Apex: Setup EDI File Settings

Make sure your Electronic Claims contain the correct information by configuring your EDI File Settings.

EDI File Settings are a common culprit in Claim Rejections. If you receive rejections stating that you are missing information from your Claims such as the Rendering Provider or Service Facility check your EDI file Settings to see if they need to be updated. 

NOTE: The PDF version of the CMS-1500 in the Client's Ledger does not affect the electronic 837 file and the EDI File Settings do not affect the PDF version of the Claim.  

Each Insurer has their own EDI File Settings.

1. Click Billing tab in primary navigation bar.
2. Click Insurer in side menu.
3. Click Edit for appropriate Insurer.
4. EDI File Settings are listed on the right. See below for a description of each Setting.
   
   

EDI File Setting Descriptions

1. Send Service Facility Location when it differs from Billing Provider Location
   • Checked - If the Address in Box 33 is different than the Address in Box 32, the information in Box 32 WILL be transmitted.
   • Not Checked - If the Address in Box 33 is different than the Address in Box 32, the information in Box 32 WILL NOT be transmitted.
2. Send Service Facility location when it is the same as Billing Provider Location
   • Checked - If the Address in Box 33 is the same as the Address in Box 32, the information in Box 32 WILL be transmitted.
   • Not Checked - If the Address in Box 33 is the same as the Address in Box 32, the information in Box 32 WILL NOT be transmitted.
3. Show Rendering Provider even if this is the same person as Billing Provider
   • Checked - If the Rendering Provider in Box 24 & 31 are the same as the Billing Provider in Box 33, the Rendering Provider information WILL be transmitted.
   • Not Checked - If the Rendering Provider in Box 24 & 31 are the same as the Billing Provider in Box 33, the Rendering Provider information WILL NOT be transmitted.
4. Show Rendering Provider when billing with Organization NPI
   • Checked - If the Organization is the Billing Provider, the Rendering Provider WILL also be sent.
   • Not Checked - If the Organization is the Billing Provider, the Rendering Provider WILL NOT be sent.
5. Ask for resubmission details prior to Re-Submit failed claim
   When a Claim is denied by Insurance they may require resubmission information. This includes a resubmission Code and the Claim Number assigned by the Insurance Company. You should only check this box if it is required by the Insurance Company. 
   
   • Checked - If checked, you will be prompted to complete Resubmission Details when Resubmitting a Claim. This information populates Box 22.
     
     
     
6. Use Rendering Provider designated in client payer settings on Claims
   • Checked - The Default Rendering Provider selected in the Client's Bill To & Insurance Info Tab will be automatically updated when the Invoice is created. (Hint- for Supervising Billing).
   • Not Checked - The Rendering Provider selected in the Client's Bill To & Insurance Info Tab will NOT auto populate on the created Invoices, and will default to the Appointment Staff.
7. Send appointment start/end times on claims
8. Send appointment start/end times in military time on claims
9. Send aggregated claims on different claim lines
   When there are 2 or more appointments for the same service date, client, rendering provider and CPT code the additional sessions are entered on separate line notes on the EDI file.

   NOTE: This setting cannot be selected if the rendering provider designated in the client payer settings is being used on claims.

10. Do not bill overlapping direct service types
    • Checked - will only bill for Supervision service type appointment times when overlapping with Direct service type appointment times. Any remaining Direct service type appointment time not overlapping with Supervision service type appointment time will also be billed.
    • Not Checked - will bill both Supervision and direct service type appointment times regardless of any overlapped time between those appointments.