Overview
If you are using a Clearinghouse, you will need to upload the 835 file provided by the insurance company, which contains payment details for your clients. Below is an example of this file and the key information that can be extracted from it.
Required Permissions and Prerequisites
- This article is in reference to our Desktop application
- Please ensure you have the appropriate profile assigned for billing
Example of an 835 Claim
CLP*INV-14816*1*325.00*140.87**MC*13197E043890~NM1*QC*1*CLIENTS LAST NAME*CLIENTS FIRSTNAME*N***MI*0001334170~NM1*IL*1*CLIENTSLAST NAME*CLIENTS FIRSTNAME*N***MI*0001334170~NM1*82*1*DOTY*CATHERINE*L***FI*200126266~DTM*050*20130723~PER*CX*DELAWARE PHYSICIANS CARE*TE*8002879860~AMT*AU*140.87~SVC*HC:99214*200.00*106.83**1~DTM*472*20130710~CAS*CO*45*93.17~REF*LU*1~AMT*B6*106.83~SVC*HC:90833*125.00*34.04**1~DTM*472*20130710~CAS*CO*45*90.96~REF*LU*2~AMT*B6*34.04*
KEY
Red writing is Claim (Inv. Number)
Dark orange indicates primary (1) or secondary (2) payment
Orange is the total charge of the claim (this is the total amount- so if there is an add on involved it will be the two services charge combined
Green is Amount Paid.
Blue is Patient Responsibility-This particular example has no amount to the patient. Therefore, there are two **. If there was an amount to be billed to the client, it would be like this *10.00*
Purple Is the Claim Filing Indicator . This example is MC for Medicaid
12 - Preferred Provider Organization (PPO) Use this code for Blue Cross/Blue Shield par arrangements.
13 - Point of Service (POS)
14 - Exclusive Provider Organization (EPO)
15 - Indemnity Insurance (Use this code for Blue Cross/Blue Shield non-par arrangements.
16 - Health Maintenance Organization (HMO) Medicare Risk
AM - Automobile Medical
CH - Champus
DS - Disability
HM - Health Maintenance Organization
LM - Liability Medical
MA - Medicare Part A
MB - Medicare Part B
MC - Medicaid
OF - Other Federal Program Use this code for the Black Lung Program.
TV - Title V
VA - Veteran Administration Plan
WC - Workers’ Compensation Health Claim
CAS*CO Claim Adjustment. “CO” Represents Contractual Obligations, leading to the *45* for the write off amount, which follows.
AMT*B6 is Allowed Amount, which follows.