EDI Claims

The EDI Claims module allows you to easily monitor patient procedures and submit insurance claims to insurance companies. You can view a wealth of related clinical information, including treatment date, practice, discipline, and code. You can also view which format the claim was in, and whether it was a primary or secondary insurance claim.

You should complete these two procedures at the end of each day to ensure that claim forms are batched, and either printed or sent electronically. This holds true regardless of whether or not your institution takes assignment for insurance.

Note: When submitting treatments, the insurance claims and pre-authorizations are first batched to a central area, then later submitted to the clearinghouse. When insurance claims are submitted, an encrypted file containing the claim information is created. This file can then be sent in for remittance.

You can search for and send all outstanding claim forms that need to be sent electronically.

  1. Open the EDI Claims module and search for unsubmitted procedures.
    1. To search by treatment date, from the Based on drop-down list, click Treatment Date.
    2. From the Claim format drop-down list, select a claim format.
    3. To search for primary or secondary claims, from the Include drop-down list, select an option.
    4. To select EDI claims for a practice, from the Practice ellipsis, select a practice.
    5. To search for claims by billing IDs, from the Billing IDs ellipsis, select a billing ID.
    6. To include claims for one or more specific insurance companies, from the Include ins. ellipsis, select an insurance company.
    7. To exclude claims for one or more specific insurance companies, from the Exclude ins. ellipsis, select an insurance company.
    8. Click Search.

      9. Note: Claims in green need to be submitted. Claims in red have errors that need to be corrected before the batch is processed (e.g., a missing field entry). Right-click a record, and select Show Errors to view errors that need to be corrected. Claims in black have been submitted.

  2. From the list view, select the batch of claims for electronic submission.
  3. Click Submit... to create a batch file.

    4. Tip: Do not change the batch number. axiUm assigns a unique number for each batch. Use a standard naming convention to reduce duplicate claims being sent (for which you'll be charged), for example, MonthDayYearNumber.

  4. Click Create to create the submission file that is sent to the third party clearinghouse (e.g. Change Healthcare).
  5. In the EDI Submission window, in the File box, at the end of the path enter Month, Day, Year.
  6. To print the list the procedures you've just submitted, click Yes.

Now, the submitted claims are in the Submitted Procedures tab.

  1. Click Print Held.
  2. From the Claim types drop-down list, choose the type of claim you want to send.
  3. To select print-held claims for a practice, from the Practice ellipsis, select a practice.
  4. To search for claims by billing IDs, from the Dr/Fee ellipsis, select a billing ID.
  5. To include claims for one or more insurance companies, from the Include ins. ellipsis, select an insurance company.
  6. To exclude claims for one or more insurance companies, from the Exclude ins. ellipsis, select an insurance company.
  7. From the Form Type list view, select the type of claim form you want to print.
  8. Click Print to print the claims.
  9. If you need to edit a claim or print a single claim, click Edit.
  10. In the Edit Held Claims list view, select and right-click a claim, and then select an option.
  11. If you need to align the page for a certain claim form, click Alignment and then Print.

You can resend an EDI claim if the insurance company did not receive it.

  1. Open the EDI Claims module and click the Submitted Procedures tab.
  2. In the top half of the window, enter any search criteria, and click Search.
  3. In the list view, select the checkbox(es) next to the claim(s) that you want to resubmit.