Jane has an 837p EDI generation tool to help manage your claim submissions. An 837p EDI file is sort of like an electronic version of a CMS1500 form. In Jane, you can select a bunch of claims you’d like to submit, and either:
submit directly to Claim.MD without leaving Jane using our integrated claims feature.
download a batch 837p EDI file for those claims that can be uploaded to a clearinghouse for submission.
Jane currently supports electronic submissions for four different clearinghouses: Claim.MD, Office Ally TriZetto and Availity.
In this lesson we’ll cover the following claim submission topics:
- Submit Claims Electronically Through Claim MD
- Submit Claims Electronically
- Submitted Claims back to the Unsubmitted Folder
- Resubmissions & Corrected Claims
If you have not done so already, please go through the US Insurance Set Up Steps first.
Through Integrated Claims with Claim.MD, you are now able to submit claims directly to Claim.MD without leaving Jane! 🎉
If you choose not to utilize this integration, the EDI Files generated in Jane can still be submitted to Claim.MD or the other clearinghouses listed below. You’ll need to login into your clearinghouse account to upload the files. You can submit this EDI file to either:
To learn more about how secondaries can be submitted through Jane, check out this guide here: Billing Secondary Insurance Claims
To submit claims electronically through the Claim.MD integration:
- Head to the main Billing tab > Unsubmitted folder
- Select the claims you’d like to include in your batch.
- Click the Submit Selected Claims button at the bottom of your screen and continue to the Pre-Submission Checklist.
After reviewing the Pre-Submission Checklist & making any last-minute changes to the claim, hit the Submit button.
And voilà! Jane will generate a batch submission and automatically send it to your Claim.MD account. 🎉
Note: Your claims will appear in your Claim.MD within 10 minutes of generating a submission.
Once you’ve submitted your claims, they’ll sit in the Submitted folder awaiting claim acknowledgements from Claim.MD and insurance companies.
The submission process doesn’t change much if you choose to not enable the Claim.MD integration in Jane, though there are some small differences.
Rather than seeing a Submit Claims to Claim MD button after selecting your claims, you’ll see a Generate Button instead:
Once selected, Click the blue Download button, then upload this file to your clearinghouse account for submission.
All submitted claims will now be moved from the “Unsubmitted” folder area to the “Submitted” folder where they’ll wait for a response from the payer.
💡Jane Tip: Don’t see the View/Submit Selected button after selecting your claims? If so, make sure you haven’t selected a claim with Unsaved Changes. You can filter your Unsubmitted folder for any claims that have unsaved changes (i.e. an additional diagnosis code added after the visit). If you find any, you’ll need to view the purchase and save the changes before proceeding with the submission.
Jane will move a Submitted claim back to the Unsubmitted folder if any changes are made to the claim after the submission process. For example, if you change the procedures or diagnosis codes after a claim is submitted, Jane will push it back to Unsubmitted.
With Jane’s integration with Claim.MD, you’ll be able to receive & manage rejections directly in Jane. This also lets Jane gain more insight into the rejections, helping you sort out those rejections faster so that you get paid as soon as possible.
For any claims rejected by either Claim.MD or the payer, these will move directly to your Rejections folder, where you can then view the reason for rejection (and know what to change for resubmission) in the Claim Summary panel.
Using one of our other clearinghouses, Jane won’t have as much context readily available, which in turn typically requires more digging and investigation, as well as checking in with you.
Below are some common scenarios in managing rejections a clinic may receive.
- Scenario 1: Receiving a Rejection From Your Clearinghouse
- Scenario 2: Receiving a Rejection From a Payer