Claims: Claims + Insurance

When creating a new claim, selecting a payer for a client having an existing insurance record for the payer. The claim pre-fills with the plan and subscriber details to ensure billing consistency and reduce chances of claim rejections.

Additional Criteria To Auto-Populate

Active Coverage: All service dates added to the claim must fall within the plan’s Effective and Expiration dates.

Eligibility Check: The latest verification for that plan must have a status of 🟢 Eligible.

The valid eligibility check must have been performed on or before the earliest service date on the claim.

Field Mapping

Box	Field Name	Data Source
1a	Insured's ID Number	Member ID from the Insurance record.
4	Insured's Name	First & Last Name of the Primary Subscriber.
6	Patient Relationship	The selected Relationship to the subscriber.
7	Insured's Address	Full address, city, state, zip, and phone of the primary subscriber.
11	Insured's Policy Group	The Group / Program Number.
11a	Insured's Demographics	Date of Birth and Sex of the primary subscriber.
11c	Insured's Plan Name	The Plan Name.
13	Insured's Signature	Subscriber's First and Last name