Claim Generators 837 Professional & 835

837 Professional Claim and 835 Healthcare Remittance Generators Coming Soon

Providers, health plans, HMOs and plan administrators will soon have new claim generator options to help them get paid faster, and to gather more detail on potentially rejected files. EMS is currently completing a new line of professional EDI file generators. These include an 837 Professional Claims Generator, an 837 Institutional Claims File Generator, an 835 Healthcare Remittance Advice Generator and an updated 277CA (Health Care Claim Acknowledgement) File Generator.

“These programs are stand-alone applications. They allow a user to create the required ASC X12 EDI format from a simple flat text file,” explains Dave Pontrello, VP of EMS Healthcare Informatics. “We’ve had many requests to offer these products, which are easy-to-use, affordable new software options.”

Benefits of a Stand-Alone 837 File Claims Generator

Pontrello says that the new 837 Professional Claims Generator is ideal for providers in fields such as Human Services, Addiction & Behavioral Health, Medical Transportation, Durable Medical Goods and others. “If you’ve had one of any number of billing systems (e.g. some custom, some industry-specific) that never concentrated on EDI transactions, and now you need to bill electronically for routine services, our file generators will be for you,” he shares. “You’ll save on paying an external clearinghouse or vendor to convert your data. Plus, your organization will retain control over all your billing submissions and results.”

Karin Zilgme is a senior software developer for EMS. She adds that the 837 Professional Generator also is ideal for HMOs and health plans when needing to report Medicare and Medicaid claims received and paid.

“Payers are typically the organizations that receive the 837s,” says Zilgme. “Often, however, they are required to send Encounter Claims, also called Post Adjudicated Claim reporting files, to their states. These are usually in the 837 claim file format. The data gets used to assess programs, set reimbursement rates, and to help set policy objectives.”

File Generators Ideal for Payer Specialty Programs

Zilgme adds that the 835 File Generator to be rolled out also is a tool for payers that administer specialty programs.

“Many such programs may not fit into a standard adjudication model,” she shares. “Organizations might have systems that handle the more ‘standard’ claims management. But specialty programs often are managed using custom or unique software—the type without a built-in tool for EDI transactions (e.g. 835 remittances).”

Pontrello says that is when add-on software is needed. The same goes for generating 277 Claim Acknowledgement (277CA) files. Because 277CA files are not mandatory to produce, many standard adjudication systems simply aren’t built to generate them.

“But 277CAs can be incredibly valuable,” he explains. “They’re payer-generated, and when used, occur one step before an actual adjudication of claims. It tells your provider partners which 837 files made it into adjudication, which didn’t, and what errors existed. Efficiency at that step is critical for making any corrections needed to ensure rebilling success.”