Payor Configuration
Once you've added your payor to eCaring, you'll need to configure their "Billing Settings" and the Payor specific "Services & Rates" for EDI.
Billing Settings:
Navigate to: Payors -> Select the Desired Payor -> Billing Settings
- For the purposes of EDI billing, the Type, Frequency and Identifier can be selected as normal.
- Place of Service - Only Required for 837i
- Payor Export Template
- Select your corresponding EDI type
- Payor: Choose your payor from the drop down list
- The Naming Convention = "Payor Name - EDI Receiver ID", you'll see some duplicate names, but unique receiver ID's, this is generally to support Direct Submission vs Clearinghouse submission.
- EDI Provider ID: This is the ID assigned to your provider organization by the Payor or Clearinghouse.
Services & Rates:
Navigate to: Payors -> Select the Desired Payor -> Services & Rates -> Add or Edit a Service
For the purpose of EDI, there are a few configuration items that are key in addition to your normal payor configuration (Units, Rates, Rounding, etc).
REQUIRED
- Procedure Code - This value must be added for the Payor's Service for EDI billing as it is included in each line item in the claim.
OPTIONAL/CONDITIONAL
- Physician NPI Required - If your payor requires you to submit the NPI # of the referring/authorizing provider, choose "Yes".
- Note - if you select this option, you'll also need to add the referring physician to the Care Circle on each client you serve.
- Taxonomy - If your organization provides services under the same NPI at multiple locations or across multiple lines, you may have a Taxonomy Code - you'll need to enter it here if applicable.
- Qualifiers - If your Procedure code requires a Qualifier, please enter it in the appropriate field.
- Modifiers - If your Procedure code requires a Modifier, please enter it in the appropriate field.
Client Configuration
Clients receiving services that are authorized by a Payor configured for EDI have a few required fields, it's a good idea to always populate these values regardless, but omitting them for EDI billing scenarios could cause errors or claim rejections.
REQUIRED
- Date of Birth - Must be completed on the client profile.
- Billing ID - You must populate the Billing ID field on the client record in the field that matches the value selected on the Payor.
- Diagnosis Code - ICD-10 code should be entered on the client's authorization for the services billed through EDI.
- Diagnosis Codes are required in the EDI file, if one is NOT entered on the client's authorization then eCaring will populate the claim file with Z59.9.
OPTIONAL/CONDITIONAL
- Referring Physician - Add the Referring Physician to the Client's Care Circle list.
- If the Physician you need to link to the client doesn't exist in your site, you'll need to go to "Settings" -> "Doctors" and click "Add New" to add a new Physician to your site's list. The only fields that are required are the First and Last Name and NPI number for the purposes of EDI Billing.
Agency Configuration
Agencies billing via EDI must ensure that at least their Primary Office if configured in eCaring. This can be accessed at "Settings" -> "Office".
REQUIRED
- Legal Name
- Short Name
- EIN
- NPI
- Admin Email
- Office Address
- For your Zip/Postal Code, you must enter your "+4" code, making the entire entry 9 characters.
- Payors (select all payors this office will be billing).
If your organization has multiple offices with different EIN's or NPI's, please enter the relevant information under each office and make sure that your clients are assigned to the proper office as their "Home Office".