Electronic Billing Setup

Use the Electronic Billing Setup routine to create an electronic billing file containing the claims to be processed electronically for the selected insurance carrier.  The Setup looks at the information in the current billing workfile and pulls in claims that qualify.  In addition, during the Setup routine the electronic billing information is verified to see if its in the correct ANSI 837 format as specified by Medicare.

 Important:  

• Before beginning, verify that you have selected to run the Setup for the appropriate insurance carrier.

• Generally, this is the second step in the electronic billing procedure.  For more information on the timing and sequence of tasks, see Electronic Billing Procedure.

• Each carrier that you bill has their own electronic billing file allowing you to process multiple carriers at the same time.

• The message Done does not mean the Setup successfully processed all claims, it simply means the process is complete.  When the Setup completes look for:

• Make sure the Workfile Built for Date during this routine matches the Workfile Build Date.

• The number of charges processed

• If the message NOTICE Setup Incomplete displays in the Process window, stop and carefully review all messages that display.  You will need to correct all errors in order for the claims to be processed electronically.  Do not continue to the next step until you have resolved the errors.  For a list of errors and resolutions, see Electronic Billing Setup Common Error Messages.  To see some of the more common errors with the steps for correcting, click More.

  Setup Error Messages:

  1.  Error message:  Referral Code Not on File - XXXXXXX (Patient ID)
  What to do:  

  • Use the Billing Claims File Edit to delete the ticket from the workfile so that your can correct the claim later.

  • Or, use Edit Patient Detail to edit the Referring Physician on the charge and then re-run the setup.
    Note:  If you are running the Setup for multiple companies, you will need to reset the EMC Table Status field to 0 to be able to re-run the Setup.  

  2.  Error message:  Policy Holder Error - XXXXXX (Patient ID)
  What to do:  Edit the patient's policy holder information and then re-do the Setup
  Note:  Medicare requires that the policy holder information to be blank, if the patient's relationship code is 1or S for self.  To edit the patient's policy holder information, use the Insurance Policy Holder Area of Patient Entry.

  3.  Error message:  Certificate Number Length - Account Flag:  xxxxxx (Patient ID)
  What to do:  Look at the scanned copy of the patient's insurance card to see what the insurance certificate number should be.  To correct, edit the patient's policy holder insurance certificate number during Insurance Policy Holder Area of Patient Entry and then re-run the Setup.

   

Directions:

To see directions for...

• Opening the Electronic Billing Setup Routine, click More.

   

  1.  Click Billing Functions from the Menu Bar.

  2.  Click Communications.

  3.  Click Professional Claims.

  4.  Click Medicare.
  Note:  Medicare is used as the carrier in the menu example.  Please select the appropriate insurance carrier name for your processing.

  5.  Click Setup.

   

  Advanced Methods:
  
  Click the following sequence:
  From the Communications Floating Menu Panel, click the carrier name; and click Setup.

   

  Electronic Billing Setup Window Example:

  

   

• Choosing the Selections at the Prompt Window, click More.

   

  Electronic Billing Setup Prompts Tip:  To see more information about a field, click the hyperlink for the field name.
  Billing Date	To accept the system date as the Billing Date for the claims, press [TAB] or enter another date. (mmddccyy - slashes and century optional) Note:  The Billing Date should match the Workfile Build Date.  You can back-date the Billing Date to match.
  Data Companies	To specify the Data Companies, click a choice in the list below. Tip:  To quickly select or de-select all data companies listed, click Check All .
  	To run the routine, click Proceed or press [ENTER]. Keyboard shortcut:  [ALT + p]
  	To escape from the routine: Click Cancel. Keyboard shortcut:  [ALT + c] Or, click Close .
  Processing Status Window	Displays information pertaining to the various phases of the Setup process to guide you. Tip:  To see an example of information displayed in the Processing window, see below.
  	Important:  If the Setup completes properly, the Processing window will display:   Note:  If the message NOTICE Setup Incomplete displays, stop and carefully review the messages that display.  All errors must be corrected for the claims to be processed.  Do not continue to the next step until all errors are resolved.
  	To close the Processing window when the process is complete, click Done or press [ENTER]. Keyboard shortcut:  [ALT + d] Note:  The Status displays ** DONE **when the process is ended.