Sending Electronic Secondary Claims

Note: If you are using InterfaceEDI's ERA Autopost module you can complete all steps below with 100% accuracy in just 1 click with the "Record" button.

1. Ensure the claim is ready to be sent electronically. To be ready, a claim must meet the following 4 requirements:
    A. The Primary claim must have an insurance payment in Medisoft (even if the payment is $0)
    B. The Primary claim status must be marked as “Done
       
   
    C. The Secondary claim status must be marked as “Ready to Send
    D. The Secondary media type must be marked as electronic (EDI) and the secondary receiver must be filled in.
     
       
2. Once your Secondary claims have met these conditions. Open the InterfaceEDI software. (Claim Management ->Pint/Send -> Electronic -> OK)
3. Before sending a secondary electronic claim you must attach the primary EOB information. Click the Second icon on the toolbar to prepare your secondary claims.
4. You will see a list of all the claims in your system that are ready to be prepared or sent electronically. The "Status" column will show the claim number from claim manager.
    Click the claim number of the claim you wish to add Primary EOB information for and click "Basic" in the top right hand corner.
   

5. On the payment detail screen you will see a list of all the transaction attached to the claim. Each transaction will have an unexplained balance in the bottom left corner. You can click the "Best Guess Adjustment" button (the calculator with the blue circle) to have EDI guess what adjustments were on the Primary EOB based on the payments, adjustments, and allowed amounts in your system. This method is NOT 100% accurate if there are special remark codes or amounts on your EOB.
    

6. The information from the Primary EOB will appear in the middle section. Remember that this information is specific to the transaction highlighted in the top section. Each transaction will have its own remittance information. Verify that the information in the middle section matches the codes and amounts on your EOB. If they do skip to step 10.

7. If a remittance code or amount needs to be modified, click on the line you wish to modify and click the Calculator icon with the pencil on it.
8. On the Adjustment Group screen you can modify the Reason Code and amount, but NOT the Group Code. If you have more than one Reason Code with the same Group Code you can add them on each subsequent line below the first. Click Save to close the Adjustment Group window once you have made your desired changes.
    
   
9.
If you need to add a new group code click the green book icon. The drop down box on the top of the window will allow you to select from a list of standard group codes. Enter the Reason Code from your EOB in the labeled column  and the amount in the box next to it. Example: if your EOB says CO-45 21.50 you will enter CO as the group code, 45 as the Reason Code, and 21.50 for the amount.

10. Click the Save button in the bottom right corner and then close the Transaction Payment Detail window. You will notice that the box next to the claim number is now checked. This indicates that the claim is ready to be sent.
11. Go back to the main InterfaceEDI window, click the Send Claims button, select Secondary Claim Sequence, and click Send Claims.
    

12. After reviewing and closing the EMC verification report, click Yes to send your claims.