Direct Submission of Claims

If your practice sends any or all claims directly to a carrier or clearinghouse, rather than sending them through EMEDIX (CompuGroup's clearinghouse), follow these instructions to use 'Direct Submission'.

Contact CompuGroup's EDI Department for assistance in setting up the Electronic Claims Integration for direct submission of claims.

The EDI Department will create, and/or assist you, in selecting the correct Insurance Form Number.

Sample Claims Integration

Data Field Information

Prompt	Response	Len
File Extension	Type the File Extension, which is generally a letter followed by the database number.	3
ECS Location	Select the location code that this type of claim is sent to from the Location Code list.	4
4010 Test/Prod Indicator	Select the appropriate option to indicate whether the submission of claims is in the Test phase or is in Production.	4
4010 DOS Download Path	Type the DOS path that the claims files will be downloaded to.	50
Interchange Sender ID	Type the Interchange Sender ID number.	15
Interchange Receiver ID	Type the Interchange Receiver ID Number.	15
Application Sender's Code	Type the Application Sender's code.	15
Application Receiver's Code	Type the Application Receiver's code.	15
EMC Provider ID/TAX ID Number	Type the unique number assigned to the provider for Electronic Medical Claims (EMC) identification purposes.	15
Receiver Name	Type the name of the entity (insurance carrier/administrator) who will receive these claims files.	60
Site ID	Type the Site ID.	10
Direct Submission	If you are sending these claims directly to the payer rather than via EMEDIX, select this check box.	1
Primary Identifier	If filled in, this will be sent in Loop 1000B, Segment NM109 of the 5010 electronic claim file which is poplated by the Receiver Code.	80
5010 Format	If claims are to be sent in 5010 format, select this check box.	1
5010 Test/Prod Indicator	Select the appropriate option to indicate whether the submission of claims is in the Test phase or is in Production.	1
5010 DOS Download Path	Type the DOS path that the claims files will be downloaded to.	50
MyReports	Type the Interchange Sender ID number.	1
Include NPI Numbers in Claims	If you want the NPI numbers from your tables to be included in the electronic claims, select this check box.	1
Suppress Legacy Numbers	If you want to suppress all legacy numbers from being included in the electronic claims, select this check box.	1
Hold Claims	If you want to hold claims from being submitted, select this check box. All claims for this Insurance Form Number will be held until you clear this check box. The held claims will appear on the Exception Report until they are transmitted electronically or moved to paper.	1
Split by GS	Enter 'Y' to generate separate file per submitter (for direct sends only)	1

NOTE:

In the File Extension field, use a letter and then the Insurance Form Number to be able to easily identify the correct claim insurance file later.
The insurance file is generated into the location specified in the DOS Download Path field.
You must select the Direct Submission check box.

When it is time for you to send your claims, go through the normal Processing Insurance Claims steps until you get to the Send Claims step. Instead of using the Prepare/Send Transmission File function, select Prepare Direct Submission File (Billing, Insurance Billing Functions, Electronic Claims).

The file generates and the screen displays the progress. The result is either Done or No file to send. Regardless, click Proceed in the lower right corner of the screen.

You can then proceed by printing the Transmission Journal.

You are responsible for the steps necessary to transmit the claim file directly to the carrier/clearinghouse.