How to Calculate and Submit Claims in FSSA Gainwell

Now that your agency bill rates have been updated, it is important to know how to calculate, submit, and adjust claims in the FSSA Gainwell system. This article is intended to provide you with step-by-step process for all three tasks:

How to Submit Claims

1. Click Submit Claim Prof under the “Claims” tab 
2. Fill in Member ID, Name, Patient Number, answer questions, and select “Continue”
3. Fill in Diagnosis Code, click “Add,” and select “Continue” 
4. Fill in all service details and select “Continue” 
5. Click “Confirm” 

How to Calculate Claims

1. Add up visit units within billing date range 
2. Multiply visit units by new rates 

How to Adjust Claims

1. Search claims under the “Claims” tab 
2. Enter the ICN you wish to edit under “Claim ID” 
3. Click the link for the claim and select “Edit” 
4. The remainder of the process is the same as it used to be