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You can use DrCloudEHR to generate and submit claims in HCFA or UB-40 04 format. You can also generate and submit Detailed Financial Transactions (DFT) in HL7 format.

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You must configure connections with each insurance provider you want to interact with electronically.

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Configure an EDI Connection to a Claims Clearinghouse

To submit HCFA or UB-40 04 claims electronically to an insurance payer, you must configure an EDI connection to the medical claims clearinghouse the payer uses to process claims.

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Use Claim Rules to automatically populate fields on UB40 UB-04 and HCFA /CMS-1500 claim forms with required values based on insurance payer requirements. The assigned value for a field is taken from existing data within your DrCloudEHR system. You can optionally specify a value for a particular field on a claim form.

The application applies a claim rule when you submit a claim for payment. Until a claim rule is applied, the claim forms created when you generate a claim using Billing Manager are not final, as values set in the form change according to the claim rule. 

You can configure the rule to send a message that is displayed in the application or in an email to specific users or groups of users. For each field in a form, you can specify the action to take if the field is not complete, and value is missing. You can also specify an error message to send to selected staff members.

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1. Click the Practice tab.
2. In the left-hand navigation menu, expand the Administrative tab, and then click Claim Rules.
3. Click the Add button.
4. Enter the information required to create the claim rule, including the claim form type and the insurance provider the rule applies to.
5. Select the checkbox indicating how the application sends notifications to DrCloudEHR users:
   • Reminder:  Select to deliver notifications in the specified user's inbox using a system reminder. 
   • Message:  Select to deliver notifications in the message section of the selected user’s Inbox. 
   • Who should be notified?: Select the users or groups of users to send notifications to.
6. Specify the users or groups who receive notifications.
   
   
   
   
7. Click Save to create the claim rule definition. The Mapping Fields section loads below.
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8. Configure each field you want to automatically populate with data. Click Add Field to add additional fields to configure.
   
   
   
   
   • Verify that the Box Value field contains the name of the corresponding property in DrCloudEHR. 
     The application populates the field in forms based on the value set for this property.
   • Select the procedure to follow when an error occurs due to incomplete or invalid data:
     • Ignore, Generate Claim: Ignores the claim error and generates the claim. This option should only be selected if the defined criteria is not required.
     • Notify Staff, Do Not Generate Claim: Blocks the claim from being generated if the data is blank or invalid, and sends the specified error notification to staff members designated to receive notifications.
       This is the best practice for handling errors of unique data specifications required by certain payers and for certain facilities.
     • Notify Staff, Generate Claim: Sends the defined error notifications to selected staff, but also generates the claim for submission.
       This option might be used when the data value is preferred, but not required. 
9. Click Save to save the claim rule.

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