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Set the Default Claim Options & Base Export Path

Q: How do I set the default claim options and base export path?

*Note: PM Setup

The Practice Management setup process must be completed in a specific order.  Please follow the setup lessons for step-by-step instructions.

1. Open Billing Maintenance > Claim Options

1. Open Billing Maintenance > Claim Options

Click on the Tools menu, then select Billing Maintenance > Claims Options.

2. Setup Paper Claim Options

2. Setup Paper Claim Options
  1. Default Printer: select the printer that should be used to print paper claims from the drop-down menu.
  2. Print Full CMS Form: check the box if you are not using the pre-printed CMS 1500 forms.  This will print the entire CMS form including the red lines (must have a color printer).

3. Setup Electronic Claim Options

3. Setup Electronic Claim Options
  1. Office Contact: enter the contact name for the staff member who will be the main contact for GatewayEDI.
  2. Office Contact Phone: enter the phone number where the office contact can be reached.
  3. Office Contact Fax: enter the fax number where the office contact can be reached.
  4. Office Contact Email: enter the email address where the office contact can be reached.
  5. Output Path: specify a file location to which electronic claims will be exported. 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 multiple people to access the claim files.
  6. Auto Submit: check the box to indicate that electronic claim files should be automatically uploaded to the clinic's GatewayEDI site. If you wish to manually save and upload claim files, leave the box unchecked.
  7. Save Local Copy: check the box to indicate that a copy of the claim files should be stored on a local drive.  If you have Auto Submit and Save Local Copy checked, you will be able to both auto submit your files to Gateway EDI, and you will have the claim file stored in a local drive, in case any discrepancy comes up, and the file needs to be re-uploaded.

4. Setup Clearinghouse Options

4. Setup Clearinghouse Options
  1. Name: enter the name of the clearinghouse (ie: Gateway EDI)
  2. Clearinghouse ID: enter the ID number for the clearinghouse (*Note: If using GatewayEDI, enter 431420764).
  3. Receiver Qualifier: enter the receiver qualifier (*Note: If using GatewayEDI, enter Mutually Defined - ZZ).
  4. Receiver ID: enter the receiver ID number (*Note: If using GatewayEDI, enter 431420764000000).
  5. User Name: enter the four digit site ID that has been assigned to the clinic by GatewayEDI.
  6. Password: enter the password giving to the clinic by GatewayEDI.  This password is needed to auto submit your claim files.
  7. Server: enter the clearinghouse server (*Note: If using GatewayEDI, enter sftp.gatewayedi.com).
  8. Testing: this box should only be checked if a test file to GatewayEDI is being sent. IMPORTANT: For your first claim submission to Gateway EDI, do not check this box. Gateway prefers to have live claims sent to them. They will manually review the file first and if everything looks good, they will forward it on to the payers.
  9. Accept Assignment: select Yes if you would like to default all claims to accept assignment. This can be overridden at the insurance company and claim level if needed.