BILLING METHODS

The Billing Methods tab stores the configuration for the standardized formats used by Behavioral Health Care organizations to submit claims electronically and by paper. The Billing Methods available to configure are:

• 837 Professions (837P) - The standard format used by healthcare professionals and suppliers to transmit health care claims electronically.
• CMS 1500 - This form is used to bill Medicare Fee-For-Service (FFS) Contractors when a paper claim is allowed.
• 837 Institutional - The standard format used by institutional providers to transmit health care claims electronically.
• UB04 - The standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed. First available in the release of version 3.13.

In addition to billing Medicare, the 837P,  837I, CMS-1500 and UB04 may be suitable for billing various government and some private insurers. Most organizations have companion guides that provide custom specifications for transactions and EDI standards relating to providers, payers, and carriers the organization has a relationship with. Companion guides along with the ANSI ASCX12N 837 Transaction Set Implementation Guide should be referenced when configuring the billing method(s) for each Payer.

Get started by clicking on the blue plus "+" of the form to be configured.