Electronic Claims Setup

If your practice has more than one location, the following instructions need to be completed for each location.

Instructions

Step One

1. Access Admin > General > Locations > open a location.
2. 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. Claims will be rejected if this is not entered.
   • 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. 
3. Click 'Save.'

Step Two

1. Access Admin > General > Practice Preferences > Practice Claims Preferences. 
2. Complete the fields according to the following:
   • Trizetto: Select Trizetto from the Clearinghouse dropdown menu. Enter the Site ID and FTP password issued by Trizetto. Both are case sensitive and will never change regardless of the username and password you use when logging into the Trizetto website. Enter "5010" (five, zero, one, zero) in the format field.
   • Apex: Apex provides all the information you need to complete your Practice Preferences. 
   • If you are using a clearinghouse that we do not integrate with, you may select Local 837 (5010). Your clearinghouse must provide you all the necessary information to complete this section. In the event your clearinghouse is not sure what we mean by Billing Location ID, Interchange Receiver ID, etc., the ANSI segments are displayed beside each of the field names. 
     • Billing Location Code: ISA06, SG02, or Loop 1000A NM109
     • Interchange Receiver ID: ISA08
     • Group Receiver ID: GS03
     • Transaction Receiver ID: Loop 1000B NM109
     • Transaction Receiver Name: Loop 1000B NM103
3. Click 'Save.'

Step Three

1. 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.
2. Click 'Save.'

Step Four 

1. 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."
   • Payor ID: If you are filing electronic claims through Trizetto, a Payor ID is required. If you are using Apex, they will communicate to you whether or not a payer id is required.
   • 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 only claims: If this is checked, then box 24J and 33a will only display the NPI. It is our recommendation this box be 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. It is our recommendation this box is checked for your Medicare payer.
   • Remove matching service facility NPI: This field is for special case use. It is our recommendation this be left unchecked. If you feel this applies to your practice, call customer support for assistance.