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Start Billing 5: EDI Claim Submission

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 then 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: Office Ally, Claim.MD, TriZetto and Availity.

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

If you have not done so already, please go through the US Insurance Set Up Steps first.

Uploading EDI files to your Clearinghouse

The EDI Files we generate in Jane can be submitted to one of the 4 clearinghouses listed below. You’ll need to login into your clearinghouse account to upload the files.

You can submit this EDI file to either:

Submit Claims Electronically

To submit claims electronically,

  • 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.

Click the blue Download button, then upload this file to your clearinghouse account for submission.

And voilà!

You can now submit this EDI file to your clearinghouse.

All submitted claims will now be moved from the “Unsubmitted” folder area, over to the “Submitted” folder awaiting 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.

Submitted Claims back to the Unsubmitted Folder

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.

Resubmissions & Corrected Claims

If you’re using Jane’s EDI feature to submit to a clearinghouse and you need some help resubmitting corrected claims, then please read on!

Scenario 1: Receiving a Rejection From Your Clearinghouse Scenario 2: Receiving a Rejection From a Payer

Managing Resubmissions & Corrected Claims

📘 Continue learning the insurance billing workflow in Start Billing 6 - Posting Insurance Payments