Several items are required in order to transmit insurance claims to the clearinghouse. The user may see an error message after clicking on Create Claims on the Create Insurance Claims tab if the information entered is incorrect or incomplete.
Possible Solutions:
- Create a charge for the patient.
- Clear or correct the "Patient Type" drop-down filter.
- Clear or correct the "Provider" drop-down filter.
- Check the "Contracted" box by clicking Persons & Institutions | Insurance Companies | Provider Information.
- Clear or correct the "Facility" drop-down filter.
- Check the "Billing status" checkbox for the insurance company by clicking Billing | View/Edit Charges.
- Date of service was not included in the date range set when creating claims.
- Add a missing CPT code by clicking Billing | View/Edit Charges on the view/edit detail for the charge.
- Add a place of service by clicking Billing | View/Edit Charges on the view/edit detail for the charge.
- Add a missing diagnosis by clicking Billing | View/Edit Charges on the view/edit detail for the charge.
- Uncheck the “Charge to patient only” box by clicking Billing | View/Edit Charges on the view/edit detail for the charge.
- Clear or correct the "Insurance Company" drop-down filter.
- Add EDI Payer ID to insurance company by clicking Persons & Institutions | Insurance Companies.
- Change the "Claims format" drop-down to "CMS-1500 (2/12)". If the claim is generated using this setting, the EDI Payer ID is missing in Persons & Institutions | Insurance Companies.
- If the Primary insurance payment did not come in via ERA, it is not possible to submit secondary claims electronically.
- Ensure the "Insurance 1" or "Insurance 2/3" button is set correctly for the type of claims to be submitted.
- For secondary claims, uncheck the "Crossover/dual coverage" box listed under the primary insurance tab by clicking Billing | View/Edit Charges.
- For Medicare/Tricare, ensure that the "Accept Assignment" box is checked by clicking Persons & Institutions | Providers.
- Ensure both Primary and add-on code are set to "Re-bill" by clicking Billing | View/Edit Charges.