Electronic Claim Submission Checklist

Updated: 11/15/2023 | Views: 17976

Follow these guidelines to ensure your practice is set up and ready to send electronic claims (e-claims) successfully. Spending a little extra time verifying correct setup before submitting claims saves considerable time and effort troubleshooting, correcting and resubmitting rejected, denied, or no-response claims. It also helps ensure claims are processed and paid as quickly as possible!

Review Claim Rejections which includes a list of the top rejections received by customers, a description of possible causes, and suggestions for correcting in the Desktop Application (PM).

Practice Setup Checklist Steps to take when initially setting up the practice to bill electronically through Tebra.	Verify the following with each payer - for all payers. Payer ID Credentialing information - confirm the NPI and Tax ID/SSN that each provider bills under for each payer Claim submission addresses with valid 9 digit zip-codes Complete Electronic Data Interchange (EDI) enrollment. Complete and upload the Transfer of Authorization Form (TAF) Sign and return any required payer agreements Track payer approvals as they're received Verify the Practice Information. Name does not exceed 35 characters, including spaces Group NPI and EIN Contact Address is a physical address with a valid 9-digit zip code Verify the Provider information and claim settings. Individual NPI Address is a physical address with a valid 9-digit zip code The default claims billing information (NPI and Tax ID) is based on how the provider is credentialed with payers The claim settings overrides are set up properly if billing information for the provider varies for a specific payer and/or service location
First E-Claims Submission  Steps to take prior to submitting e-claims to ensure proper set up to bill the payer for the first time through Tebra.	Verify enrollment approval received from the payer (if applicable). Received approval email from Tebra Enrollments or directly from the payer Verify insurance setup. Insurance Plan Address with a valid 9-digit zip code Insurance Company Insurance Program (e.g., selecting CI for a Medicare payer may result in claim rejection) Electronic Claims Settings  “This payer accepts electronic claims” checkbox is selected Clearinghouse Payer ID Practice Settings Enrollment is approved by the payer (if applicable) The Enrollment Status is set to Enrolled in live mode The “Disable electronic claims for this payer” checkbox is not selected If billing to this payer as secondary, the “Use electronic billing when this payer is secondary” checkbox is selected To avoid multiple rejections, submit one claim first. Once successfully acknowledged, submit the rest of the claims.
E-Claims Submission Best Practices Steps to take prior to e-claim submissions for all patients. Building a practice workflow that incorporates these steps help reduce rejections and delays in claims payment.	Verify patient eligibility information. Attach a copy of the patient’s insurance card (front and back) and ID to their Patient record Verify the patient's name, date of birth, and address against the patient's ID Verify the patient's policy information against the insurance card Insurance Type if billing to Medicare as secondary Policy # Effective Start date is not after the date of service Insured information (if applicable) Run real-time patient eligibility check if available in Tebra or verify eligibility directly with the payer.