Submit Claims
Add new medical claims to the review queue for ICD validation
Manual Entry
Import CSV
Claim Entries
1
Add Row
Claim #1
Claim Number
*
Begin DOS
*
End DOS
*
Billed Amount
Provider
*
Line of Business
Select LOB…
Commercial Self-Insured
Workers Compensation
Medicare
Medicaid
Auto Liability
General Liability
Event Type
Select event…
Motor Vehicle Accident
Slip & Fall
Work Injury
Sports Injury
Assault
Medical Malpractice
Other
ICD Codes
*
(ICD 1 required; up to 5)
Injury Description
Add another claim
Submit to Review Queue