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Description: In this article, the user will learn how to create a new manual EDI/837 billing batch. This is a manual process to make updates and corrections to data in the EDI/837 file generated in a billing batch. Examples of why updates and corrections are needed to the EDI/837 file, incorrect data was submitted to the funding source, or the file was submitted and denied by the funding source for incorrect data i.e., Medicaid numbers or authorization numbers, etc. Any data updates or corrections made will need to be updated in DCI for future billing batches to be successful.
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All three procedures must be completed for the EDI/837 transmission file to be generated for resubmission to the funding source.
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Log in to your personal profile
Select Billing from the main menu
Select Batches from the submenu
Locate the Batch with the EDI/837 CSV file needing to be updated and manually processed
Select the Batch from the Batches table by clicking anywhere in the batch row
In the EDI Details widget on the Batch Details page, select the blue hyperlink for the EDI/837 Raw Dump File to download
Please note: The EDI/837 Raw Dump File template is specific for the funding source
Update the Batch ID number to the new manual EDI/837 billing batch ID number created in procedure #1 - Create Manual EDI/837 Billing Batch
Add the following column headers after the last column on the file. Please note, these columns must be present and in the format and order outlined below; however, data does not need to be present in the fields.
ClaimTypeCode
ICN
PayerIdentifier
ProviderId
FundingSourceName
PayerClaimControlNumber
Optional column header:
clientGender
M = Male
F = Female
U = Unknown
Blank
If an invalid value is provided, the gender sent to Claims Manager is blank.
If your organization utilizes Claims Manager, additionally complete the following:
Update the ClaimTypeCode column - This number tells Claims Manager what type of claim it is:
1 = Replacement claim
7 = Corrected claim
Update the PayerClaimControlNumber column
The Control Number is located on the Claim Details page in the Claim Payment Details section in Claims Manager
Update and make corrections to data for successful EDI/837 file generation/upload
Examples: Medicaid numbers, authorization numbers, fields listed on the EDI/837 Raw Dump File
Please note: Updates or corrections made within the file will need to be corrected within DCI for future billing batches to be successful
Save the file
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