Exporting Insurance Claims

You can export claims to print image files, ANSI files, and VSP Interface files to send electronically to insurance companies. OfficeMate automatically sends the claim to the correct electronic file format based on the options selected in the Insurance Setup. The administrative location maintains the Insurance Setup claim options. For more information on maintaining the claim options in the Insurance Setup window, go to Setting Up Insurance Carriers.

This topic tells you how to export insurance claims to send to insurance companies.

  1. Open the Third Party Processing window. For more information on opening this window, go to Opening the Third Party Processing Window.
  2. Search for insurance claims. For more information on searching insurance claims, go to Searching for Insurance Claims.
  3. Correct any errors in the insurance claims. For more information on correcting errors, go to Correcting Errors in Insurance Claims.
  4. View or add additional information to the CMS 1500 forms. For more information on adding information to a CMS 1500 form, go to Recording Additional Information on the CMS 1500 Form and ANSI File.
  5. Click Create Claim Files.

    The Process Warning dialog box opens and warns you that processing claims can take a few minutes or more.

  6. Click Yes on the Process Warning dialog box to continue.
  7. Click OK on the Print Image Created window after the print image is created.
  8. Click Yes on the Do you want to move Claim records? window to mark these claims as Billed.

    OR

    Click No to keep the claims marked Open.

    Claim files are located in the OfficeMate\DATA\EMC folder (if you are a new user or were an OfficeMate Enterprise user who upgraded to OfficeMate 9.0 or above) or OMATE32\DATA\EMC folder (if you were an OfficeMate user who upgraded to OfficeMate 9.0 or above).

    The print image file, PrintImg.txt, is located in the EMC folder. Send the PrintImg.txt file to your insurance carrier. A copy of the print image file is also located in the EMC folder and identified by the first two letters of the insurance carrier’s name, the date, and the .exp extension.

    The electronic file (ANSIClaim.cnx, MKANSIClaim.cnx, or GWANSIClaim.cnx) is located in the EMC folder. Send the ANSIClaim.cnx or GWANSIClaim.cnx file to your insurance carrier. A copy of the ANSI file is also located in the EMC folder. A copy of the ANSI file is identified by the date and the .ae extension. A copy of the TriZetto ANSI file is identified by the date and the .ge extension.

    If you have multiple users creating insurance claim batch files, or if you otherwise suspect that some batch claims are not being sent to your clearinghouse, send the .ge files in the EMC folder that correspond to the date(s) the batches were created. The .ge file names start with the creation date in the MMDDYY format. For example, if you want to send claims that were batched on July 16, 2010, you would upload all of the files in the EMC folder that have names that start with "071610" and end with ".ge". Send the .ge files rather than sending the .cnx file.

  9. Follow the instructions provided by your clearinghouse to transmit or upload the claim files.

    OR

    If you are using the McKesson clearinghouse, you can send your claim files directly from OfficeMate at this time. For more information about sending files to McKesson, go to Using the Batch History.

  10. To view the billing history of an insurance claim, go to Using the Batch History.