Overview
Submitting claims through an 837 file in PIMSY streamlines the billing process and ensures a more efficient transmission to insurance payers. The workflow involves filtering invoices to capture only those ready for submission, reviewing claim details for accuracy, and then generating and submitting the 837 file. By following this process, practices can reduce errors, improve claim acceptance rates, and keep their billing operations running smoothly.
Required Permissions and Prerequisites
- This article is in reference to our Desktop application
- Please assign the Create, Modify, View, and Delete permissions for the following rule(s):
- Electronic Data Exchange (EDE)
- Electronic Data Exchange (EDE) Type...
- Electronic Data Exchange Download
- Electronic Data Exchange Submit
- Invoice List
Step-by-Step Instructions
Step 1:
From the top navigation menu, go to:
Financial > Invoicing
Step 2: Filtering
When accessing the Invoicing screen, a prompt will appear asking if you would like to filter the results. Click Yes to open the Filter. Set the following parameters:
Invoiced > No
Primary > Yes
Released > Yes
Billable > Yes
Click OK to set the filter.
Next, from the Invoicing screen grid, right-click the header column to open the Column Chooser. Pull down the Exclude from EDE column into the list.
Step 3: Sending the 837 File
Before beginning, verify all information looks accurate such as ID Numbers, Diagnosis Codes, Allowed Amount to Invoice / Rates (make sure there are no zeroes).
Click the EDE button.
Select the correct EDE Type (837P/837P COB for Professional file formats, with the COB file format used for secondary claims, and 837I for Institutional/UB-04 claims).
Next, select the Billing Location and Description. Your billing location selected will populate in the Billing Address of the claim form.
Checking Auto Exclude will automatically mark claims excluded from EDE and notates the reason if there is a front end edit that caused the errors. This will allow the correct invoices to be included in this 837 file but not the claims with errors. You can investigate the errors and send another 837 file to the insurance company.
Click Generate to create the 837 file. Once generated, the 837 results will appear in the EDE file section as shown below. click Submit to submit the file.
ClaimMD, Gateway/Navicure, Trizetto and Office Ally are set up to receive your 837 by simply clicking on the Submit button. Once you click Submit you are done. Claims sent in the file will now become invoiced.
Other clearinghouses that are not linked to PIMSY via SFTP will require you to Download the file and upload the 837 to the insurance company/clearinghouse. Click Update to mark those claims invoiced.
Step 4: Making Adjustments at the Claim Level
Click the Claim Adjustments and Remarks button. For example you can change the rendering provider, auth #, and add/edit modifiers to the claim.
Any changes made with the claims adjustments and remarks button will stamp changes on the Billing Notes within the Claims Adjustment window.