HOW TO BILL ELECTRONICALLY

Currently, TPS2000 utilizes 2 choices for electronic submissions. The way you will be submitting will help to determine which method is needed. If you will be using a clearing house, there is a lot less setup time and work involved initially. If you will be going directly to the carriers, you will need to use the 837 Health Care Professional form and each carrier will require paperwork and testing phases.

1. You have the ability to use a print image file.

This file has been tested to properly submit electronic billing to the company ECLAIMS.COM. This is an Internet based clearing house. To sign up with ECLAIMS.COM or to get more information, go to the web site ECLAIMS.COM. Then just follow the instructions on the site.

SETTING UP YOUR FILES FOR ELECTRONIC SUBMISSION

Selecting the files to be transmitted electronically is as simple as editing your Carrier Information form. Click on the “open file folder” on your Navigation Icon Bar to get the Select Files menu. Click on Carrier Information. This form opens to a Cash Carrier, click on the Show List of Records icon on the far right of your Navigation Icon Bar. Find the first carrier for whom you will be submitting electronically and double click on the carrier name to load this carriers form. In the field “Claim Form” use the drop down arrow to see the list of HCFA forms. Choose the form E-CLAIM Electronic Billing Form.

Find the next carrier for whom you will be submitting electronically. Repeat the above steps until you have selected each carrier that will be billed electronically.

2. ANSI 4010A1 (837 Health Care Professional form)

The ANSII 4010A1 form (837 Health Care Professional form) has already passed the test in several states. If you decided to use this HIPAA compliant form for any Payer, these are the Step-by-Step instructions you will use.

· Determine which Payers you are going to bill electronically.

· Contact each Payer and get the following information:

1) Trading Partner Agreement about Electronic Date Interchange which you have to review and sign.

2) Get necessary data such as a Business EDI ID, Mailbox, etc.

3) Find out about the communication protocol using by Payer for exchanging be EDI transactions and get documentation.

· Setup communication software. You can use TPS communicator or a 3rd party software.

· Test communication software: make sure that you can send/receive files.

· Enter received information #2 into TPS 2000.

· Generate bills for the Payer (Carrier) #1.

· Export bills in TPS 2000 into 837 Professional Claim file and send it.

· Receive 997 Functional Acknowledgment file in communication software and import it into TPS2000.

If all bills were rejected make changes to fix the errors. If you have any problems with the transmission of your claims, contact with Payer EDI department (you can find contact information in your agreement #2.1 or communication protocol document #2.3 or other source)

SETTING UP YOUR FILES FOR ELECTRONIC SUBMISSION USING THE 837 HEALTH CARE PROFESSIONAL FORM

In the field “Claim Form” use the drop down arrow to see the list of HCFA forms. Choose the form 837 Health Care Professional Form. In the Carrier type be sure to select one of the entries that end in (EB) (make sure that it is an appropriate entry (i.e. Blue Cross would use BC-Blue Cross (EB)).

Now click on the Carrier Doctor Numbers. This will open the following screen:

Fill the carrier specific identification number for this carrier, select the appropriate type using the pull down arrow. If your carrier has provided business specific mail box and identification information, fill that in here as well. When you are done, click on Save Changes.

Find the next carrier for whom you will be submitting electronically. Repeat the above steps until you have selected each carrier that will be billed electronically.

TO DO YOUR BILLING ELECTRONICALLY

When you do your normal bill processing for carriers, TPS 2000 will create both the paper claim forms as well as the electronic file for transmission. When you choose print bills, the electronic print image file (ECLAIM.TXT) is created.

Tag all bills for printing then click on Print Bills, the patients whose carrier has been set to the E-CLAIM Electronic Billing Form will place it’s bills in the file; ECLAIM.TXT. This file will be located in your main TPS2000 directory (so if this is the main, or the only computer, it would be found in the path C:\TPS2000\ECLAIM.TXT). You will have the option to Overwrite the ECLAIM.TXT file, or to Append to this file.

Overwrite – When you choose to Overwrite this file, you completely replace the data that was in this file from previous bill batches. If you transmit this file every time you bill, you want to choose Overwrite.

Append – When you choose to Append this file, you ADD additional bill batches to the data that was in this file from previous bill batches. If you will be doing several bill batches throughout the day or the week and wish to transfer the file ONCE, then use the Append.

After you have finished printing your bills, transmit the ECLAIM.TXT file to either ECLAIMS.COM or your own Clearing House per the instructions of that company.

If you are using the 837 Health Care Professional Form, you will not click on Print Bills. Instead you will click on [Export]. This will create the file for transmission.

TPS2000 will display a list of the bills that have been processed to this file and note any errors or corrections that need to be made prior to transmitting this form.

Press on the “Save” button. The “File Save” dialog window will open. The first time that you process bills for a carrier set to the claim form type of “837 Health Care Claim Professional” you will see the messages as TPS2000 creates the new and needed folders. After these files have been created, you will no longer see these folder creation messages. You will simply see the “File has been Saved” message.

If you are using the TPS Communicator, press on the “Send” button to Start Communication software. If this communicator is not needed, your carrier or clearing house will let you know what is needed for transmitting the file.

When you are ready to update your bill status. Press on the “Import” button to start “Import e-bill data” form. You will see the following screen:

Click the [Import] button to start the download of information. When data has been obtained, click the [SAVE] button to update your files.

This gives you an overview of what is needed for each type of transmission. Your first step is to determine what is best for you in your area. You might wish to start by asking other offices with your specialty what it is that they are doing currently. If they are using a clearing house, is the reimbursement faster and easier than paper submission? What is the cost of doing business through the clearing house?

This might be the deciding factor in whether or not you decide to go direct or through a single entity.