Clearinghouse Screen Instructions for ANSI837

Transcription

1 Clearinghouse Screen Instructions for ANSI837 Provider Number (Required): The number which uniquely identifies the provider entity to which this clearinghouse record applies. If you have multiple provider entities that appear on services in your database, you will need to create a new clearinghouse record for each provider entity that will submit claims through a given clearinghouse. Suggested Resource for Data Values: These values should already be set up in your system. You can press F3 to get a list of current provider entities in your database. If you need to enter additional provider entities, you can do so from the Provider Reference File screen (Medical Reference Files/Provider). This information populates loop 1000A (submitter name), segments NM Claim Form Name (Required): To submit in ANSI837 Format in Cortex Medical Billing, the claim form name must start with the string ANSI837. Multiple ANSI837 Format claim form names can be created by creating unique claim form names starting with the string ANSI837. For each clearinghouse you should specify a unique claim form name this will allow the system to generate just the set of claims intended for that clearinghouse.

2 For example, if you want to submit to ZirMed and your local Medicare office in the ANSI837 format, you might create two claim form names: ANSI837ZIRMED and ANSI837MEDICARE. Claim form names are limited to a total of 20 characters, may not contain spaces, and must begin with ANSI837. These claim form names will then fill in the primary claim form name field for all the payors to which you wish to submit electronically. For example, when you run ANSI837MEDICARE, any payor with that claim form name in the primary claim form name field would be picked up. Suggested Resource for Data Values: Since you can create your own ANSI837 claim form names, any names that can be remembered easily, are easy to spell and are under 20 characters will be suitable. Login ID (Required): The login name used to connect to your claims clearinghouse for the purpose of uploading claim files. This information populates segment GS02 of the header loop. Clearinghouse (Required): Text string identifying your clearinghouse. It is important that you are consistent in how you enter the same clearinghouse name across different clearinghouse records. For example, entering McKesson on one screen and McKesson Corporation on another screen is not acceptable if you intend those to represent the same clearinghouse. Suggested Resource for Data Values: You may create your own clearinghouse names. However, as mentioned above, once a clearinghouse name is created, its entry must be identical across each clearinghouse record that refers to that clearinghouse. This information populates loop 1000B (receiver name), segments NM103. Submitter Name (Optional): This field is not used at the moment; leave it blank. Contact Person (Required): The contact person within your organization that the claims clearinghouse should contact should they need additional information on claim files submitted. This information populates loop 1000A, segment PER02. Contact Phone No (Required): The phone number for the contact person within your organization that the claims clearinghouse should contact should they need additional information on claim files submitted. This information populates loop 1000A (submitter name), segments PER04. Submitter ID (Required): A unique identifier assigned to your lab by the claims clearinghouse. If you had a submitter ID assigned to your group for submission of earlier claim formats, verify with your clearinghouse that you should use the same number for the ANSI837 format. ZirMed and McKesson this is the 6-digit number assigned to you when you signed up as a customer. This information populates loop 1000A (submitter name), segment NM109.

3 Billing ID (Optional): A second unique identifier assigned to your lab by the claims clearinghouse; some claims clearinghouses do not assign billing identifiers. If you had a billing ID assigned to your group for submission of earlier claim formats, verify with your clearinghouse that you should use the same number for the ANSI837 format. This information populates loop 1000A (submitter name), segment NM109. Specialty Code (Optional): This field is not used at the moment; leave it blank. Submission Number (Optional): This field is not used at the moment; leave it blank. Address 1 (Optional): This field used only for informational purposes and is not used directly by the Address 2 (Optional): This field used only for informational purposes and is not used directly by the City (Optional): This field used only for informational purposes and is not used directly by the State (Optional): This field used only for informational purposes and is not used directly by the Zip Code (Optional): This field used only for informational purposes and is not used directly by the Claim Path (Optional): If you would like your claim files to be directed to a specific file folder rather than where they currently are directed by the claims program, you can enter, cut and paste, or browse for that path here. This may be helpful if you would prefer to have a folder on your desktop or a different place in the system than in the Solomon folder. Format Version (Required): Enter the following value in this field: X098 This information populates segments GS08 and REF02 of the header loop. Retransmission Status (Optional): This field is not used at the moment; leave it blank. Modem Number (Optional): This field used only for informational purposes and is not used directly by the claims program. If you want to note the dial-up modem number for your claims clearinghouse, you may do so here. Test Production (Required): Denotes whether you will be submitting claims in Test or Production Mode. Possible values are TEST for test mode and PROD for Production mode. ZirMed only put PROD here in all cases, even when testing. ZirMed determines on their end whether a customer is in testing mode or not. Putting TEST in this field will cause a claim file to reject. This information populates segments ISA15 and REF02 of the header loop.

4 Password (Optional): This field used only for informational purposes and is not used directly by the claims program. If you want to note your dial-up password for connecting to your claims clearinghouse, you may do so here. Vendor Software Update (Optional): This field is not used at the moment; leave it blank. Receiver ID (Required Status Varies): This field is used by some clearinghouses and payors (if you get a rejection due to GS03 or NM1*40, it s required). McKesson Customers should enter the following value in this field: ECGCLAIMS ZirMed customers should enter the following value in this field: ZIRMED Other clearinghouses may use their tax id for this value. This information populates segment GS03 of the header loop and loop 1000b (receiver name), segment NM109. Vendor Software Version (Required): Enter the following value in this field: This information populates segment ISA12 of the header loop. Interchange Receiver ID (Required): This value is required as part of the ANSI387 format and is assigned by your claims clearinghouse. McKesson customers should enter the following value in this field: CLAIMSCH ZirMed customers should enter the following value in this field: ZIRMED This information populates segment ISA08 of the header loop. Interchg Receiver Qualifier (Required): This drop-down box value is required as part of the ANSI837 format and is assigned by your claims clearinghouse. McKesson customers should choose the following drop-down value for this box: ZZ. ZirMed customers should choose the following drop-down value for this box: ZZ. This information populates segment ISA07 of the header loop. Interchange Sender ID (Required): This value is required as part of the ANSI-387 format and is assigned by your claims clearinghouse. McKesson Customers should enter the tax number for the given provider entity in this field. ZirMed Customers should enter their submitter id in this field. This information populates segment ISA06 of the header loop. Receiver Identification Code (Optional): This value is currently not required. Receiver Name (Optional): This value is currently not required.

5 Remittance Path (Required for Electronic Remittance Only): This field is required for positing electronic remittance files only, and is not used in sending claim files. If you are simply testing ANSI837 claim files at this point, leave this field blank. Transmission Program (Optional): Denotes the name of the program used to transmit data to the claims clearinghouse (e.g. HyperTerminal, Cycom, etc.) This field is not used by the program and is intended for informational purposes only.