Claims Admin User Guide:

The following document is a user guide to help you navigate the 'Claims Administration System'.

Overview:

The Pegasus Claims Administration System (ClaimsAdmin) is a web-based tool that provides an overview of subsidy claiming via Claims OnLine (COL) forms.

The ClaimsAdmin app can be found at https://claimsadmin.pegasus.health.nz.

ClaimsAdmin provides a view of all claim submissions and tracks their state from submission to payment as described below.

Table1 - Claims States:

Claim State: Meaning:

Void:

Claim failed to meet eligibility requirements.

Pending:

Claim is awaiting manual or 3^rd party funder approval.

Bankable:

Claims is ready to be added to the next payment run.

Deleted:

Claim has been deleted.

Declined:

Claim will not be paid.

Transferred:

Claim control has been handed over to the Banking System.

Paid:

Claims has been added to a payment run.

Reversed:

A paid claim has been debited out as the claim was paid in error.

Security:

ClaimsAdmin is secured by Azure Active Directory authentication using a UPN as your login name. Most users will use logins of the form firstname.lastname@srphc.health.nz. If you are unsure of your SRPHC UPN please contact the Pegasus Service Desk.

You will use the same password that you’ve used to login to PegasusWorld with your SRPHC account name (e.g. JohnS1).

Your BCTI permissions will transfer to ClaimsAdmin with the same authorisation that you previously received in PegasusWorld.

Modules:

Modules are accessed via the blue Navbar at the top to the page. The options presented to you are based on your access permissions so you may not see all the buttons displayed below.

BCTI Files;

This page presents a list of BCTI files for the payees / HBLs that you have been granted view access.

<BCTI Table IMG> Add.

Sorting Files;

By default, the BCTIs are ordered by Pay Date (descending), then Payee (ascending).

The files may be ordered by any column by clicking on the column header. A small arrow will appear in the header to indicate which way the ordering is currently set. A second click will reverse the ordering, while a third click will remove the ordering.

Note: Only one column can be sorted at a time.

Filtering;

Filters may be applied to most columns. Hover the mouse pointer over the column header until an ellipsis appears and select on it. Filter types are specific to the type of data that is contained in the column.

Column: Filter: Usage: Payee: Multi-select Options. Check one or more options to show only these payees.
Pay Date: Date Ranges.
You can specify filters such as 'Before X', 'After Y' or 'between x and Y'. Banking Run: Multi-select Options.
Check one or more options to show only these banking runs. HBL Number: Multi-select Options.
Check one or more options to show only these HBLs. File Name: String Search.
Find filenames matching a search pattern using a search string.
Action: Sorting only.
No Effect.

Downloading;

Individual BCTI files can be downloaded by selecting the “Download” button in the “Action” column, next to the file you want.

To download multiple files at once, select the check boxes on the left-hand side of the list for the files you want to download, then select the “Download Files” button below the “Payee” column.

The BCTI’s that you have downloaded will be saved according to your browser settings, usually into your “Downloads” folder.

Claims;

The Claims page offers a list of claims with their current state as described above.

<Claims Table IMG> Add.

Predefined Search;

Common search options are available from the “Predefined Search” combo.

Search Options: Meaning:

Today:

Claim with a date of service today.

Previous 7 days:

Claim with a date of service in past 7 days.

Previous 30 days:

Claim with a date of service in past 30 days..

Previous 90 days:

Claim with a date of service in past 90 days.

All Claims:

All claims (limited to 5 years of history).

Recently Paid:

Claims paid in the last 7 days.

The default setting is Previous 30 Days.

Selecting a predefined search will re-populate the claims data using that search definition. This is different from filtering the data using column headers since the data will be reloaded from the claim server.

Exporting Claims;

You can download a copy of these claim data by clicking “Export To CSV”.

This is useful if you want to import claim data into other software packages like Excel.

Data Refresh;

ClaimsAdmin is a real-time service. If you want to see the claims that may have been submitted since you opened / searched / refreshed, you can select the “Refresh Grid” button to retrieve any recently submitted claims.

The pre-defined search and column filters will still be applied to any newly submitted claims.

Filters;

Filters are a way of reducing the volume of claims being presented on screen.

Column: Filter: Usage:

Service Code:

Multi-select.

Check one or more options to show only claims for these services.

ClaimCode:

Multi-select.

Check one or more options to show only claims for these types.

Service Code:

Date.

Find claims with a specific service date.

Claim Date:

Date.

Find claims with a specific claim date.

Facility:

String Search.

Find Facilities matching a search pattern using a search string.

HBL Number:

String Search.

Find HBL Numbers matching a search pattern using a search string.

Payee:

String Search.

Find Payees matching a search pattern using a search string.

NHI:

Exact Match.

Find claims for the patient with a specific NHI (No partial matches).

Patient Surname:

String Search .

Find patient surname matching a search pattern using a search string.

Patient First Name:

String Search.

Find patient firstname matching a search pattern using a search string.

DoB:

Date.

Find claims for patients with a specific Birth Date.

Amount (GST Incl):

String Search.

Find claims with a value matching the pattern.

Claim State:

Multi-Select.

Check one or more options to show only claims in these states.

Column filters can be individually set and cleared, or all filters can be removed by clicking “Clear Filters”.

To hide / show the filter options click the icon to the right of the screen.

The Claim State column includes a hover-over pop-up with additional details, if available.

Content Menu;

A content menu is available on the left side of the claims grid rows.

From any patient-based claim (i.e. excluding SIA Practice Nurse Intervention), you can put the patient in context by selecting “Put patient in context”. The claims list will refresh showing all claims for that patient regardless of previous Predefined Search or Column Filter settings. This functionality is the same as that provided by the patient search module (below).

If a claim is in Paid State and the Pay Date has passed, then the context menu will contain an option to “Download BCTI File”. This will download the BCTI file in which the claim is present.

Managing Claims;

Add Detail.

Pagination;

Pagination controls can be used to define the number of claim rows to display a once, which page of claim to display and move forwards or backwards through pages.

Patient Search;

To see the entire claim history for a specific patient, you can search for the patient and put them in context to access their claim history.

<Patient Search IMG> Add Image.

Supply the patient details (NHI, Name DOB) and click search to return matching patients.

<Matching Patients IMG> Add Image.

User column filters to narrow down the results if necessary.

Select the appropriate patient using the icon to the left of the row to put the patient into context.

You will be taken to the claims view, with the claim data filtered for that specific patient.

The patient in context will appear at the top of the screen.

Note: You will not be offered any Predefined Search options when a patient is in context.

Remove the patient in context by selecting the 'Clear' button to the far right of the screen.