This article explains the layout of the Create Claim and Edit Claim modal in MedMe and what each field means. It is a reference for pharmacists who are reviewing a prefilled claim or coding a claim manually.
Table of Contents
Overview
The claim modal is split into a fixed sidebar on the left and a scrolling form on the right. The sidebar holds the claim title, a bookmark for each section, and the two actions: Submit for Billing (or Resubmit when editing a rejected or denied claim) and Save as Draft.
Layout and Navigation
Bookmarks list General Information followed by Service 1, Service 2, and so on. They update as service lines are added or removed.
Select a bookmark to scroll the form to that section. As the form is scrolled, the bookmark for the section in view is highlighted.
When Submit for Billing finds an error, the bookmark for the affected section is marked so the error is easy to find.
Select X or press Esc to close the modal. Unsaved changes are discarded, so Save as Draft first if the claim is not ready.
Tip: Pressing Enter inside a field does not submit the claim. Use the Submit for Billing button when the claim is ready.
General Information Fields
Field | What to enter | Required |
Patient | The patient being billed. Locked when the modal is opened from a patient profile or appointment; searchable by name from the Claims page. | Yes |
Payer | The patient's insurances in policy order. Defaults to the primary (order 1). Only one payer per claim. The payer cannot be changed after the claim is saved; to bill a different insurance, create a new claim. | Yes |
Linked Entity | The appointment the claim is for. Prefilled when created from an appointment; select it when creating the claim from the Billing tab or the Claims page. Other same-day appointments for the patient are suggested under the field and can be added, so several appointments can be billed on one claim. Each linked appointment adds its own template's service lines. | Yes |
Place of Service | CMS place-of-service code. Defaults to 01 - Pharmacy; all CMS codes are searchable. | Yes |
Rendering Provider | The pharmacist (or organization) who performed the service. Add it to every claim so the payer knows who provided the service. | Recommended |
Billing Provider | The organization (or practitioner) that receives payment; usually the pharmacy. | Yes |
Referring Provider | The prescriber who referred the patient, when the payer requires one. | No |
CLIA number | The pharmacy's CLIA certificate number for lab-type services such as point-of-care tests. Offered only when the pharmacy has one on file with MedMe. | No |
Prior Authorization Code | The authorization number the payer issued before the service was provided. Enter it exactly as the payer gave it when the payer requires prior authorization for the service. | No |
Providers are selected from a shared list for the pharmacy; + Add New … Provider at the bottom of each list creates one. See How to Manage Providers on Claims in MedMe.
Please Note: If the patient has no active insurance, the form shows No insurance on file for this patient and stays disabled. Add the insurance on the patient profile first.
Service Line Fields
Each Service section is one line on the claim.
Field | What to enter | Required |
Service Date | The date the service was performed. Prefilled from the linked appointment. Cannot be a future date. | Yes |
CPT / HCPCS Code | The procedure or product code (for example 90480 for a COVID-19 vaccine administration, or the vaccine product code). With a template, a searchable list of suggested codes is shown as CODE — description; other codes can be typed. | Yes |
Modifiers | Up to 4 two-character modifiers (for example 59 for a distinct procedure on the same day). Type a modifier and press Enter or comma to add it; with a template, search the suggested list. | No |
Units | Whole number of units, 1 or more. Defaults to 1. | Yes |
Charge Amount | The billed amount for the line in dollars. Prefilled from the pharmacy's fee schedule when a rate is on file for the CPT / HCPCS code and the selected payer; otherwise enter it manually. | Yes |
Diagnosis (ICD) | One to 4 ICD-10 codes that justify the line (for example Z23 for an immunization encounter). Type a code and press Enter or comma, or search the suggested list. To reuse the codes from another line, select Copy ICD Codes from Service N above the field. | Yes |
NDC, NDC Units, Unit Qualifier | The National Drug Code of the product, the quantity, and its unit (Gram, International Unit, Milligram, Milliliter, or Unit). Enter them when a payer requires drug-level detail. Once an NDC is entered, NDC Units and Unit Qualifier are required. | No (Units and Qualifier required with an NDC) |
Ordering Provider | The prescriber who ordered the service, when required by the payer. | No |
Additional Information | Free-text note sent to the payer with the line. | No |
For Instance: A flu vaccine for a Medicare patient is usually two lines: the vaccine product code (1 unit) and the administration code G0008 (1 unit), both with diagnosis Z23. When flu and COVID-19 vaccines are given on the same day, the second administration line carries modifier 59.
Copying ICD Codes Between Lines
Many services use the same diagnosis codes on every line. Instead of retyping them, copy them from another line:
On the line that needs the codes, find the link at the top right of the Diagnosis (ICD) field.
If one other line has codes, the link reads Copy ICD Codes from Service N. Select it to copy that line's codes.
If several lines have codes, the link reads Copy ICD Codes from Another Service. Select it and choose from the list. Each option shows the line and its codes, and lines with the same codes are shown as one option (for example Services 2 and 3).
Copied codes are added after the codes already on the line, and codes the line already has are skipped. The limits of 4 codes per line and 12 unique codes per claim still apply.
Copying happens once. Later changes to the source line are not carried over, and copied codes can be edited or removed like any other code.
The link is hidden when the line already has every code from the other lines, or already has 4 codes.
Copying works in both Create Claim and Edit Claim.
Tip: The first code on a line is the primary diagnosis. Check the order of the codes after copying.
Adding and Removing Service Lines
Select Add Another Service Line at the bottom of the form to add a line. The new section is numbered and gets its own bookmark.
Select Remove at the top of a service section to delete it. Remaining lines are renumbered.
Lines added by a template can be edited or removed like any other line.
When a linked appointment is removed, the lines it added are removed too, unless they were edited. Edited lines are kept and a notice asks to review them. On a claim already saved as a draft, removing a saved appointment keeps its lines and asks to review them.
A manually added line offers the suggested codes from every linked appointment's template.
Limits and Validation
Limit | Value |
Service lines per claim | 6 — create a separate claim for anything further |
Modifiers per service line | 4 |
Diagnosis codes per service line | 4 |
Unique diagnosis codes per claim | 12 |
Units | Whole number, 1 or more |
Charge Amount | Required; a dollar amount with up to 2 decimal places |
Service Date | Required; today or earlier |
Diagnosis codes | At least 1 on the claim, and every service line must reference at least 1 |
When a limit is reached the field shows a message such as A service line can have up to 4 modifiers and no more values can be added.
The rest of the checks run when Submit for Billing is selected. If something is missing or invalid, the claim is not submitted and an error explains what to fix. Along with the fields on the form, MedMe checks that:
The Billing Provider, Place of Service, and a Payer are selected.
Every service line has a Service Date, CPT / HCPCS Code, Units, Charge Amount, and at least one Diagnosis code.
The patient's profile has a sex, date of birth, and complete address. Payers require these on every claim.
Please Note: Save as Draft skips these checks, so a draft can be saved at any point and finished later.
Save as Draft vs Submit for Billing
Save as Draft — saves whatever has been entered, even with required fields empty, and keeps the claim in Draft. Saving a draft several times updates the same claim; it never creates duplicates.
Submit for Billing — runs full validation and queues the claim for the clearinghouse (Ready for Submission), with 24 hours to undo.
Resubmit — replaces Submit for Billing when editing a Rejected, Denied, or Partially Paid claim. The correction is tracked on the same claim number.
Troubleshooting
A bookmark is marked red after submitting. That section has a missing or invalid field; select the bookmark to jump to it.
I cannot add a fifth modifier or diagnosis code. The per-line cap has been reached. Remove one or move the service to another line.
The Copy ICD Codes link is missing. The line already has every code from the other lines, or it already has 4 codes.
The CPT picker does not list the code I need. Type the code anyway; codes outside the template's list are accepted.
Charge Amount changed after I picked a different payer or code. Fee-schedule amounts refresh for the new payer or CPT / HCPCS code. Amounts typed by hand are never overwritten.
The Payer field is greyed out when editing a claim. A claim's insurance cannot be changed after it is saved. To bill a different insurance, create a new claim.
Submitting shows an error about the patient's sex, date of birth, or address. Update the patient's details on the patient profile, then submit the claim again.
Conclusion
The claim form has two parts: General Information (patient, payer, linked appointment, place of service, providers) and one Service section per billable line. Bookmarks make it easy to move around, templates prefill the codes for known services, and the built-in limits keep the claim within what payers accept.
See more:
If additional assistance is needed, contact the MedMe RCM team.