If your practice has more than one location, the following instructions need to be completed for each location.
Important Note: Selecting Submit in RevolutionEHR when using an Unintegrated Clearinghouse does NOT send the claims to the clearinghouse. The action of Submit changes the status of the claim to Submit and creates an 837 electronic claim file that downloads to your computer. The 837 files need to be manually uploaded by the practice to the unintegrated clearinghouse to complete the submit process.
Instructions
Step One - Locations
- Access Admin > General > Locations > open a location.
- Complete the following fields:
- NPI: Enter your billing NPI. Note: This number depends on how your practice is credentialed, enter either the Group NPI (Type 2 NPI) or Individual NPI (Type 1 NPI).
- FEIN: Enter your tax identification without dashes (e.g.,1234567890).
- Address: Enter the physical address of your location. Do not enter a PO Box.
- Zip Code: Enter your 9 digit Zip Code. Do not use a space or hyphen in the zip code. e.g., 775981234. See Example
- Facility Type: This is generally set to "11," for Office. This can be edited on the invoice, if necessary.
- Billing Provider Name: Enter your billing provider name which must match the name assigned to the billing provider NPI as registered on the NPPES website. This field displays in Box 33.
- Billing Location Claims & Statements: If you would like to use a different location address for the billing location for claims and statements (box 33), enter the correction location address.
- Billing Provider ID: Select the EIN or SSN. This populates box 25 of the HCFA form. Note: If your provider has credentialed with a social security number instead of a tax identification number, please contact RevolutionEHR.
- Claim NPI Entity: If you entered a group NPI in your Location, select Organization. If you entered an individual NPI in your Location, select Individual.
- Pay to Address: The Pay To Address cannot be the same address as your physical address. If the pay to address is the same as your physical address, leave the pay to address blank.
- Click 'Save.'
Step Two - Practice Preferences
- Access Admin > General > Practice Preferences > Practice Claims Preferences.
- Complete the fields according to the following:
- Clearinghouse: Select Local 837 (5010)
- Billing Location Code: Enter your Trizetto assigned Site ID.
- Interchange Receiver ID: 263923727000000
- Group Receiver ID: 263923727
- Transaction Receiver ID: Enter your Trizetto assigned Site ID.
- Transaction Receiver Name: Trizetto Provider Solutions
- See Example
- Click 'Save.'
Step Three - Employee/Roles
- Access Admin > Employee/Roles > Employees > open the employee that is a provider > Provider Details > Provider ID's.
- The NPI entered should be the individual NPI or Type 1 NPI.
- The UPIN number may be left blank.
- The insurance companies (on the right side of the menu) are a special case setup. If you need exceptions. please call customer support and we will assist with your special case setup. Otherwise, this area should be left blank.
- Click 'Save.'
Step Four - Insurance Companies
- Access Admin > Vendors/Partners > Insurance Companies. Ensure the following fields have been populated for each insurance company.
- Insurance Company Name.
- Address (only required if not sent electronically).
- Classification: This field is required for paper claims and pertains to Box 1 of the HCFA form. Please complete accordingly. See Example
- Claim Submission: If claims for this payer will be sent electronically from RevolutionEHR to the clearinghouse, select Electronic. If the claim will be sent another way (not through the clearinghouse) select either "mail or print." These selections allow you to manually mark these claims as submitted. For any payer that you do not want to create a claim, select None.
- Payer ID: If you are filing electronic claims a Payer ID is required. Please refer to your clearinghouse for payer ID listing requirements.
- Claim Filing Code: This is required for electronic claims.
Claim Filing Code Payer Claim Filing Code Indicator Medicare, Railroad Medicare, Medicare Advantage Plans, DME, anything "you think of" as Medicare. MB-Medicare Part B Medicaid, Ucare, anything "you think of" as Medicaid. MC-Medicaid Champus CH-Champus Blue Cross Blue Shield BL-Blue Cross/Blue Shield Tricare OF-Other Federal Program All other payers; e.g. UHC, Cigna, Aetna, UMR. CI-Commercial - Participating Practice: If you accept assignment, check the participating provider checkbox. If you do not accept assignment, you will not check this box and the patient will receive the insurance check. This is Box 27 on the HCFA form.
- NPI Only on claims: If this is checked, then box 24J and 33a will only display the NPI. We recommend this box is checked.
- User Rendering Provider as Referring: If checked, this will automatically set the rendering provider as the referring provider on each claim. This is HCFA Box 17. We recommend this box is checked for your Medicare payer.
- Remove matching service facility NPI: This field is for special case use. We recommend this is left unchecked.
- Log out and log in to see the changes associated to the setting.