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Electronic Claims Transmission - an overview
There are three steps in the generation of electronic claims:

  1. Create an Electronic Claim Holding File - This is accomplished during the day as you "print" insurance claims. We use the word "print" loosely because with electronic claims, the claim does not print on your printer. Instead the claim data is sent to a holding file. As you go through the day "printing" claims for electronic transmission this holding file increases in size as it accumulates the claim data written to it.
  2. Convert Electronic Claim Holding File to an Emdeon Transmission File - This step usually takes place at the end of the day. During the day you have collected several, perhaps dozens of claims into the temporary holding file just described. A special screen is used to convert this data into a file that is of the structure that Emdeon needs for claim processing.  More on this later.
  3. Transmit the Emdeon Transmission File to Emdeon - Use the Emdeon supplied software to transmit the file to Emdeon.

Electronic Claim "Printing"
Generating an electronic claim is similar to printing a standard paper claim. When you access the Insurance Form Printing screen you are given the option to select the type of form you want to print via the Form To Print drop down list seen in the upper right of the form. One of the choices available from the list Electronic Claim. Selecting this choice will create an electronic claim rather than a paper claim. When Electronic Claim is selected, the claim data is stored in a special holding file instead of being printed as an insurance form on the printer. When you are ready to transmit the claims (usually the end of the day, but not necessarily), the hold file is converted to an Emdeon transmission file, and the file is sent to Emdeon using Emdeon's transmission software. Emdeon, will then convert each claim contained in that file to the proper format for the particular insurance carrier for which it is intended, and then forward that electronic claim to the carrier.

The Insurance Form that the Insurance Form Printing screen defaults to can be set via the User Defaults screen which is accessed from the Utility Menu. You can make Electronic Claim the default, or any other insurance form in the Insurance Form Library the default. The default form will be the one that comes up automatically when you enter the Insurance Form Printing screen.

Sending The Claim To The Holding File
Generating an electronic claim is exactly the same as printing a paper claim. For a complete discussion, see the section on Insurance Claim Printing. The only difference is, when you click the Print button, the insurance form data is sent to a holding file instead of the printer, and nothing prints. The claim is now stored in a holding table, for the time being. You will notice that the Print Preview button is disabled. Print Preview is not allowed for electronic claims. The Batch Printing button is also disabled. Batch Printing is reserved for paper claims only, although electronic claim processing is a form of batch processing by it very nature. After the claim is stored in the holding table, click on the Close button to return to the Main Menu.

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