This section has the following topics:
- Assigning insurances to go electronic
- Changing the ECS Number for many insurance records
- Setting Up the Eclaims Computer
- Creating, Sending and Receiving Files
- Transmitting Your Claims
If you are sending claims via a dial-up connection to Medicare or any other insurance, you need to read the section on Modem Programs before you continue.
Once you are approved for sending in claims electronically, here are the step by step instructions to get the job done!
Assigning insurances to go electronic
First, you need to change each insurance that you want to send electronically from paper claims to electronic claims. Initially , all insurance claims are sent via paper and assigned the ECS# of zero (0). To send claims electronically just change to the correct ECS# and all future claims will be assignd this number and picked up for transmission.
- In the Insurances module look at the Electronic Claims Submision section.
- Make
sure that ECS# if Pri is
assigned
to the correct ECS# for the receiver you have in mind. Below it
has been changed to "98" which indicated the "MCS Clearinghouse". This
insurance happens to be Aetna with NAIC code of 60054.
- ECS if Sec determines if the insurance can be sent as a secondary claim. At present, most insurances do not accept secondary insurance electronic claims (also called COB or coordination of benefits).
- In Eclaims
Name enter the name of this insurance as it must be transmitted
electronically. In Pennsylvania, specifically, they want the insurance
name to be "Highmark" or "Independence". If any other name appears the
entire file is rejected. There is more on this section in the Insurance Module.
If there are many insurances that are going to be sent to the same ECS receiver, such as all the Aetna's, you do not need to change them one at a time. Just do the following to get a mass effect.
- First, find the insurance company that has many records to change, like Aetna. When you find more than one record you are given a list, as shown below with the update dialog already showing.
- The NAIC code is the field that must contain a number that tells the receiving computer where the claims get routed to, kind of like a zip code.
- To change the NAIC code of the found set of records, click
the checkbox
icon above NAIC
column. Complete the dialog and click OK.
Note: Only claims created after this change is made will be correctly flagged. To find previous claims that need to be assigned follow the instructions for doing custom finds in the Billing chapter. Then change the ECS# of the entire set of records and flag them for resubmission.
Setting Up the Eclaims Computer
One computer
must be designated as the only computer that will send and
receive
your eclaim files. We will only support one computer for these
functions.
At the top of the data entry screen is tab called ECS Toolbox. This screen tells PracticeMaker® where files are created and where they must be moved to for either YOU or our automated system (if available) to find.
Files and Folders
As already discussed in the section on ECS Control, PracticeMaker is expected to have a place to put the files it creates and yoru modem software needs to have a place to put the files it receives. The way we want the PracticeMaker5 workstation folder to look is shown below. Note this is where the PracticeMaker Client module is located as well as the folders used by electronic claims. If you do not have a similar folder on the workstation that will send claims it must be created.
When the file system is not properly setup the dialog below warns you of it after the file has been created (or attempted to be created) and hopefully moved to the correct location.
Creating, Sending and Receiving Files
At the top of the data screen for each carrier/receiver are the buttons below.
At the top of the data entry screen is tab called ECS Toolbox. This screen tells PracticeMaker® where files are created and where they must be moved to for either YOU or our automated system (if available) to find.
- The Memo and Carrier support section is for any contact information and phone number for this carrier
- The older format has its fields in the NSF Upload Records section.
Files and Folders
As already discussed in the section on ECS Control, PracticeMaker is expected to have a place to put the files it creates and yoru modem software needs to have a place to put the files it receives. The way we want the PracticeMaker5 workstation folder to look is shown below. Note this is where the PracticeMaker Client module is located as well as the folders used by electronic claims. If you do not have a similar folder on the workstation that will send claims it must be created.
When the file system is not properly setup the dialog below warns you of it after the file has been created (or attempted to be created) and hopefully moved to the correct location.
Creating, Sending and Receiving Files
At the top of the data screen for each carrier/receiver are the buttons below.
- Find enters search mode so you can find a specific carrier.
- Review Records will list for you those claims in the ECS Module for this carrier. It is possible none are there.
- Clicking goto web opens you web browser to the URL entered in this field. For example, to go to our clearinghouse, MCS, the url is "https://trymcs.com".
- Find, Send & Receive-This finds all claims ready to be sent, creates the upload file, puts it into the Send folder and either sends them with our automated system or allows you to send them manually.
- Redo, Send, Receive-This recreates the file using the same claims found using the step above. This is used if there were fixable errors during file creation, a power failure or other interruption in the computer or any other situation where the file just needs to be recreated.
- Send & Receive-This only works with the automated system.
- Receive only-This only
works with the automated system.
This is what PracticeMaker® does when you click Find, Send & Receive.
- Finds all flagged claims in Billing using this ECS# and whose billing date is today or earlier.
- Puts today's date at the top of the ECS Date(s) field for your reference and ability to find claims to reprocess if needed.
- Loads the found claims into the ECS Module for correct field formatting. For the National Standard Format each record must have exactly 320 characters using a strict fixed field format. For ANSI X12 the records use a much different scenario.
After the Upload File is created
When the claim file is properly made, you get this dialog. The file is actually created by the ECS Creator database. In addition to the upload file being created, another file is created and placed in the Send Archive folder. This file has the same name as the one to send BUT ends in "tsf" (short for "tech support file") instead. If a file ever has errors in it we can look at this file to find them.
Transmitting Your Claims
Using a dial-up connection
If you have not already don so, you need to read the section on modem software. Depending on your platform and insurance carrier, we may supply you with the programming needed to dial into the carrier's computer, login and either submit the claims or take you to a menu so that you can send or receive files.
After a file has been created and you want to send it, click the Open Telecom button to open the telecom program referenced on the ECS Toolbox screen. You will need to select the place to call and then send the file.
Sending claims to our clearinghouse
If you are sending claims to MCS Clearinghouse, you have two choices. You send them via a toll-free dial-up connection, or via the website at https://trymcs.com. The web connection is far better because of the real-time interaction between sending claims and getting back confirmations. Visit their website for more details on who to send claims and read reports. We signing up for MCS, which is dome via the website, you MUST mention Medical Databases as your sponsor. Our spondor code is MEDDS.
last updated 6/6/2004