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Insurance Billing 5: Claim Submission

  1. Insurance Billing Training (US)
  2. Insurance Billing 5: Claim Submission

    3. 10 min read
    Practice Plan Thrive Plan

If you haven’t already, please go through the US Insurance Set Up Steps first. This is lesson 5 of 9 in the US Insurance Billing training:

Billing Lesson Lesson Complete
Patient Insurance 🥳
Adding Billing Codes to a Visit 🥳
Managing Insurance and Patient Responsibility on a Visit 🥳
Claim Submission Folders 🥳
Claim Submission ✍️
Managing Rejections ☐
Posting Insurer Responses ☐
Resubmissions ☐
Accounts Receivable ☐

In this lesson, we’ll cover the following claim submission topics:

Clearinghouse Options

Jane generates 837P EDI files to help you manage your insurance claim submissions. An 837P EDI file is an electronic version of a claim form. In Jane, you can submit claims in one of two ways:

  • Submit claims directly to Claim.MD without leaving Jane, using the Claim.MD integration.
  • Download a batch 837P EDI file from Jane and upload the file to your clearinghouse for submission.

If you don’t use the Claim.MD integration, you can still upload 837P EDI files generated in Jane to any of the following clearinghouses. Log in to your clearinghouse account to upload the files.

📣 Heads up: Jane’s 837P EDI files and Availity don’t always work well together for Medicare claims. If you bill Medicare, we recommend using a different clearinghouse.

Selecting Your Clearinghouse in Jane

To select or update your clearinghouse:

  1. Go to Settings > Billing Settings.
  2. Scroll to the Insurance section.
  3. Select your clearinghouse from the Clearinghouse drop-down.
  4. Click Save Billing Information.

The Insurance section of Billing Settings with the Clearinghouse drop-down set to Claim.MD and a confirmation that the Claim.MD account is connected

For more on setting up your clearinghouse in Jane, check out our guide on Setting up Your Billing Settings.

Before You Submit Claims Electronically

📣 Heads up: Claims with Unsaved Changes block electronic submission. If any selected claim has unsaved changes, the Submit Selected Claims button is greyed out.

Unsaved changes happen when a claim is updated after the visit (for example, an additional diagnosis code is added). To find and fix claims with unsaved changes:

  1. In the Unsubmitted folder, select the Unsaved Changes checkbox to filter the list.
  2. View the purchase for each claim with unsaved changes.
  3. Save the changes before you submit.

The Unsubmitted folder filtered by Unsaved Changes, with the Submit Selected Claims button greyed out and a message that 2 claims have Unsaved Changes

Submitting Claims Electronically Through Claim.MD

To submit insurance claims electronically through the Claim.MD integration, follow these steps. Once complete, Jane sends a batch submission directly to your Claim.MD account.

  1. Go to Billing > Draft or Unsubmitted.
  2. Select the checkbox next to each claim you’d like to include in your batch.
  3. Click Submit Selected Claims at the bottom of the screen.
  4. Review the claim details in the Pre-Submission Checklist and make any necessary changes to the claim.
  5. Click Submit [number] Claims To Claim.MD (for example, Submit 1 Claim To Claim.MD).

The Pre-Submission Checklist for an invoice showing staff, location, invoice, and billing code details, with the Submit 1 Claim To Claim.MD button

What to Expect

And voilà! Jane generates a batch submission and automatically sends it to your Claim.MD account. 🎉

  • Your claims appear in your Claim.MD account within 10 minutes of generating the submission.
  • Submitted claims move to the Submitted folder, where they wait for the insurer’s response.

Submitting Claims Electronically Through Office Ally, TriZetto, or Availity

If you don’t use the Claim.MD integration, the submission process is the same up to the final button. Instead of submitting directly to Claim.MD, you generate an 837P EDI file in Jane and upload the file to your clearinghouse.

  1. Go to Billing > Draft or Unsubmitted.
  2. Select the checkbox next to each claim you’d like to include in your batch.
  3. Click Submit Selected Claims at the bottom of the screen.
  4. Review the claim details in the Pre-Submission Checklist and make any necessary changes to the claim.
  5. Click Generate Submission For [number] Claims (for example, Generate Submission For 3 Claims).

The Generate Submission For 3 Claims button at the bottom of the Pre-Submission Checklist

  1. Click Download 837p EDI File.
  2. In your clearinghouse account (Office Ally, TriZetto, or Availity), upload the 837P EDI file for submission.

A confirmation that the 837p EDI file is ready for download, with the Download 837p EDI File button and the submitted claims listed below

What to Expect

Your submitted claims move from the Draft or Unsubmitted folder to the Submitted folder, where they wait for a response from the insurer.

Submitting Paper Claims With the CMS1500 Form

Jane can generate a CMS1500 form (also called a HCFA form) as an editable PDF for paper claim submission.

Generating a Single CMS1500 Form

  1. Open the Appointment Panel or Purchase Screen.
  2. Click the drop-down arrow next to the Pay button.
  3. Under PDF, select CMS1500 (Primary) or CMS1500 (Secondary).
  4. Edit the form, if needed.
  5. Print the form.

The Pay drop-down on the Appointment Panel with CMS1500 (Primary) and CMS1500 (Secondary) listed under PDF

When printing CMS1500 forms:

  • CMS1500 forms print best on blank paper.
  • Print in color. Some insurers can’t process a claim that’s printed in black and white.
  • Jane can’t print claim details directly onto a pre-printed CMS1500 form.

Need a little help figuring out what goes into each box and where that information comes from in Jane? Check out our guide on Insurance Claims and the CMS1500 or our CMS1500 Reference Sheet.

Generating Batch CMS1500 Forms

📣 Heads up: Printing CMS1500 forms doesn’t move claims to the Submitted folder. Mark the claims as submitted after printing.

  1. Go to Billing > Draft or Unsubmitted.
  2. Select the checkbox next to each claim you’d like to include. A batch can include up to 25 claims.
  3. Click the Selected drop-down.
  4. Under Batch (limit 25), select CMS1500.
  5. Print the forms.

To mark printed claims as submitted:

  1. In the Draft or Unsubmitted folder, select the claims you printed.
  2. Click the Selected drop-down.
  3. Select Mark as Submitted.

The Selected drop-down in the Unsubmitted folder showing Mark as Submitted, with CMS1500 listed under Batch (limit 25)

For a deeper dive, check out our guide on Generating a Batch: Superbills & CMS1500 forms.

Why did a submitted claim move back to the Draft or Unsubmitted folder?

Jane moves a submitted claim back to the Draft or Unsubmitted folder if any changes are made to the claim after it’s submitted. For example, if you change the procedures or diagnosis codes after submitting a claim, Jane moves the claim back to Draft or Unsubmitted.

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