System > EDI Options

Key Info  
Purpose:

Configure system settings related to EDI.
Related Module(s):

EDI Claims, EDI Remittance
Accessed From:

Maintenance > System > EDI Options
Window(s):

EDI Options

Security Login

Rules for Process Types

EDI Remittance Overrides

Dependencies:

None.

EDI Options Window

The EDI Options window allows you to specify system settings related to EDI.

For more information, refer to the EDI documentation.

Field Description
EDI Contact

A text field that indicates the user at your institution that Emdeon can contact for claim processing issues.
Submitter...

A button that displays the Security Login window and allows you to enter your submitter ID as part of the EDI setup.

For more information on this window, see below.
EDI Phone

A text field that indicates the phone number of the user specified in EDI Contact field.
Payment Code

A text field that indicates the insurance payment code used for EDI remittance payments.

The ellipsis is used to display the Payment Codes window and select a payment code.
Direct Deposit (EFT Code)

A text field that indicates the insurance payment code used for direct deposit EDI remittance payments.

The ellipsis is used to display the Payment Codes window and select a payment code.
Payment Date

A drop-down list used to set the remittance payment date displayed in the Transactions module:

  • Payment date: The date of the payment, as indicated in the remittance file.

  • System date: The date the payment was processed in axiUm.
Pmt Audit User

A text field that indicates the audit user for the EDI payment and allocations.

The ellipsis is used to display the Users List window and select a user.
For Under Pmt

A drop-down list that indicates how axiUm deals with underpayments on claims:

  • Add payment, no adjustments: axiUm adds the insurance payment allocation and leaves the debit balance unadjusted.

    • Note: This option prevents axiUm from applying adjustments, so users must apply adjustments manually.

  • Change tx to match: axiUm rebills the treatment and the treatment fee to match what the insurance paid.

    • Note: This option prevents axiUm from applying adjustments, but permits axiUm to automatically rebill treatments for the amount that insurance covered (preventing manual adjustments).

  • Adjust (based on Ins): axiUm transfers the balance to the patient or writes off the balance, as specified in the insurance company setup.

    • Note: This option allows axiUm to use adjustments or Intelli-adjustments.
For Over Pmt

A drop-down list that indicates how axiUm deals with overpayments on claims:

  • Add payment, no adjustments: axiUm adds the insurance payment allocation and leaves the debit balance unadjusted.

    • Note: This option prevents axiUm from applying adjustments, so users must apply adjustments manually.

  • Change tx to match: axiUm rebills the treatment and the treatment fee to match what the insurance paid.

    • Note: This option prevents axiUm from applying adjustments, but permits axiUm to automatically rebill treatments for the amount that insurance covered (preventing manual adjustments).

  • Adjust (based on Ins): axiUm transfers the balance to the patient or writes off the balance, as specified in the insurance company setup.

    • Note: This option allows axiUm to use adjustments or Intelli-adjustments.
Debit

A text field that indicates the adjustment code used for debit insurance payment adjustments.

The ellipsis is used to display the Adjustment Codes window and select an adjustment code.
Credit

A text field that indicates the adjustment code used for credit insurance payment adjustments.

The ellipsis is used to display the Adjustment Codes window and select an adjustment code.
Transfer (from Pt)

A text field that indicates your universal transfer balance adjustment code.

The ellipsis is used to display the Adjustment Codes window and select an adjustment code.

Note: If you use Intelli-adjustments, this code must be set. For other adjustment methods, leave this field blank.
Create Process Log File (for this station) A check box that, when selected, indicates that axiUm creates a log file for the EDI Remittance process.
Log Folder

A text field that indicates the location where the log file is stored.

The ellipsis is used to navigate to and select the folder path.
Rules...

A button that displays the Rules for Process Types window and allows you to specify which Process Types should display in the report as requiring attention.

For more information on this window, see below.
Overrides...

A button that displays the EDI Remittance Overrides window and allows you to specify payee overrides.
Task Procedure
Update EDI Information

  1. Modify the fields as necessary and click OK to save your changes.

Enter Submitter ID

  1. Click the Submitter... button to display the Security Login window.

  2. Enter your submitter ID and click OK.
Define Remittance Report Rules

  1. Click the Rules... button to display the Rules for Process Types window.

  2. In the Attention not Required section, select the item(s) and click the > button to move to the Attention Required section.

  3. Click Close.
Define Remittance Overrides

  1. Click the Overrides... button to display the EDI Remittance Overrides window.

  2. Complete the fields as necessary and click OK.

Security Login Window

(Maintenance > System > EDI Options)

The Security Login window allows you to enter your submitter ID as part of the EDI setup. It displays when you open the EDI Options window and click the Submitter... button.

Field Description
Security Code

A text field that indicates the EDI submitter ID that is used with the EDI software for submitting EDI claims.
Field Description
Configure Security Code

  1. Complete/modify the field as necessary and click OK.

Rules for Process Types Window

(Maintenance > System > EDI Options)

The Rules for Process Types window allows you to specify which Process Types should display in the report as requiring attention. It displays when you open the EDI Options window and click the Rules... button.

Field Description
Specify Rules for Process Types

  1. In the Attention not Required section, select the item(s) and click the > button to move to the Attention Required section.

  2. (Optional) To remove item(s), in the Attention Required section, select the item(s) and click the < button to move to the Attention not Required section.

  3. Click Close.

EDI Remittance Overrides Window

(Maintenance > System > EDI Options)

The EDI Remittance Overrides window allows you to specify payee overrides to deal with payees that require different settings than the default behavior used to process most insurance payments. It displays when you open the EDI Options window and click the Overrides... button.

Field Description
Payee ID

A text field that indicates one of the following:

  • The practice’s NPI or Tax ID.

  • An individual’s NPI or Tax ID.
Payment Code

A text field that indicates the insurance payment code used for EDI remittance payments for this Payee ID.

The ellipsis is used to display the Payment Codes window and select a payment code.
Direct Deposit (EFT Code)

A text field that indicates the insurance payment code used for direct deposit EDI remittance payments for this Payee ID.

The ellipsis is used to display the Payment Codes window and select a payment code.
For Under Pmt

A drop-down list that indicates how axiUm deals with underpayments on claims:

  • Add payment, no adjustments: axiUm adds the insurance payment allocation and leaves the debit balance unadjusted.

    • Note: This option prevents axiUm from applying adjustments, so users must apply adjustments manually.

  • Change tx to match: axiUm rebills the treatment and the treatment fee to match what the insurance paid.

    • Note: This option prevents axiUm from applying adjustments, but permits axiUm to automatically rebill treatments for the amount that insurance covered (preventing manual adjustments).

  • Adjust (based on Ins): axiUm transfers the balance to the patient or writes off the balance, as specified in the insurance company setup.

    • Note: This option allows axiUm to use adjustments or Intelli-adjustments.
For Over Pmt

A drop-down list that indicates how axiUm deals with overpayments on claims:

  • Add payment, no adjustments: axiUm adds the insurance payment allocation and leaves the debit balance unadjusted.

    • Note: This option prevents axiUm from applying adjustments, so users must apply adjustments manually.

  • Change tx to match: axiUm rebills the treatment and the treatment fee to match what the insurance paid.

    • Note: This option prevents axiUm from applying adjustments, but permits axiUm to automatically rebill treatments for the amount that insurance covered (preventing manual adjustments).

  • Adjust (based on Ins): axiUm transfers the balance to the patient or writes off the balance, as specified in the insurance company setup.

    • Note: This option allows axiUm to use adjustments or Intelli-adjustments.
Debit

A text field that indicates the adjustment code used for debit insurance payment adjustments.

The ellipsis is used to display the Adjustment Codes window and select an adjustment code.

Note: This is the default code used for non-claim based debit type provider adjustments.
Credit

A text field that indicates the adjustment code used for credit insurance payment adjustments.

The ellipsis is used to display the Adjustment Codes window and select an adjustment code.

Note: This is the default code used for non-claim based credit type provider adjustments.
Task Procedure
Add EDI Remittance Overrides
  1. Click the Clear Data () icon.
  2. Complete the fields as necessary and click the Add a new Record () icon.
Edit EDI Remittance Overrides
  1. Select a listed entry.
  2. Edit the fields as necessary and click the Modify Record () icon.
Delete EDI Remittance Overrides
  1. Select a listed entry and click the Delete Record () icon.
  2. When prompted, click Yes to confirm the deletion.