ClaimRev Clearinghouse Module

ClaimRev Clearinghouse Module

Overview

• This module provides these features:
  • Eligibility
    • On the patient dashboard is an option to check eligibility for a patient. The detailed results are returned there. What comes back is payer specific but normally will include deductibles and other benefit information .
  • Real-time Eligibility
    • When an appointment is created, an eligibility request is sent to the clearinghouse. A detailed response is presented on the patient dashboard that lets you know if coverage is found.
  • Claim Processing
    • Claims can be sent from the billing manager to the clearinghouse. The module currently will download the response files of 999 and 277 and save them to the proper directories.
    • Claim search screen is available with-in the module to quickly check status of claims in the processing system.

Configure Module

Register the module

• On the top menu click "Modules->Manage Modules"
  • Click on the Unregistered button and look for ClaimRev Clearinghouse Connector
    • Click "Register" on the far right

Install the module

• Click on the Registered button and look for ClaimRev Clearinghouse Connector
  • Click Install then Enable on the far right

Setup Globals

• On the top menu click "Admin->Config". On the right you should now see the option ClaimRev Connect
  • In the ClaimRev Connect option you now have several options
    • ClaimRev Environment -> This should be set to P
    • Client ID -> This will be assigned once your account is setup
    • ClaimRev Client Secret -> This will be assigned once your account is setup
    • X12 Partner Name -> This defaults to ClaimRev and we will discuss the details of this later
    • Eligibility Service Type Codes -> This is a comma delimited list of service type codes for eligibility checks. This list defaults to 30 which means Health Benefit Plan Coverage to see other options visit the link https://x12.org/codes/service-type-codes.
      NOTE: Not all payers will accept all possible codes.
    • Auto Send Claim Files -> When checked, the module will send claim files to ClaimRev
    • Add module menu item -> This needs to be checked and the menu option will appear in the top menu under "Modules". You must log out and back in of OpenEMR to to see this take affect.
    • Add ClaimRev Eligibility Card To Patient Dashboard -> This places the eligibility card on the patient dashboard so that viewed and checked.
    • Use Facility for Eligibility -> This uses the facility record when sending eligibility checks, when not checked the provider record is used instead.
    • Turn on Real-Time Eligibility -> This will watch for new appointments, and when a new appointment is created the eligibility check is created for that appointment. The results are displayed in the patient dashboard.
    • Eligibility Age To Stale -> Recommended value is 30, which would mean that if eligibility was checked 25 days ago and the patient is back again, then eligibility will not be checked. However, if it has been over 30 days then an eligibility check will be created.
    • Turn on Eligibility Send Service -> This option must be checked to actually send the eligibility to ClaimRev
  • Once you're ready click Save to save the configuration.