Permissions: Users must have __________ permissions in order to manage Billing submissions.
Standard format for transmitting health care claims electronically. Add and complete the 837 fields to your Providers table; these are the fields preceded by a value that includes "8." The mandatory ones are: Name First, Name Last, Is Person (you'll enter "T" for True), Taxonomy Code, NPI. These are fields that are required by all carriers; anything extra will be specified by the carrier (just like on a CMS)
With the 837, you have the ability to send an electronic file directly to the carrier instead of going through a clearing house. Sending an 837 is much like sending a HCFA/CMS-1500 print file to a clearing house, and the procedure is going to vary from carrier to carrier as it does from clearing house to clearing house. A carrier will typically have one of two methods in which to send files up to them. The first is through a website that you log into; the other is with a program that they provide that reads and sends the claim file.
See Chapter 7 Claim Generation on how to actually create an 837 file.
At the beginning of each 837 file is header information which identifies for whom the claims are and to whom they are destined. In many cases, you are already going to be logged into the carrier for which you wish to send claims, so the carrier already knows who you are. Thus, header information may not be required.
The following header information may be set in the General Information | EDI Identification part of Clinic Controller:
NOTE: These codes and identifiers will be supplied to you when you enter into an EDI relationship with a carrier.