Electronic Direct Connect Claims Integration

With the Electronic Direct Connect Claims Integration function, you can enter the information required to set up each type of electronic claim your practice will be sending.

Note: You must contact the EDI Department to complete the registration process prior to sending claims. They will also provide detailed information on completing the Electronic Claims Integration screens.

Upon accessing this function, you need to select the Insurance Form Number you want to set up.

Sample Screen Shot for - Medicare (30)

Data Field Information
Prompt Response Req 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 the 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 populated 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

Click Mlt Submitter ID's in the Action Column to enter and store multiple Submitter ID's for multiple Tax ID's. Type the Tax ID in the Tax ID column and the corresponding Submitter ID in the Submitter ID column. In this example there are three different Tax ID's requiring three different Submitter ID's for claims sent under Form Type 30 (Medicare) so, when a claim is sent for Tax ID 99-9999999, the claim would be sent with Submitter ID JUX8763.