HIPAA Compliant File Maintenance For Electronic Billing

To comply with the 837 format for electronic billing perform the following maintenance.

Perform Insurance Maintenance

1. Open Insurance Maintenance by clicking File Maintenance from the Menu, Standard Maintenance and then Insurance.

2. Maintain the following fields:

a. Assign a Payer Code as the Contact/Payer ID field.
Important:

For Medicare only, assign 31142 as the Payer Code.
For all other insurances, if they do not have a Payer Code, you must assign OTHER in the Contact/Payer ID field and set the Claim Receiver type to Z.
To get an updated list of Payer Codes go to www.emdeom.com and select payer lists. Generally, the Payer Lists are updated every couple of months. It's important to maintain the most up-to-date list.

b. Assign a Claim Receiver Type.
Below are the valid Claim Receiver Types:

c. Assign the appropriate EMC Table ID.
Below are the appropriate EMC Table IDs.

Claim Receiver Types
Insurance	Claim Receiver Type	EMC Table ID
Medicare	C	WEBMD - If submitting claims through Change Healthcare (WEBMD) NSFME - If going through any clearinghouse except Change Healthcare (WEBMD)
Medicaid	D	MCAID - If submitting claims directly to Medicaid WEBMD - If submitting claims through Change Healthcare (WEBMD)
Blue Cross	G	ANTHME - If submitting claims through Availity WEBMD - If submitting claims through Change Healthcare (WEBMD)
Commercial	F	WEBMD
Tricare/Champus	H	WEBMD
Other	Z

d. Maintain the appropriate Medigap Number.
Note: Medicare has an updated list of MEDIGAP codes that you can download at www.medicarenhic.com/download.

e. If there is a Contact/Payer ID and the insurance claims should go electronically, then set Prevent Autobill to No.

Perform Provider Maintenance

1. Open Provider Maintenance by clicking File Maintenance from the Menu, Standard Maintenance and then Provider.

2. Make sure the provider name, address and Federal ID number fields are filled in correctly.

3. If the provider has individual provider number for an insurance, enter them here.

Perform Miscellaneous Provider Maintenance

1. Open Provider Miscellaneous Information Maintenance by clicking Additional from the Provider Maintenance Menu and then click Misc. Provider Info.

2. Verify that the Providers Last Name, First Name, Middle Initial, and Suffix are entered properly.

3. Verify that Prevent Autobill is set to No. This allows claims to be sent electronically.

Perform Provider Set Maintenance

Use the following directions if you are submitting claims to the Change Healthcare clearinghouse. If you are submitting claims to multiple clearinghouses, please contact NDS Support at 1-800-649-7754 for assistance with additional setup.

1. Open Provider Set Maintenance by clicking Additional from the Provider Maintenance Menu Bar and then Provider Set.

2. Press [TAB] through the Location, Department and Insurance Set so they default to ALL.

3. Maintain the following Provider Set fields:

a. Enter the provider's Federal ID number. For Change Healthcare, enter *.

b. Enter the physician's state license number.

c. Enter the Network ID, if the insurance carrier requires it.

d. Enter the provider's NPI as the National ID field.

e. Enter the Taxonomy code (if the site chooses to) for the Specialty field.

f. Enter the Site Number for insurance carrier WEB MD.

Additional File Maintenance

When entering policy holder information during Patient Entry - Insurance Policy Holder Area, if the policy holder is the patient (self), DO NOT free type the name. Simply press [TAB] through the fields and the system will default to the patient's name.