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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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