Permissions! Clinic Staff must have Administrator, Billing Assistant, Billing Manager Permissions assigned in order to manage billing submission.
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 clearinghouse. Sending an 837 is much like sending an HCFA/CMS-1500 print file to a clearinghouse, and the procedure is going to vary from carrier to carrier as it does from clearinghouse to clearinghouse. 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.
At the beginning of each 837 file, there is header information that 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:
837 Header Information
|EDI Name||Name set by you for this header information set.|
|Submitter Name||Name the carrier identifies you by.|
|Submitter Password||Password supplied by the carrier.|
|Submitter ID||Code supplied by the carrier.|
|Sender Code||Code supplied by the carrier.|
|Sender ID||Code supplied by the carrier.|
|Contact||Contact of person sending claim.|
|Phone/Fax/Email||Phone/Fax/Email of person sending claim.|
|Reciever Name||Name of Carrier.|
|Receiver ID||ID of carrier you are sending the claim to.|
|Receiver code||Qualifying code of the reciever.|
|Receiver ID||ID of the reciever.|
NOTE: These codes and identifiers will be supplied to you when you enter into an EDI relationship with a carrier.