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Importing 835 Files Electronically (article)

Summary:

If you are using a Clearinghouse, you will need to post the 835 file that is returned from the insurance company containing payments to your client accounts. This file is imported into the PIMSY system to make it easier for you instead of entering payments singularly. For manually retrieving 835 files, see THIS article.

Fields & Buttons:

83510.PNG

EDE Batch # - number for this posting. Every EDE file will receive a Batch number, which starts in numerical order at the beginning of your use in PIMSY. The Batch # will be automatically entered when you click Save.

EDE Category – Tells PIMSY what type of file to prepare for. For posting you must select the “835 option” [835-RA Payment Posting 835].

Active – If the particular EDE is or was active at any point.

Description – we recommend using the file name from the file you import so you can locate it in the clearinghouse in the future if needed.

Billing Location – You will not need to fill this out for processing an 835.

Processed – The system will check this box once the file has been processed.

Processed By – PIMSY will automatically fill in the user’s name once the “Update” button has been processed.

Processed Date – The system will automatically stamp this when it stamps the “Processed By.”

Misc. Notes – When PIMSY processes the ERA, it will extract the amount of the check along with any available information, such as payer name, check date, amount processed and any difference. If there were multiple payments in the 835, PIMSY will break that down during the 835 import. Additionally, if there are any claims that PIMSY was unable to identify, you will see a remark “There were claims that could not be processed.”

83511.PNG

EDE File – This is the data that PIMSY sorts through to post the payments to each invoice in the system.

Go to Invoicing for EDE – view invoices directly involved with this 835.

Instructions:

  1. Go to Utilities at the top left of the menu.
  2. Select EDE (Electronic Data Exchange)
  3. On the top right, select your EDE Category (835- RA Payment Posting 835).
  4. Enter a description (we recommend the EDE number from the file you bring in so you can match it up if needed later). The filename will be automatically entered.
  5. Save it at the top left of the window.
  6. Click the Retrieve button top right. An SFTP popup window will appear to Retrieve SFTP file. Click Yes to import electronically.
  7. Select one 835 file or multiple 835 files to import at one time. You can double-click on one file to download but for multiple selections, click the Download button.
  8. When you have finished retrieving your 835 file(s), click the Update button on the top right of the main import window.


    PIMSY will ask if you want to view a Preliminary Run to see what is in the 835 file.



    After you have finished your review, click on Update again.

  9. On the bottom right, click Go to Invoicing for EDE.

    This will take you to the invoicing page where we recommend you look over the claims to see if there is anything that doesn’t look right. If there was a denial reason you should find it in the Remarks Private - a column in the invoicing screen.

To locate all EDE files, Go to Utilities, then EDE. This will retrieve all EDE files that have been generated. The 837 and 835 files are housed here in order of date with most recent on top.

Use Case:

Provider, Marcia Smith, has seen client Kelly Clark for an hour long session (90837). Kelly has a $25 copay, however, Marcia did not know this at check in. When the session is paid electronically via an 835 file, BCBS agreed to the allowed amount of $95.00 and paid Marcia $95.00. Marcia must write off $20.00 and now collect the $25.00 copay from Kelly. PIMSY will track the totals in the bottom right corner to make sure the proper amounts are there for Marcia’s use.

Related Articles:

If you cannot find what you need in this article, please contact Support (email) or call 877.334.8512 ext. 3.

 

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