(DRAFT) Easy Claims User Manual Outline - Gallium v7

Table of Contents
How to login on Easy Claims
How to login on Easy Claims Connect
How to file a claim?
File a claim
Check Eligibility
Member Information
Fetch
Verify
Patient Information
Save for E-Claims?
Claim Identity
Bypass Eligibility Check
Confinement Information
Health Care Institution Information
Patient Confinement Information
How to Add Diagnosis?
How to Input Valid Item Code Properly?
Special Considerations
Fees and Charges
Claim Type
Professional Fees and Charges
Are there enough benefits?
Consent to Access Patient Record
Claim Particulars
Claim Receipts
Claim Documents
Admission Information
N/A
New
Old
Claim Summary
Save Claim
How to Generate CF4?

Generate CF4
Patient Enlistment
Patient Profiling
Patient Consultation
Generate Claim
Link Claim
Easy Claims Gallium (7.0.0.0) 2019 | page 1

How to file a claim with CF4?
File a claim
Link Consultation
Generate Consultation
Link Consultation
How to Submit a claim with CF4?

Completed Claims
Submit Selected
Check Claim List
How to Submit all claims? (Submit All)

Submit All
Check Claim List
How to Submit selected claims? (Submit Selected)

Completed Claims
Submit Selected
Check Claim List
How to Refile CF4?


HOW TO LOGIN ON EASY

CLAIMS?



1. Input your username
2.. Input your password

2.. Click Log in
You must be redirected on this page

HOW TO LOGIN ON EASY

CLAIMS CONNECT?



1. Input your connect username
2. Input your connect password

3. Click Connect
The system should display the following information on the same page

HOW TO FILE A CLAIM?


1. ote: A
Choose from the following options below on how to start. N ll options will
redirect to the creation of claims.
Note: All fields with * are required

1.a Go to Home then click File Claim button
1.b Go to Claims then choose File Claim on the submenu
1.c Go to Claim List then click File Claim button

2. Fill out the CHECK ELIGIBILITY form [Claim Form 1]

Complete the Member Information
etch button - Provide correct member PIN and it will auto-populate

F
member ’s complete name and date of birth and don’t forget to select the gender
of the member.
Example: [Successful Fetching] Example: [Failed Fetching]

Member information successfully fetched. Member PIN does not exists!
Verify button - Provide member’s complete name, and date of birth it
will auto-populate member’s PIN
Example: [Successful Verification] Example: [Failed Verification]

PIN successfully verified NO RECORDS FOUND. PLEASE PROCEED TO ANY
PHILHEALTH OFFICE FOR PIN REGISTRATION.

Note: Fetch and Verify functions are not available on offline mode.

Complete the Patient Information
pouse, Child, or Parent: Input the Patient

If the patient is not the member but the S
Name, Birth Date, Gender and PIN.

2.1 Choose saving options Save for E-Claims?
a.) Yes - to continue filing the claim

2.1.a.1 Input Claim Identity
Transmittal Number - Unique identifier of a group of claims or specific claim
Claim Number -Unique identifier of the claim
2.1.a.2 Click Continue t o proceed on PBEF and to Confinement Information


Note: Tick Bypass Eligibility Check checkbox to skip the eligibility checking
b.) No - to check the member’s eligibility only. This won’t allow you to
proceed on the next page. If you wish to, tick Yes on Check Eligibility page.
2.2.b.1 Click Continue t o navigate to Philhealth Benefit Eligibility Form only.


3. Complete the CONFINEMENT INFORMATION [Claim Form 2]

3.1 Identify the Health Care Institution Information

3.2 Complete the Patient Confinement Information


How to Add Diagnosis?
1. Click the Add Diagnosis button
2. Input the Discharge Diagnosis
3. Click the + Add ICD Code button
4. Choose one ICD code from the dropdown then click [Update]
Note: Repeat step 3 and 4 for multiple ICD Codes.

How to Input Valid Item Code Properly?


3.3 Tick the checkbox of the Special Consideration that applies

3.4 Click Continue to navigate to Fees and Charge

4. Fill out the FEES and CHARGES [Claim Form 2]

4.1 Select Claim Type [All Case Rate]
4.1.1 Select Case Rate Type

4.1.2 Select Case Rate Type
Note: Do not input multiple ICD and multiple RVS at the same time

4.2 Add Professional Fees and Charges Information
4.2.1 Click the + Add Professional Fees and Charges button
4.2.2 Complete the Professional Information then click [Update]

4.3.a Identify if there are enough benefits? [NO]
Complete the Health Care Institution Fees and Professional Fees
4.3.b Identify if there are enough benefits? [YES]

Complete the Consent to access Patient Records


Complete the Claim Particulars (if applicable)
1. Click the + Add Drugs Or Medicines button
2. Complete the Drugs Or Medicines Information then click [Update]

3. Click the + Add X-Ray, Laboratory, And Supplies button
4. Complete the X-Ray, Laboratory, And Supplies information then click [Update]

Complete the Claim Receipts (if applicable)
1. Click the Add Receipt button
2. Complete the Add Receipt information

3. Click the + Add Receipt Item button
4. Complete the Receipt Information then click [Update]
5. Click Save
Note: Repeat steps 1-4 for multiple Claim Receipts.

Add Claim Documents
1. Select a file to be uploaded
ote: The system only accepts .pdf file format and .xml file format for CF4
N

2. Click Select files button to select the file to be uploaded
The image below shows the selected document attached in the system
3. Click Continue

5. Fill out the ADMISSION INFORMATION [Claim Form 3] (If applicable)

5.1 N/A
5.1.1 Click Continue to proceed on Claim Summary

5.2 New
5.2.1 Complete the Admission Information

5.2.2 Complete the Physical Examination

5.3 Old
5.3.1 Complete the Admission Information

5.3.2 Complete the Physical Examination

5.3.3 Complete the Maternity Information
5.3.4 Complete the Clinical History Details

5.3.5 Complete the Risk Factors

5.3.6 Complete the Consultations
5.3.6.1 Click the + Add Consultation button

5.3.6.2 Complete the Consultation details then click [Update]
5.3.7 Complete the Delivery Details

5.3.8 Complete the Post-Partum Details

6. Review the Claim Summary

6.1 Click the Export As PDF button to save a copy of the summary

6.2 Click the Save Claim button to save the claim
6.2.1 Click the ADD NEW button to file another claim
6.2.2 Click the NO button to view the created claim and you will be redirected
to Claim List page


HOW TO GENERATE CF4


1. Go to Patients on the menu bar then click Register button

1.1 Fill-out the Patient Information

1.2 Click the Save & Add Profiing button

1.2.1 Complete the Past Medical History
1.2.1.1Tick the checkbox of the Medical History and its specifics that applies
Example:
1.2.1.2 Click Save & Proceed button
1.2.2 Complete OB-GYNE History

If Menstrual and Pregnancy History does not apply tick Not Applicable checkbox
If Patient is MALE OB-GYNE History is automatically not available

1.2.2.1 Fill-out the Menstrual History
1.2.2.1.1 Input the Last Menstrual Period
1.2.2.2 Fill-out the Pregnancy History
1.2.2.2.1 Click the Add History button
1.2.2.2.2 Add the History Information then click Add button
1.2.2.3 Click Save & Proceed button

1.3 Review the CF4 Summary then click [Save & Add Consultation]

1.3.1 Click the Add Consultation/SOAP button
1.3.1.1Fill-out the Subjective

1.3.1.1.1 Click the Save & Proceed button

1.3.1.2 Fill-out the Pertinent Physical Examination Findings
Note: Physical Examination is automatically set to

Essentially Normal, if nothing is ticked

Example:
1.3.1.2.1 Click the Save & Proceed button
1.3.1.3 Fill-out the Course in the Ward
1.3.1.3.1 Click the + Add Doctor’s Action button
1.3.1.3.2 Complete the Add Action information then click Add button

1.3.1.3.3 Click the Save button
1.3.1.4 Complete the Medicine
If Medicines does not apply tick Not Applicable checkbox
1.3.1.4.1 If it applies, click the Add Medicines button
1.3.1.4.2 Complete the Medicines Information then click Add button

Note: Tick the checkbox Manually Input Drug Description if the Drug Code is not available on the
dropdown

1.3.1.5 Click Create New Record button to add another consultation
1.3.1.5.1 Click Cancel you will be redirected on Consultation page

2. Click the Link Claim button on Consultation/SOAPS page

2.1 If there is no existing claim, click the Generate Claim button

2.1.1 Click the Generate button from the modal
Note: This notification should appear

2.2 If there is an existing claim, click the auto populated claim.
2.2.1. Click the Link Claim button to link the claim

2.2.2 Check the details before linking
2.2.3 Click the Link button to proceed on linking the claim
2.2.3.1 This notification should appear

HOW TO FILE A CLAIM WITH CF4


1. File a claim [Follow the steps on How to file a claim]

2. On your created claim found on the Claim List, click the Link Consultation button

2.1If there is no existing consultation, click the Generate Consultation button

2.1.1 Click the Generate button from the modal
Note: This notification should appear

2.2 If there is an existing consultation, click the auto populated consultation.
Note: Existing consultation means a consultation has been added before the linking process.
2.2.1 Click the Link Consultation button to link the consultation

2.2.2. Check the details before linking
Note: If the transmittal Id and Claim Id of the Consultation is not equal to the
transmittal Id and Claim Id of the Claim, t he transmittal Id and Claim Id of the Claim
will be followed.

2.2.3. Click the link button to proceed on linking the consultation
2.2.3.1 This notification should display

HOW TO SUBMIT A CLAIM WITH CF4?


1. Identify a completed claim indicated by orange text and white background.
Notice: [Unlink Consultation] button is enabled. Identifies Claim with CF4
2. Tick the corresponding checkbox of the claim

3. Click the Submit Selected button

A modal will appear with Hospital Information.
3.1 Click Continue to proceed
3.2 Click proceed to confirm you are using a correct account

A Receipt Ticket modal will appear. Identifies that the claim was submitted
successfully.
3.3 Click OK to close the modal

4. Go to Claim List to check the submitted claim. You can use the search box to
find the submitted claim. You may use the Transmittal No, Receipt Ticket No.,
Claim No. Claim Series LHIO and Patient Name for searching

HOW TO SUBMIT A CLAIM? (SUBMIT ALL)


1. Go to Home page then click Submit All button
A modal will appear with Hospital Information


1.2 Click Proceed to confirm you are using a correct account
A Receipt Ticket modal will appear. Identifies that all completed claims were
submitted successfully.

2. Go to Claim List to check [all completed] submitted claims. You can use the
search box to find the submitted claim. You may use the Transmittal No, Receipt Ticket
No., Claim No. Claim Series LHIO and Patient Name for searching

HOW TO SUBMIT CLAIM? (SELECTED)


1. Identify completed claims indicated by orange text and white background.
Notice: [Link Consultation] button is enabled. Identifies Claim without CF4
2. Tick the corresponding checkbox of the claims

3. Click the Submit Selected button

A modal will appear with Hospital Information.
3.2 Click proceed to confirm you are using a correct account

A Receipt Ticket modal will appear. Identifies that claims were submitted
successfully. Notice that each claim has its own Receipt Ticket Number

4. Go to Claim List to check the submitted claims. You can use the search box to
find the submitted claim. You may use the Transmittal No, Receipt Ticket No.,
Claim No. Claim Series LHIO and Patient Name for searching

HOW TO REFILE CF4?
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How to Generate CF4?

Easy Claims Gallium (7.0.0.0) 2019​ ​|​ ​page​ 1

How to Submit a claim with CF4?

How to Submit all claims? (Submit All)

How to Submit selected claims? (Submit Selected)

How to Refile CF4?

HOW TO LOGIN ON EASY

Easy Claims Gallium (7.0.0.0) 2019​ ​|​ ​page​ 3

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​2.. ​Input your ​password

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You must be redirected on this page

Easy Claims Gallium (7.0.0.0) 2019​ ​|​ ​page​ 6

HOW TO LOGIN ON EASY

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2. ​Input your ​connect​ ​password

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HOW TO FILE A CLAIM?

Easy Claims Gallium (7.0.0.0) 2019​ ​|​ ​page​ 11

Note: All fields with ​*​ are required

1.b Go to ​Claims​ then choose ​File Claim​ on the submenu

1.c Go to ​Claim List​ then click ​File Claim​ button

Easy Claims Gallium (7.0.0.0) 2019​ ​|​ ​page​ 12

​ etch ​button - ​Provide correct member PIN and it will auto-populate

Example: [Successful Fetching] Example: [Failed Fetching]

Example: [Successful Verification] Example: [Failed Verification]

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​ pouse​,​ ​Child​, or​ ​Parent​: Input the Patient

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Claim Number​ -​Unique identifier of the claim

2.1.a.2 ​Click ​Continue t​ o proceed on PBEF and to Confinement Information

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2.2.b.1 Click ​Continue t​ o navigate to Philhealth Benefit Eligibility Form only.

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2. Input the Discharge Diagnosis

3. Click the ​+ Add ICD Code​ button

​ Note: Repeat step 3 and 4 for multiple ICD Codes.

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4.1.1 Select Case Rate Type

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4.2.2 ​Complete the Professional Information then click [​Update​]

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4.3.b Identify if there are enough benefits? [​YES​]

Easy Claims Gallium (7.0.0.0) 2019​ ​|​ ​page​ 32

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2. Complete the Drugs Or Medicines Information then click [​Update​]

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2. Complete the Add Receipt information

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4. Complete the Receipt Information then click [​Update​]

Note: Repeat steps 1-4 for multiple Claim Receipts.

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2.. Input your password

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2. Input your connect password

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Note: All fields with * are required

1.b Go to Claims then choose File Claim on the submenu

1.c Go to Claim List then click File Claim button

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etch button - Provide correct member PIN and it will auto-populate

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pouse, Child, or Parent: Input the Patient

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Claim Number -Unique identifier of the claim

2.1.a.2 Click Continue t o proceed on PBEF and to Confinement Information

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2.2.b.1 Click Continue t o navigate to Philhealth Benefit Eligibility Form only.

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3. Click the + Add ICD Code button

Note: Repeat step 3 and 4 for multiple ICD Codes.

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4.2.2 Complete the Professional Information then click [Update]

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4.3.b Identify if there are enough benefits? [YES]

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2. Complete the Drugs Or Medicines Information then click [Update]

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4. Complete the Receipt Information then click [Update]

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5.1.1 Click Continue to proceed on Claim Summary

5.2.1 Complete the Admission Information

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5.3.4 Complete the Clinical History Details

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5.3.7 Complete the Delivery Details

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5.3.9 Click Continue to proceed on Claim Summary

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6.2.1 Click the ADD NEW button to file another claim

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1.2.1.2 Click Save & Proceed button

If Patient is MALE OB-GYNE History is automatically not available

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1.2.2.2.1 Click the Add History button

1.2.2.2.2 Add the History Information then click Add button

1.2.2.3 Click Save & Proceed button

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1.3.1.2.1 Click the Save & Proceed button

1.3.1.3.1 Click the + Add Doctor’s Action button