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...
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. ...
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 83...
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...
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. ...
If you choose, you can designate an alternate pay-to-address to transmit claims on the EDI claim submission file. This option would be helpful if your billing office is in a separate location from where you render services. Payments from paye...
Each payer or insurance company has its payer ID number to accept electronic claims. It is the electronic address , so the clearinghouse knows which payer/insurance company to send the claim to. Some national payers, such as Aetna (60054), C...
By definition, a clearinghouse is a company that functions as an intermediary between the provider's PM system and the insurance payer. Clearinghouses review claims for common errors and provide a pathway for the payer to return electronic f...
If you need to update payer IDs for multiple patients, DrChrono has a way to do this in bulk instead of having to go into every single patient account to make the update. A potential reason why you might need to do this would i...
This feature will assist the biller, Office Manager, and/or provider in identifying claims that the insurance payer did not process with the expected allowed amount. Allowed Amount = amount paid by the insurance company + the amount the...