# Request Claim Form

For insurance visits, the **Claim Form** option becomes available in the **More Actions** menu. Staff can use this option to present the insurance claim form to the patient for their signature, which is typically required for claim processing and billing purposes.

{% hint style="info" %}
**Claim Forms** appear only if they are mapped in the[ **Price Group**](/uniteemr/master-modules/insurance/price-group.md) screen. To add a form, go to the **Price Group** screen and upload it under the desired **Insurance Price Group** and **Speciality**.
{% endhint %}

***

### Steps to Request a Claim Form

* Open the **Patient Queue  (Home > Front Desk > Patient Queue)** screen. Choose the respective patient visit, then click on the **More Actions** menu to open the pop-up screen.

  <figure><img src="/files/RqCMcNz1QOlvilIvhaBy" alt=""><figcaption></figcaption></figure>

* From the pop-up menu, select the **REQUEST CLAIM** option. This action opens the **Claim Form** pop-up screen.

  <figure><img src="/files/A9vAuuY1Oz2vjIlHl5ql" alt=""><figcaption></figcaption></figure>

* Select the **Claim Form** using the checkbox, then click the **REQUEST CLAIM FORM** button to proceed to the next page.\
  \&#xNAN;***Note:** If there is only one claim form, it will be displayed by default.*

  <figure><img src="/files/VZhjJwdOjmejmDq4KDmz" alt=""><figcaption></figcaption></figure>

* Click on the **Form Name** to open and view the claim form details. After the doctor consultation in the **Medical Records** screen, the patient details and captured medical information (e.g Services, Procedure) will appear in the form.\
  \&#xNAN;***Note:** Data will be auto-filled only if the field variables are mapped according to the Unite EMR format. If not, the details will not be populated in the form.*

  <figure><img src="/files/hPsSw4rak8o7xRYLUABB" alt=""><figcaption></figcaption></figure>

* To collect the patient's signature, select the **SIGNATURE** button. A pop-up window appears, allowing the signature to be drawn or uploaded.\
  \&#xNAN;***Note:** Clicking **SAVE AND CONTINUE** keeps the form editable and sets the status to **In Progress**.*

  <figure><img src="/files/ocHS18qmhkp34d6PqJbo" alt=""><figcaption></figcaption></figure>

* Once all steps are completed, click the **FREEZE** button to finalize the process. The status of the claim form will change to **Obtained**.

  <figure><img src="/files/g04BKGKRsSbvza6gprMK" alt=""><figcaption></figcaption></figure>

* The form will now be in **read-only mode**, and a lock icon will appear next to the form name, indicating that no further edits can be made.

{% hint style="info" %}
**Claim Form** can be requested from the **More Actions** menu in the **Scheduler**, **Patient Queue**, or **Medical Records** screen.
{% endhint %}


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