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


START WITH THE CARRIER FILE

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 carrier’s 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), Medicare would use MB-Medicare (EB), and so on).

 

In the E-Billing Information area you will need to enter the numbers that were provided by either your clearing house or the individual insurance company.  The first number will be the EB Payor ID.  This is the number used to recognize this particular insurance carrier.  The EDI ID and the EDI Mailbox in this area must be filled in.  This will represent your clinic identification for this carrier (NOTE: If there is only 1 business for your clinic, this information will appear in two locations, both on this screen and in the Carrier Doctor Numbers area of the program).

 

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


Fill the carrier specific identification number for this doctor, select the appropriate type using the pull down arrow.  If your provider or doctor is a PPO or HMO member with this carrier, there is likely be an unique number assigned so that they are easily identified.  This would be the number seen in box 33 of the HCFA form.

 

If your carrier has provided business specific mailbox and identification information, fill that in here as well. (NOTE: If there is only 1 business for your clinic, this will likely be the same information as on the previous screen). 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.

 

 

 

 

 

 

 

 

 

NEXT FILL IN THE BUSINESS INFORMATION


You will need to fill in the business address, city, state, zip and phone number to properly fill in the 837 format.

 

NEXT FILL IN THE DOCTOR TAXONOMY CODE


 

 

In the Doctor Information screen you need to be sure that each provider for your clinic has the correct Federal ID number listed.  There is also a field called Taxonomy Code.  As of October 16, 2003, this field will no longer be required on the 837 billings.  If, however, you do enter the ID code here, please be sure to keep it up to date (these codes occasionally change).  While it is no longer required, an incorrect code in this field will cause a denial of the entire claim.

 

 

 

 

NOW FOR THE PATIENT CLAIM INFORMATION

Many of the basic fields will be the same as for the HCFA form.  Insured’s information, ID numbers, group numbers etc. will still need to be entered just as before.

 

On the General Tab, there are some additional fields that will be needed.


 

For the 837 only, you will need to select a Claim Type that contains (EB) as part of the name.

 

In the Electronic Billing Info field, you will only need to fill in the following fields if the claim is for Medicare:

Gov’t Assigned – Used for Medicare only.  If your patient has assigned their benefits

then select “Assigned”; There are also the settings of “Assigned except for

Clinical”, “Not Assigned”, and “Patient Refuses to Assign Benefit”.

            Info Release – Select the appropriate entry that describes the release of information

for this claim or case.

            Symptom Indicat. – If appropriate, select the entry

            Release of Info – Select the date of that you received the Release of Information.

            Compl. Case – Place a checkmark in this box if this claim is classified as a

complicated case.

 

The following fields are for those providers dealing with vision and vision care:

Vision Condition – Select the correct assignment for the patient’s purchase of

replacement vision products.

 

On the Visit Info / Misc tab there are new entries as well.

 

 

 

 


 

On this tab, there is the area that contains the information for the referring physician.  Within this area you select the type of number being used (Just like your providers, the referring physicians could have many numbers that identify them to different agencies like Medicare, Blue Cross, Work Comp, etc.).  This allows you to setup the referring physician once, but use them for multiple types of cases. 

 

There is also the date referred field.  This tracks the “Date Last Seen” by the primary or referring physician.

 

If your provider is a chiropractor, you will need to fill in the EB Sublux field(s).  This needs to indicate the level of subluxation (i.e. T1 or C3).  You will also need to fill in the EB Acute /Chronic field.  There is a pull down arrow here so that you may select from the approved entries.

 

Finally, there is a button on this field that takes you to a new screen [Show UB92 Info].


 

 

There is only one entry in here with which you need be concerned.  That is the Frequency field.  Since this field was already in use with our clients that file a UB92 form, we didn’t want to add the field a second time.

 

These are the main fields that will need to be filled in to process a bill batch with the 837 Health Care Professional Form.  Please remember that if there is a secondary on this claim, you will need to fully fill in the 2nd Resp tab with all applicable information.