There are many ways claims can be submitted to a Medicare administrative contractor. However making claims electronically is an easy and efficient way to do so from the comforts of home. In short, a claim can be submitted to a provider using a computer with software that meets electronic filing requirements that have been put in place by HIPAA claim standard. Requirements by CMS must also be met that are contained in one’s provider enrollment and certification.
Electronic claims submissions are transmitted from the providers computer to the MAC. At this point the MAC’s first edits will determine if the claim meets some of the basic requirements required by the HIPAA standard. If any errors are detected at this point all claims will be rejected and must be corrected and resubmitted. Further information is provided in your Medicare claims processing manual in chapter 24 if you need further assistance. Below you will find a list of software provided for most Windows and Mac operating systems that will work on your home computer, laptop, tablet or smartphone.
As with any software management, this module requires a practice management software that is compliant with ANSI format claims and remittances. This claim module can process both professional and institutional claims that include physicians, surgery centers, therapy practices, podiatrist, DME providers and chiropractors.
- Medicare claims are filed for free with no charge per claim
- electronic claims are produced to be HIPAA compliant ANSI format claims directly from aASPC practice management system
- completeness of information is checked by the carrier data audit
- there is no hassle and expense of clearinghouse operations because claims go direct to the payer. This leaves you in complete control of the billing process.
- Each report can be printed when needed and viewed on screen.
- Remittances can be posted directly into the practice management system using electronic posting of payments
- physician services, podiatry, speech therapy, visible therapy, occupational therapy, chiropractic and much more professional processing and institutional claims for a variety of practices.
Electronic Data Interchange Software
This software is PC friendly and available for providers to view and print H IPAA compliant EERA’s from the comfort of their own computer. Available at no charge, this is an easy to use software that saves both time and money if you currently receive SPR.
For a minimum of 31 days SPR will be mailed for a provider number that has been set up for ERA. Keep in mind if you submit a claim through a billing service or clearinghouse, using a submitter or sender ID that is currently receiving EERA’s, then you will no longer see the SPR effective with the completion of the ERA set up date.
- Valid users for this software include any customer that submits Medicare part A
- only requirements are one must be set up for ERA
- the initial application is free
- all upgrades can be downloaded for free, and one can be notified of upgradability signing up for the mailing list
- upgrades are typically based on CMS changes
- the minimum system requirements for APC is that one will be compatible and supported by Microsoft windows operating system.
Key features include the following:
- Medicare part a is combined with institutional all payer and professional claims system
- electronic submission of claims is done and ANSI – 837 formatclaim import using existing systems is flexible
- real-time claims are comprehensive using editing that minimizes rejected claims
- immediate user feedback is available at field level added validation
- code validation is automatic
- claim import and edit validation error reported is detailed
- any provider that has access to the Internet should have easy access and capability to download this billing software at no charge.
Ability PC – Ace
this electronic claim submission management software is a complete system that can be used in a standalone configuration or in conjunction with an existing claims system. No office system is needed to integrate because PC – ACE easy to use software application is ready to go to work the minute you install it. This provides a simple way to enter a claim, imported and managed to convert your electronic remittance into a readable format.
This software also provides the ability to import your Print Image Files into ABILITY PC-ACE
CMS – 1500 form software
Used by licensed healthcare providers to bill medical insurances that include Medicare as well as Blue Cross and Medicaid. This software starts at $80 and runs up to $150 for a five year user annual license. This software is ideal for medical billing as well as chiropractic, physical therapy, psychology, drug treatment, behavioral therapist, optometry, and many more specialties. This software provides an online form that looks just like a paper you would fill out in person. Simply fill out the form as you would a piece of paper and then save and load claims anywhere to your hard drive or external diskettes for quick retrieval. This software is HIPAA compliant and NIP ready.
This software is designed to make your form claim processing as simple, reliable and fast as possible. You receive a warranty for 30 days to receive a full money back guarantee if you are not happy with the services. They provide industry-leading customer support, allow for both paper and electronic claim compatibility. Purchasing their software gives access to a full year of automatic software updates.
These are just a few of many available electronic filing services for Medicare and Medicaid available for purchase and for free. Make your own assessment based on the options provided by each company to find the one fits your needs the best.