Electronic Filing

To file claims electronically, you need to determine if you are going to file with a clearinghouse or directly with the payer.  In most cases, filing with a clearinghouse is simpler since it allows you to work with one organization to handle all your payers.

If you’ll be using a clearinghouse, before you begin you’ll need to setup the information for the clearinghouse.

Select the File Menu – Practice Information.  Then click the Defaults tab.  Select the Clearinghouse that you want to use.  If the Clearinghouse is not listed, then click the New button.

M.D. Complete supports two file formats for electronic files.

1. Flat Image File

2. ANSI 837

The Flat image file is simply a text image of the actual data on the CMS-1500 form.  This is the simplest type of electronic file.  ANSI 837 is the HIPAA approved standard for sending electronic claim information.  You should contact your clearinghouse to determine what file format they will accept.

The information on the Clearinghouse form is largely defined by the Clearinghouse.  The only required information is:

· Name

· Sender ID 1

· Sender ID 2

· Sender ID 3

· Receiver ID

· Receiver Name

· Taxonomy Code

Typically, Sender ID 1, ID 2, and ID 3, will always be the same.  Some Clearinghouses may require unique ID numbers.  Receiver ID is typically your Tax ID number.  Receiver Name is typically the same as the Name field.  These fields are only required is you are sending the claims using the ANSI 837 file format.

The Taxonomy code for the provider can be entered on this screen, but you can also enter the providers Taxonomy code in the Provider screen.

File Option are:

1. Always use the same file name.  Use this option if your Clearinghouse ‘pulls’ the file from your computer.  After they read the file, they will remove it from your hard drive.

2. Use the date for the file name.  When you create an eFile, the file name will automatically be set to the current date.  For example, ‘04122007_0.edi.  If you create more than one file for a given day, then last digit in the file name will increment each time you create a new file.

3. Prompt for a File Name.  MDC will prompt you to enter a file name.

For most cases, you will need to send test files to the Clearinghouse.  If you’re sending using the ANSI format, you uncheck the Production Mode check box.  This will mark the file as ‘Test Mode’.  After testing is complete, you should re-check this box.  When this box is checked, it indicates that the file contains real claims that should be processed and passed to the payer.

If your clearinghouse will be automatically sending secondary claims, then you should check the box that says ‘Include extended secondary information with claim data’.  Your e-file will include additional information about the secondary payer that your clearinghouse may require.  Additionally, when this box is checked MDC will not prompt you to place a claim back into the print queue after the primary payer had paid on the claim (see transferring a claim to secondary).

Creating the electronic file

To actually create the electronic file, see the section on printing claims in the print queue.