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A claim is a draft until you have looked at every field and confirmed it. ClinikEHR never accepts a box for you, and a claim cannot be marked ready while any box is unconfirmed.

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What you’re looking at

Your claims lists each claim with its Claim number, Patient, Date of service, Charge, Status and Notes. Each row ends with a ⋯ menu: Open claim, Generate file… (for a ready or approved claim) and, for a ready claim, Approve. Search by claim number, or filter with All statuses. The Notes column carries badges: The status runs Draft, Ready, Approved, In a file. Accepted, Rejected, Paid and Denied are set when you add Medi-Cal’s reports under Reports; ClinikEHR never sets them on its own. When you open a claim, a scanned or PDF page shows beside the form on a wide screen (Show the page and Hide the page on a phone), and selecting a box highlights where it came from on the page.

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Check and confirm the fields

1

Choose the billing provider

Under Billing provider (box 33), choose who is billing. If the list is empty, add one in Setup first.
2

Work through To check

To check lists the boxes that were read or filled in, least sure first. Compare each with the page.
3

Tick and confirm

Tick I’ve checked this on each box you have compared, then select Confirm the fields I’ve checked (or Confirm on a single box). Each box shows where its value came from: Typed, From PDF, From CSV or AI. A box read with AI also shows a Confidence (or Low confidence), and the least sure come first in To check. AI can misread a box, so compare it with the page. See Read a scan with AI.
4

Fix what the panel lists

To fix before a file shows to fix (Fix) and to look at (Look) counts. A Fix stops a file; a Look does not. Some are marked “(Needed for production files only.)”.
5

Save

Select Save draft, or Mark ready to save and mark in one go. While boxes are unconfirmed the bar at the bottom reads “N to confirm before it can be ready”.
The diagnoses (box 21) take ICD-10 codes A to L: type the code or use the search. Each Service line (box 24) has a pointer saying which diagnoses it is for, for example A or AB, and charges are plain numbers such as 125.00. Add a service line and Add a diagnosis add more; Remove takes a line out after a confirmation. A claim marked ready can go Back to draft if you need to change it.

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Run the code checks

Once a claim is saved, Check codes compares its procedure codes, modifiers, units and diagnoses with the rules Medi-Cal and Medicare apply. Each finding names the box and line, and is marked Fix or Check. When nothing is found it says “Nothing found. Medi-Cal makes the final decision.”
The checks are advice. Medi-Cal makes the final decision, and the checks never stop you making a file. A claim that passes can still be rejected, and a finding can be one you are right to ignore.
If the check needs reference data that has not been loaded for a rule, the claim says so instead of passing quietly. For example: “The code-pair (NCCI) check did not run because its data is not loaded yet. Check pairs of procedures billed the same day yourself.” and, for units, “The unit-limit (MUE) check did not run because its data is not loaded yet. Check the units billed for each code yourself.” A claim that has unsaved changes asks you to save first, because the check reads the saved claim.

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Check it worked

  • The panel reads “Nothing to fix. Mark the claim ready when you have checked it.”
  • The status badge reads Ready and the claim appears in Your claims with that status.
  • The step bar moves to Generate once no drafts are left.

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Common issues

At least one box is still unconfirmed. Open To check, compare each box with the page, tick it and confirm.
Once a claim has gone into a file it is locked. Make a corrected claim instead. See Corrected claims and voids.
The check reads the saved claim. Select Save draft, then Check codes.
You cannot move a claim to Approved from the editor. See Approve claims.

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FAQ

A value read from a file can be wrong, and a wrong value on a claim goes to Medi-Cal under your name. Confirming each box is the point of the review.
Yes, but changing an approved claim withdraws its approval, and it needs approving again.

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Changing boxes by conversation

Instead of typing a correction, you can ask Ozni to change a few boxes. It shows each box with what it says now and what it will say, and nothing is saved until you confirm. A box changed this way counts as checked by you, and an approved claim goes back to ready. See US insurance and Medi-Cal claims with Ozni.