Submitting Test Claims to Your Clearinghouse

Now you are ready to send test claims!


About the Test Claim Process

You will set up your clearinghouse configuration, which will ensure your electronic claim files are properly formatted. You will then create a test claim file and submit it to the clearinghouse. Oftentimes you will get a response back indicating that one or more changes are required. We will work with you to make any necessary adjustments until the file passes successfully. The good news is that this is typically a one-time process, and once you have the proper configuration, you will never need to repeat it.

 

Note: The claims files you create can be sent directly to a payor, but for this article, we will use terminology as if you are sending to a clearinghouse. The process is identical with the difference being that a file sent to a clearinghouse can include claims from multiple payors. 

Setting Up Electronic Claim Transmission

  • Go to BillingTracker > Settings > Electronic Claim Transmission Setup
  • Enter Your Clearinghouse details.
  • Verify the Service Location ID setting is correct.
  • Verify the Send Provider Commercial Number (REF*G2) is correct.
  • Note: If you are unsure what these settings should be, you can submit test claims and make adjustments based on the responses.

Creating Your Test Claims

You will need to submit a test batch to the Clearinghouse with 10 - 15 claims for various insurers. To do this you will need to identify a patient for which you would like to create these claims. Some clinics use actual patients and actual claims. If you choose to do so, skip to the next section, otherwise identify a patient or create a test patient and follow the steps below:

  • Go to: BillingTracker > Manage Accounts > [select patient] > Manual Claim.

  • Responsible Party Select Client.

  • Enter Client Address - do not use special characters ($%#).

  • Select a Billing Provider and Location.

  • Select a Program.

  • Select an Insurer from the Company dropdown.

  • Enter Policy Number 12345 for testing.

  • Select Client from the Patient Relationship dropdown.

  • Enter Client Address do not include special characters.

  • Click the + next to Diagnosis.

  • Select a Diagnosis.

  • Click Update.

  • Click the + next to Service.

  • Select a Service.

  • Enter Quantity 

  • Update

  • Select No to assign the balance to the payor.

  • On the Manage Account screen, highlight the newly created claim and go to the Claims tab

  • Highlight the claim and click Add Similar

  • On the Edit Claim screen, change the Company to a different insurer

  • Click Update

  • Select No to assign the balance to the payor.

  • Repeat steps 18-22 to create claims for each insurer that will submit claims via the Clearinghouse

Creating and Submitting Your Test Batch

After you've created the test claims, you will need to batch them and send them to the Clearinghouse using the following steps:

  • Go to BillingTracker > Claim Management.

  • Select Queued in the Claim Status dropdown.

  • Select Electronic Claim in the Claim Type dropdown.

  • Select Queued in the Date Filter dropdown.

  • Enter the Date that you created the test claims.

  • Select the name you set up (e.g. TriZetto) in the Transmission Type dropdown.

  • Click Display Claims.

  • You should see all the test claims listed below.

  • Highlight the claims and click Process Claims.

  • Press OK to confirm.

  • If you see a message stating "Exceptions were reported, please review the log file. Would you like to view the submission batch details?", click Yes and then click Log (small button at the bottom).

  • A folder on your computer will open.

  • Double-click the highlighted file and look for the exceptions reported at the end of each claim.

  • To requeue your claims please see the section below labeled Requeue and Resubmit Test Batch.

  • Skip to the next step if you do not receive the Exceptions Were Reported message.

  • Click Yes If you see the message: Would you like to open the FTP utility?

  • Click Connect (upper right).

  • Highlight the batch file you have just created.

  • Go to your Remote Desktop and open the claims folder. (The folder labels may vary by clearinghouse).

  • Click Upload and then disconnect.

  • Your claims have been sent to the clearinghouse.

Requeueing and Resubmitting Your Test Batch

  • Go to BillingTracker > Claim Management.

  • Select Pending in the Claim Status dropdown.

  • Select Claim Type in the Electronic Claim dropdown.

  • Select Queued in the Date Filter dropdown.

  • Enter the date that you created the test claims.

  • Select the name you set up (e.g. TriZetto) in the Transmission Type dropdown.

  • Click Display Claims.

  • Highlight all of the claims that you will be resubmitting.

  • Click the Requeue All Claims button on the bottom of the form.

  • Click on Clear Results.

  • Select Queued from the Claim Status dropdown.

  • Click Display Claims.

  • You should see all the test claims listed below that you are ready to process.

  • Highlight the claims.

  • Click Process Claims.

  • Click OK to confirm

  • Click Yes If you see the message Would you like to open the FTP utility?

  • Click Connect (upper right)

  • The newly created batch will be highlighted.

  • Go to your Remote Desktop and open the claims folder. (The folder labels may vary by clearinghouse).

  • Click Upload and then disconnect. 

  • Your claims have been sent to the clearinghouse.

Reviewing Your Test Results

Within a few days after you submit the test file, you will receive an email from the Clearinghouse with the results of the test batch.

Turning Off Test Mode

  • Go to BillingTracker > Settings > Electronic Claim Transmission Setup
  • Select Transmission Type.
  • Uncheck Test.
  • If you do not receive the results email, please open a support ticket to let us know.

 

 

 

 

 

Was this information helpful?
-