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Creating an EDI File to Submit to a Clearinghouse

The time has come - Jane is now able to generate an EDI text file of your claims to download from Jane and then upload to either Office Ally, Trizetto, and/or Availity!

If you have not done so already, please go through the Pre-Flight Checklist first before creating an EDI file.

Generating an EDI File

From the Appointment Panel (Single Claim)

As long as your insurers, claims, and billing codes have all been added correctly when you add the billing codes and insurance claim to the visit, you will see a “Submit” button at the bottom of the Insurance Info section.

Clicking Submit will bring you to the “Submit Claims” pre-flight check page. If a required field for EDI generation wasn’t entered in properly prior to pushing the Submit button (i.e. no diagnosis codes were entered), you will need to fix those areas before you are able to generate an EDI.

Once your invoice is valid for generating a submission (all required fields are filled out correctly), you will need to press the Generate Submission button, which can be found at the top or bottom of the page.

After you’ve selected this button, you’ll see a blue Download button that you can click to download the EDI file for this claim. Once downloaded, you can upload this file to your clearinghouse account for submission.

From the Billing Tab (Multiple Claims)

To generate an EDI file for more than one invoice, head to the main Billing tab > Unsubmitted > select the claims that have insurers set up as a “US Insurer” so that these claims are highlighted in blue.

You will see a yellow/orange View/Submit Selected button. This will launch the pre-flight check page for all the selected invoices.

This is the same “Submit Claims” screen you can navigate to from the appointment panel.

Check the red text for errors and click on the blue “Edit…” text to launch a new tab to fix these errors. Once these errors have been fixed, you will be able to hit the Refresh button to update the changes.

Once all the fixes are reflected, then you can generate an EDI file for multiple claims.

Click the blue Download button once to download one EDI file that includes all of these claims and then upload this file to your clearinghouse account.

And voilà!

You can now submit this EDI file to either:

Once you receive the Explanation of Benefits (EOB), you can follow the steps to Receiving an Insurer Payment (EOB)

As mentioned in our New Insurance Workflows blog post, we are continuing to work on the next phase of the Office Ally Integration features, so stay tuned!