Visits
A visit is the encounter: who was seen, where, by whom, and what was done. Claims are generated from visits. The automatic refreshes keep any line a biller added or edited on a draft claim; only Generate Claim or a regenerate on the visit rebuilds every line from what the visit says.
Who Can See It
Section titled “Who Can See It”User only, when the client is licensed for visits. Administrators and Managers have no access to visit data by design, which Roles and Access explains.
The List
Section titled “The List”| Column | What it shows |
|---|---|
| Visit # | The visit number |
| Patient | Who was seen |
| Admit Date | When the encounter started |
| Discharge Date | When it ended, or a dash |
| Status | Where the visit is in its life |
| Unbilled | Not yet billed for a New or Ready visit, or the count and charge of services added after its claim was filed. Blank otherwise |
Statuses
Section titled “Statuses”| Status | What it means |
|---|---|
| New | Arrived, not yet checked |
| Ready | Readiness passed; a claim can be generated |
| Billed (Primary) | A claim went to the primary payer |
| Billed (Secondary) | A claim went to the secondary payer, or on to a tertiary payer |
| Patient Responsibility | What remains falls to the patient |
| Completed | Nothing further is expected |
| Cancelled | The encounter did not happen, was withdrawn, or was resolved as not billable from a follow-up item |
Above the list, three figures count the whole client rather than the page you have scrolled to: Total, Unbilled and Cancelled. Unbilled is the one to watch - a visit that is New or Ready and has no claim behind it yet, or a billed visit with a service that was added after its claim was filed and is on no claim. Clicking it filters the list to exactly those, which is the shortest path from “are we leaving money on the table” to the visits responsible. The Unbilled column says which: Not yet billed, or the count and charge of the services left off the claim. The filter rail also narrows by Status.
On such a billed visit the header reads 1 service not billed, a note says which claim was filed without it, and the service’s status reads Not Billed. Replacing the claim to bill a late service isn’t available yet.
Search matches the visit number or the patient’s first or last name. What you type in the search box stays out of the page address, so a bookmark or a shared link carries the filters but never the name you searched for. The search is kept while you move around ClaimPod, and cleared when you reload the page or sign out.
The Visit Page
Section titled “The Visit Page”Three tabs, Overview, Claims and Activity. A note pinned to the visit shows as a banner above them, on every tab.
On a New or Ready visit, the cards are edited in place, and Admit Date is required: change a field and a bar appears at the bottom of the page with Save Changes and Cancel. Nothing is written until you save, and Cancel asks Discard Changes? first. If someone else saved the visit first, Reload takes the place of Save Changes; see A Save Was Refused. A visit that has been billed, or any visit on a read-only instance, shows its fields read-only.
| Card | Fields |
|---|---|
| Visit | Visit Number, Patient, Patient Class, Reason, Admit Date, Discharge Date, Location, Imported, Updated. The Location picker offers the locations open on the admit date, and a closed one already chosen reads “(Inactive)” after its name |
| Admission | Admission Type, Admission Source, Discharge Status, Hospital Service, Financial Class, Admit Reason |
| Care Team | Attending Provider, Admitting Provider, Referring Provider |
| Diagnoses | The coded diagnoses for the encounter, each with its order, code, type and date |
| Services | The service lines that become claim lines, with CPT, Modifiers, Diagnoses, POS, Charge, Transactions (a count that opens Linked Transactions), Units, Service Date and Status. The card’s column menu adds more, such as Rendering Provider, Source, Revenue Code and NDC, and marks one the window has no space for No room. Each service is each Captured, Billed or Voided, or Not Billed when it was added after the visit’s claim was filed; hover it to see when. A service kept off every claim reads Withheld, followed by the reason, who withheld it and the day. A service with no charge reads Not priced in red; hover it to see that no price is on file for its code and date |
Patient Class is one of Inpatient, Outpatient, Emergency, Preadmit, Recurring, Obstetrics or Unknown.
A diagnosis Type is one of Final, Admitting, Working or Other. The order decides which code leads the claim.
The Claims tab lists what has already been generated from this visit, with each claim’s Claim, Payer, Status, Charge, Open balance and Created date. A claim billed to a later payer carries a Secondary or Tertiary chip, and a primary that has one carries Primary. Claims are grouped by their correction or rebill chain, and within it by payer: the primary first, its secondary right after it, then the tertiary.
Activity holds the notes written about it, the follow-up decision taken on it, the work queue items it has been through, and the secondary-billing milestones of its claims - see Record Activity.
Readiness
Section titled “Readiness”Readiness is a live verdict rather than a status you set. The control beside the visit title counts the checks that are failing, and opening it names each one, why a failing check fails, and where to go and fix it. The control reads, for example, 2 of 10 failing, or Ready. There are ten checks:
| Check | Fails while | Fix link |
|---|---|---|
| Patient Linked | The visit has no linked patient | Link Patient → |
| Active Insurance Coverage | No coverage covers the admit date | Add Coverage →, or Edit Coverage → |
| Billable Service | The visit has no billable service | Add Service → |
| Services Priced | Any service has no charge | Enter Charge → |
| Services Coded | Any service has no procedure code | - |
| Coding Released | A service is waiting in Coding Review | - |
| Fits One Claim | The visit has more than 50 billable services | - |
| Rendering Provider | No rendering provider is set | - |
| Place of Service | No place of service is set | - |
| Coded Diagnosis | The visit has no coded diagnosis | Add Diagnosis → |
The verdict reads Not Checked Yet, Ready to Bill or Not Ready to Bill, with when it was last checked and a Recheck button. A check that fails to run shows “Couldn’t check readiness.” with a retry. Services Priced fails while any service has no charge, and offers Enter Charge →, which opens the first unpriced service for its charge. Active Insurance Coverage fails when no coverage covers the admit date. When the patient has a coverage that ended before the visit, or one that starts after it, the check names the plan, the member ID and the date, and offers Edit Coverage →, which opens that coverage to correct its dates, beside Add Coverage →. The visit checks again once you save.
A visit that has moved past readiness - one that is already billed, or has a claim - reads Not Applicable, because nothing will check it again. A cancelled visit reads it too, because a cancelled visit isn’t billed.
Actions
Section titled “Actions”| Action | What it does | When it is offered | When it is offered but greyed |
|---|---|---|---|
| Check Readiness | Runs the readiness checks | Before the visit has a verdict | While a check is running |
| Generate Claim | Builds a claim from the visit | On the Claims card of a New or Ready visit. Missing on any other visit and on a read-only instance | Until readiness has been checked (“Check readiness first”) and passes, with the tooltip listing what is unmet, including a service with no charge; while a claim on this visit has moved past draft, when the tooltip tells you to revert that claim to draft on the claim page first; and while the visit’s claims could not be loaded |
| Add Service | Adds a service line | In the Services card’s menu, on any visit that is not cancelled, billed visits included | - |
| Add Diagnosis | Adds a coded diagnosis | In the Diagnoses card’s menu, on a New or Ready visit | - |
| Edit | Opens a service to change it | In a service row’s menu, on a New or Ready visit | - |
| Void | Voids a service. It asks for a Reason, which then shows under the Voided status | In a service row’s menu, for a User who is also a Manager or Administrator, billed visits included | - |
| Withhold from Claims… | Keeps a service off every claim, for every payer, for example when the patient paid for it in full and asked that the plan not be billed. It asks for a Reason. The service stays on the visit, marked Withheld, and comes off the visit’s unsent claim; a claim left with nothing to bill is removed | In a service row’s menu, on a service that is not voided and not on a sent claim. A service on a sent claim can’t be withheld: send a corrected claim without the line instead. Nor can a service the patient has paid on: move the payment or refund it first | Withhold stays greyed until a reason is entered |
| Release to Claims | Lifts the withhold, so the next claim generated for the visit bills the service again: regenerate the visit’s claim to bill it | In a withheld service’s row menu, for a Manager or Administrator, unless the service is voided | - |
| Cancel | Withdraws the encounter. It asks for a Reason (Duplicate encounter, Not billable or Entered in error) and an optional Note, removes the visit’s unfiled claim, and the visit page then shows why, who cancelled it and when | In the Visit actions menu, on a New or Ready visit with no unsaved edit. Cancel Visit in a row’s menu on the Visits list, and on the claim page of a Draft or Ready primary claim, does the same. The dialog’s Cancel button stays greyed until a reason is chosen | - |
| Restore Visit | Reverses a cancellation and clears its reason | In the Visit actions menu, on a cancelled visit with no unsaved edit | - |
| View History | Shows what changed and when | In the Visit actions menu, always | - |
| Delete | Removes the visit, or from a service row’s menu the service | In the Visit actions menu and a Visits list row’s menu, on a New, Ready or Cancelled visit with no unsaved edit, for a User who is also a Manager or Administrator. A service on a claim offers no Delete | - |
While an edit is unsaved, Cancel, Restore Visit and Delete are missing from the menu rather than greyed; save or discard the edit to bring them back.
Regenerating from the visit rebuilds every line, so hand-edited claim fields are overwritten with what the visit says. ClaimPod asks before doing that while the visit still has a claim in draft to rebuild. Where the visit’s only claims are voided, generating builds a fresh claim and asks nothing; once a claim has moved past draft, the action is greyed rather than offered, and Revert to Draft on that claim is the way back. A filed, unpaid primary can instead be billed to another coverage with Rebill to Another Payer on the claim page.
Code pickers offer only codes in effect on the service date, and saving one that is not is refused, for example “CPT 0001U isn’t in effect on Jan 5, 2019.”.
States
Section titled “States”- Not Applicable - readiness no longer applies to this visit.
- Couldn’t generate the claim appears inline with a Retry, beside the visit it belongs to rather than away from it.
- The visit no longer exists if it was deleted while you were away.
- Empty - a client with no visits says so. Visits usually arrive through imports rather than typing.
- Blocked - without the visits module the screen is not in the sidebar, and a saved link to it says the module is not part of your plan.
Related: Patients · Providers · Generate a Claim from a Visit · The Claim Loop