This One Has Specific Requirements!
week 30 ECLIPSE® v11Today's industry standards require us to pay attention to some of the options specific to your specialty and carrier guidelines. The settings offered in the Payor database are uniquely different than the paper billing set-up that has worked in the past. Other settings are built in to your software for the region you are in. You should also keep in mind how this database could be affected by the configuration in the workstation set-up, the way your "CPT's" have been programmed and also the Provider database tables.
Set-up is pretty straight forward for basic demographics in the "General Tab".Many offices can leave the default settings for "service types on bills" and "expected ID from referring provider. The source of payment drop down menu selects the format for the entity receiving the claim. The results vary between paper and electric claims.
In the "printed claims options" you have a whole list of choices a few which will be standard for you and others are required for your regional settings. VERY important – one misused check mark here could mean a series of denied claims and lost revenue. The difference on paper claims vs. electronic claims also changes greatly in these options. Our research and development department is constantly keeping up with latest requirements and implementation the industry throws at us… so it's more important than ever to stay on software maintenance and be able to regularly update your software for state of the art features and mandatory compliance.
Finally the "Electronic Claims" tab allow you the options of configuring your claims to go paper, electronic through to a clearing house and/or the comprehensive format of ANSI billing direct to the carrier. With the electronic formats, today's technology even allows for automated "EOB" downloads for some carriers you may already be submitting to!
There are still a few of you out there that are not even using the billing aspect of ECLIPSE® or you don't have any software to submit claims. Your time is much to valuable not to take a little time to implement this standard let alone reduce the common formatting errors. Did you know 80% of the claims that get rejected don't even get to the adjuster due to formatting errors? It's also a fact, if you submit a paper claim – it is turned into an electronic claim when it hits the insurance company inbox! All they do is scan the piles of paperwork that comes in and process it just like the electronic claims that route directly. The real difference… administration, postage, paper and time!
If you're a smaller operation and you need a little help, call us – we can help. It's well worth the investment in today's economy.
goto: File> Database Tables> Payors>
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