Category : Databases and related files
Archive   : WINCL403.ZIP
Filename : MANUAL.TXT

W I N C L A I M

Reference Manual

Version 4.03















Oxford Medical Systems
2490 Fatima Place
Hamilton, OH 45013
513-896-5110




The entire contents of this document
Copyright 1992 Gary W. Boehm

CONTENTS - 1

WINCLAIM MEDICAL BILLING SOFTWARE


TABLE OF CONTENTS:



Getting Started

Installation
Start-up


Special Keys

Help Keys
Function Keys
Alt Keys
Navigation Keys


Maintain Files

Doctor
Insurance
Procedure
Diagnoses
Referring Physician
Facility
Miscellaneous Descriptions
List Files


Patient Maintenance

Assigning a Responsible Party
List Patients


Transaction Entry

Selecting a User File
Command Menu
Entering Transactions
Editing User Entry
Editing Posted Information
List Transactions
Posting Entry
Transaction Flow
CONTENTS - 2

Open Payment Entry

Selecting an Open File
Command Menu
Entering Payments
Editing Open Entry
List Payments
Posting Payments
Xfer to History


Reports

Aged Trial Balance
Financial Analysis
Billing Report


Forms Printing

Statement Forms
Insurance Forms


Utilities

Program Parameters
Validate Files
Validate Entry
Directory Select
INSTALL - 1
To Install:

Create a subdirectory on your hard disk called WINCLAIM. Then
change to that directory and copy all of the floppy disk to that sub-
directory. If the program was ZIPped (compressed into a smaller file
in order to fit on a smaller disk) then you will need to UNZIP that
file. Once the compressed file is expanded, you can erase the original
file in order to conserve disk space (you will not need the ZIPped file
once it has been expanded). The following steps are an example of how
to accomplish the above - note that your drive letters may be
different so you may have to edit these instructions to match your own
particular system configuration. What the computer displays is shown
in capital letters and what you should type is shown in small letters.
Press the Enter key after each of the commands listed below.

C>cd \ (starts you in the ROOT directory)
C>prompt $p$g (DOS prompt shows you the dir name)
C:\>md winclaim (Makes Directory called WINCLAIM)
C:\>cd winclaim (Changes Directory to WINCLAIM)

-- insert the Install Disk in drive A: now --

C:\WINCLAIM>copy a:*.*/v (copy all of the install disk)
C:\WINCLAIM>winclm (expand or UNZIP the compressed file)
C:\WINCLAIM>erase winclm.exe (erase the unneeded compressed file)

If the program was NOT shipped to you in a compressed file, then
you will not have to do the last two steps.


The CONFIG.SYS file:

You are now almost ready to start the program. However, before you
do there is one thing you MUST check about your system configuration.
In the ROOT directory there is a file called CONFIG.SYS. There MUST
be a line in that directory which says FILES = nn where the digits nn
MUST be at least 47. If there is NO FILES line, or the numbers after
the equal sign is LESS THAN 47, then you must change or add the line to
the file and RE-BOOT your system. It is WELL beyond the scope of this
manual to tell you EXACTLY how to modify every possible system con-
figuration out there but we will help as much as we can. Also, there
is a small sample CONFIG.SYS file shipped as a part of this program
set to give you an idea of the minimum requirements. You MIGHT be able
to use that file as-is on your system just by copying it to your ROOT
directory and re-booting your system. You probably should re-name
your existing CONFIG.SYS file before using our sample.

FAILURE TO HAVE THE MINUMUM NUMBER ON THE FILES LINE IN YOUR
CONFIG.SYS FILE ABSOLUTELY !!WILL!! CAUSE DOS ERRORS WHEN YOU
TRY TO RUN THE WINCLAIM PROGRAM. THESE ERRORS WILL MOST
LIKELY BE DOS ERROR (4).

INSTALL - 2

To check your CONFIG.SYS file, simply change back to your ROOT
directory and TYPE the file to your screen. Look for the FILES line
(if there is one) and check the number. If there IS a FILES line but
the number is less than 47, you will have to edit the file (with an
editor or word processor in non-document or text mode) and change the
number.

C:\WINCLAIM>cd \ (change back to the ROOT directory)
C:\>type config.sys (display your current file contents)

Now, LOOK at the file. If the line is there and the number is
greater than or equal to 47, then you're OK - go start the using the
program! If not, then edit the file yourself, or call for local tech-
nical assistance (such as where you bought the system), give them the
above information, and they can help you.

If you want to try to use OUR sample CONFIG.SYS program, then

use the following steps:

C:\WINCLAIM>cd \ (change back to ROOT directory)
C:\>ren config.sys config.org (saves your original file)
C:\>copy winclaim\config.sys (copies our file from WINCLAIM dir)

Now re-boot or reset your system (usually by pressing the Ctrl,
Alt and Del keys at the same time). You should be ready to start
WINCLAIM now. NOTE - after installing the sample CONFIG.SYS file it
is possible that OTHER programs which have their OWN special CONFIG.SYS
requirements may not operate properly now. This is NOT the fault of
the WINCLAIM program, but is because you simplefied the system con-
figuration. The solution is to combine the minimum requirements of
ALL the programs you will be using so that they will ALL run properly.
This is the job of your local dealer or local technical support person
who is familiar with YOUR system and the programs you are using.


Starting up WinClaim:

To start the WinClaim program, you must first be sure that you are
IN the WINCLAIM subdirectory, and then type winclaim .

C:\>cd \winclaim (change to the right directory)
C:\WINCLAIM>winclaim (start the program!)

You could also put these two lines in a Batch file and place it
in your ROOT directory.
KEYS - 1
HELP SCREENS

There are three different types of Help Screens available in
WinClaim, all using the F1 function key:

F1 = Field Help Help Screen description of each field
Alt F1 = Alt Key Help Alt/Function Key Help Screen
Sh F1 = Navigate Keys Help Screen showing all the Navigation Keys


F1: Field Help

The F1 key by itself will show a Help Window for the field you
are in, primarily for the Patient File and Transaction Entry areas.
Not all fields have a help screen, just the unique or unusual ones.


Alt F1: Alt/Function Key Help

Holding the Alt key and pressing F1 with show you the Alt Keys
that are available. Not all of the keys shown are active in all parts
of the program (they will be 'locked out' if not). Refer to the next
section for more detail on these keys.


Shift F1: Navigation Keys

Holding the Shift key and pressing F1 will show a list of the
Navigation keys that are available in an open file window. These keys
allow you to 'move around' in a file to see all the data. More infor-
mation about these keys is in the following section.


THE FUNCTION KEYS

The function keys along the top or left side of the main key-
board area give you additional operations in WinClaim. Some of these
operations are extended by the use of the Alt key:

F2 = Add add a new record to a file
F3 = Window opens a Window to search for an item to select
Alt F3 = Lock Lock a row when editing in a window
F4 = Select Selects the item highlighted in a window
F5 = Calculator Pop-up calculator
Alt F5 = Calendar Display a Calender
F6 = Patient Window to edit/select a patient in Trans Entry
Alt F6 = Pat Display Displays a summary of the patient's information
F9 = Diagnosis Enter a patient's Diagnoses
F10 = Chart Enter a screen of general patient information


F2: Add

Whenever you have a file window open and you want to add a new
record, just press F2. A blank record will be appended to the bottom
of the file (or top, depending on the file) for you to fill in.
KEYS - 2
F3: Window

Whenever you are in Patient Maintenance, Transaction Entry, or
Open Payment Entry and want to select an item from another file to fill
in a field, you can press F3 to open a Window to that other file. Use
the Navigation Keys (see Shift F1) to "move around" in the window until
you find the record you want. Then press F4 to Select it and close the
Window. The item you selected will automatically be inserted in the
field where you originally pressed F3.

The following files are available in a Window:

Patient
Responsible Party
Doctor
Insurance
Procedure
Diagnosis
Referring Physician
Facility
Misc Description


Alt F3: Lock a Row

This function key is provided for you to 'lock' the cursor on
a record of a window so you don't 'slip off' by accidentally pressing
an Up or Down Navigation key. Press Alt F3 again to 'Unlock' the row.


F4: Select

When you have opened a file window and located the record you
want to select, press the F4 key. This will close the file window and
return the record you have selected to the original field where you
pressed the Window key.


F5: Calculator

The program features a built-in pop up calculator available
just about anywhere! Press F5 and you can Add, Subtract, Multiply, and
Divide. Press the "=" to get the result, or F4 to return it to the
field where you started (if numeric).


Alt F5: Calender

Another convenience provided with the program is a pop up
Calender. The calender will start with the current month, but you can
change the month with the Up and Down arrow keys, and you can change
the year with the PgUp and PgDn keys.


F6: Patient Window

This key is only available in Transaction Entry and Open Entry
when you are entering or editing transaction lines. It is the same as
using the F3 key from a patient account field in that it allows you to
edit the current Patient File record during other entry.
KEYS - 3

Alt F6: Patient Display

This is another convenience function available during Trans-
action Entry and Open Entry. This key will display a window of the
key patient information, along with full descriptions of the items.


F9: Diagnosis

Although you can use the F6 key and access the Patient Diag-
noses fields in that window, the F9 key gives you a short-cut to that
operation by opening a special window just for the diagnoses. Note
that when this window is open you can still use the F3 window key to
look up and select the diagnosis.


F10: Patient Chart

To create a patient chart press F10 and answer Yes to "create a new
patient chart". Enter in the appropriate information for this chart
and when finished, press Ctrl W to write. This will close up patient
chart correctly and allow you an option to either press "P" to print
the chart or press any other key to close the window. If you have
trouble keeping your entry aligned in the chart, just be sure to press
the space key BEFORE pressing the Enter key at the end of a line. You
may actually enter more than one screen full of information (it will
scroll down automatically).


THE ALT KEYS

These keys give you some additional operations whenever a
patient has been selected in the Patient Window, or during Transaction
Entry or Open Entry. The Erase function is available for other windows
as well.

Alt A = Aging Displays a window with patient's Aging
Alt B = Balance Balance Display based on Responsibility Ind.
Alt E = Erase will erase the line or record highlighted
Alt L = Ledger Card Displays/Print a patient's Ledger Card
Alt R = Resp Balance Balance due by all accounts under a Resparty


Alt A: Aging Window

This window displays the aging of a patient account based on
amounts current, 30, 60 and 90 days and more past due. It also shows
credit amounts, Date of Last Service, Date of Last Payment, Amount of
Last Payment and total Balance due.


Alt B: Balance Window

This window will display what is currently owed by the Patient
based on what is pending by Insurance, Medicare or Medicaid (Medi-Cal),
ChoiceCare, Other and credits. It also shows the total balance due by
the account.
KEYS - 4
Alt E: Erase

If you have entered a record in one of the files and then decide
you want to get rid of it, DON'T just press the space bar and try to
blank it out - that will not change anything. Instead, put the high-
light bar on the record row that you want to erase, be sure you are
NOT in the data entry mode (you should not be able to see the cursor)
and then just press Alt E to Erase. This way the record will be
deleted from your system when Entry is Posted (for Transaction Entry)
or when re-building files under Utilities.
There is no Erase function needed in Open Payment Entry - just
enter a zero amount for both Payment and Adjustment on the right side
of the screen and the line will have no effect when posted.


Alt L: Ledger Card

A Patient's Ledger consists of three parts: the History records,
the Open Items, and Payment Summaries. The History file is all the
"Paid Off" items that have been entered, paid, and stored away. These
items are sometimes also refered to as X Items because once they are
paid, the program automatically puts an X in the Responsibility
Indicator field. The Open Items are items that have been entered but
are not paid off yet. There can also be X Items in the Open Item
area which have been paid off but have not been transferred to the
History File yet. The Payment Summary consists of a record of each
payment entered into the system.
When displaying a Ledger Card, you can choose to see any one of
these files or each one in turn. You can also print or "List" just

one or All of these records on your printer along with a header area
consisting of the patient's Name and Address, Insurance numbers,
Diagnosis Codes, etc.


Alt R: Resparty Balance

This window shows you all patients that have been assigned to a
specific Primary Responsible Party. The window will list the account
number, patient's name, Date of Last Payment, Amount of Last Payment
and balance.


NAVIGATION KEYS

The navigation keys allow you to 'move around' in a file window
either to let you see more records (up and down) or more fields (left
and right). The last three control the window and editing of fields.

Up Arrow = Up one row or record Down Arrow = Down a row or record
Left Arrow = Move left one field Ctrl Left = Pan columns left
Right Arrow = Right one field Ctrl Right = Pan columns right
Page Up = Up one full window Ctrl PgUp = To Top of file
Page Down = Down one full window Ctrl PgDn = To Bottom of file
Home = To left column Ctrl Home = To left most column
End = To right column Ctrl End = To right most col

F4 = Select and return the highlighted record and close the window
Esc = Close the window without returning a selected record

Ctrl Enter = Begin editing the currently highlighted field (you can also
just start typing to overstrike the existing information).
MAINT - 1
MAINTENANCE FILES

The Doctor File -

In this file you should list ALL persons in the practice who
provide services for which you will be billing. This includes
physical therapists and anyone else for whom you may want to run
selective reports.

The first 'Doctor' you enter should be the overall practice name
because that is the one which is generally used as a return address on
statements and at the top of Ledger Cards. Then enter each individual
provider in the practice in the records following that.


Insurance File -

This file holds the list of all Insurance Companies used  by
your patients. A company need only be entered once, even  though
they may be one persons Primary Insurance and another's Secondary
Insurance. You should also enter Medicare and Medicaid  carriers
as an Insurance record.

The Box 1 field in the Insurance File is used to mark the appro-
priate box on the new HCFA 1500 Form. To mark the right box, count
the number of boxes on the form: if an "X" is to go in first box, enter
a "1" in this field in the Insurance File, if "X" is to go in second
box, fill in a "2", etc. Most commercial insurance claims would be
5's. These do have to be filled in for the program to meet all the
different claims processing requirements.


Procedure File -

This  file is for all the procedures that are  performed  by the
doctor, including those by anyone else in the practice  where you  will
be billing for their services. It has fields  for  the procedure code,
description, and the usual fee, and some fields that are  necessary for
insurance forms and electronic claims. Like the diagnosis codes, you
don't have  to enter the entire CPT book! Just enter the ones on the
superbill, or your current list.
You should enter each procedure code once for category PR, and
again for any other category ONLY where the Description, Fee, Place of
Service, etc. is DIFFERENT for another type of billing.


Diagnosis File -

The Diagnosis file is where you keep your list of Diagnoses seen
by the Doctor and their Descriptions. To the basic  ICD9 code and
description is added one other  item  called the 'Group' which can be
used to group together the Diagnoses on a printed list. To work  with
this  file, select 'Maint' from the Main Menu  and  then 'Diagnosis'
from that menu (remember to use the arrow key to get down  to
Diagnosis - if you just press `D' you'll get the  Doctor file!).
MAINT - 2

If you are just starting WINCLAIM, don't worry - you don't
have to enter the entire ICD9 book! If you currently have a 'Super
Bill' for the office, just put in any Diagnoses on that, and  any
others can be added as you go along.


Referring Physicians -

The Referring Physician file is where you maintain the list of
other doctors who refer patients to your practice. Besides the name
and address information, there is a field for a provider number (used
in some states), and also fields for a name and phone number for
whomever you usually contact at that office.

The UPIN# is used in Box 17A of the HCFA 1500 when the Doctor is
a referring physician. Medicare usually wants any doctor who does lab
work in their office for a Medicare Patient to consider themselves the
ordering physician for that service. In that case you must enter the
Doctor as a Referrinjg Physician too AND then put their Referring
Physician number on the first transaction entry line in the REF field,
so that their name will print out in Box 17 and their UPIN number will
print in Box 17A.


Facility File -

The Facility file is where you maintain the list of any locations
outside your office where the doctor(s) provide services. Like the
Referring Physician file, there is a field for a provider number (used
in some states), and also fields for a name and phone number for
whomever you usually contact at that office. The Facility is printed
on the HCFA 1500 form in box 32, "Name and Address of Facility where
Services Rendered".

Miscellaneous Description File -

This file is provided to assist the practice in grouping accounts
and reports by Patient Categories, Billing Types, Payment Types and
Adjustment Types.

Examples of Patient Categories:

PR - Private (cash patients, or file their own insurance)
IN - Insurance (general category)
CC - Choice Care
MR - Medicare
MD - Medicaid
MC - Medi-Cal
WC - Workers Compensation
SP - Self Pay (No Insurance)
WE - Welfare
MAINT - 3
Examples of Billing Types:

IN - Insurance (print a HCFA 1500 form, for example)
PR - When patients are paying at the time of service
and submitting their own claims
MR - Medicare Paper Claim on HCFA 1500
WE - Print special state Welfare/Medicaid form
MD - Print Medicaid claim (might also be on HCFA 1500)
PA - Prior Authorization (charges IGNORED when reporting balances)
KC - File the claim electronically

Examples of Payment Types:

CA - Cash
CK - Check
IC - Insurance Check
MO - Money Order

Examples of Adjustments Types:

WO - Write Off
AD - Adjustment
PC - Professional Courtesy

To identify which of the four Misc Types an entry is in this file,
enter one of the following two letter codes in the Type field:

PC - Patient Category
BT - Billing Type
PT - Payment Type
AT - Adjustment Type


LIST FILES

Use the List selection at the bottom of the Maint Menu to print out
lists of the files you have entered.

List Options -

List Format: The Procedure, Diagnosis, and Misc Desc files can only be
printed in a table format. However, the Doctor, Insurance, Referring
Physician, and Facility files also have an option to print Labels.

File to List: Select any of the files from the window.

Order of List: The Doctor, Facility and Misc Desc files can only be
printed in record number order. The Insurance and Referring Phys files
are printed in alphabetical order.

Procedure File: This file has the options to print in procedure Code
order, Alphabetically by description, by procedure Group, or by
procedure Category.

Diagnosis File: This file has the options to print in diagnosis Code
order, Alphabetically by description, or by diagnosis Group
PATIENT - 1
PATIENT MAINTENANCE FILE


You can maintain the Patient File (adding, editing or deleting
Patients) by selecting Patient from the Main Menu, or by pressing F3
when starting entry for a new account in Transaction Entry or Open
Payment Entry. These selections will open a window at the bottom of
your screen showing your accounts.
This window is considered to be very 'wide' with over seventy
fields going out to the right with all the permanent account informa-
tion. Use the Navigation Keys (press Shift F1) to move around and see
the various data fields. Watch the bottom right line of the window
to see a brief description of each field. Where a field is to be
printed on the HCFA 1500 form, you will see a # sign followed by a
number/letter combination. These correspond to the item box on the
form by the same number. The specialized fields also have a Help
Screen assigned to them. Just press F1 for more information.

When you first open the Patient Window, it begins with account
number 1 (which should be your Cash account) and shows you the file in
account number order. To jump directly to a particular account, press
F3 and enter the account you want in the entry box provided.
You can also use this feature to 'find' an account by name. In
this case, enter the patient's last name, or last name, a comma, and
first letter of first name. Now - two things will happen: the order
of the accounts shown will switch to alphabetical by last name, and
then the program will try to find the account by the name you entered.
If you just entered the last name, you might have to Page Down to find
the exact account you want.

To add a new patient, press F2. To enter data in a field, simply
begin typing. To edit data that is already IN a field, you might first
want to press Ctrl Enter to go into the Field Edit mode, then edit the
data in the field like you would in a word processor.


To assign a Responsible Party to a Patient:

You sometimes see the words Insured, Guarantor, Patient as Insured,
Guardian, Spouse - all meaning someone other than the Patient who has
the actual insurance policy or who is ultimately responsible for the
bill. WinClaim refers 'these people' as the Responsible Parties,
(sometimes abbreviated to Resparties) which are stored in a seperate
file. They are assigned to a Patient account at the far right 'end' of
the Patient window (press Ctrl End). There you will see three RES
fields, for up to three Resparties per account. There are three
numbers provided in case the Resparty is different for their Secondary
or Tertiary Insurance. You will usually just use Res 1.

PATIENT - 2

When adding a new Patient account, move to the Res 1 field and
press F3 to open the Resparty Window. If another account has the SAME
Resparty and that Resparty is already entered in the file, then just
locate that Resparty record, press F4 to Select it, and you're done!
If the Resparty is not there yet, press F2 to add a new one, and
then fill in the record.

NOTE: You DO NOT and SHOULD NOT enter a Resparty for every patient
account, particularly if the Patient and the Insured are the same.
You really only need a Resparty record if they are different or you
need to store the additional information in that file (such as
employment data).


LIST PATIENTS

Use this selection from the Patient Menu to print lists or labels
for your accounts.

Report Options -

Report Format: list to Screen or Printer or print Labels.

Labels: For the labels you have further options to select the number
of lines per label, the left margin offset, whether you want the
phone number printed on the label. If you don't want to print a
whole series of labels, you can opt to print just one at a time.
You also have the option to print test label for printer alignment.

Order of list to print: You can print labels or lists Alphabetically,
by account Number or Zip code.

Select: you can print a series of accounts by account number (such as
all those entered on a certain day since they will be in order).

Patient Category: allows you to print for just one Category.

Doctor: If you have multiple doctors within the group and would like
print for just one, enter the Doctor number here.

Location: You can also select by the Location field as well. This
field is provided for multiple-office practices but you can use it
for ANY other way you want to 'group' your patients.
TRANS - 1
TRANSACTION ENTRY

This is where you will spend most of your time in WinClaim. Here
you will enter all the procedures that are performed in the practice
and also edit any old entry that needs corrections. A Transaction
consists of a Procedure Code and a Charge for that service, plus a
great deal of other information for printing reports and forms. Pay-
ments and Adjustments should ONLY be entered under Open Payment Entry
(covered in the next section). The only exception is if the patient
pays for part of the services AT THE TIME OF SERVICE.

The normal flow of your daily work is to Enter new transactions,
List them to verify the entry (and for permenant storage), and then
Post them to the patient accounts. These process is the same as the
three Menu selections for this section of the program.

Selecting a User File -

A User File is a block of transactions entered by one person which
has not been posted yet. You can have up to nine User Files that you
can enter, print, correct and post independently of the others. These
files are denoted by a number from 1 - 9. Files which have been
started but not posted will be checked-marked at the right of the User
File window when you start Transaction Entry. To select a User File,
use the down arrow key to highlight the number you want and then press
the Enter key.
You can also edit the History, Open Items, and Payment Summary
files from Transaction Entry. CAUTION - editing these files WILL alter
account balances and affect your overall accounting. This should ONLY
be allowed by authorized users. Passwords are available to protect
this feature (see the Utilities section).

Transaction Entry Command Menu -

After you have selected a User File, you will be given a command
menu at the bottom of the screen. It has selections to Enter transac-
tions, Review your entry, display entry Totals, Ledger display/print,
display Aging, display Balance, User File selection and Quit. These
are described briefly here, with more detail on the steps of entering
transactions following.

Enter: This is where you will enter all new transactions into the
system. If you are editing the History, Open Items, or Payment
Summary files you WILL NOT be permitted to add new items. This can
only be done through a User File entry and the normal posting process.

Review: The Review selection allows you to display on the screen, a
list of all the entry to the User File currently in use. The account
number is at the right end of the transaction line.

Totals: This selection simply totals up all the Charges, Payments, and
any Adjustments in the current User File.

Ledger: The Ledger selection allows you to display a Ledger Card for a
patient when you are not currently doing Entry for them. It is the
same as pressing Alt L except that you can get a Ledger for ANY
patient (not just the one currently selected).
TRANS - 2

Aging: Like the Ledger selection, you can get an Aging window for ANY
patient account.

Balance: This also allows you to display an account's balance even
though you are not currently doing entry for them.

User: Use this selection when you have finished entry in one User File
and want to use one of the other Files.

Quit: Returns you to the Transaction Entry sub-menu.


Entering Transactions -

To enter transactions for an account, you will follow these basic
steps:

1) select Enter from the command menu
2) select the patient account
3) verify that their default information is correct
4) enter and verify their first transaction line
5) press F2 to add additional lines - OR -
6) press Esc to end entry and return to the menu

1) To select Enter from the command menu at the bottom of the
screen, just press the letter "E" or press Enter when the word
Enter is highlighted on the menu line.

2) There are several ways to select the patient account. If you
know the patient's account number, just type that in the field provided
and press enter. Answer 'Yes' to "Is this the one?" and you are ready
to go.
You can also enter their last name, a part of their last name, or
their complete last name followed by a comma (,) and their first
initial. When the account is displayed, if it is not the correct
account (due multiple similar names), you can answer 'No' or 'Backup'
to scan forward and backward alphabetically through the file.
A third method of selecting the account is by using the Window Key
(F3). If you enter an account number before opening the window, then
the window will be displayed by account number order. If you enter
even just one letter of a name, then the window will be displayed
alphabetically. Use the Navigation Keys to move about in the file
until you locate the correct account, then press F4 to select it.

3) Once you have selected an account, the rest of their 'default'
information is displayed on the screen. This includes their Resparty,
Insurance Companies, Referring Physician and Facility, and the
Diagnoses you have stored for them. These are called 'default' items
because they will be automatically filled in on the first and all sub-
sequent transaction lines as you enter them. For this reason, you are
asked to verify that these items are correct as shown BEFORE you enter
the first transaction.
If one of the defaults is blank, incorrect, or needs to be updated,
answer 'No' to the question and the Patient Browse/Edit window will
open up and you can make any changes necessary.
TRANS - 3

4) Now you begin entering transactions for them. Use the Help Key
[F1] for information about each field as you go across the line. Some
notes for certain special fields:

Date - After you have entered the first line, the date you entered
will be carried forward to all subsequent lines until you change it.

Proc/M1 - After you have entered a Procedure code AND you have pressed
Enter past the M1 field, the program will try to find that Code and
Modifier in the Procedure file in order to fill in the Charge, Place of
Service, Type of Service, etc. This process uses the Category field
(in the Procedure File) as follows: first it will try to find a match
to the Patient's Category, if not found it will try to match the
Billing Type on the transaction line, if still not found it will fall
back to the default category PR (ALL procedures should be entered in
the Procedure File ONCE with the Category PR), finally it will look for
ANY record in the Procedure File with that Code. It goes through all
this because you might want to enter multiple copies of the SAME code
in the Procedure File where the Place of Service, Type of Service or
fee is different (if allowed) for different types of claims.
You can also use the Window Key (F3) on the Procedure field and
just 'pick out' the code to enter from the list. If you are not sure
of the EXACT code to use, just enter the first part of it in the Proc
field BEFORE pressing F3 ('99' for example), and the window will open
up already positioned at that part of the file. To position the
window alphabetically, just press any letter key after it is open.

Dia - The Diagnosis Indicator shows which one (or more) of the
Diagnoses you have stored for this patient applies to the Procedure
you have entered on this line. It is important that these match in
order for you to get paid.

BT - This is the Billing Type field and is used to determine 'how you
want to be paid' for this line. For example, entering IN would mean
that you will print an Insurance form for this line, or entering KC
would mean that you want to file it electronically.

R - The Responsibility Indicator field is used to determine 'who is
responsible for the balance due' on this line. For example, entering
an I means the patient's insurance company is primarily responsible, or
entering a P means the patient is responsible for the entire amount.

Most of the time you will not have to enter anything more than the
columns of information on the first part of the Transaction Line. If
you want to edit or verify the additional information to the right side
of the line, use the Navigation Keys.
While you are entering transactions you can use the Alt keys (see
[Alt F1]) to view the account's Ledger [Alt L], Balance [Alt B], Aging
[Alt A], etc. You can also use [Alt F6] for a detailed display of the
Patient's account, or just [F6] by itself to edit the Patient's record.
If you need to enter or change the Patient's Responsible Party, you
will find Res 1 at the 'right end' (use [Ctrl End] and then the left
arrow a few times) of the Patient window. Note that if you change some
of the patient's default information AFTER you have started entry for
them, the changes you make WILL NOT affect any lines you have already
entered.
TRANS - 4

5) After you have finished entering the first transaction line for
an account, just press [F2] to enter any additional lines. The program
will automatically take you to the Procedure field of the next line.

6) When you have finished all entry for an account, all you need to
do is press the Esc key. You can now start entry for another account
or perform any other function shown on the command menu.


Editing User Entry -

To edit existing entry for an account or to add additional lines
BEFORE IT IS POSTED, just select the User File which has the record(s)
that you want to edit, select Enter and select the account. Any exist-
ing lines for that account will be displayed and you can use the Navi-
gation keys to move to the field you want to change and edit it by
typing over the old data, or by pressing [Ctrl Enter] and editing it.
When editing an account in a User file you can use [Alt E] to erase a
line or [F2] to add a new one.



Editing Posted Information -

You can also use Transaction Entry to edit information that has
already been posted to the History, Open Items, or Payment Summary
files. You WILL NOT be permitted to Add line to these files this way.
Also, you should be very careful because the changes you make WILL
affect account balances. See Passwords in the Utility section for
information on how you can protect this function.


Backing up your Entry -

One of the most important things you can do for yourself is to
'back up' your User files. Emphasis is made in the next section on
keeping printed copies of your entry, but making a copy to a floppy
disk is even better. There is one simple rule to follow: BACK UP AS
OFTEN AS YOU DON'T WANT TO ENTER IT OVER AGAIN. This means that if
have been working all morning on some entry, and you don't want to
have to spend all afternoon re-entering it because the system crashed
during lunch time --> BACK UP BEFORE YOU GO TO LUNCH!
It is also important to know that you must back up BEFORE POSTING.
This is because the posting process erases user files once it is
finished with them.
Keep a floppy disk just for yourself for this purpose. Start a
new one every month. User entry files follow the pattern USERn.DBF
where the character 'n' is a number from 1 through 9. Develope a
'system' for naming the file you enter and back up every day so that
you don't copy over and erase the previous day's backup. For example
use the last three characters of the back-up file name to indicate
the month and day: USER3.723 would be the backup of your USER 3 entry
for July the 23rd. The DOS command for this operation would be:

C:WINCLAIM>copy user3.dbf a:user3.723

You would have to use the letters "N" and "D" to indicate the
months of November and December (just use "0" for October). While we
are on the subject - you should also back up you Patient and Resparty
files on any day you add patients, and back up ALL files at the end of
every month, and KEEP that back up (don't overwrite it next month)!
TRANS - 5
LIST TRANSACTIONS

After you have entered data in a User File, the next step in the
flow is to print that entry to check for any possible errors. If you
see something that needs to be corrected, just go back to Transaction
Entry, select Enter and that account, and fix the error. Once you are
sure that everything is right, PRINT A FINAL COPY of the User file
before posting and KEEP this copy! We cannot emphasize this enough!
As much as we work towards the concept of the paperless office (and
electronic claims leads the way to that) the harsh reality of Hard Disk
errors and Network crashes is STILL with us today. The occasional need
for re-entering data then is much easier from a printed report rather
than from scraps of superbills (most of which have been thrown away,
lost, or crawled away on their own by the time you notice the error).

You can also use the List Transaction selection to print from the
History, Open Items, and Payments files. While this report will show
totals at the bottom, you should not generally use this as a financial
report because the transactions for earlier months will be 'split' be-
tween the History file and Open Items and therefore will not all show
up on one report. Use the Financial Analysis Report for this purpose.

However, you can use it to print a summary of ALL transactions
entered and posted during a given period of time by printing the range
of line numbers from the Open Items file. This will work because all
entry is first posted to the Open Items file (even if paid off) before
to the History file. However, it WILL NOT work AFTER you have
used the Xfer selection (under the Open area of the Main Menu) because
it moves the paid-off items to the History file and renumbers the re-
maining items in the Open Items file. Also, the totals WILL NOT MATCH
the totals from the Financial Analysis IF during the same period you
entered one or more transactions from an earlier or later Reporting
Month. See the notes and diagram at the end of this section.


List Options -

User File: Press Enter and use the up and down arrow keys to highlight
the User File you want to print, or select one of the Posted files.

List to: You can send the list to the Screen or your Printer.

First/Last Line numbers: You can print any series in the range shown.

Doctor/Category/Location: These are used if you want to SELECT or limit
the items printed within the range you entered.
TRANS - 6
POST TRANSACTIONS

Once you have entered transactions, made any corrections, and then
printed a final copy of the User File, you are ready to Post them to
the permenant files. This is a very simple process for you (just
select the User File number and say "Go"), but a fairly complex one for
your computer system. This process updates the Patient file (Date of
Last Service, etc.), the Open Items file (all items are posted here
first) and the Payment Summary file (in case there were any payments).
Refer to the diagram on the next page for a picture of this process.
When a User File has be posted and the process is complete, the
file will be deleted.

There is one new term for you to understand here, which is the
concept of the "Reporting Month". This feature was added to the
program in order to speed up some processes such as printing forms, and
also to give you the opportunity to run reports for any reporting
period at a later date, regardless of when the data was entered. A
very typical example of this is when you are in the month of June,
but still entering transactions for the month of May. Your best bet in
this situation is to enter the May transactions in THEIR OWN User File,
and then Post them with a Reporting Month of 05/92.
This becomes even MORE critical if you want your actual bank
deposits to match up with the Financial Analysis for a given Reporting
Month later on. Just be sure that whenever there is a payment entered,
that it gets posted with the SAME Reporting Month that you made the
deposit.


* * BACK UP YOUR ENTRY FILES TO FLOPPY DISK BEFORE POSTING! * *


Posting Options -

User File: Press Enter and use the up and down arrow keys to highlight
the User File you want to Post.

Report Month: You must enter the Reporting Month for the transactions
that are to be posted. Enter it as Month/Year.

For Advanced Users -

There is an over-ride option built in to the program by way of the
Rpt column in Transaction Entry. If you are doing a whole batch of
entry to a User File and you suddenly see maybe just one or two lines
that you want to be posted to a different Reporting Month, you can
still enter them along with everything else BUT on THOSE lines, move
over to the Rpt column at the right end of the Entry Window and
manually enter the special Reporting Month FOR JUST THOSE LINES. VERY
VERY IMPORTANT ---> you MUST enter the Report Month in REVERSE order
and WITHOUT the slash character! For example: a Report Month of June,
1992 would be entered as "9206".
When these lines are subsequently posted, the Reporting Month that
YOU entered will be retained by the system.
TRANS - 7
The Flow of Transactions -

There are three main files in the program: the History File (which
contains all the paid off items), the Open Items (which contains all
un-paid items and recently posted items), and the Payment Summary File
(which contains a summary line for all payments entered). These files
are built up from the transactions you enter and are maintained by the
Posting processes. The flow of transactions can be illustrated as:


------------
| | Entry Posting
| User Entry |-----------------------------
| | | |
------------ V V
------------ ----------- -----------
| | | | | |
| | | | | |
| | | | | |
| | | Open | Xfer | |
| Payments | | |------->| History |
| | | Items | | |
| | | | | |
| | | | | |
| | | | | |
------------ ----------- -----------
------------ ^ ^
| | | .
| Open Entry |---------....................
| | Open Posting
------------


Posting Transactions -

Posting Transactions from a User File will add the lines to the
Open Items file and add a record to the Payment Summary file for any
account where there is a Payment or Adjustment entered to one or more
lines for that account. A seperate Payment Summary record will also
be added if more than one Doctor performs a service for an account and
the payment is entered on seperate lines along with the different
Doctor Number.
Although paid-off items (Charge - Payment - Adjust = 0) entered
during Transaction Entry belong in the History file and will eventually
end up there, they are first posted to the Open Items file along with
everything else. The 'Xfer' selection under the Open Menu (usually run
at the end of a month) will transfer them to the History file with all
other items that were paid off during the month.

Posting Open Entry -

Posting Open Entry also adds records to the Payments file. The
Doctor on the original Transaction line will be 'credited' with having
received the payment in the Payment Summary record, unless you enter a
different doctor number on the summary line at the top of the screen.
TRANS - 8

Open Entry Posting does not add any NEW records to the Open Item
file. The payment and adjustment amounts are only posted to the Pay-
ment and Adjustment fields of the original Transaction line (as shown
by the dotted line above).

Xfer -

Finally, in order to speed up the system, something is needed to
remove paid off items from the Open Item file and transfer them to the
History file. This is accomplished by the "Xfer" selection at the
bottom of Open Menu. This selection can be made at any time, however
one time at the end of the month is all that should be necessary. Be-
cause this removes records from the Open Item file, you can only Xfer
when there are NO OUTSTANDING Open Entry files.


End of Month Notes -

You should print all insurance forms BEFORE doing an Xfer at the
end of the month. The reason for this is that if there are one or more
trnasaction items that are paid off (by the Patient, for example) but
you want them to appear on an insurance form - if you do an Xfer first,
the items would have been transferred to the History file and therefore
would not be in the Open Items file to print! You could still print
them from the History file of course, but they would be on a seperate
form.

If you want paid-off items to appear on the Statement forms, then
print the statements BEFORE doing the Xfer at the end of the month. If
you only want to print items that are still open, then go ahead and
do the Xfer selection FIRST and print statements afterwards.

The Aged Trial Balance report can be run before or after doing the
Xfer but it will run faster if you run it after.

If you want to see a summary of Payments received over a certain
period of time (not necessarily relative to the Reporting Month) then
use the Transaction Print program, printing from the Payments file and
selected by the series of line numbers that cover the specific range of
dates you want. This summary will include payments received from both
Transaction Entry and Open Payment Entry.
OPEN - 1
OPEN ENTRY

This is where you should enter ALL payments which are to be posted
to any transaction lines. The ONLY exception to this is where the
patient makes a payment AT THE TIME the service is rendered. This
process will seem a little more complicated than some other accounting
methods but then this is just about the ONLY business where there are
often two or three payors not only on a single account, but on indivi-
dual line items! And then after all that, you might have to write-off
the rest of each item with an adjustment!

Open Entry payments can only be made to lines that have already
been entered and posted through Transaction Entry. Before getting into
the detail of Open Entry, we will go over two examples:

1. A Medicare patient comes to the office and has three services done
which are $100.00 each. You print a HCFA 1500 form for a total billing
of $300.00. Medicare then sends a payment of $240.00 ($80.00 on each
of the three services. You select Open Entry, locate the three trans-
actions and enter an $80.00 payment AND a $20.00 Adjustment ON EACH of
the three lines. Now the lines are 'paid-off' and will be transferred
to the History file at the end of the month.

2. Another patient comes to the office with insurance coverage and
agrees to pay whatever is not covered. They have the same three
services for a total of $300.00 and you print and send the insurance
form off for payment. The insurance sends a check for just $180.00
($60.00 for each line item). Select Open Entry and enter the $60.00
payment on EACH line, and also enter a "P" in the Responsibility
Indicator column to show that the PATIENT is responsible for the bal-
ance due on the line. At this point the Ledger Card for Open Items
shows three lines with a $100.00 Charge and a $60.00 Payment. A
statement will be printed at the end of the month and sent to the
patient. The patient then sends a payment of $60.00 so you enter Open
Entry and enter a $20.00 payment on each of the same lines. After
posting this file, the Ledger Card shows the same $100.00 Charge items
with $80.00 paid on each one. After continuing to bill the patient
for several months, they move and you realize that you are not going
to be able to collect the rest, so you select Open Entry AGAIN and
bring up the same account and enter a $20.00 Adjustment to each of the
three lines as a "Write-Off". Now the lines are considered "paid"
(Charge 100.00 - Payment 80.00 - Adjustment 20.00 = 0) and they will
be moved over to the History file by the Xfer selection.


Selecting an Open File -

An Open Entry file is a set of payments which will be posted to
EXISTING transaction lines in the Open Item file. You can have up to
nine Open Files that you can enter, print, correct and post indepen-
dently of the others. These files are denoted by a number from 1 - 9.
Files which have been started but not posted will be checked-marked at
the right of the Open File window when you start Open Entry. To
select an Open File, use the down arrow key to highlight the number you
want and then press the Enter key.
OPEN - 2
Open Payment Entry Command Menu -

After you have selected a User File, you will be given a command
menu at the bottom of the screen. It has selections to Enter payments,
display entry Totals, Ledger display/print, display Aging, display
Balance, Open File selection and Quit. These are described briefly
here, with more detail on the steps of entering payments following.

Enter: This is where you will enter all payments into the system. You
will select the account, and then the line items for payment.

Totals: This selection simply totals up all the Payments and any
Adjustments in the current Open File.

Ledger: The Ledger selection allows you to display a Ledger Card for a
patient when you are not currently doing Entry for them. It is the
same as pressing Alt L except that you can get a Ledger for ANY
patient (not just the one currently selected).

Aging: Like the Ledger selection, you can get an Aging window for ANY
patient account.

Balance: This also allows you to display an account's balance even
though you are not currently doing entry for them.

Open: Use this selection when you have finished entry in one Open File
and want to use one of the other Files.

Quit: Returns you to the Open Entry sub-menu.


Entering Payments -

To enter transactions for an account, you will follow these basic
steps:

1) select Enter from the command menu
2) select the patient account
3) locate and select the first line for payment
4) enter the payment and any adjustment for that line
5) enter payments/adjustments for any other lines
6) press Esc to end entry and return to the menu

1) To select Enter from the command menu at the bottom of the
screen, just press the letter "E" or press Enter when the word Enter
is highlighted on the menu line.

2) Select the patient exactly the same way as in Transaction Entry:
either enter the account number, last name, or use the Window Key [F3].
OPEN - 3

3) If there are a lot of Open Items, use the Navigation Keys to
locate the first transaction for payment. You can identify it by the
Date, Procedure Code, and/or the Date Filed in the Comment field. Move
the highlight bar directly over the item. To select the item once you
have highlighted it, press the Select Key [F4].

4) Enter the seperate Payment amount FOR THIS LINE ITEM ONLY in the
Payment column, and the adjustment amount (if any) in the Adjust column.
Even if you received a lump sum payment for several items, YOU MUST
distribute the payment over all the items it covers so they will be paid
off and moved over to the History file. Don't forget that you can use
the Calculator [F5] to help apportion the payment and figure out any
remaining Adjustment amount.
When you are entering the FIRST payment line for an account, you
will be permitted in the Payment Summary area at the upper right corner
of the screen. Here you can enter the Date of the payment, any Comment
for the Payment Summary file line, the Payment Type, etc. Note that
this information appears ONLY in the Payment Summary file on a line
which gathers all individual payment line amounts into a single summary
line which matches the total payment amount received. In the first
example on page one of this section, you should see a single Payment
Summary line showing the $240.00 payment and the $60.00 adjustment.

5) After completing entry of the first line, the Open Entry program
will automatically move to, and highlight, the NEXT open line in the
file. If you need to enter a payment on that line, just press [F4] to
select it and enter the payment amount.

6) Once you have entered all payments for the current account, just
press Esc to return to the Command Menu.


Editing Open Entry -

If you check or List your Open Entry and notice that a correction
needs to be made, just select the Open File which has the record(s)
that you want to edit, select Enter and select the account. Any exist-
ing lines for that account will be displayed along with the payments
you entered. Use the Navigation keys to move to the line you want to
change and then select it by pressing [F4]. Type over the old data and
the press Enter to move to the next field. Press Esc when you are
finished editing the line, and then Esc again to leave the account.
There is no Erase or Alt E function necessary for Open Entry. Just
enter 0 for the Payment and Adjustment of any line you don't want. The
line will then be ignored by the Posting process.
OPEN - 4
LIST OPEN ENTRY

After you have entered Payments and Adjustments in an Open File,
the next step is to print that entry to check for any possible errors.
If you see something that needs to be corrected, just go back to Open
Entry, select Enter and that account, and fix the error. Once you are
sure that everything is right, PRINT A FINAL COPY of the Open File
before posting and KEEP this copy!

List Options -

Open File: Press Enter and use the up and down arrow keys to highlight
the Open File you want to print.

List to: You can send the list to the screen or your printer.

First/Last Line numbers: You can print any series in the range shown.


POST OPEN ENTRY

Once you have entered Payments and Adjustments, made any correc-
tions, and then printed a final copy of the Open File, you are ready
to Post them to the Open Items file. This is as easy as posting trans-
Entry. Just select the Open File, enter the Reporting Month, and say
"Go". This process updates the Patient file (Date of Last Payment),
the Open Items file Payment and Adjustment fields (but does not add any
new records) and the Payment Summary file. Refer to the diagram at the
end of the TRANS section.

When an Open File has been posted and the process is complete, the
File will be deleted.

Posting Options -

Open File: Press Enter and use the up and down arrow keys to highlight
the Open File you want to Post.

Report Month: You must enter the Reporting Month for the Payments that
are to be posted. Enter it as Month/Year.


XFER TO HISTORY

The Xfer or transfer operation takes all 'paid-off' items in the
Open Items file and moves them to the History file. This makes the
system faster because the program does not have to scan through thou-
sands of old items in order to find something to report a balance or
print a form.
You will usually make this selection as the LAST thing you do in a
month. Refer to other parts of this manual to see how Xfer affects
other operations.
Because Xfer changes the number of records in the Open Items file,
you cannot have ANY unposted Open Payment files outstanding when you
make this selection. The program will warn you if it finds any.
REPORTS - 1
AGED TRIAL BALANCE

This report shows all accounts with outstanding balances and
whether the amounts are current, 30, 60, or over 90 days past due. If
you are printing this report, the individual account detail will be
followed by an Analysis page with sub-totals by Patient Category.


Report Options -

Report Format: The Report can be sent to screen or printer, or you can
choose to skip printing the detail and print the Analysis only.

Order of Accounts: Print Alphabetically or by account Number.

Type of Report: You can choose to print by Debit accounts (those that
owe you money), Credit accounts (those that are overpaid or who you
owe refunds), Zero Balances (accounts with zero or an insignificant
balance in the range -0.99 to 0.99), or All accounts (which does
not print accounts with EXACTLY zero).

Debit: When you choose a Debit report, you can further select by the
aging 'bucket' - for example, if you only want to see accounts that
are over 90 days past due; and you can select the minimum balance
due to report - those that owe more than $500.00 for instance.

Responsibility Indicator: With this selection, you can customize the
report to show you the balances based on WHO is responsible for the
amount due. For example, selecting "P" would report those items
where the Patient is responsible for the balance due, or "I" would
report where the Insurance companies are responsible.

Insurance Company: This selection lets you run the report for an indi-
vidual insurance company. To see if Medicare is paying in a timely
manner, enter their Insurance File record number and examine the 60
and 90 day columns.

Category/Doctor/Location: These selections allow you to customize the
report based on the way you identified the patients in the Patient
File. You can use one or all of these in the same report: the more
of these you enter, the more selective the report will be.

Go for it: Run the report with the selections shown!
REPORT - 2
FINANCIAL ANALYSIS

The Financial Report is the key report that you should use to
determine the Charges entered, or the Payments and Adjustments made
during a given reporting period. The File to Report option is very
important. Although you can select just the History or Open Items
files, you should generally select Both in order to see all Charges
whether they are paid-off (in History) or still outstanding (in Open
Items).
When selecting History, Open Items, or Both - the Payment and
Adjustment columns show the total which has been APPLIED to the items
for each account entered during the reporting period you selected.
To see the total of payments RECEIVED during a given reporting
period, select the Payments file as the File to Report.


Report Options -

Report Format: The Report can be sent to screen or printer, or you can
choose to skip printing the detail and print the Analysis only.

File to Report: Select to report from the History file only, the Open
Items file only, or Both. Select Payments to see payments actually
received (the Charge column will be zero).

Begin/Ending Reporting Month: With this option (required) you can
select the reporting period from monthly to quarterly to yearly.
Enter the SAME month and Year to get just one month.

Category/Doctor/Location: These selections allow you to customize the
report based on the patient's Category, Doctor, and/or Location AT
THE TIME the transactions were entered. This means that if their
Category changes from Medicaid (MD) to Private (PR) between services,
the items would be reported seperately if you select by Category.

Go for it: Run the report with the selections shown!
REPORT - 3
BILLING REPORT

This report is designed to answer the questions "What billing
did I just file?", "What billing have I filed and have been paid?", and
"What billing have I filed where I have NOT been paid?". You get the
answers to these questions by carefully filling in the options for this
report. This report revolves around the Comment field, where the Forms
Print programs and the Electronic Claims programs will fill in the two
letter Billing Type field and the Date Filed whenever a claim is
printed or sent.
To answer the first question - select the Open Items file,
Filing Status "Filed", and the date you printed the form or sent the
claim. To answer the second question, select the History file instead
(because it has all the paid-off items). To answer the third question
above, select Open Items again and Filed, but leave the Date Filed sel-
ection field blank (for all filed by that Billing Type).
You can also use this report to find out what you have entered
but not yet filed, which will also show you claims where the Electronic
Claims program found too many errors to transmit. Use the Local Error
report to locate and correct the errors.


Report options -

Report Format: The Report can be sent to screen or printer.

File to Report: Select to report from the History file only, the Open
Items file only, or Both.

Filing Status: The choices here are Filed and Unfiled. Filed means
that the two letter Billing Type you enter below MUST be in the first
two positions of the Comment field followed by the Date Filed in order
to report what was filed on a particular day, OR the Billing Type you
enter must match the billing Type on the Transaction line in order to
report all billing of that type during the reporting period you enter.
Selecting Unfiled means that the transaction line would have the
Billing Type you enter, but the Comment field is blank.

Date: Enter a Date Filed means you are selection for ONLY that date.
Leaving that field blank means that you want ALL claims filed for
reporting period you select.

Begin/Ending Reporting Month: Select the range for the Reporting Month
when the claims were ENTERED. Note that this may be different than
the Date Filed if you have printed forms late for an earlier month or
you have re-printed and re-dated a claim.

Category/Doctor/Location: These selections allow you to customize the
report based on the patient's Category, Doctor, and/or Location AT
THE TIME the transactions were entered.

Go for it: Run the report with the selections shown!
FORMS - 1
STATEMENT PRINT

You will print statements to bill your private or cash paying
patients, or to bill insurance patients for the balance due after the
Primary (and Secondary) insurance companies have paid. Unlike insurance
forms which can be printed as often as every day, statements are usually
only printed once per month. This DOES NOT mark or change the Comment
field but the Date of Last Statement in the Patient record IS updated.
There are basically two types of statements which you can print:
a '1 Part' Statement which you fold and inserted into a window envelope
(this can be special ordered with two or three copies, however) and a
'6 Part' Mailer which has a top copy to be retained by the office, and
contains a return envelope for faster payments by the patients.
All forms for this program are available from Data Media Asso-
ciates at 800-533-1640 or 404-475-4464. Ask for Tricia Van Nostrand
and tell her you are ordering statements for WinClaim or WinMedical.

Statement Options -

Statement Date: Enter the date to be printed on the statements.

Statement Number: This will be the statement number printed on the first
form. You can start it at the same number each month to see how many
you print, or let it count up from one month to the next.

Starting Account: Normally start at 2 (since 1 is your Cash account).
If you have to re-start printing forms in the middle of a run, you
can enter the LAST account printed here in order to continue.

Number of Statements: Set to All to run statements for all accounts. If
you want to print a statement for just one account, select One.

Statements per Patient: If you have entered more transactions than will
fit on one statement (8 for the 6 Part or 13 for the 1 Part), and you
would like them ALL to be sent to the patient, use this option to
print Continuous statements. This means that extra transactions will
be continued on the next form. Selecting a Single statement per
patient will only print one form, but the Balance due will show the
correct amount for all the transactions.

Responsibility Indicator: By entering a "P" in this field, this option
allows you to print items only where the Patient is responsible for
the outstanding balance on a transaction line. Leaving it blank will
print all open items for an account.

Transaction Month: Enter the current month and year to show just the
most recent transactions for each account.

Statement Type: This is where you select either a '1 Part' Statement
or the '6 Part' Mailer which has the self-contained return payment
envelope. Note that your printer must be capable of handling a six
part form.

Selections: The Category, Doctor, and Locations selections lets you be
really choosey about which accounts you print for each run of forms.

Dunning Amounts: At the bottom of the statements are boxes for dunning
amounts. This selection gives you the choice to fill them in or not.
FORMS - 2

Print Messages: With this option you can have the program print dunning
messages of your choice at the bottom of each statement depending on
whether the account is 30, 60 or over 90 days past due. There is also
a message available to be printed on ALL statements.

Postal Insignia: For the 6 Part mailers you can set up an agreement with
the postal service for pre-paid postage and have a special insignia
printed on the statements by the program (this saves you from having
to stamp each one). For more information contact the post office.

Statement Order: You can have the statements print in order by Patient
account number, Alphabetically, or Zip code (used for bulk mailing).

Doctors Address: For the outgoing Return Address, You can select to
print a Selected doctor number for all statements, print the address
based on the doctor assigned to each account in the Patient file, or
print it from the doctor who performed the service (from the Trans-
action line). If you are printing enough statements, you can have
yours custom printed with your address pre-printed on the form. In
that case select "None" for this option.

Print Test Form: This option allows you to adjust and test the position
of the printing on the forms without having to move it in the printer.

Test: This selection prints four 'corner stars' and a sample Return
Address on the first statement. Align the stars to the backround
carbon area on the Mailers or the corner marks on the Statements.

Feed: Automatically feeds out the proper number of lines and puts
you at the top of the next form.

Margin: Changing this number affects the left margin for ALL printing
on the form (INCLUDING the Offtop discussed next).

Offtop: For the printing of the 1 Part Statements to match up with
your window envelopes, this option allows you to move JUST the out-
going doctor Return address and the outgoing Patient address.

Return: Returns you to the main Option window.

Go for it: Start printing statements!
FORMS - 3
INSURANCE FORMS

This selection prints Insurance and Medicare claims on the new
red OCR HCFA 1500 form. All insurance carriers are accepting this form
and some states use it for Medicaid as well. Since Medicare is the
most critical, most of the instructions here are designed to follow
their rules. Commercial claims are a lot simpler (you just use the
Primary and Secondary Insurance fields in the Patient file), but you
still use the same Options and Specific Form Items where they apply.
All forms for this program are available from Data Media Asso-
ciates at 800-533-1640 or 404-475-4464. Ask for Tricia Van Nostrand
and tell her you are ordering Insurance Forms for WinClaim.

Options -

Date Filed: This date will be printed on the form in box 31, and will
also be used to mark the Comment field as the 'Date Filed'.

File to Print: Normally you would print from the Open Items file to get
the most recent transactions you have entered. However, to Reprint a
form where the items have already been paid, you might have to choose
the History file.

Report Month: This tells the program how far back to go to begin scan-
ning for transactions to print.

Billing Type: Enter the Billing Type you used during Transaction Entry.
Usually this is IN for Insurance, or MR for Medicare.

Carriers to Print: This is where you choose the claims to print

Primary: Prints a form for only the Primary carrier for each patient.

Secondary: Prints forms for only the Secondary carrier.

Both: This selection prints just the Primary and Secondary, but not
the Tertiary. Store the second form until the first carrier pays,
enter the payment into the system in Open Entry, and then WRITE it

on the Secondary form in Item 29 and mail it to that carrier. This
has proven to be the easiest method of handling secondary claims.

Tertiary: Prints forms for only the 3rd carrier.

All: Prints for all three carriers, if present in the Patient record.

Billing Name: Choose the doctor name to print in Item 33.

Selected: Enter a particular Doctor File number to print on ALL forms.

Transaction: Prints the doctor from the Transaction Entry line.

Patient: Prints the doctor assigned in the Patient file.

None: Leaves it blank if you are using pre-printed forms or a stamp.

Doctor Select: This option allows you to select and print forms for
just one doctor at a time. Leave blank for all.
FORMS - 4

Signature Print: This will print the doctor's First and Middle Initials
and the Last Name (from those fields in the Doctor File) in Item 31.

Order of Transactions: You can determine the order to print the line
items on the form.

Trans: Prints in the same order as Transaction Entry.

Svc Date: Prints them in order by the Date of Service.

Dollar: Prints in order of decending dollar amount. This is used
where a carrier pays a greater percentage of the FIRST line on the
form. Naturally, you would want this to be your largest line item.

Top Option: Depending on the type of claim, this option allows you to
choose what is printed at the top of the form.

Insurance: Used for most insurance carriers, you can insert the claim
into a window envelope (available from Data Media Associates).

Resparty: Certain claims might need to have the Responsible Party at
the top, or this can be used to mail directly to them.

Employer: Used for employment related claims such as Workers Comp.

None: Leaves the top area blank. Required by Medicare.

Reprint Form: Select Reprint whenever you want to print a claim that
has already been printed and Dated. This option will ask for the Date
Filed which it will match up with the Billing Type in the Comment field
in order to find the lines to re-print. Be sure you set the Reporting
Month back far enough to pick up the month you posted the transactions.
Also, if the items have been paid and transferred to the History file,
you would have the choose History as the File to Print.

Provider Line ID: This option will print the Doctor Number (from the
Transaction line) to the right of Item 24K, padded with the number of
spaces you enter. Enter a zero to leave blank. CAUTION: Medicare
MAY consider this extraneous writing on the form and reject the claim!
Either push it into the perforated area or DON'T use this option!

Print Test Form: This option allows you to adjust and test the position
of the printing on the forms without having to move it in the printer.

Test: This selection prints the first couple of lines on the form.
Just make sure the X's fit in the boxes in Items 1 and 3.

Feed: Automatically feeds out the proper number of lines and puts
you at the top of the next form.

Margin: This 'moves' the printing on the form to the left and right
by one character without having to adjust the paper in the printer.

Offset: This positions the printing of the 'item' at the top (see Top
Option) so that it will match your window envelope.

Return: Returns you to the main Option window.

Go for it: Start printing forms!
FORMS - 5

Printing the red OCR HCFA 1500 form for Medicare Claims

According to the Medicare instructions, there are fourteen ways
to fill out the new HCFA form covering each of the following situations:

1. Medicare is the only policy

2. Medicare is Secondary and one Primary Insurance (MSP)
3. Medicare and MediGap (MG)
4. Medicare and there is a Supplemental Policy (SP)
5. Medicare and Medicaid (MCD)

6. Medicare is Secondary, two Primary Insurance, (2MSP)
7. Medicare is Secondary, one Primary, and MediGap (MSP/MG)
8. Medicare Secondary, one Primary, and Supplemental (MSP/SP)
9. Medicare is Secondary, one Primary, and Medicaid (MSP/MCD)
10. Medicare, MediGap and a Supplemental Policy (MG/SP)
11. Medicare, MediGap and Medicaid (MG/MCD)

12. Medicare is Secondary, two Primaries, and MediGap (2MSP/MG)
13. Medicare is 2nd, one Pri, MediGap, and Supp (MSP/MG/SP)
14. Medicare is 2nd, one Pri, MediGap, and Medicaid (MSP/MG/MCD)

The first item is Medicare by itself, the next group is Medicare
with one other policy, the third group is Medicare and two other pol-
icies, and the last group is Medicare and three other policies. Many of
the claims in the last two groups require an attachment because not all
of the information fits on the form.
Most medical offices will only need to handle 1 - 5 above, with
some in the third group. Medicare may not crossover to Medicaid in
all states so you may not ever have situations for 5, 9, or 11,

The table below summarizes where you should put the patient's
other coverage information and where it will print out on the form.
There are three areas on the form for this 'other' coverage: 11 and 11c
is where Primary Insurance coverage is printed, 9 is for supplemental
coverage, and 9c and 9d are for the address of either the Primary In-
surance or the supplemental coverage. The 1st, 2nd, and 3rd columns
represent those field areas in the Patient File where you should fill
in the data. MR means put the patient's Medicare information in this
area, and IN means put their Primary Insurance information there.

Category 1st Ins 2nd Ins 3rd Ins

1. MR only MR -- --
2. MSP IN (11,9c) MR --
3. MG MR MG (9,9c) --
4. SP MR SP (9,9c) --
5. MCD MR MCD (9) --
6. 2MSP IN (11,9c) MR IN (2nd IN attach)
7. MSP/MG IN (11) MR MG (9,9c)
8. MSP/SP IN (11) MR SP (9,9c)
9. MSP/MCD IN (11) MR MCD (9)
10. MG/SP MR MG (9,9c) SP (attach)
11. MG/MCD MR MG (9,9c) MCD (11)
12. 2MSP/MG IN (11) MR MG (9,9c/2nd IN attach)
13. MSP/MG/SP IN (11) MR MG (9,9c/SP attach)

14. MSP/MG/MCD IN (11) MR MG (9,9c/MCD attach)
FORMS - 6

If you examine the table above, you will see that Medicare is
ONLY placed in the 1st or 2nd areas (and is only in the 2nd area when
there is insurance Primary to Medicare). Also, Supplemental coverage
is NEVER placed in the 1st Ins fields. The word 'attach' means that
this information IS NOT printed on the MEDICARE form and you are in-
structed to send it on an attachment. A third form WILL be printed for
that coverage if the 3rd 'Bill this Carrier' field has a Y and you are
printing for ALL forms.


Claim Category Summaries

The following section covers the details for how to fill in the
fields of the patient record, in order for all the various forms to be
printed correctly.
If you expect Medicare to 'cross-over' or forward claim informa-
tion to another carrier and you don't want or need to print a form for
that carrier, then enter N for No in the Bill this Carrier field in THAT
insurance area of the patient's record. The information will be filled
in on the Medicare form but a seperate form will not be printed for that
carrier. If for some reason you do not want to print a form for Medi-
care then enter N in the Bill this Carrier field and Y in the other(s).
See the instructions for Item 4 for how to fill in that field
in the patient record for the Insured. For the other fields in the
patient record, follow the summary for each category:

1. Medicare is the only policy

1st Ins Co - Medicare Insurance File record number
1st In/Med - Patient's Medicare number
Item 9a - blank
Item 10d - blank
Item 11d - N
2nd Ins Co - blank or 0
2nd In/Med - blank
3rd Ins Co - blank or 0
3rd In/Med - blank

The areas for items 9 and 11 on the form will be blank.


2. Medicare is Secondary and one Primary Insurance (MSP)

1st Ins Co - Primary Insurance File record number
1st In/Med - Primary Insurance Policy/Group number
Item 9a - blank
Item 10d - MSP
Item 11d - Y
2nd Ins Co - Medicare Insurance File record number
2nd In/Med - Patient's Medicare number
3rd Ins Co - blank or 0
3rd In/Med - blank

This will fill in items 11 and 11c from the above information.
Items 9, 9a and 9b will be blank. Items 9c and 9d will have the In-
surance company's address. "MSP" will be printed in Item 10d.
FORMS - 7
3. Medicare and MediGap (MG)

1st Ins Co - Medicare Insurance File record number
1st In/Med - Patient's Medicare number
Item 9a - MEDIGAP
Item 10d - MG
Item 11d - N
2nd Ins Co - MediGap Co Insurance File record number
2nd In/Med - MediGap Policy number (only!)
3rd Ins Co - blank or 0
2nd In/Med - blank

This will fill in item 9a and 10d from the information above.
Items 9c and 9d will have the MediGap company's address. The program
will print "MEDIGAP" (what you enter in field 9a) and their Medigap
number (from the 2nd In/Med field) in Item 9a on the form.


4. Medicare and there is a Supplemental Policy (SP)

1st Ins Co - Medicare Insurance File record number
1st In/Med - Patient's Medicare number
Item 9a - EMPLOYER-SUPP
Item 10d - SP
Item 11d - N
2nd Ins Co - Supplemental Insurance File record number
2nd In/Med - Policy number (only!)
3rd Ins Co - blank or 0
3rd In/Med - blank

This will fill in item 9a and 10d from this information. Items
9c and 9d will have the Supplemental Policy company's address. The
program will print "EMPLOYER-SUPP" (what you enter in field 9a) and
their Supplemental number number (from the 2nd In/Med field) in Item
9a on the form.


5. Medicare and Medicaid (MCD)

1st Ins Co - Medicare Insurance File record number
1st In/Med - Patient's Medicare number
Item 9a - MEDICAID
Item 10d - MCD
Item 11d - N
2nd Ins Co - Medicaid Insurance File record number
2nd In/Med - Medicaid number
3rd Ins Co - blank or 0
3rd In/Med - blank

This will fill in item 9a and 10d from this information.
Items 9c and 9d will have Medicaid's address. The program will
print "MEDICAID" (what you enter in field 9a) and their Medicaid
number (from the 2nd In/Med field) in Item 9a on the form.
FORMS - 8
6. Medicare is Secondary, two Primary Insurance, (2MSP)

1st Ins Co - First Primary Insurance File record number
1st In/Med - First Primary Insurance Policy/Group number
Item 9a - blank
Item 10d - 2MSP
Item 11d - Y
2nd Ins Co - Medicare Insurance File record number
2nd In/Med - Patient's Medicare number
3rd Ins Co - Second Primary Insurance File record number
3rd In/Med - Second Primary Insurance Policy/Group number

The only difference in this category and one Primary Insurance
is putting 2MSP in item 10d. Medicare does not want the other insurance
information in the item 9 area - you will have to provide it as an at-
tachment to the form.


7. Medicare is Secondary, one Primary, and MediGap (MSP/MG)

1st Ins Co - Primary Insurance File record number
1st In/Med - Primary Insurance Policy/Group number
Item 9a - MEDIGAP
Item 10d - MSP/MG
Item 11d - Y
2nd Ins Co - Medicare Insurance File record number
2nd In/Med - Patient's Medicare number
3rd Ins Co - MediGap Co Insurance File record number
3rd In/Med - MediGap policy number (only!)

This category of claim has just about everything filled in on
the form. Items 9a and 10d will print from the information above.
Items 9c and 9d will have the MediGap company's address and name.
Items 11 and 11c will be filled in from the Primary information.


8. Medicare is Secondary, one Primary, and Supplemental (MSP/SP)

1st Ins Co - Primary Insurance File record number
1st In/Med - Primary Insurance Policy/Group number
Item 9a - EMPLOYER-SUPP
Item 10d - MSP/SP
Item 11d - Y
2nd Ins Co - Medicare Insurance File record number
2nd In/Med - Patient's Medicare number
3rd Ins Co - Supplemental Co Insurance File record number
3rd In/Med - Supplemental policy number (only!)

This category of claim also has just about everything filled
in on the form. Items 9a and 10d will print from the information
above. Items 9c and 9d will have the Supplemental company's address
and name. Items 11 and 11c will be filled in from the Primary data.
FORMS - 9

9. Medicare is Secondary, one Primary, and Medicaid (MSP/MCD)

1st Ins Co - Primary Insurance File record number
1st In/Med - Primary Insurance Policy/Group number
Item 9a - MEDICAID
Item 10d - MSP/MCD
Item 11d - Y
2nd Ins Co - Medicare Insurance File record number
2nd In/Med - Patient's Medicare number
3rd Ins Co - Medicaid Insurance File record number
3rd In/Med - Medicaid number (only!)

Except for the fixed information in items 9a and 10d shown here,
the directions for this category of claim is the same as for categories
5 and 7 above.


10. MediGap and a Supplemental Policy (MG/SP)

1st Ins Co - Medicare Insurance File record number
1st In/Med - Patient's Medicare number
Item 9a - MEDIGAP
Item 10d - MG/SP
Item 11d - N
2nd Ins Co - MediGap Co Insurance File record number
2nd In/Med - MediGap Policy number (only!)
3rd Ins Co - Supplemental Co Insurance File record number
3rd In/Med - Supplemental policy number

The only difference in this category and an ordinary MediGap
claim is putting MG/SP in item 10d. Medicare does not want the Supple-
mental Policy information in the item 11 area - you will have to provide
it as an attachment to the form.


11. MediGap and Medicaid (MG/MCD)

1st Ins Co - Medicare Insurance File record number
1st In/Med - Patient's Medicare number
Item 9a - MEDIGAP
Item 10d - MG/MCD
Item 11d - N
2nd Ins Co - MediGap Co Insurance File record number
2nd In/Med - MediGap Policy number (only!)
3rd Ins Co - Medicaid Insurance File record number
3rd In/Med - Medicaid number

This is the only time the Medicaid number will be printed in
Item 11 on the form instead of Item 9. Other than that, this is the
same as category 3 above.


12. 2MSP/MG, 13. MSP/MG/SP, 14. MSP/MG/MCD: If you ever run into one of
these categories of claims, handle them the same as category 7 above.
Send any 'fourth' carrier information on an attachment.
FORMS - 10
Specific Form Items

Item 1: (CARRIER)

Be sure and enter your state Medicare carrier as an insurance
company in the Insurance File, and enter a 1 in the Item 1 field of
that record so that the first box is marked for 'Medicare' in Item 1
of the form.


Item 1a:

Enter the patient's complete Medicare number in the In/Med field
of the Medicare area of their Patient File record. Do not enter any ANY
dashes or spaces in this number nor between the number and suffix.


Item 4: INSURED'S NAME

Despite what is being said by 'comsultants' in some of their
seminars, the MEDICARE instructions say to leave Item 4 BLANK if the
Patient and the Insured are the same. In this case, leave the Item 4
field blank in their patient record. However, you can have the program
print the word "SAME" by entering SAME in the Item 4 field.

If you need to print an Insured in Item 4, the program can
either print the same Resparty as the Insured on all forms printed for
the patient, or it can print a different one depending on the Resparty
that has the coverage. If you enter "RES1" in the patient Item 4 field
then the program will print their 1st Resparty name in Item 4 on the
Medicare form and on all other forms. However, if you enter the word
"RESP" then the name printed in Item 4 will follow the Resparty field
number that matches the form being printed: the patient's Res 1 Res-
party name will print on the 1st form, their Res 2 Resparty will print
on the second form and their Res 3 Resparty will print in the 3rd.
These Resparty number fields are at the 'right end' of the Patient
window. Use F3 to open the Resparty window and F2 to add a new one.


Item 6: PATIENT RELATIONSHIP TO INSURED

To properly mark the item, use the following table -

Self - S or 01
Spouse - H W M or 02
Child - C or 03
Other - O or 99

Enter one of the codes above in the Rel field for EACH of the in-
surance areas (first, second and third) where it applies. You can use
the single letter codes (left justified in the field), or you can use
the two digit fields (you MUST enter the leading zero) where you might
ALSO be sending electronic claims.
FORMS - 11
Item 7: INSURED'S ADDRESS

If there IS a Resparty record, THEN there is the possibility
that the Resparty's address and the Patient's address are the SAME. In
that case, Medicare wants the word SAME in Item 7 rather than printing
the address again. To handle this, open the Patient's Resparty window
and enter the word "SAME" the the 'Item 7' field. The CITY, STATE, ZIP
CODE, and TELEPHONE fields will be left blank.

Item 8: PATIENT STATUS

To mark the Marital Status item, use the following table -

Single - S
Married - M
Other - O

Enter one of these codes in the Marital Status field in the
Patient's record. Only "O" will mark the Other box, a blank or any
other character in the Marital Status field will leave ALL the items
blank on the form.

To mark the Employed item, use any of the follwing codes -

Employed - E Y F P

These stand for Employed, Yes, Full Time, and Part Time. This dis-
tinction might be required by other carriers or for electronic claims
but ANY of them will mark the Employed box on the form.

To mark one of the two Student Status items, use the following -

Full Time Student - F
Part Time Student - P

Use one of these letters or leave the Student Status box blank in
the Patient record if they are not a student at all.

Item 9: OTHER INSURED'S NAME

The items 9, 9a, and 9b are reserved by Medicare for information
relating ONLY to MediGap, Medicaid, and Employer Supplemental Insurance,
and the Responsible Party information if different from the Patient.
To fill in items 9 and 9b: if the Patient and Insured for this other
policy are the same, enter the word SAME in the patient's Item 4 field.
The program will automatically print the word "SAME" in Item 9 and leave
everything in Item 9b blank.
If there IS a different Resparty then open a window on the Patient's
Resparty field for the corresponding Res field and fill in their Name,
Birth Date and Sex (see the instructions for Item 4 above). These will
then be printed on the form in Items 9 and 9b.

Item 9a: OTHER INSURED'S POLICY OR GROUP NUMBER

To print the number in this item, enter it in the Patient's third
insurance Ins/Med 3 field. To identify which type of coverage this is,
Medicare wants the words MEDIGAP, MEDICARE, or EMPLOYER-SUPP to preceed
the policy number. HOWEVER, DO NOT enter the word in the In/Med number
field itself (this would confuse the electronic claims program) but
enter it in the special Item 9a field provided. This is VERY important.
FORMS - 12
Item 9b: OTHER INSURED'S DATE OF BIRTH, SEX

See the instructions for Item 9 above.

Items 9c & 9d:

First of all these items are NOT used for what they say on the form.
They are used for the address of the MediGap, Supplemental, or Primary
Insurance carrier address and name. Item 9c is used for the carrier's
address and Item 9d is use for the company name. Please note that the
space for this item is ONLY 28 characters. You may have to abbreviate
their Street Address or City in order for it all to fit in.
For two Primary carriers (2MSP) Item 9c and 9d are used for the first
carrier's address and name. You must send an attachment for the other
carrier.


Item 10: IS PATIENT'S CONDITION RELATED TO:

Item 10a: EMPLOYMENT?

Enter a Y in the Related to Employment field to mark the Yes box
here. Entering N or leaving that field blank will always mark this box
No.

Yes - Y
No - N or blank

Item 10b: AUTO ACCIDENT?

Entering Y or A in the Related to Auto Accident field of the Patient
record will mark the Yes box here. N or blank will mark the No box.

Yes - Y A
No - N or blank


Item 10c: OTHER ACCIDENT?

Entering Y or O in the Related to Other Accident field of the
Patient record will mark the Yes box here. N or blank will mark the
No box.

Yes - Y O
No - N or blank
FORMS - 13

Item 10d: (RESERVED FOR LOCAL USE) Medicare Ins Coverage Categories

This item will print directly from whatever you enter in the Item 10d
field in the Patient record. The information you fill in here will be
use by the program to determine how to fill out the form and will be
used by Medicare to determine how to handle the claim. Leaving this
field blank when it is supposed to be filled in WILL CAUSE REJECTIONS.
Leaving it incomplete or entering codes NOT authorized by Medicare WILL
CAUSE REJECTIONS. As of this printing, the proper codes are:

(blank) - Medicare is the only policy
MSP - One Primary policy and Medicare is Secondary
SP - Medicare Primary and Employer Supplemental policy
MCD - Medicare and Medicaid
MG - Medicare and MediGap
2MSP - Two Primary policies, Medicare is Secondary

You MUST enter one of the codes above or else leave it blank if
Medicare is the ONLY coverage. The codes listed above can be combined
(seperated by a /) to cover all fourteen situations listed at the be-
ginning of this section. Refer to the individual Item descriptions and
the Summary section for how to fill in the Patient record fields for
each situation.


Item 11: INSURED'S POLICY GROUP OR FECA NUMBER

This item is to be filled in when the patient has insurance
Primary to Medicare. You must enter the Insurance File record number
for the insurance company in the Ins 1 field, and their insurance ID
number in the In/Med 1 field. You must also enter the letters "MSP"
in the Item 10d field to indicate Medicare is the Secondary Payor.


Item 11a: INSURED'S DATE OF BIRTH and SEX

If there IS a Resparty record (see the instructions for Item 4
above), then the program can print the information in these items. If
the Resparty and the Patient are the same, you should leave the Birth
Date and Sex fields blank in the Resparty record so they will not be
printed here.


Item 11b: EMPLOYER'S NAME OR SCHOOL NAME

Fill in this field in the Resparty record when you want it to print
on the form. The Medicare instructions indicate that this should be for
all MSP situations, and probably should be printed whenever there is
EMPLOYER-SUPPLEMENTAL coverage as well.
FORMS - 14
Item 11c: INSURANCE PLAN NAME OR PROGRAM NAME

When there is one or more Primary carriers and Medicare is
Secondary, the Name of the carrier for the Primary policy (the Name
field from the Insurance Company file) will be printed in this item.
See the instructions for Item 11 above.


Item 11d: IS THERE ANOTHER HEALTH BENEFIT PLAN?

This item comes straight from the Patient record Item 11d field where
you enter either Y or N. Follow the instructions from Medicare which
as of this printing are:

Y - If there is ANY Primary policy and Medicare is Secondary
Y - When a Primary policy, Medicare Secondary and MediGap
N - For Medicare with Medicaid or MediGap ONLY claims
N - If there is Employer Supplemental Insurance


Item 12: PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE (Release of Info)

If you enter a date in the Patient's record Release field the pro-
gram will print the words "SIGNATURE ON FILE" and that Date in Item 12.


Item 13: INSURED'S OR AUTHORIZED PERSON'S SIGNATURE (Payment of Benefits)

Entering Y for Yes in the 'Payment of Benefits' field in the Patient
record will print the words "SIGNATURE ON FILE" in Item 13. Per Medicare
this should only be for MediGap claims and all others should be blank
(enter N for No in the patient record).

Item 15

This item is to be left blank for Medicare claims.


Item 17a: I.D. NUMBER OF REFERRING PHYSICIAN

If a patient is referred to your office by another physician, enter
that physician's Referring Physician File number in the Patient's record
Referring Physician field BEFORE entering any transactions for them.
That File number will then be entered on each Transaction Line from that
point on. When printing Medicare forms, the Referring Physician File
number will be picked up from the transaction line by the program and
the UPIN number from THAT Referring Physician's record will be printed
in Item 17a on the form, along with the Name in Item 17.

Item 18: HOSPITALIZATION DATES

WinClaim does print the Hospital From and To dates (from the Patient
record) in Item 18. Be sure to enter the Service Date and Service To
Date in Transaction Entry along with the correct Units/Days of Service.


Item 22

This item is to be left blank for Medicare claims.
FORMS - 15
Item 24 C, H, I, and J

These items are to be left blank for Medicare claims.


Item 24K: RESERVED FOR LOCAL USE (Medicare PIN)

When you are printing Medicare forms, this item will be automatically
filled in from each Doctor File record's Medicare Number (PIN) field.
If the services are performed by different providers over the lines of a
claim, just be sure you have entered each Doctor's Number on the line
in Transaction Entry for the Procedure that doctor performed. The
program will then pick up the individual doctor's PIN number and print
it in Item 24k on that particular line. Up to nine characters will be
printed in this item.


Item 25: FEDERAL TAX ID

The original instructions from Medicare say to leave this Item
blank. However they DO need this information in order to forward claims
to MediGap carriers. So the program fills in this Item as follows:
If an individual doctor's Employer ID field is blank for their record in
the Doctor File, then the Social Security field from that Doctor record
will be printed. If the Employer ID is there, it will be printed.


Item 27: ACCEPT ASSIGNMENT?

This Item prints from the patient record Assignment field but
you also have two other choices with the Insurance Form Options: you can
select to always mark 'Yes' to Accept Assignment (regardless of what is
in the patient file) or always mark 'No'.


Item 30: BALANCE DUE

This item is left empty on any secondary or tertiary forms printed
so that you can keep those forms on file, fill in the payment amounts as
they come in, and send them off to the other carriers WITHOUT having to
reprint the forms.


Item 33: PHYSICIAN/SUPPLIER BILLING NAME (and PIN/GROUP)

Besides printing the doctor's Name and Address, the program will
print the Medicare PIN or GROUP number in this item. The doctor it
prints depends on the Doctor Option you chose at the beginning of the
program (the Patient's record doctor, a fixed or Selected doctor, or
the doctor from the Transaction Entry line).
For non-group practices, the individual doctor's PIN number will be
printed from their Doctor File record MR Num field. The MR Group field
should be empty in ALL Doctor File records.
For Group practices, the MR Group number will be printed in Item 33.
The MR Group field should be filled in for ALL Doctor File records.
On commercial claims, the Insurance ID number from the Insurance
File record will be printed in this Item.
UTILS - 1
UTILITIES

Utilities are used to set up the Program Parameters, to Val-
idate Files (to re-index, re-structuring or verifying file integrity),
and also to select the directory or practice for data entry for 'Batch
Mode' or Billing Center operation.


PROGRAM PARAMETERS

This is where you will set your various operating parameters,
such as screen colors, passwords, and printer codes, etc. These affect
how the program runs on your unique system.

Program Parameters -

Compressed Print: Selecting this parameter allows you to enter up to
eight DECIMAL numbers which will set your printer into compressed
print mode (approximately 15 to 16 characters per inch). This is
necessary if you are going to use only 9 1/2 inch wide paper which
normally can only handle just 80 characters across the page, whereas
many of the reports print up to 132 characters.
This parameter, used in conjunction with the Chars per Line para-
meter, will automatically set your printer to compressed print when
ever it is necessary.
You will have to look up this code in your printer manual. Any
printer which is Epson (tm) compatable will use the code 15 to go
into compressed print.

Normal Print: This code (or set of codes) is necessary in order to set
the printer BACK to normal print size (10 characters per inch) AFTER
the program has used Compressed Print.
Again, you will have to look up this code in your printer manual.
The equivalent Epson code is just the number 18.

Lines per Page: Almost all printer paper is 11 inches high per sheet
which is 66 lines per inch at 6 lines per inch. However there is one
size which is 110 characters 'wide' by 51 lines.

Characters per Line: The most common size of printer paper in use today
handles just 80 characters per line, making the use of compressed
print necessary. By selecting the number 80 here, you are telling
the program to use the Compress Print Code above whenever it is about
to print a report which will be MORE than 80 characters wide.
If you are using full sized 15 inch computer paper, then set this
number to 132 and it is unnecessary to enter either of the Compressed
Print or Normal print codes.

Passwords: There are five different passwords installed throughout the
program. When the program is initially installed, ALL passwords are
disabled which means ANY USER is allowed access to ALL operations.
To enable a password - just change it!

1) Start-up Password: A user must know this password before they can
reach the Main Menu of the program.

2) Posting Password: Used to restrict any Posting operation where all
entry must be verified by an authorized person before it is posted.
UTILS - 2

3) File Edit Password: This prevents an un-authorized user from edit-
ing the History, Open Items, or Payments files in Transaction
Entry (which would greatly affect your account balances).

4) Reports Password: Keeps someone from viewing or printing sensitive
financial reports.

5) Master Password: This password protects all the other passwords!
By changing this Master password, someone would need to know what
it is before being able to change any of the other four.

To disable a password and allow all users access to the operation
it protects, just change the password to the word "DOCTOR".

Screen Colors: As you use the program and open more and more windows,
it would appear confusing unless those windows looked different on
the screen. This is accomplished by setting different color para-
meters (or inverse video for monochrome) for each window level. The
windows can be opened up to four levels deep so there are four color
level parameters.
To change a color, first select the Screen Color level. Then
select the Standard color set (the Backround and Foreground display
which the computer prints on the screen) or the Enhanced color set
(the colors where YOU are doing entry). It is suggested that you
set a Backround color first. Backround colors only use every other
color choice.
Now use the up arrow and down arrow to select a color from the
window at the right. As you do, you should see the current selection
(pointed out by the arrow) change in the display window at the bottom
of the screen. The actual color codes also appear in that window
according to the following pattern:

Std Foreground/Std Backround,Enh Foreground/Enh Backround

The color codes are:

N - Black N+ - Gray
B - Blue B+ - Bright Blue
G - Green G+ - Bright Green
BG - Cyan BG+ - Bright Cyan
R - Red R+ - Bright Red
RB - Magenta RB+ - Bright Magenta
GR - Brown GR+ - Yellow
W - White W+ - Bright White

You might have to adjust your monitor color controls to match
the hues listed above.

Suggested default values are:

Level Color Monitor Monochrome Monitor

Color 1 W+/B,GR+/R W+/N,N/W
Color 2 BG+/G,BG+/RB N/W,W+/N
Color 3 R+/RB,G+/BG W+/N,N/W
Color 4 G+/W,G+/B N/W,W+/N
UTILS - 3

Default Zip Code/City/State: This is a time saving feature of the
program which allows you to assign a default city and State to a Zip
Code (or a subset of that Zip Code). For example: if any Zip Code
which begins with the digits 452 is for the city of Cincinnati, Ohio
then enter 452 as the Default Zip Code, Cincinnati as the Default
City and Ohio as the Default State.
Now when you are entering Patients for the Cincinnati area,
skip past the City and State fields (you must leave them blank) and
enter the complete Zip Code (45241 for example). The program will
recognize the first digits as matching the same number of digits you
entered as the Default, and automatically fill in the City and State.

Batch Mode: If you are using the program as a Billing Center then you
must select "Yes" for Batch Mode so the directories for each practice
will be recognized. this feature is covered thoroughly under the
Directory Select section of this manual.


VALIDATE FILES

This is a 'support' utility which you should very rarely have
to use. It has two purposes: 1) to display a count of records in all
files and verify that the appropriate Index files exist, and 2) to
verify or re-build one of the files. To use this selection just to
display a file count, just select Validate Files from the Utils Menu
and then Quit once you have viewed the counts (you can also do a Print
Screen for your records if you want).
You might need to Rebuild an Index file if it is corrupted by
a hard disk error or after restoring files from a back up. You might
need to Rebuild a file's structure if the database itself is damaged or
when instructed to Rebuild a file as part of a program update.
One other time you would use the Rebuild feature is on the Pro-
cedure or Diagnosis Files where you have deleted a number of records
from one of those files and don't want the erased records to show up in
the window. Rebuilding those files will remove the records. Note that
this works ONLY for those two files.
To select a file to Rebuild, use the Up and Down arrows to
highlight the file and press Enter to select it.

Index: An Index file is a seperate file that works as a pointer into
a database file to show the database in a certain order. If you get
an "Index corrupted" error or records are not showing up where they
should, you might need to Rebuild the Index(es) for that file.

Structure: A database's Structure is the number and name of the fields
it has in each record and the records themselves. If a program up-
date adds or changes fields, or a disk problem damages some of your
records, Rebuilding the Structure might be needed.

Verify: This is a simple test of a file. All the records are 'read' by
the system and the internal record number is compared to the Record
Number field in the record itself. Any dicrepancy is reported.
Rebuilding the file's Structure should correct any problems.


VALIDATE ENTRY

This selection works EXACTLY the same as Validating the other
program files except that it works on the Transaction and Open Entry
files. Refer to the section above for information.
UTILS - 4
DIRECTORY SELECT

If you are a 'Billing Center' type of operation who is doing
data entry and billing for several medical offices, then you will use
the Directory Select feature of the program. This is also referred to
as 'Batch' operation.

To use this feature there is something you must do OUTSIDE of
the program: you must create a DOS subdirectory for each practice that
you are providing your billing service. This will be done using the DOS
Make Directory command (MKDIR or MD) whenever you add a new practice to
your service.
Also, you must make certain that there are NO data files for any
practice directly IN your WinClaim directory. This is different from
operating a single practice where ALL files are in the same directory
as the program.
Finally, to let the program know that you expect to operate
using data files in several subdirectories, you must enter a 'Y' for
the 'Batch Operation' option under Utils/Program Parameters.

From that point on, whenever you start up WinClaim it will auto-
matically select Utils/Directory Select and require that you select a
practice (subdirectory) before you do anything else. Of course, you
can always make this selection yourself any time after that and chose
a different practice without exiting the program.

All of these operations are covered in the rest of this section.
Without getting too technical, there are a few words you need to under-
stand before going any further:

DIRECTORY: The hard disk on your system is divided up into Directories
which are given a name of from one to eight letters. Each application
program you use would be in it's own directory: you should have one
for word processing, one for this program, etc. YOU determine the
names of these directories as you install new programs or when you
create them yourself.

ROOT DIRECTORY: The first directory on any drive doesn't really have
a name but is always called the ROOT. ALL other directories are
considered to be UNDER this directory. You usually don't put any
programs or data files in THIS directory, just the names of other
directories.

SUBDIRECTORY: This term is really the same as Directory and is used
interchangeably. The term is SUBdirectory because it is UNDER the
Root Directory.

With DOS, you can have directories several levels deep. This
concept can be illustrated this way:

C: (Root) --------- WORDRITE --------- LETTERS
| |
| |---- DOCUMENT
| |
| ---- PERSONAL
|
---- WINCLAIM
UTILS - 5

Using this type of notation for the same example you can see
the same WORDRITE and WINCLAIM directories, but now you can also see
that the WORDRITE directory ALSO has three directories under it: one
for letters, one for documents, and one for personal notes.


SIMPLE WINCLAIM INSTALLATION

In its simplest form of installation, WinClaim is installed in
one directory called "WINCLAIM" under your "Root Directory", and all of
the program and data files having to do with WinClaim are in that dir-
ectory. That is what is pictured above. This type of installation
DOES NOT use the Directory Select utility at all.


BATCH OPERATION

However if you are operating as a billing service, you will
need to keep all the patient files and records seperate for each
practice that you do billing. This is an ideal application for using
the subdirectory feature of DOS. In short, all you have to do is
create a subdirectory for each practice under your WINCLAIM directory.
Then, just once, you will enter WinClaim and set an option in Utilities
to tell WinClaim that you want to operate that way. From that point on
WinClaim will keep all the records seperate for you automatically!

IMPORTANT NOTE! If you are going to operate in Batch Mode you must not
have any data files for a particular Doctor IN the WinClaim directory.
If you have already started one practice in that directory and decide
to change your mode of operation later, then follow the directions to
create a new directory, copy the existing data base files and index
files into it, and then erase them from the WinClaim directory. If
you don't understand those directions then this would be a good time
to get some technical help. There must not be any .DBF files in the
WinClaim directory except the 'parameter' file (WINPARMS.DBF).


CHANGING YOUR DOS PROMPT

One of the things that would be very helpfulis for you to have
your DOS Prompt (the little C> character) always show you which dir-
ectory you are in (if it does not already). If you are currently in
WinClaim at a menu then Quit all the way out to DOS. Now, to make sure
you are in the WinClaim directory, enter the following command:

C>CD\winclaim

It does not matter if the letters you type are in caps or not.
Note that the '\' character you type is the back-slash: NOT the one
over the Question Mark.
At this point your DOS prompt will look like one of two pos-
sibilities: either C:\> or C:\WINCLAIM>. If it has the word WINCLAIM
in it then you DO NOT have to do the next command. If not, then enter:

C>prompt $p$g

This command line should also go in your AUTOEXEC.BAT file in
your Root directory but that gets a little more advanced for right now.
At this point, your DOS prompt should look like C:\WINCLAIM> and you
are ready to begin creating your first subdirectory under it.
UTILS - 6
CREATING SUBDIRECTORIES

The command you will be using will be the Make Directory command
from DOS (also called MKDIR or simply MD). It is very easy to use.
Just remember that the directory names you create are limited to eight
characters. As an example, assume you are going to be doing billing
for a doctor named Rollins. Starting from the WinClaim directory, the
command you enter would be:

C:\WINCLAIM>md rollins

And that's it! You don't have to change to it or do anything
else. If you happen to have two doctor Browns (but different practices)
then you can call one BROWN1 and the other BROWN2.

Before you start utilizing subdirectories, you must tell the
program to go look for them (you only have to do this once). Start up
WinClaim as usual and select the Utils and then select Program Para-
meters. From the next level, then select Batch Operation. Set the
answer to that question to 'Y' for Yes. You're now ready to begin.

After you have created several such directories, your drive might
look something like this:

C: (Root) --------- WORDRITE --------- LETTERS
| |
| |---- DOCUMENT
| |
| ---- PERSONAL
|
|
---- WINCLAIM --------- ROLLINS
^ |
| |---- MORRIS
no .DBF's in this dir - |
except WINPARMS file |---- BROWN1
|
---- BROWN2


DATA ENTRY IN BATCH MODE

From now on, when you start up WinClaim, you will be taken
straight to the Directory Select selection under Utils and will not be
permitted to do anything else until you select one from the list shown.
Once you have chosen a directory, the name will appear near the upper
left hand corner of the screen so you can always tell which practice
you are in. When you are finished doing entry for that practice you
can always change to another by returning to the Main Menu, selecting
Utils and then Directory Select again.