Creating Alberta Health claims

Creating Alberta Health claims

You can open the AHC claim entry window from several locations:

  1. Select ‘new claim’ from the toolbar on the tabletop screen.
  2. Click on the billing menu, select new claim.
  3. On the appointment detail window, click ‘bill AHC’.
  4. On a chart note, click the ‘bill’ button.

If opening the window from the toolbar or the menu, select the practitioner, then search and select the patient in the lookup window.

If opening the window from the appointment detail or the chart note, the practitioner and client will automatically select the patient and practitioner the note or appointment is associated with.

                  
  1. Enter the service date, service code, diagnostic codes, and any modifiers as required.

*Note, if these codes have been entered into the chart note, use the bill button in the chart note, and the codes will pull into the claim window.

    1. Select these items from the dropdown (commonly used items), or
    2. Double click in the service and diagnostic code fields to bring up the search box,

                  

For more information on the selected codes, right click in the service and diagnostic code fields to open additional details.

                  
  1. Make sure the facility code and functional center are filled in appropriately. (Enter these into the practitioner tab on their client card so they automatically pull into every claim created).
                  

AHC Claim Entry tabs

With proper setup, it should only be the ‘base’ tab that needs to be completed.

Base – holds all the information for the services provided to the patient and by the practitioner selected. *Note, if this is a consultation AH claim, there MUST be a referral doctor selected. (Double click to open the search window, ctrl + right click to open the client card of the patient to see who the referral doctor is.

Location – holds the information for where the service was conducted. The ‘facility’ and ‘func center’ will populate if filled in from the base tab.


Patient – holds some of the patient’s demographic information, which will populate all required information when selecting the patient. This tab is most relevant when billing a newborn, this is where to place the relative PHN usually mom’s PHN).


Claim – holds information regarding the claim in Healthquest. It shows the claim number as assigned by Healthquest; this is NOT the same as the number AH assigns. If paper documents need to be sent in along with the claim, select the ‘Paper to follow’ check box.


Text – is a free text field to add any notes related to the claim. 


Doctor – hold information regarding the attending practitioner, this information will populate based on the information on the doctor client card practitioner tab.


Pay to – is only important if the claim is being paid to someone other than the attending practitioner submitting the claim.


  1. Click ‘done’, this will save the claim details and close out the window.
  2. Click ‘next’ to save the claim, place it into the list at the bottom of the window, and clear the values from the claim entry at the top to create the next claim. *Note the same patient and practitioner are loaded.

Other actions

Undo – cancels the previous action or information manually entered in any of the tabs prior to clicking done or next (these will save the claim entry).

Last – loads the last claim that was created and saved (this may change the patient and practitioner loaded).

New client – opens a new client card to generate a new patient.

AHC history – opens a patient medical history window to view all AH claims submitted for the current patient.



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