How to start billing electronically

Print this guide which contains helpful hints, suggestions and ideas to consider when choosing an electronic claim submission system.

• Choosing a Vendor
• Submitter ID Number
• Hardware and software requirements
• Testing
• Submitting production claims
• Payer IDs

Choosing a Vendor

Questions to ask Vendors:

• Does the Vendor submit claims to Idaho carriers?
• What are the costs for installations and upgrades?
• How much time does the Vendor guarantee for training?
• How much does the Vendor charge you to connect with each Carrier?
• What type of customer service does the Vendor offer (west coast hours)?
• What type of on-site customer service will you receive if system problems occur?
• How prompt are the Vendors upgrades when changes occur in the electronic claims formats?
• Does the Vendor test system changes before upgrading your system?
• Will you be provided with references from the Vendor?
• Ask the Vendor to provide you with a list of cost savings by using their system. How long will it take you to recoup your initial investment?

  Questions to ask the Vendor's references:

• How long have they had the system in their office?
• How long did the installation and training take?
• Was the Vendor prompt when correcting system problems?
• What do they like best about the system?

Questions you could be asked by a Vendor:

• Why type of computer hardware and software do you currently have in your office?
• How many carriers will you need to bill?
• Where is your office headed in the future?
• What are your long term goals?
• What are your short term goals?
• Will any physicians or other professional providers be retiring soon?
• Are there any office mergers in the foreseeable future?
• Will there be any increases or decreases in claim volume?

Submitter ID Number
Download an enrollment packet from Availity^® or contact the Availity EDI Helpline via phone at (800) 282-4548 or by e-mail at info@availity.com. This allows you to begin the claims submission process with Availity.

Hardware and software requirements

Dial-up:
Your claims file is transmitted using one of four popular asynchronous telecommunication protocols: Kermit, Zmodem (Check Sum), Ymodem (Batch), and Zmodem at speeds up to 56 kbps. Most off-the-shelf communication software will support one or all of these protocols. Some examples of communication software packages are: proComm Plus 2.01 (DOS) or 2.11 (Windows), Crosstalk 2.2 (Windows), QuickLink2 1.4.3 (Windows), PC Anywhere 5.0 (DOS) or 2.0 (Windows), Term 6.1, 6.2 & 6.3, Mlink 6.07 and Hyperterminal which is included in Windows 95, 98, 2000 & NT.

Internet:
You can submit your electronic claims via Internet FTP which requires that you have PGP encryption. You can obtain more information about PGP encryption at www.pgp.com. You can download enrollment forms from Availity.

Testing
Testing will only be necessary if the software vendor, billing service or claims clearinghouse does not already have clients submitting through Availity. You will send Availity your test claims and they will check the integrity of your data (correct diagnosis codes, ID numbers, programming by your vendor, etc.). Contact Availity prior to submitting test claims during this phase. You can request to move from test to production once you receive clean test reports by sending in an EMC Production Request Form. Live claims should be submitted on paper during this phase. Download the testing requirements from Availity.

Submitting production claims
Production claims (which are claims you expect to receive payment for, submitted after the testing phase) may be submitted 24 hours a day.

Payor identification numbers (IDs)
Use the following Payer IDs when sending Regence BlueShield of Idaho claims and other Regence sponsored payers:

For a list of commercial payer IDs please download the most current payer list from Availity.