How to start billing
electronically
Print this guide
which contains helpful hints, suggestions and ideas
to consider when choosing an electronic claim submission
system.
Choosing a Vendor
Questions to ask Vendors:
- Does the Vendor submit claims to Oregon carriers?
- What are the costs for installations and upgrades?
- How much time does the Vendor guarantee for training?
- How much does the Vendor charge you to connect with
each Carrier?
- What type of customer service does the Vendor offer
(west coast hours)?
- What type of on-site customer service will you receive
if system problems occur?
- How prompt are the Vendors upgrades when changes
occur in the electronic claims formats?
- Does the Vendor test system changes before upgrading
your system?
- Will you be provided with references from the Vendor?
- Ask the Vendor to provide you with a list of cost
savings by using their system. How long will it take
you to recoup your initial investment?
Questions to ask the
Vendor's references:
- How long have they had the system in their office?
- How long did the installation and training take?
- Was the Vendor prompt when correcting system problems?
- What do they like best about the system?
Questions you could
be asked by a Vendor:
- Why type of computer hardware and software do you
currently have in your office?
- How many carriers will you need to bill?
- Where is your office headed in the future?
- What are your long term goals?
- What are your short term goals?
- Will any physicians or other professional providers
be retiring soon?
- Are there any office mergers in the foreseeable
future?
- Will there be any increases or decreases in
claim volume?
Submitter ID Number
Download an enrollment packet from Availity, LLC
or contact the Availity, LLC EDI Helpline via phone at (866)274-4923
or by e-mail at THIN@THINedi.com. This allows you to begin the claims submission process
with Availity, LLC.
Hardware and software
requirements
Dial-up:
Your claims file is transmitted using one of four popular
asynchronous telecommunication protocols: Kermit, Zmodem
(Check Sum), Ymodem (Batch), and Zmodem at speeds up
to 56 kbps. Most off-the-shelf communication software
will support one or all of these protocols. Some examples
of communication software packages are: proComm Plus
2.01 (DOS) or 2.11 (Windows), Crosstalk 2.2 (Windows),
QuickLink2 1.4.3 (Windows), PC Anywhere 5.0 (DOS) or
2.0 (Windows), Term 6.1, 6.2 & 6.3, Mlink 6.07 and
Hyperterminal which is included in Windows 95, 98, 2000
& NT.
Internet:
You can submit your electronic claims via Internet FTP
which requires that you have PGP encryption. You can
obtain more information about PGP encryption at www.pgp.com.
You can download enrollment forms from Availity, LLC.
Testing
Testing will only be necessary if the software vendor,
billing service or claims clearinghouse does not already
have clients submitting through Availity, LLC. You will send
Availity, LLC your test claims and they will check the integrity
of your data (correct diagnosis codes, ID numbers, programming
by your vendor, etc.). Contact Availity, LLC prior to submitting
test claims during this phase. You can request to move
from test to production once you receive clean test
reports by sending in an EMC Production Request Form.
Live claims should be submitted on paper during this
phase. Go to http://www.thinedi.com/downloadforms.htm
to download the testing requirements from Availity, LLC.
Submitting production
claims
Production claims (which are claims you expect to receive
payment for, submitted after the testing phase) may
be submitted 24 hours a day.
Payor IDs
Use the following Payer ID’s when sending Regence
BCBSO claims and other Regence sponsored payers:
|
Payer Name |
ANSI Payer ID |
NSF Payer ID |
Regence BCBSO |
G00851 |
00851 |
Noridian Medicare Part B |
COR001 |
OR001 |
For a list of commercial payer ID’s please go
to http://www.thinedi.com/ where you can download the most current payer list from
Availity, LLC.
Note: To view and print the documents listed on this
page, you must have the Adobe® Acrobat® Reader
installed. Get more information and/or download the
free Adobe
Acrobat Reader.
|
