Before you can create an EDI file, there are areas in your Jane account that need be set up properly. This includes items such as insurers, claims, and billing codes.
And if you haven’t enrolled with a clearinghouse, now would be a great time. The EDI file has been designed and tested to work with Office Ally, TriZetto, and Availity. However, if you use another clearinghouse let us know by sending us a quick email.
You will need to be logged in under a “Full Access” account to access this area of your Jane account.
We’ll first want to set the clearinghouse (Office Ally, TriZetto, or Availity) that you’ll be submitting to by heading to the billing settings. In the Clearing House area, click on the drop-down menu to select your clearinghouse. If you’re using TriZetto, you’ll have the option to enter in your Clearing House Site ID.
Insurers must have been set up as “Health Insurance” in Jane (rather than a third-party payer). Currently, Insurers require both a Payer ID and full address information.
Please reach out to our team if you are uncertain whether this has been set up correctly.
See also: Creating a Health Insurer
Once you have set up your first Heath Insurer, you will be able to proceed to the next step.
Clinic Info & Locations
Clinic Info & Locations > View location > valid 10-digit NPI and Place of Service Code
The patient profile must have all the required fields complete.
This includes the patient’s first name, last name, birth date, sex (male or female), and address.
The state must be entered in the “Province” field as a two-letter abbreviation (eg. Oregon –> OR)
Make sure the patient claim under the patient’s Profile > Billing > Claims > select the claim > Edit is complete.
See also: Creating a Claim
If there are any missing fields, when you hit “Submit” to generate the EDI file, there will be a message to let you know what is missing.
The invoice for the appointment will need to have at least one billing code and diagnosis code added. Additionally, the appointment will need to have an insurance policy (patient claim) added.
Here is our guide document on Adding Billing Codes and Insuring a Patient Visit that walks you through how you can complete the Insurance section of your patient visits.
Staff Members require an NPI and a Tax Identifier to create an OA EDI. This Tax Identifier can be either an SSN, EIN, or TIN. These can all be added as Provider Numbers in the Staff Profile. The SSN will be favored for the EDI if all Tax Identifiers are listed, followed by the EIN then TIN.
Additionally, if you require a Taxonomy number for submission, you can enter that in as a Staff ID number in your staff profile (more details on that below). Please note that this is not a required field, so you will not receive an error message if it is omitted.
Insurer Specific NPI Option:
Do you have an Insurer Specific NPI that you need to use in replacement of your Clinic’s NPI for claim submission?
If this is the case, you can set up an Insurer Specific NPI within your Staff profile under ID Numbers. When you press the Add button, you’ll see the list of the Health Insurance Insurers you’ve set up on your account. You’ll just need to select the Insurer you’d like to add in a specific NPI for and be sure to add in your valid 10-digit NPI.
Here is our guide document on Adding Provider Numbers for your reference.
Completed the Pre-Flight Checklist?
You can go now ahead and Create an EDI File to Download and Submit to a Clearinghouse.
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!