Emdeon- Electronic Claims Module

SOS Electronic Claims –  ANSI Module for Emdeon ^tm

Filing claims electronically is designed to save you and your payers time and money. In order to make that happen, claims must meet certain standards. Paper filing is more forgiving than electronic filing can be; a human being is never involved in the electronic process, so you must be sure all the necessary information is there for a computer to process the claim. It is time to let your inner perfectionist come to the fore. Don’t worry about how you did it before. We are going to make sure that you know just what to do to get everything set up so your claims fly through the Emdeon ^tm system and on to your payers successfully!

This manual is provided to guide you through the process of enrollment, set up of SOS Office Manager and filing your electronic claims. Please work your way through it step-by-step so you complete all of the necessary information. If you do so carefully, you will successfully file electronic claims on your first try. If you rush through parts or skip other steps, your claims will be rejected. Use the checkboxes in each section of the manual when you have completed a particular task. Use the checklist on page 2 to make sure you have completed all parts of the process.

SOS will provide you with brief training videos to assist you in completing this process. Contact us with your email address so we can send you the training modules.  Enjoy the process. Once you have completed the following steps, you will start to save significant amounts of time on filing claims. Then you will be able to spend your time collecting money rather than stuffing envelopes!

CHECKLIST

Use this checklist to make sure that you have completed all the necessary requirements to send claims electronically.

• Complete the Provider Agreement for Electronic Transactions via Emdeon ^tm and Enrollment Setup forms and fax to Linda at SOS, Inc. (888) 609-5514.
• Once the enrollment has been done, enroll for Emdeon Vision.
• Complete Payer Registration forms and mail to Emdeon ^tm as required.
• Download the newest release of OM and expansi.exe module.
• Enter the license information for the Electronic Claims module.
• Add the Emdeon ^tm Ansi module to your menu.
• Enter setup information in the ECM Setup screen in the Claim File Formatter.
• Make sure that all provider information has been entered:  NPI, taxonomy code, SSN and/or tax id, and electronic provider number (site id).
• Make sure that all supplier information has been entered:  NPI, and tax id.
• Enter the type of service code for all the service codes.
• Insurance Carriers – Enter NEIC/Payer number, Coverage type, insurance address (make sure that first line of address is entered),  and carrier category.
• Referral Sources – Enter address, taxonomy and NPI.   Facilities – Enter address and NPI.
• Activate the Claim Batch Warning and select the ones that pertain to your practice.
• Verify that you have done everything on your checklist.  Once you have, contact Linda at SOS to setup an appointment for your first batch submission.   

 

The Enrollment Process

Provider Enrollment

The first step to sending claims electronically is to complete the Emdeon Enrollment Forms. The faster the forms are completed and sent to the proper entities, the faster the approval will be.

• Complete one (1) Provider Agreement for Electronic Transactions via Emdeon for your organization. This document is a contract with SOS for filing claims through Emdeon ^tm. You will receive this as part of your purchase process and it must be completed and signed before proceeding.
• Register for Emdeon’s Vision Suite tool so you can track your claims status. Go to www.emdeon.com/signup to register. Emdeon ^tm will email a user id and password to you. You will need this information before we can help you send your first claims batch. If you file for multiple tax ids, please contact Linda at SOS for special instructions.
• Complete one (1) Emdeon Claims Provider Setup Form for each provider (need to say where the form is located).  ***REMEMBER, IF YOU ADD PROVIDERS AT A LATER DATE YOU WILL NEED TO COMPLETE A FORM FOR EACH OF THEM AND SEND IT TO SOS BEFORE YOU CAN START SUBMITTING CLAIMS FOR THEM.***
  • Complete the Emdeon Claims Provider Setup Form in this fashion:
  • Section 1. Enter the information for your organization and each provider. Complete all fields.
  • Section 2. This section is completed by SOS for you.
  • Section 3. Enter your TSO (mailbox at Emdeon ^tm) if it has been previously assigned.
  • Section 4. Enter the NEIC Payer ID for any insurance company that requires enrollment. To find these IDs and whether they require enrollment, go to www.emdeon.com. On the left side of the page under the heading Resources, click on Payer Lists. On the next page, under the heading Payer Lists, click Medical/Hospital/Dental Payers. This will bring you to a screen where you can search for your payers by name or by Payer ID number. To simplify your search results, set your filters so that Line of Business is Medical or Hospital; for Services choose Claims. Type the name of the insurance company in the Payer Name field and click View List. Be sure you are looking at the correct payer for Professional (M) or Institutional (H) claims. Check the Enroll column. If there is any letter except N, you must list this payer on your form by Payer ID.
• Fax the forms to Linda at (888)609-5514.
• You will receive an email from Emdeon ^tm to confirm the commercial setup which will give you the provider’s site id. You should then complete any necessary payer registration forms for carriers you entered in Section 4 above. The forms can be found at www.emdeon.com; on the left under Resources, click on the link  for Enrollment Forms. On the next page, under the heading Enrollment Categories, click the appropriate link for either Professional Claim Payers or Institutional Claim Payers.  Click the link for your payer to go to the page with the Enrollment form for the desired insurance company. Download the appropriate forms, complete the Emdeon ^tm cover sheet and payer document, and send all pages to Emdeon according to their instructions. DO NOT send the payer registration form to the payer unless specifically instructed to do so.

NOTE:  Whenever you start filing for a new provider or a new tax id for an existing provider, complete an Emdeon Provider Setup Form (PSF) for that provider and fax it to SOS. Also if this provider has a different tax id then register this new tax ID for Emdeon’s Vision Suite by contacting Linda at (352) 242-9100 ext 1 or Linda@sosoft.com to provide your Vision user id.

 

ERA Enrollment

 

 

You will need to complete the ERA Provider Setup (need to say where it is available) Form for each tax id/billing NPI combination and fax back to me. You do not need a separate form for each provider if multiple providers file using the same tax id and billing NPI combination.  Be sure to include your tax id as the Receiver ID and complete the appropriate information in Sec. 4 for the payers you are requesting. Please note that you must enroll for each payer for ERA if you want to receive ERA transactions. Information on whether a payer returns an ERA to Emdeon can be found by checking the Emdeon website and searching for the payer on the payer list. Go to www.emdeon.com; under Resources, click the link to Medical/Hopsital/Dental payers; from there you can search for your payer and see if ERA service is available.

IMPORTANT: Once the setup is complete, you will then need to submit to Emdeon the ERA payer registration forms that you can download from Emdeon’s website from Enrollment Forms>Professional ERA payers. You will not begin receiving ERA files from your payer until the approval process is complete.

 

Because the ERAs are electronic transactions that are processed through the Emdeon clearinghouse, there is a $0.15 charge for each transaction.  After you begin receiving ERAs, you can view the payment information in Vision Suite on Emdeon’s website under the Payments tab using your current login user id.

If you want to download the ERAs and post payment in Office Manager from those ERAs you need to purchase the ERA Posting module from SOS.  Please contact Trish at 352-242-9100 extension 1 or email her at Trish@sosoft.com.

 

System and File Requirements

• Windows XP, 2003 Server, Vista, or Win7.
• The current version of SOS Office Manager.
• A current Support/Update contract.
• The SOS ANSI claim formatter module for Emdeon ^tm with the license control number.
• Internet access with a DSL or other high speed internet access connection.

 

 

Download the current version of SOS and ANSI module

• You must install and patch the most recent version of the SOS Suite of products before you can start sending claims electronically. If you are not sure if you have the most current version go to our web site www.sosoft.com and click on Support > Download Files > Current Releases. (Under Current Releases, there is an option that will tell you ‘How to Check Your Software Version’.) This page will indicate the current release of our products. Depending on the version that you are running on your system, you may be able to download the update from the web site. If the version that you are currently using is too old you will need to call us to request a CD. Even after installing from a brand new CD, you will need to go to our web site to download any patch that has been posted.
• Once your SOS software is updated, you will need to download the latest version of the ANSI module. Even if you just updated SOS Office Manager or you just installed from a CD you may not have the latest version of the ANSI module. Go to our website. Click on Support > Download Files > Electronic Claims Formatter (expansi) for release xxxx.xx (this will be the same release number as your SOS Suite) to get the latest version. If you are working on a network, this file must be present in the SOS folder of all workstations that will be used to format and send electronic claim files to Emdeon ^tm. 
• If you are running on a Windows 2003 Server and will be sending your claims through that server you will need to import the certificate for the curl program. To do this go to Start > Control Panel > Internet Options. Under Internet Options select the Content tab then click on Publishers under the Certificates section. Click on the Import button and follow the wizard. Under Browse go to your \SOS folder and select curl-ca- bundle.crt and install it as a Trusted Root Certification Authorities. In some cases you may find that you are not allowed to make any changes to the Internet Options. In that case notify your network administrator who will be able to make the changes for you.

The Setup Process

 

License the ANSI module

  SOS will send you license information for the EXPANSIWMD product which you must add to the licensing data in your SOS database.

1. Click on Start > Programs > SOS Applications > DBTools.
2. Once DBTools is open, click on File > Licenses.
3. In the Products window find the product labeled EXPANSIWMD.
4. Highlight it and click on Change.
5. Enter the licensee name and the control number as it appears on your license sheet.
6. Click OK to Save.
7. Exit DBTools.

 

 

Add the Emdeon^tm ANSI Module to your Menu

  To see the module in you menu, you must add it to the list of options.

1. Start OM. 
2. Select Bills/Claims > Create HCFA/CMS 1500 Claims.
3. With your mouse pointer over the white area of this window, click with the RIGHT mouse button to display a popup menu.
4. Left-click on Add.
5. For Report Description type: ANSI – Emdeon 
6. For Command Line type:   EXPANSI.EXE /WM /A1 /F2 /2310B /2000APRV /5
7. Click OK to save.

 

Enter ECM Setup Information

  Enter the setup information for the new module using the instructions below.

1. Select Bills/Claims > Create HCFA/CMS 1500 Claims.
2. Highlight ANSI – Emdeon ^tm on the list. Select Output Current Batch.
3. OM will now invoke the Claim File Formatter – Emdeon ^tm  program. The first time that you access the Claim File Formatter you will receive a message asking you if you want to copy an ECM Setup that is already entered or if you want to enter it yourself. In most cases you will enter the information yourself, so select NO.  If you have already entered the information in your first dataset and you have other datasets to set up for your electronic claims submission you can choose YES and select the dataset to which you want to copy the information. Make sure that once the information is copied you go back into the ECM Setup to make any necessary changes.
4. When the formatter comes onto the screen, select ECM Setup on the main menu, then select the Setup Information tab. 
5. At the Name to use for claim file type: CLAIMEMD.DAT
6. Check the field Create a ZIP claim file.
7. Enter the number 29 in the Maximum number of detail records field.
8. Enter the ITS Login ID and ITS Password that was provided to you by SOS. Check the Submit claims via Emdeon website box. If you do not have this information yet, you can enter it when you receive it.
9. Check the Check if the transmit file matches the Current Batch box.
10. Leave the Set the “Go to web site” button on Main screen to this web address field blank.
11. Go to the Submitter Tab.
12. Check the appropriate box for the Submitter is field. If you are submitting for a provider, select Person and if you are submitting as an organization select Organization.
13. Click on PROD for the Test/Production Indicator.
14. Enter the Submitter information. If you have selected Person in step 12, make sure that you enter the last name of the provider in the Submitter Name field and the first name of the provider in the First field. If you have selected Organization then enter the organization’s name under the  Submitter Name field. Enter the address, street, city, state, zip, contact name, phone, fax and e-mail.
15. Go to the Receiver/Misc Tab.
16. Leave the box unchecked for Ack. Requested (ISA14) field.
17. Put 00 (these are zeros and not the letter O) in the Auth. Information Type (ISA01) field.
18. Leave the Auth. Information (ISA02) field blank.
19. Put 00 (these are zeros and not the letter O) in the Security Information Type (ISA03) field.
20. Leave the Security Information (ISA04) field blank.
21. Under the Billing Service Info tab leave all the fields blank unless you are a billing service. If you are unsure please give SOS a call.
22. Click OK to save.
23. Click on Exit Program.

 

 

 

Add Supplementary Information to OM Data Files

 

 

Using the ANSI module to submit Emdeon ^tm  claims requires that certain additional information be added to your existing OM data. The necessary additions are detailed in the following sections.

 

System Setup

System Setup in OM controls a variety of data entry defaults, i.e. the data that appears automatically. Making entries here will not change data that is already entered, but it will control what appears for new patients. Make sure that you go through every item on every tab of the Setup form (Setup > System Options), entering the appropriate default information.

Patient Information

• Click on File > Active Patients or on the Active Patient List icon.
• Be sure to enter complete address, date of birth and insurance ID information for each patient and for the insured. 
• Assure that Intake date is the date the patient was actually first seen and is not a default date supplied by OM on the day you entered the patient information (Active Patient > highlight the patient and click Edit > Additional tab).
• Make sure your Policy information for the patient is correct and complete. 
• Be sure that the CSU/1500 information contains the Date of the Current Illness and that this date precedes the Intake Date, the Admission Date and the Date of Service. Make sure you have an ICD diagnosis entered.

Providers

There are several changes that must be made to provider information. Go to Lookups > Providers.

• General tab: in the Title field enter the provider’s title (e.g. MD, PhD, LCSW, CISW, etc). Leave out punctuation and spaces.
• General tab: in the Specialty/Taxonomy Code field enter the appropriate taxonomy code for this provider’s specialty. You can find a list of Taxonomy codes at the following address:  http://www.wpc-edi.com/codes/taxonomy