EDI Generation and Claim Submission involves two main procedures such as Claim Generation and Claim Submission.

Generating Claims

Click on the Charges module and choose Submit Claims to open the Generate/ Batch Claims screen.

When the Generate/ Batch Claims window opens up, choose appropriate start and end dates for generating the claim. Other filtering options can also be used to narrow down the claims generation. Other filtering options are explained below.

  • To generate claims between two Accounting dates, use the Acct. Date From and To.
  • Enter the Insurance/ Payer ID to generate claim for a particular Insurance.
  • To send the claim to a particular clearing house select appropriate Claim Receiver from the drop-down list.
  • Select a Legal Entity from the list to generate claims for a particular Legal entity.
  • Select a Provider to generate claims for a particular Provider.

Now, click on  button to generate all the available claims between the given dates. Once the claim generation is processed, the available claim batches information will be shown as below.

Click on  button to complete the claim generation process.

When claim batching is completed, the tab will automatically switch to Batch Summary where all unbilled EDI claims and Paper claims will be listed.

Click on “Send To Clearing House (TRIZETTO)” to send the un-billed EDI claims to the clearing house.

Sometimes EDI claims can be downloaded and uploaded to the clearing house by selecting the “Download” option if clearing house permits.

In case of paper claims, you can print the same by selecting the appropriate print claim format at the bottom of the screen.