Processing CMS 1500 Claims

You can print insurance claims on CMS 1500 forms to mail to insurance companies and you can export claims to print image files, ANSI files, and VSP Interface files to send electronically to insurance companies. You must follow the steps below to properly process printed and electronic insurance claims:

1. If this is the first time Third Party Processing has been used in OfficeMate and you are sending claims electronically, verify that the third-party receiver’s information has been set up. For information on setting up third-party receiver information, go to Maintaining Third-Party Receiver Information.
2. Select insurance claims. For more information on selecting claims, go to Searching for Insurance Claims.
3. Correct errors in insurance claims. For more information on correcting errors, go to Correcting Errors in Insurance Claims.
4. Record additional information on CMS 1500 forms. For more information on recording additional information, go to Recording Additional Information on the CMS 1500 Form and ANSI File.
5. Print or export electronic insurance claims. For more information on exporting insurance claims, go to Exporting Insurance Claims.
6. Preview and print insurance claims. For more information on previewing and printing insurance claims, go to Printing Insurance Claims.
7. View insurance claim billing histories. For more information on viewing billing histories, go to Using the Batch History.

Before you begin processing insurance claims, set up the following information in OfficeMate:

• Insurance information. For more information on setting up insurance carriers, go to To modify or add appointment schedule resources. For more information on recording insurance information in a patient’s record, go to Recording Patient Information.
• Provider information. For more information on setting up provider information, go to To modify or add provider information.
• Procedure codes. For more information on setting up procedure codes, go to To add and modify procedure codes.
• Products and services. For more information on setting up products and services, go to Recording Product Information.
• Electronic claims clearinghouse. Eyefinity recommends using VisionWeb or TriZetto to process your insurance claims. If you converted to OfficeMate from RLISYS, you can also use McKesson. For more information on VisionWeb and TriZetto, go to www.eyefinity.com/strategic-partners/CertifiedPartners.html.

In addition to setting up the information above, you must also have recorded fee slips with insurance carriers.

This section includes:

• Opening the Third Party Processing Window
• Maintaining Third-Party Receiver Information
• Searching for Insurance Claims
• Correcting Errors in Insurance Claims
• Recording Additional Information on the CMS 1500 Form and ANSI File
• Exporting Insurance Claims
• Sending Claims to and Receiving Reports from McKesson
• Printing Insurance Claims
• Adjusting CMS 1500 Form Margins
• Using the Batch History
• Releasing and Closing Claims on Hold