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Reviewing a claim

The claim detail: what was billed, what Adentris suggests instead, and the findings behind every suggestion.

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Written by Sergey Yudovskiy

Select any claim to open its full detail. This is where a coder or biller can see not just what to change, but the reasoning for each change, side by side with the codes that were billed.


A claim detail with billed codes, suggested changes, and findings

A claim detail. Suggested changes are shown right against the codes that were billed.


The header

Patient, date of service, provider, clinic, specialty, and the primary and secondary diagnoses, together with the revenue or risk badge and the dollar range for the claim. Everything you need to place the claim in context is at the top.


Codes and suggestions, side by side

  • Billed codes are what is on the claim today.

  • Suggested changes are what Adentris recommends, with removed codes struck through, added codes highlighted, and modifier changes called out clearly.


Findings

Below the codes, each finding is listed and can be expanded. Every suggested change traces back to a finding, so before you accept anything you can see exactly why a code should move. The next article looks at a single finding in detail.

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