Chapter IV: Inquiries Submenu (01)
Claim Count Summary (56)
Purpose
The CLAIM COUNT SUMMARY option provides a review of the total claim count and total dollar amount for claims pending in a specific location. This information is updated in the system daily.
Note: Claims in locations with the last four positions of 9997, 9998 and 9999 will not be displayed on the claims summary totals inquiry. However, claims in a status/location of TB9997 will be displayed using the Claim Count Summary option.
To access the CLAIM COUNT SUMMARY option from the FISS online INQUIRIES submenu, type “56” at the Enter Menu Selection: prompt and press the <Enter> key.
Upon selecting the CLAIM COUNT SUMMARY option, the CLAIM SUMMARY TOTALS INQUIRY screen is available:
Press the <Enter> key to display all pending claim data, or type in a specific status/location in the S/LOC field or category type in the CAT field to narrow the selection option.
| Field | Description |
|---|---|
| Provider | Provider number – Identifies the specific provider number of the facility (13-position alphanumeric field, system-generated). Note: if the user is authorized to view other provider number information, overkey the PROVIDER field. |
| S/LOC | Status/Location – Status identifies the condition of the claim, e.g., suspended, rejected (one-position alphabetic field). location identifies where the claim resides in the system (five-position alphanumeric field) |
| CAT | Bill category – Identifies the type of claims in specific locations by the first two positions of the bill type and the following alpha categories: GT (Grand Total) = Total of all categories in all status/locations. Total will print at the beginning of the listing. TC (Total Count) = Total within each status/location excluding claims with a category of AD, NM or MP. AD (Adjustments) = Adjustments within each status/location. Claims in this category are counted under the standard bill category. NM (Nonmedical Policy) = Claims in status/location TB9997 only. Identifies RTP claims where the first digit of the primary reason code is not 5. Claims in this category are counted under the standard bill category. MP (Medical Policy) = Claims in status/location TB9997 only. Identifies RTP claims where the first digit of the primary reason code is 5. Claims in this category are counted under the standard bill category. |
| NPI | National Provider Identifier – Numeric ten-digit identifier |
| CLAIM COUNT | Claim count – Identifies a total claim count for specific category. |
| TOTAL CHARGES | Total charges – Identifies the total dollar amount accumulated for the total number of claims identified in the claim count. |
| TOTAL PAYMENT | Total payment – Identifies the total Medicare reimbursement amount for claims in the associated bill category and status/location. This is an accumulated dollar amount for the total number of claims identified in the claim count. For those claims suspended in locations prior to payment calculations, the total payment will equal zeros. |
To display details for additional status/locations, press the <F6/PF6> key.
Revised 8/16/2023