Billing - New Manual EDI Billing Batch 837

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.

All three procedures must be completed for the EDI/837 transmission file to be generated for resubmission to the funding source.

*Please note: EDI/837 needs to be enabled in your organization’s instance-level setting and enabled on the funding source. Please submit a support ticket for assistance. For customers using Claims Manager, only use this process for modifications that cannot be made in the portal. These updates and corrections to data are made in the EDI file generated in a billing batch. Also use this process for claims that are not created in portal (i.e., fee-based claims). 

Roles: Super User, Billing Team

Permissions: N/A

Billing - New Manual EDI Billing Batch 837 Claims Manager.pdf

1.   Create Manual EDI/837 Billing Batch

1. Log in to your personal profile

2. Select Billing from the main menu

3. Select Batches from the submenu

4. Click the Actions button

5. Select New Manual EDI/837 Billing Batch from the drop-down menu

6. Complete the form wizard on the Create Manual EDI/837 Billing Batch screen

   1. Required Fields

      1. Name – Type Batch Name

      2. Funding Source – Select Funding Source from the drop-down

         1. Please note: If your funding source is not listed, EDI/837 has not been enabled for the funding source. Please submit a support ticket for assistance.

      3. Select Next

      4. Review the Batch Summary tab in the form wizard

      5. Select Save

      6. Select Yes in the confirmation alert window

   2. The Batch Details page will be displayed. The batch is created and in approved status.

      1. The batch will be listed in the Batches table. To view the batches table, select Billing on the main menu and Batches on the submenu.

   3. Take note of the Batch ID for the manual EDI/837 billing batch created to update in the EDI/837 CSV file

2.  Download and Update EDI/837 Raw Dump File

1. Log in to your personal profile

2. Select Billing from the main menu

3. Select Batches from the submenu

4. Locate the Batch with the EDI/837 CSV file needing to be updated and manually processed

5. Select the Batch from the Batches table by clicking anywhere in the batch row

6. In the EDI Details widget on the Batch Details page, select the blue hyperlink for the EDI/837 Raw Dump File to download

   1. Please note: The EDI/837 Raw Dump File template is specific for the funding source

7. 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

8. 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.

   1. ClaimTypeCode

   2. ICN

   3. PayerIdentifier

   4. ProviderId

   5. FundingSourceName

   6. PayerClaimControlNumber

9. Optional column header:

   1. clientGender

      1. M = Male

      2. F = Female

      3. U = Unknown

      4. Blank

   2. If an invalid value is provided, the gender sent to Claims Manager is blank.

10. If your organization utilizes Claims Manager, additionally complete the following:

    1. Update the ClaimTypeCode column - This number tells Claims Manager what type of claim it is:

       1. 1 = Replacement claim

       2. 7 = Corrected claim

    2. Update the PayerClaimControlNumber column

       1. The Control Number is located on the Claim Details page in the Claim Payment Details section in Claims Manager

11. Update and make corrections to data for successful EDI/837 file generation/upload

    1. Examples: Medicaid numbers, authorization numbers, fields listed on the EDI/837 Raw Dump File

    2. Please note: Updates or corrections made within the file will need to be corrected within DCI for future billing batches to be successful

12. Save the file

3.  Upload EDI CSV and Generate EDI for Manual EDI/837 Billing Batch

1. Log in to your personal profile

2. Select Billing from the main menu

3. Select Batches from the submenu

4. Select the Manual EDI/837 Billing Batch from the Batches table by clicking anywhere in the row of the batch

   1. The manual EDI/837 billing batch was created in procedure #1 – Create Manual EDI/837 Billing Batch

5. Select the Upload EDI CSV and Generate EDI button

6. Click the Add Attachment next to Choose File

7. Locate the updated file for upload

   1. This is the file updated from procedure #2 - Download and Update EDI/837 Raw Dump File

8. Select the file and click open

9. DCI will upload the file and display a success message in the Upload EDI/837 Raw Dump File and Generate EDI/837 window

   1. If an alert displays in the Upload EDI/837 Raw Dump File and Generate EDI/837 window, the file is not configured as per the funding source. Please review procedure #2 - Download and Update EDI/837 Raw Dump File.

10. Click Save

11. Click Yes in the confirmation alert window

12. The Batch Details page will be displayed, and the status will be EDI/837 Generation InProcess.

    1. This process can take up to ten minutes

13. The status will update to EDI/837 Generated

14. Select the file next to the EDI/837 Transmission File field, in the EDI Details widget.

15. Select the file next to the Name field in the Attachment Details widget to download.

16. Save the file

17. Proceed with your organization and funding source file upload procedure

Related articles