Last week’s article, “Out with the Old, and In with the New” focused on the many ways that CPR+ customers can submit claims to payors – specifically, ways to avoid transmitting by modem. This week, I’ll discuss how to set up your Payors for direct submission - via Direct Connect or manual upload.

To submit via Direct Connect, there are only a few steps you have to take to make this happen. First, you must ensure that the applicable insurance company has an Electronic Medical invoice type. (If you need to review, check out last week’s article.) The Requires Invoice Type field should be “Electronic Medical”.

After clicking the Electronic Setup (F8) button, the Advanced 837 Claim Setup Options window opens. By default, when this window opens all the fields below the checkboxes will be greyed out. If your payor requires you to upload claims to their website, check the Payor requires direct submission of claims checkbox. Once this is checked, the fields below will become accessible. These are the "837 header" fields. Each payor has a companion guide, usually available on their website, that provides information to assist in determining which fields need to be completed. Use your mouse to rollover each field to view the Segment ID provided by CPR+ hover text.

Using ZirMed, for example, you will be submitting claims via FTP to your payor, so you will need to also select the “Enable Secure FTP Direct Transmission” checkbox. Just like the first checkbox, clicking here will make the fields in the FTP Communication Info section accessible. Complete the fields with information provided by the payor.

The process of transmitting your claims, whether by manual upload or Direct Connect, will include an additional step. In order to get your claims to the designated payor or clearinghouse, you will need to navigate to Billing/Financial (5) > Electronic Claims Submission (4) > WebMD Medical Claims (3). First, select the Filter by payor (1) drop-down option located in the upper right corner of the window. (Some clearinghouses will require this.) Select your direct connect payor from the list. Next, use your spacebar or click the Mark to Transmit button (2) to mark your claim(s) to transmit. Finally, press <F5> or click the Transmit Menu button (3) to submit your claims.

The Electronic Transmission Menu will open. Select the first option, Trans. Invoices Ready to Send. This menu is also where the options to receive reports can be found. When receiving reports, either confirmation or remittance reports, you will again select to Filter by Payor.

If you are submitting by Manual Upload, the 837 file name will appear in the lower portion of the next pop-up window (in a red font.) This is the file that will be uploaded to the payor. If using Direct Connect, simply click Yes to upload the file.

I’ve covered a lot of information, and we still haven’t discussed the details of eligibility checks. So you know what to do… Stay Tuned!

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Make plans NOW to attend the 2nd Annual CPR+ HME Summit, Wednesday, March 10th in Columbus, Ohio at the Hyatt on Capitol Square. Last year’s invitation-only conference was so successful, we’ve decided to make it an annual event for all of our HME customers.

We’ve secured an unbeatable $99 room rate at the Hyatt on Capitol Square - in the heart of downtown Columbus and just minutes from the airport. Attendance is FREE and includes a networking lunch buffet.

What's on the Agenda?

Our primary purpose is to listen to YOU. We want to hear about your needs, your challenges and your ideas. We want to get consensus and set priorities. We also want to show you the latest HME-related features in CPR+ and train you on their use. Finally, we’ll be demonstrating our new, web-enabled delivery management application called Delivery Plus.

You definitely don’t want to miss this event.

The CPR+ HME Summit is a great opportunity to network with other HME providers from around the country. We’ll discuss best practices and you will have direct input into our development priorities.

Did we mention attendance is FREE? To register, just click here so we’ll know how many guests will be joining us for lunch.