EDI Submission

Before sending your claims to the clearinghouse for submission to the payer, they undergo a scrubbing process. If an issue is identified, the claim will be moved to the "Missing Information" status and populated with the specific error. ...

In an attempt to assist providers in ensuring their claims are submitted cleanly and processed without delay, CMS and associated MACs are rolling out a series of Smart Edits. The idea is to identify the error more quickly so it can be correcte...

An EDI Claim file indicator is a code transmitted on an EDI/837 Claim file that tells the payer whether the primary insurance is Medicare or another commercial payer. It is included on all electronic 837P (professional claims) and 8...

One required element when submitting electronic claims is the claim filing indicator code. It identifies to the payer what type of claim is being submitted. When a patient has multiple insurances, it also indicates which payer is primary. ...

Can claims be submitted and ERA transactions received immediately after submitting the EDI and/or ERA agreement ? No. The payer will need time to process the paperwork within their processing systems, referred to as the payer t...

What determines a payer’s turn-around time for EDI/claim submissions? Each payer determines its own turn-around time (TAT) based on its internal processes, requirements, and volume. Each payer’s processing time may change base...