837 Setup

  Permissions! Clinic Staff must have Administrator or Billing Manager Permissions assigned in order to set up the 837.

Steps to set up 837

1. 1. 1. Fill out EDI Identification table under Administration > General Information > Billing > EDI Identification. You will get this information from the clearinghouse or the carrier (if filing direct). When filing direct, one table per carrier will be required. This is also sometimes called ISA information, or header info if your clearinghouse seems confused when asked. You can use the following picture for mapping purposes: The picture is attached to the email.
         
         
      2. In your Carriers table, you'll need to edit the Auxiliary Information.
         
         Go to Admin > Carriers, select the carrier, and then right-click Edit Carrier Auxiliary Info. Right-click Add and select Claim Filing Indicator. Fill out the Claim Filing Indicator (CFI) for any carrier that will ever appear on the claim (i.e., even if they're not the carrier being billed). These may already be filled in. The standard list is available when you go to edit one of these codes. Click on the ellipsis (box with three dots in it) to get to the list. You can also simply type in the value rather than picking it from the list.
         
         These values would come from the carriers themselves, although there are some typical ones you can use if you don't want to call everyone. Generally, for any commercial insurance, you can use CI ("C" followed by an uppercase "i") for the Claim Filing Indicator. Medicare will use MB for the CFI. When Medicare is secondary, they want to also have the Insurance Type Code filled in. Because the information for Medicare as primary is different from Medicare as secondary, you'll need a separate carrier for Medicare Secondary.
         
         
      3. Fill out PayerIDs for any carrier that will ever appear on the claim (even if they're not the carrier being billed).
         
         
      4. When sending secondary claims, for any transactions already entered from the primary payer, you will have to use the standardized adjustment codes (CO 45, PR 1, etc). If they weren't used originally, you'll need to edit them. On 837s, you have to show Payments + Adjustments = Charge. Balance is not factored in, so the Balance must appear with a corresponding PR adjustment line. (If you are posting using 835s, this is taken care of automatically.)
         
         
      5. 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:
         
         
         • First Name
         • Last Name
         • In-Person (you will 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)
         
         
      6. Under Administration > General Information > General, check the Clinics table and Holding Companies table to ensure NPIs are present. If not, fill them in.

NOTE: You'll want to use the 837P-5010 format when you change the format for your claims.