Electronic Submission

If you have never setup a practice for claims submissions, electronic claims advice (ERA) or electronic funds transfer (EFT), then you are in for a challenge.  But, it is well worth the challenge when streamlining internal processes.  A huge part of a medical biller day is submitting claims and posting payment explanations.  The auto export/import process makes this job a whole lot easier.  Getting it to where it works seamlessly is crucial.  Understanding when it doesn’t, well that is the bigger challenge.   Major insurances are for the most part not the issue, unless you are working with Medicaid  and their quirky mandates for legacy ID’s, it is the smaller insurances or newer insurance that give us billers a very difficult task to solve.  The first step is to see if they are listed in your clearinghouse payor list, do they accept electronic claims, do they require an EDI agreement, do they allow EFT.  More times than not you have to call them and hope you get a CSR who knows what you mean when you say, can I speak to someone in EDI?  Or do you know your payor ID?  This conversation can go many different ways particularly if the insurance is managed by a TPA…..daunting!  Electronic claim submission is no easy task and when we bring on a client they are counting on a very quick turnaround, they have to have a seamless transition from old to new so you really need to know how to implement quickly and target where transmissions go wrong.  Thankfully we have jumped this hurdle many times, we link to a EDI specialist on our practice management software side to facilitate the setup and we are confident in the process.  Though, we still deal with those random insurances patients sign up for that we find ourselves fervently trying to  figure out their claims submission protocol and how they adjudicate claims and make payments.  I can say in all my years of dealing with medical billing this is one area that I have to tackle from time to time, in fact just recently, thus this post.   

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