used for the insurance submission of a single medical provider on a single computer or local area network. This program and support documents are for trial and demonstration purposes. Any other use is strictly prohibited. SHAREWARE: This program is released as shareware. It is not free and is not in the public domain. This program is not for sale outside of the United States. This program until registered will limit the number of patients and claims you may enter on it. REGISTRATION: The registration fee for the program is $79.00. Registered users will receive a registration file allowing them full use of the product. The registration file may only be used by the registered user on a single computer or local area network. Updates of this program are made available on a regular basis through online services and bulletin boards. Registered users may use new versions of the program as they become available as long as only the right most alpha character in the version number has increased. Latest versions of the program may be ordered on 3.5 inch floppy disks for $10.00 and a printed copy of the manual for $30.00. To register please fill out the ORDER.TXT document and send a check or money order for $79.00 to: Com1 Software, Inc. P.O. Box 482 Hudson, OH 44236 (216) 653-3771 DISTRIBUTION: You may make copies of the C1A1A170.EXE, C1A1A170.TXT, C1A1A170.CFG, C1A1A170.DOC, and ORDER.TXT program and documentation files together and distribute them to others. All five files must be present and may not be distributed without the other files. No additional files may be present without the prior written consent of Com1 Software, Inc. None of the files may be modified in any way. This program or any portions of it may not be distributed outside of the United States. CONCEPT: This product is designed to allow a single provider of medical services to submit primary insurance claims for their patients direct to insurance carriers via asynchronous modem using the Health Care Financing Administration's National Standard Format electronic claims format, the HCFA-1500 universal claim form, or indirectly through the claims clearing house of your choice. Claims are entered into the system in batches organized by insurance carrier. FEATURES ELECTRONIC CLAIMS - NSF and Prolink formats allow claims to be sent DIRECT to the insurance carriers. Direct electronic claims avoid the per claims charges associated with clearing houses. - HCFA-1500 image files can be used to transmit claims to a clearing houses. - Built in asynchronous communications eliminates the need for any additional communications software. Integration simplify processing and eliminates the need to exit and reenter applications. - Supports the Xmodem and Zmodem protocols. - Built in script language allows users to write custom logon procedures for uploading and downloading of claims data to the host computer. Scripts are stored as a database relative to each insurance carrier allowing for seemless integration and organization. - Supports COM1 through COM4 serial ports up to 9600 baud. Allows direct connection to serial ports or Hayes compatible modems. PAPER CLAIMS - HCFA-1500 Revision 12/90 universal claim form. - Supports current Medicare requirements. - Handles most government and private insurance requirements. - Custom form controls allow for modified form rules required by some state administered programs. - Supports free form documentation records direct to form in field 24. DATABASE DRIVEN - Information entered into system is stored and organized into appropriate database. Data remains in system for later reuse or verification. - Insurance carrier database for all the insurance carriers that wish to submit claims to. Store carrier specific notes for each carrier in an easy access linked database. - Procedure code database support for most any coding method separate or mixed. Tracks procedure base fee and unit values in both database and history and relative to each claim. - Diagnosis code database support for virtually any coding method. - Modifier code database linkable to insurance carriers for carrier specific modifiers. - Referring Source database with insurance contract table for recording each referring providers insurance specific ID numbers. - Provider insurance contract table for storing and controlling carrier specific ID's and processing requirements. - Relational database method designed for quick and reliable data retrieval and update. - Front end edits and processing help enforce data integrity for more reliable claim information. - Patient database is designed to handle virtually any combination of guarantor, coverage, and patient relationships. Enter patients through standard patient data entry screens or on the fly at the time of claim entry. Alternate ID's allow you to enter and search for patients based on your own ID's or ID's used in another systems. Store note on each patient in an easy access linked database. BATCH PROCESSED CLAIMS - Organize claims into carrier specific batches. - Primary claims submission. - Claims reordering for resubmission. - Search for batches by carrier name. - Process batches individually. - Print or transmit claims carrier by carrier as you see fit. - Claims adjudication at processing validates and will suspend claims with errors prior to submission. - HCFA-1500 like claim screen. - Batch listings and register provide clear hard copy of claims activity. NETWORK READY - Compatible with any DOS Network Operating System. The only limit to the number of users is the limits of your network. UPWARD COMPATIBILITY - As your needs change and you wish to add to or replace your Model 170 with a more advanced system or additional products form Com1 Software, your existing investment in data entry is protected. ONLINE HELP - Extensive online context sensitive help. - Tutorial Assistance for novice users. - Alpha search on all documentation topics. TYPICAL APPLICATION As patients visits are completed use the Batch Entry to determine if a batch has been created for the patients insurance carrier. If on has and it is still in the NEW status add the patient's claim into that batch. If that patients insurance carrier does not have a batch in the new status, create a new batch for that carrier. Repeat this process. When an adequate number of claims have been entered into a batch process that batch. Verify suspended claims after processing to see if any errors have occurred. Use the batch listing as an audit the batch. Transmit or print claims. Use the processing register to determine the status of pending batches and their claims. Use the processing register update to clear completed batches from the Batch Entry screen. We suggest that in a typical office claims should be completed on a weekly basis. INSTALLATION: Create a new subdirectory. For example if you are using the a hard disk drive C: and the subdirectory you want is \C1A1A170, enter the following at the DOS prompt: C: MD\C1A1A170 Change the current subdirectory to the one we have just created using CD\C1A1A170 Copy all files from the program floppy disk to the new subdirectory. example: COPY A:*.* C:\C1A1A170 Five files should have been copied into the \C1A1A170 subdirectory. C1A1A170.EXE The Claim Entry System program C1A1A170.TXT The shareware documentation ORDER.TXT Order and registration form C1A1A170.CFG Documentation transport file C1A1A170.DOC Documentation transport file To print the documentation to a printer use the DOS type command. For example to printer 1: TYPE C1A1A170.TXT>LPT1 TYPE ORDER.TXT>LPT1 To run the program from the C: drive under the \C1A1A170 subdirectory in the following and then press ENTER. C1A1A170 The program will being execution by either verifying or creating the files required by the system. When either process has been completed you will be placed in the Claim Entry System Model 170 main menu. This product comes with complete documentation. A full users manual can be printed from within the product. - Choose the HELP option under the Main Menu. - Select DOCUMENTATION. - Arrow down to PRINT. - Hit ENTER and highlight will go over to READY. - Arrow down to LPT1. - Hit ENTER to print manual. GENERAL SPECIFICATIONS: - Designed to be a batch based system. - Will allow you to create a batch of 1 to 999 claims for any insurance carrier with a total dollar value from $0.00 to $99999999.99 per batch - Processing batches 999,999,999 per system. - Patients 999,999 per system. - Guarantors 999,999 per system. - Coverage contracts 999,999 per system - Dependents 999,999 per system. - Active coverage 15 per dependent. - Insurance carriers 999,999 per system. - Provider Contracts 999,999 per system. - Primary insurance claims only. - Four diagnosis maximum per claim - Six procedure maximum per claim - Three modifiers per procedure maximum. - Supports HCFA-1500 rev. 12/90 - Printed or transmitted async. - Supports Prolink(sm) transmission format. - Supports NSF National Standard Format 001.04