Different way of electronic claim submission EDI

How Does It Work?

Providers have several alternatives for entering and electronically submitting claims data:

• Providers may work through a software vendor who can provide the level of practice management system support they need for their practice.

• Providers may submit their Medicare Part B claims directly to TrailBlazer Health Enterprises® or choose to submit claims through a clearinghouse.

Providers may choose to have a billing agent handle all or part of their Medicare billing.

• If the provider’s office has the required hardware, it may choose to use Medicare’s free billing software.

Welcome to the exciting world of electronic billing! If a provider is new to the concept of electronic claims submission or has never used a computer, the following tips and hints may make the transition to a computerized billing system easier.

• When buying or leasing a system, deal with a knowledgeable, established vendor. Avoid the temptation to base a buying decision solely on price. Ask for references from current users of the systems considered and check them. Providers should try to find another provider in their specialty that is using that particular software or someone who has billing practices similar to their office.

• A dedicated phone line is recommended; this will eliminate interrupted transmissions.

• Regularly make backups of all patient and claim data. Disaster-recovery procedures suggest two backup files be kept – one on-site and one off-site. Keep backups in a safe and protected place. In the event of fire or system problems, a current backup will enable a provider to reconstruct his office’s records.

• If the office is prone to power blackouts, brownouts or voltage surges, consider using an Uninterruptible Power Supply (UPS) with a built-in surge suppressor to protect equipment. During severe weather, disconnect the system’s modem from all phone connections to prevent damage.

• If the system has difficulty connecting, check the submitter number and password to be sure they are correct and are in uppercase letters. Most connection problems can be traced to invalid submitter numbers or passwords.

• If transmitting claims directly to TrailBlazerSM, always read the response file received. This report tells the provider what was received, when it was received and whether it was accepted. For questions about the report, contact the EDI Technology Support Center at (866) 749-4302. If filing claims through a clearinghouse, providers should contact their representative there for a copy of their response file.

• Changes in Medicare filing requirements are communicated in various newsletters and publications as well as listserv messages (if providers have signed up to receive EDI information via listserv). Read these carefully for advance notice of enhancements and changes for the electronic billing environment.

• Often, new computer systems can have issues that need to be resolved. Be patient and give it a chance; all change takes an adjustment period.

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