Payer Doesn't Accept eClaims
Though they are becoming fewer, year by year, there are still payers out there that do not accept electronic claims. If a payer does not accept electronic claims, there are a number of options available to the user. Possible options are listed below:
Create a Paper Claim
Drop to Paper Option at Clearinghouse
Force eClaim to Paper at Clearinghouse
Create a Paper Claim
One option is to create a paper claim within the ledger of the patient and mail it the old fashioned way.
To create a paper claim in the patient ledger, highlight the items that need to be sent to insurance within the ledger. Click on the "Print" drop-down menu and select 'Create Insurance Claim'
The Claim Creation Window will then appear. Within that window, click the "Form/Template" drop-down menu. Select the desired paper claim form.
Once the form is selected, press 'OK' at the bottom of the claim creation window. From there, follow the prompts to printing the paper claim. Address an envelope to the payer, apply postage, and send with the outgoing mail.
Drop to Paper Option at Change Healthcare Clearinghouse
There may be a charge when this option is used. Please speak to MacPractice EDI Enrollments about pricing for this option before utilizing.
If a user cannot find the payer ID they are looking for and does not wish to print and mail a paper claim from their office, there is an option to drop the eClaim to paper at the Change Healthcare clearinghouse.
In order to drop eClaims for a payer to paper, go into the insurance reference for the carrier.
For Change Healthcare claims, go to the insurance reference. In the Company Info Tab, change the Claims Payer ID to "PAPER".
What this does is it communicates the clearinghouse system to check to see if there is a payer ID whose address information matches the address information that is present in the claim.
If the system finds a payer ID that has matching address information, the clearinghouse will add the appropriate payer ID to the outbound claim file and send electronically to the payer.
If the clearinghouse system does not find a matching address for the payer ID on the claim, Change Healthcare will convert the electronic claim to a paper claim and mail the paper claim to the address that is indicated in the claim file.
There is no 'PAPER' equivalent for Change Healthcare Dental. The DentalXchange equivalent to 'PAPER' would be 'DXPRT'.
Force eClaim to Paper
There may be an additional charge when this option is used. Please speak to MacPractice EDI Enrollments about pricing for this option before utilizing.
If a user does not want to worry about the payer ID, and only wants the clearinghouse to print a paper claim, there is an option to force the eClaim to paper at the Change Healthcare clearinghouse.
In order to force eClaims to paper for a particular payer, go into the insurance reference for the carrier. Within the insurance reference, in the Company Info Tab, change the Claims Payer ID to 'PRINT'.
For DentalXchange or Change Healthcare Dental eClaims, go to the insurance reference. In the Company Info Tab, change the Claims Payer ID to '06126'. This will force dental claims to be printed on paper and mailed from the clearinghouse.
When the payer ID "PRINT" is used, Change Healthcare will not try to match the payer in the claim file to a known payer ID. The eClaim file will go straight to being converted to a paper claim and will be mailed to the address that appears in the eClaim file.