Q: I want to send ANSI 837 claims, is My Vision Express capable of generating them?
A: Yes
Q: Where do I generate ANSI 837 claims in My Vision Express?
A: For single claims, you can generate ANSI 837 claims in the Insurance module under Supplier tab by selecting ANSI 837 option and clicking the Electronic button. For batch or multiple claims, go to the menu File | Reports | Insurance | HCFA/CMS 1500.
Q: How do I generate the ANSI 837 claim.
A: Create a claim in the Insurance module. After filling up all necessary information, go to the Provider Tab. Click on the ANSI 837 Radial Button found on the right portion of the screen. Click on the Electronic Button. This will generate the ANSI 837 claim. You can upload this file to your clearing house using their website or other interface.
Q: I tried to generate an ANSI 837 claim but it says there are errors. Then it popped out a window (which looks like notepad), with error messages in it. What do I do?
A: When some required information is missing, the ANSI 837 claim cannot be generated. My Vision Express will generate an error report, as an example:
Interchange Receiver ID is missing. Please go to File | Setup | Company Information | Settings
Application Receiver Code is missing. Please go to File | Setup | Company Information | Settings
When this happen, follow the instructions indicated in the error report. In the example above, in order to fill out the Interchange Receiver ID, go to File | Setup | Company Information | Settings. Fill out the fields in question with the appropriate information. If you are not sure what to put in the fields call your clearinghouse and ask for the information, such as the Interchange Receiver ID. By following the instructions indicated in the error, you will be able to find where the missing information is and fill it with the proper data.
Q: What is the required setup to generate ANSI 837 claim?
A: You need to go to the File | Setup | Company Information screen. Click on the Settings Tab. You need to fill the fields in the Insurance Clearinghouse for ANSI 837 Group Box.
Q: There are two or more doctors in our practice but we bill our claims as a single entity or group. Is My Vision Express capable of handling this when generating ANSI 837 claims?
A: Yes. My Vision Express can handle a group practice, such that multiple doctors or providers can bill and get paid as a group. You have to check the Group practice for electronic claims submission using ANSI 837 Checkbox. This checkbox can be found in the File | Setup | Company Information, under the Settings Tab.
Q: I am using or plan to use Gateway EDI as my clearinghouse. Is My Vision Express certified to send ANSI 837 claims to Gateway EDI?
A: Yes. My Vision Express is certified by Gateway EDI to send ANSI 837 claims to them. In fact Gateway EDI is one of our partners for sending ANSI 837 claims. We have also made it easy for clients to setup My Vision Express to use Gateway EDI by making relevant information such as Interchange Receiver ID and Application Receiver Code available in the Company Information Screen. You just need to copy them and type them in the appropriate fields (fields that are right beside them already).
Q: I am using or plan to use Availity as my clearinghouse. Is My Vision Express certified to send ANSI 837 claims to Gateway EDI?
A: As of December 2006, My Vision Express team is in the process of getting Availity certification. We actually have some customers that are already sending claims to Availity. Some of the relevant settings can also be found in the Company Information window, under the Settings tab, such as Interchange Qualifier and Acknowledgement Requested.
Q: I am using or plan to use other clearinghouse beside Gateway EDI and Availity, is this even possible in My Vision Express?
A: Yes. My Vision Express generates two formats of electronic claims Print Image and ANSI 837 that most clearinghouses accept. You can check with your clearinghouse which format they accept. My Vision Express generates ANSI 837 claims according to the 004010X098A1 implementation guide. You just need to set proper Clearinghouse information in the Company Information window under the Settings tab. Ask your clearinghouse the appropriate information for the fields related to the clearinghouse.
Q: I want to generate an ANSI 837 claim with BLUE CROSS BLUE SHIELD as the payer. I needed to put my PIN (Item #33 under the Provider Tab of the Insurance/Claim Screen), but my BLUE CROSS BLUE SHIELD PIN is not in the drop down. What do I need to do in order to have it there?
A: You need to do 2 things.
First, go to File | Setup | Categories screen. Click on the Provider Insurance category group. Add the category item BLUE CROSS BLUE SHIELD. You can add by clicking on the Add button, typing in BLUE CROSS BLUE SHIELD and then clicking on the Save button.
Second, go to File | Setup | Provider. Select your specified provider. On the lower right portion, there is a group box called Insurance. Click on the Add Button. Type in your Blue Cross Blue Shield PIN for the Insurance Number. Select BLUE CROSS BLUE SHIELD for the Insurance Type. Click on the Save Button.
Close My Vision Express and reopen it. Go back to your claim and to the Provider Tab. Click on the PIN, the BLUE CROSS BLUE SHIELD pin drop-down should already be there. Choose that PIN and generate your ANSI 837 claim.
Note: In order for claims to be properly generated, the PIN should exist in this dropdown. This is true for most claims including Medicare, Medicaid, Blue Cross Blue Shield. There are specific qualifiers for those claims and they need to be properly designated as either Medicare, Medicaid or Blue Cross Blue Shield.
Q: What other qualifier specific claims need to have their own entry in the Item #33 PIN dropdown?
A: The list below contains PIN types needed to be in the dropdown should you file claims that needs them:
§ STATE LICENSE
§ BLUE CROSS BLUE SHIELD
§ MEDICARE
§ MEDICAID
§ UPIN
§ CHAMPUS
§ EIN
§ LOCATION
§ PPNI
§ SSS
§ SIAP
All other types will be qualified as COMMERCIAL.
Q: I tried to generate a batch ANSI 837 claims in the File | Reports | Insurance | HCFA/CMS 1500 screen, but the file contains only four lines of entries. I thought ANSI 837 claims should have more lines of entries than that. What is happening?
A: The criteria you have put in may not be returning the claims you wanted to submit. Make sure that you put in the correct criteria such as the Date submitted range. Check the claims you want to include in the batch by going to the Insurance/Claim Screen to make sure that they will fall in the criteria you specified. Check the date submitted, claim status, and insurance type.
Q: How do I send this ANSI 837 file to my clearinghouse?
A: Mostly this is done by uploading the file to your clearinghouse's website. You may need to login with your username and password to use your clearinghouse's services.
Q: I understand that in ANSI 837 there is a billing provider address. I have not put in any billing provider address in the Insurance/Claim Screen in My Vision Express. Where is the billing provider address being taken from?
A: The billing provider address is taken from your Company Information address.
Q: When I create a new claim in the Insurance/Claim Screen, My Vision Express defaults the Facility address to my Company Information address. What if I rendered the service at another facility which is not in the same address as my company address? If I change the facility address to a different address Will My Vision Express generate a correct ANSI 837 file with a different facility address?
A: Yes. The Version 4.20 and above of My Vision Express is capable of generating ANSI 837 files with facility address different from your company address.
Q: What is loop 1000A and loop 2010AA? Is Loop 2010AA a type of eye exam result in ANSI 837? What does this have to do with me?
A: Loop 1000A is the Submitter Name according to the ANSI 837 specifications. While Loop 2010AA is the Billing Provider Name. Loop 2010AA is NOT an eye exam result in ANSI 837. The terms loop 1000A and loop 2010AA should not have any thing to do with you. This is a technical term in ANSI 837. Ask your clearinghouse or any other person talking to you with regards to ANSI 837 to talk in layman's terms such as Submitter Name, or Billing Provider Name. There are too many technical terms in ANSI 837 that you should not be bothered with.
Q: Do you have clients that are actually using this ANSI 837 generation in My Vision Express?
A: Yes.
Q: The claim filing indicator code in loop 2000B segment SBR09 should be "MB" for DMERC (DME DMEPOS DURABLE MEDICAL EQUIP) claims – the qualifiers in loops 2010AA and 2310B REF01 should be "1C".
A:To correct: DMERC claims are basically medicare claims, so we need to make the Item #1 in the Insurance/Claim window to be an insurance type of Medicare. And we also need to correct the PIN number and type that you are sending. There are four sets of things we need to do:
I.
a.) Go to File | Setup | Insurance.
b.) Select the DMERC insurance company name you have in this Insurance Screen. (If you do not have DMERC then you need to add it with its corresponding information. I am assuming that you have it there)
c.) Change the insurance type to Medicare. The insurance type is in the lower right portion of the window.
d.) Save your changes.
e.) Close this window.
f.) For future claims, use this company for all your DMERC claims.
II.
a.) Go to File | Insurance. This is the Claim Screen.
b.) The Insurance Search Screen will open, select one of your DMERC claims.
c.) Change item #1 Insurance Type to Medicare.
d.) Save your changes.
e.) This should correct this single claim for the issue stated above.
f.) You must repeat this with each DMERC claim that you have, you need to change item #1 Insurance Type to Medicare for every DMERC claim.
g.) Alternatively you can change item #11c Ins plan to another insurance company and then change it back to DMERC. This should automatically change item #1 Insurance Type to Medicare since you already set it to Medicare in step I. above.
h.) Save your changes.
i.) You must repeat this with each DMERC claim that you have.
III.
a.) Go to File | Setup | Provider. This is the Provider Screen.
b.) Select the Provider that you have in the DMERC claim you are sending.
c.) On the lower right part, the Insurance Group Box, look for your DMERC insurance number and verify your DMERC insurance number.
f.) Change the Insurance Type of your DMERC number to Medicare.
g.) Save your changes.
h.) Close this window.
i.) For future claims, use this DMERC number in the item #33 PIN under the Provider Tab in the Insurance/Claim Screen.
IV.
a.) Go to File | Insurance. This is the Claim Screen again.
b.) The Insurance Search Screen will open, select one of your DMERC claims.
c.) Go to the Provider Tab.
d.) Change item #33 PIN by selecting your DMERC pin from the drop-down. Make sure that you select Medicare - xxxxxxx. That is the correct pin you should use.
e.) Save your changes.
f.) You must repeat this with each DMERC claim that you have.
g.) You can now generate your ANSI 837 file for the DMERC claims.
Q: For Medicare group/billing provider number (2010AA REF02), one on the digits is missing:
REF*1C*xxxxxx~ This should be "xxxxxx1".
A: The guide for correcting the second issue is included above in step III. and step IV., if you had followed the correction guide for the first issue, then this should already be resolved.
Q: The qualifiers in loops 2010AA and 2310B REF01 on their ANTHEM claims should be "1B". They are presently sending this as "G2".
A: Qualifier G2 means that the pin for the claim is being sent as a Commercial claim. Where as qualifier 1B means it should be sent as a Blue Cross Blue Shield claim. There are 3 sets of steps we need to do to correct this:
I.
a.) Go to File | Setup | Categories.
b.) For the Category Group, scroll down and select Provider Insurance.
c.) This will list all the Category Items.
d.) Check to see if Blue Cross Blue Shield is there. If it is already there then you can go to step II.
e.) If Blue Cross Blue Shield is not in the Category Items, you can add it by clicking on the Add Button and typing in Blue Cross Blue Shield. Make sure you correctly spell it. Also check if you have Provider Insurance selected as the Category Group.
f.) Save your changes.
II.
a.) Go to File | Setup | Provider. This is the Provider Screen.
b.) Select the Provider that you have in the ANTHEM claim you are sending.
c.) On the lower right part, the Insurance Group Box, look for your ANTHEM insurance number.
d.) Change the Insurance Type to Blue Cross Blue Shield by selecting it from the dropdown.
e.) If you do not have your ANTHEM insurance number then you can add it there by clicking on the Add Button. Type in the correct ANTHEM insurance number and select Blue Cross Blue Shield as the Insurance Type.
f.) Save your changes.
III.
a.) Go to File | Insurance. This is the Claim Screen.
b.) The Insurance Search Screen will open, select one of your ANTHEM claims.
c.) Go to the Provider Tab.
d.) Change item #33 PIN by selecting your ANTHEM pin from the dropdown. If you already have the correct pin there, the one with the Blue Cross Blue Shield insurance type then you don't need to do anything.
e.) Save your changes (if you changed your pin).
f.) You must repeat this with each ANTHEM claim that you have.
g.) You can now generate your ANSI 837 file for the ANTHEM claims.
Q: The qualifiers in loops 2010AA and 2310B REF01 on their CARESOURCE claims should be "G2". They are presently sending this as "1D".
A: Qualifier 1D means that the pin for the claim is being sent as a Medicaid claim. Where as G2 means it should be sent as a commercial claim. The steps for correcting this issue is very similar to the third issue. There are 3 sets of steps we need to do to correct this:
I.
a.) Go to File | Setup | Categories.
b.) For the Category Group, scroll down and select Provider Insurance.
c.) This will list all the Category Items.
d.) Check to see if Other is there. If it is already there then you can go to step II.
e.) If Other is not in the Category Items, you can add it by clicking on the Add button and typing in Other. Make sure you correctly spell it. Also check if you have Provider Insurance selected as the Category Group.
f.) Save your changes.
II.
a.) Go to File | Setup | Provider. This is the Provider Screen.
b.) Select the Provider that you have in the CARESOURCE claim you are sending.
c.) On the lower right part, the Insurance Group Box, look for your CARESOURCE insurance number.
d.) Change the Insurance Type to Other by selecting it from the dropdown.
e.) If you do not have your CARESOURCE insurance number then you can add it there by clicking on the Add Button. Type in the correct CARESOURCE insurance number and select Other as the Insurance Type.
f.) Save your changes.
III.
a.) Go to File | Insurance. This is the Claim Screen.
b.) The Insurance Search Screen will open, select one of your CARESOURCE claims.
c.) Go to the Provider Tab.
d.) Change item #33 PIN by selecting your CARESOURCE pin from the dropdown. If you already have the correct pin there, the one with the Other insurance type then you don't need to do anything.
e.) Save your changes (if you changed your pin).
f.) You must repeat this with each CARESOURCE claim that you have.
h.) You can now generate your ANSI 837 file for the CARESOURCE claims.