Submitting electronic work comp claims

[ProCareSabrina]

I have several questions lately on submitting claims electronically thru the Emdeon portal. Do you have a particular subsection those questions should go in? I'm new to using the portal, so this is why I have so many questions, which Gavin has been able to answer all so far!!

New question - The Emdeon portal is supposed to allow you to attach your supporting documentation required by work comp with your electronic work comp claim. When inquiring how to do that, Emdeon's tutorial has stated that you need to put how many attachments you are sending in the 837 claim form before submitting the claim!! I have never heard of this. Where do you even notate that within Medisoft?

[Gavin Walker]

In Medisoft Transaction Entry windows, click the EDI Notes button and create a new PWK record. Fill out the Report Type, Transmission Code, and unique Control Number for matching.

[ProCareSabrina]

Thank you! I have never used that before. So, for the Transmission Code and Control # - do I just "make one up" and be sure that # is referenced on the documents I attach? (I selected Medical Record Attachment (M!), by the way.)

What is the difference between a Transmission Code and Control #?

[ProCareSabrina]

i think I got it. The Transmission Code is EL for electronic.

Now, for the control #, i was going to put the claim # and dos. Or does each company require a certain numeric sequence for this tracking #?

[Gavin Walker]

Most payers can only take Transmission Codes FX - Fax or BM - Mail. If your payer takes EL, you'll need to work out with the payer how to send the file electronically and what attachment control # to use. The control # needs to be worked out between you and the payer but it CAN be set by you and you just need to make sure it is unique for each one so the payer can match on their end. If they allow you to use AA, then the control # would be what you use to look up the document when it is requested.

[ProCareSabrina]

Ok. Per the clearinghouse, for those work comp claims that are submitted electronically, you can attach the notes through the portal as long as the 837 is coded thusly.

I have just attempted to send a small batch with the EL and unique transmission codes per claim. I will await to see what the clearing house says.

I am still waiting on THEIR IT dept to get back to me btw!

Thanks, Gavin!

[Gavin Walker]

If you marked EL, you must also send the file to the payer electronically. They don't just get sent in the claim file because you typed an EL.

[ProCareSabrina]

Understood. EMdeon's portal has a report you can run stating "WC Claims Awaiting Attachments" Once the list is created, per their How To videos, you can attach your pdf paperwork as attachments and send them as a batch, electronically, through the portal.

However, none of my electronic work comp claims have shown up on this report since i have started using the edi notes.

Emdeon's support techs have escalated my question internally and i'm STILL waiting on the supervisor to get back to me to see if my PWK notification is even coming through to them. They are looking up a few of their trace ids to see why my claims are not populating in that report.

[Gavin Walker]

Emdeon must require something special on the ANSI 5010 claim file to trigger this functionality.

[ProCareSabrina]

Ok! I just got an answer back from Change (formerly Emdeon, formerly Capario)

They state that their system looks for the PWK record/note on the claim level (2300 loop), not on the Service Level (lopp 2400) as I entered it via the Transaction Window per your suggestion. However, the segment is the same.

I'm not familiar with the claim level area to add the EDI Notes. Can you help with this?

[Gavin Walker]

This is on the Case -> Diagnosis tab -> EDI Report frame. Press F1 for help to read how to fill this out.