4. Setting Default Claim Options/Base Export Path
Setup how paper and electronic claims are exported from the system.
Tools -> Billing Maintenance -> Claims Options
Paper Claim Options
1. Default Printer: Select from the drop down to set the default printer when printing paper claims.
2. Print Full CMS Form: If not using preprinted CMS 1500 forms, check Print Full CMS form to print the entire claim form, including the red lines (must have color printer).
3. If using preprinted CMS 1500 forms, leave blank. Only text will print.
Most printer manufacturers install a PCL (Printer Command Language) driver by default. This works well if printing documents in plain text with very little formatting, e.g., a word document on a home computer. However with the complexity of forms and page layouts, selecting a PS (Post Script) Print Driver instead of a PCL driver is recommended. This type of printer driver will handle the forms information most efficiently. SOAPware recommends using a business grade printer, or a color laser jet printer, if selecting Print Full CMS Form.
Note: Selecting Print Full CMS Form will print the front of the CMS 1500 only, and will not include the print on the back of the form. If a payer requires the standard front and back of the CMS 1500 form, the claim will not be acceptable.
SOAPware does not support printers/scanners. Meaning that SOAPware does not install printer drivers or set printer configurations. Please contact an IT person for additional hardware matters. However, it is recommend to download the most recent printer drivers needed from the manufacturer's website. It is usually a FREE DOWNLOAD. For any issues locating the driver needed, please contact the manufacturer directly. Be cautious of downloading drives from an alternate source other than the printer manufacturer.
Electronic Claim Options
1. Office Contact: Enter the name of a person within the office that clearinghouses can contact if any issues arise.
2. Office Contact Phone: Contact Phone Number.
3. Office Contact Fax: Contact Fax Number.
4. Office Contact Email: Contact email address.
5. Output Path: Specify a file location to which a copy of the claim file will be saved. Note: Make sure that the Save Local Copy box is checked to save your claim files to a local file. If more than one person in the office works with claims, it is recommended that this file path be stored in a shared file/drive to allow any computer/user to access the claim files.
6. Auto Submit: If this box is checked, electronic claim files will be automatically uploaded to the clinic's TriZetto site. You will have to have the correct information entered in the Clearinghouse fields in the section below to ensure this will work correctly. Leave blank if manually uploading claim files to TriZetto.
7. Save Local Copy: Check this box if you would like to store a copy of your claim files on a local drive/file location. If you have Auto Submit and Save Local Copy checked, files will automatically upload to TriZetto and you will have the claim file stored in a local drive, if the file needs to be resubmitted.
1. Name: Indicates the name of the Clearinghouse.
2. Clearinghouse ID: If using TriZetto as your clearinghouse, enter the following number in this field: 431420764
3. Receiver Qualifier: If using TriZetto as your clearinghouse, select Mutually Defined - ZZ from the drop down list.
4. Receiver ID: If using TriZetto as your clearinghouse, enter the following number: 431420764000000
5. User Name: Enter the 4 digit site ID. This number is assigned by TriZetto.
6. Password: This password will be given to you by TriZetto. This password is necessary in order to auto submit your claim files using their sftp site.
7. Server: If using TriZetto as your clearinghouse, enter the following: sftp.gatewayedi.com
8. Testing: Only check this box if you are instructed by the receiver to do so. IMPORTANT: TriZetto prefers live claims for testing. They will manually review the file and if it passes, they will forward on to payers.
9. Accept Assignment: Check this box if you would like to default to Accept Assignment on all claims. Options are Yes, No, or Lab Charges Only. This can be overridden at the claim level, if needed.
Note: Selecting Lab Charges Only will apply to electronic claims only, and will not automatically split lab charges from other charges for paper claims. If this option is selected and a paper claim is printed, the Accept Assignment box will default to No.
10. Click Okay to save.