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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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1. Click the Practice  tab. 
2. In the left-hand navigation menu, expand the Administrative tab, and then select Practice.Click the Insurances link under Practice Settings at the top of the page.
   Image Removed Feature Settings.
   
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3. Expand the Billing tab. , and then click the ERA Processing Options Options tab. 

4. Select each setting you want to modify.
   
   

   Setting	Description
   Claim Matching Options	Select

   the option

   criteria to use to match claim identifiers with identifiers in

   the system

   DrCloudEHR. The system matches the original claim identifier by default.
   Service Line Matching Options	You cannot modify the current default settings.
   Denial Adjustment Reason Codes	Specify the

   adjustment denial

   status codes that indicate

   the

   a claim was denied. An ERA file containing the specified codes will be marked as denied.  Note that you must also select the Denied Adjustment Reason option from the Denied Service Options menu to enable the denial process.

   Denied Service Options

   Select one or more options that indicate a service is denied

   Specify under what conditions a claim should be considered as denied. Denied claims appear in the Denials Manager.

   Move To Next Responsibility Options

   If the patient has multiple insurance providers, specify the conditions that determine

   Specify when to move

   the claim

   claims to the next level of responsibility, such as to the patient's secondary insurance provider.

   Reversal Claim Options

   Select one or more options that indicate a claim is reversed

   Specify the status that indicates a reversed claim.

   Denied Claim Options

   Select one or more options that indicate a claim is denied

   Specify the status that indicates a denied claim.
   ERA Handling Options	Specify how to process incoming ERA files.

   
   

5. Click Save.

Configure Payer-specific Electronic Remittance Advice Processing Settings

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1. Click the Practice  tab. 
2. In the left-hand navigation menu, click the Administrative tab, and then select  Practice.
3. Click the Insurances link under Practice Settings at the top of the page.
   
   
4. Click the ERA Settings button.
   
   
   
   
5. Click Add. 

6. Select each setting you want to apply.
   
   

   Setting	Description
   Setting Name	A unique name for the custom settings.
   Processing From and To dates	Optional date range during which to apply the settings.
   Claim Matching Options	Select

   the option

   criteria to use to match claim identifiers with identifiers in

   the system

   DrCloudEHR. The system matches the original claim identifier by default.
   Service Line Matching Options	You cannot modify the current default settings.
   Denial Adjustment Reason Codes	Specify the

   adjustment denial

   status codes that indicate

   the

   a claim was denied. An ERA file containing the specified codes will be marked as denied.  Note that you must also select the Denied Adjustment Reason option from the Denied Service Options menu to enable the denial process.

   Denied Service Options

   Select one or more options that indicate a service is denied

   Specify under what conditions a claim should be considered as denied. Denied claims appear in the Denials Manager.

   Move To Next Responsibility Options

   If the patient has multiple insurance providers, specify the conditions that determine

   Specify when to move

   the claim

   claims to the next level of responsibility, such as to the patient's secondary insurance provider.

   Reversal Claim Options

   Select one or more options that indicate a claim is reversed

   Specify the status that indicates a reversed claim.

   Denied Claim Options

   Select one or more options that indicate a claim is denied

   Specify the status that indicates a denied claim.

   
   

7. Click Save.

Manage Insurance Contracts

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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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You can use an existing billing rule as a templates for a new rule. Search for the existing rule at the bottom of the Billing Rules page, make any modifications, and then add the new rule.

1. Click the Practice   tab. 
2. In the left-hand navigation menu, expand the Administrative tab, and then click Billing Rules.
3. Enter a descriptive name for the rule.
4. Select the service code the rule applies to. The selected code appears in the table under Output Service Code. 
   
   
   
   
5. Enter the starting date on which the rule takes effect.
   You can optionally enter an end date. If you do not specify an end date, the rule remains in effect.
6. Optionally select additional parameters the rule applies to, such as the insurance payer name and type.
   
   
   
   
7. Select or enter the parameters to apply to the primary service code in the row created for the service code in the table under Output Service Code, including modifiers and billing units.
   You can specify a maximum of four modifier codes, separated by a space, in the Modifier field. 
   
   
   
   
8. Select additional service codes to include in generated claims from the Output Service Code menu.
   Each code you add appears in the table under Output Service Code. For each code you add, select or enter the parameters to apply.
   
   
   
   
9. Click Add to save the billing rule.

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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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