Insurance Company Electronic Claims Settings

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Updated: 01/14/2025 | Views: 9374

To submit claims electronically, the practice must first be enrolled in electronic claims services. Once enrolled, you can configure the Electronic Claims settings for the insurance company.

Configure Electronic Claims Settings

Click Settings > Insurance > Insurance Companies. The Insurance Companies window opens.
Find and click the insurance company name to open. The General tab of the Edit Insurance Company window opens by default.

Select the Electronic Claims tab. The electronic claims settings information displays.
Click to select or clear the selection for "This payer accepts electronic claims".
Note: When enabled, this option allows the submission of electronic claims for this payer.
Review and select the appropriate options as necessary.
- Clearinghouse: Click the drop-down arrow and select the clearinghouse the provider/practice is enrolled with for this payer.
- Electronic Payer Connection: Used by the clearinghouse to route the electronic claims to the appropriate payer for processing. Click Electronic Payer Connection to search and select the payer connection.
- Clearinghouse Payer ID: The payer ID that displays is based on the Electronic Payer Connection selected. Verify the correct ID displays.
- Once the payer connection is selected, review the shaded checkboxes.
  - "Requires authorization or enrollment" indicates enrollment agreements are required for electronic transactions with this payer. If not already completed, complete Electronic Data Interchange (EDI) Enrollment for this payer.
  - "Supports patient eligibility requests" indicates this payer supports electronic patient eligibility requests also known as real-time eligibility checks.
Enrollment Status by Practice section: Applicable for Tebra accounts with multiple practices. View the list of practices and their enrollment statuses with this payer.
Click Save to record any changes.