Before you start to send claims to your clearinghouse, there are a number of configuration settings that you should review:

1. Admin -> Locations:

• Demographics sub-tab: Be sure that each of your practice location (which translate to Billing Facilities or Service Locations on the HCFA 1500) have a complete address with Zipcode +4 populated. Remember that your payors must have you credentialed with this name and address
• Demographics sub-tab: NPI needs to be correct for how you are credentialed. This is typically your Group NPI
• Preferences sub-tab: In the Billing section of this screen, you can set default payment method and default search criteria for payors. You can also check that encounters must be closed or set to Ready for Billing before they show up in the Edit Claims screens. You can also check to always include CLIA number. NOTE: You also have the ability to map CLIA to certain CPT codes if you prefer to not have it go on all claims.
• Billing sub-tab: Be sure to have Tax ID Number, Default CLIA (if applicable), and Taxonomy code. ReLiMed Support should be able to set the Clearinghouse and Submitter SITE/ID for you if this is not populated. 
• Billing sub-tab: You should also choose your default provider and service code that will be used for eVerification queries to the Clearinghouse
• Billing sub-tab: Also populate a Billing contact name and at least Main Phone number. These will go on every electronic claim. 
• Billing sub-tab: Auto Posting section at the bottom of this screen can be checked if desired:
  • Transfer Patient Liability to Secondary/Tertiary/Supplemental per RA
    • If the ERA shows additional payors and a patient responsibility, the system will do a transfer from payor to new payor
  • Transfer Patient Liability to Secondary/Tertiary/Supplemental per Patient Insurance
    • Even if ERA does not show additional payor, but EMR has additional payor(s), system will do a transfer from payor to new payor
  • Send claims back to pending when transferred to Secondary/Tertiary/Supplemental
    • When manually posting, the system will prompt you to send claim back to pending in case you need to scrub and send manually to the additional payor
  • Send claims back to pending when forwarded to Additional Payor as per RA
    • If this is checked, the system will send the claim back to pending if the ERA has a claim status = "Processed as Primary, forwarded to additional payor..."
  • Post Denied Claims
    • If this is checked, the system will attempt to Auto-post claims that have a Claim Status = "Denied"
  • Post Secondary/Tertiary/Supplemental Insurance Payments
    • If this is checked, the system will attempt to Auto-post claims that have a Claim Status = "Processed as Secondary" or "Processed as Tertiary"

2. Admin -> Personnel -> Personnel Entry:

• Be sure your credentialed providers have accurate information entered (i.e. Name, NPI, Taxonomy code)

   ** Review overrides help article if you need to bill under a different provider:

https://relimed.happyfox.com/kb/article/287-billing-provider-overrides-how-to-change-certain-values/ 

3.  Admin -> Encounter Related Lists -> CPT Codes

• You have the ability to add NDC Codes with Qty and Qty unit required for medications and Vaccines 

   ** Review CPT Codes help tutorial or many others that can be searched:

https://relimed.happyfox.com/kb/article/118-admin-cpt-codes-tutorial/ 

4. Admin -> Billing -Master Charges

• You need to enter your master charge amount per CPT code in this screen. The easiest way to do this is by common category. Fill in the Charge Amount (the Cost field is only for information and is not used any where), set Active checkbox to checked and be sure to set the start date to be the first DOS you will need this charge amount for. 
• Later, if you need to change this amount, end date the current row and re-search the code to enter a new amount with a new Start date. This is will ensure older claims retain the previous charge amount. 

5. Admin -> Encounter Related Lists -> Immunization List (OPTIONAL)

• You can review this screen where you can map CPT codes and optionally a Diagnosis code to an immunization which can make billing easy for the provider. Once a clinician charts the administration of an immunization and it's mapped, the codes will be added automatically to a claim.

6. Admin -> Encounter Related Lists -> Tests and Procedures Results Tracking List   (OPTIONAL)

• You can review this screen where you can map CPT codes and optionally a Diagnosis code to an in=house test or procedure which can make billing easy for the provider. Once a clinician charts the completion of an item in this screen and it's mapped, the codes will be added automatically to a claim.

7. Admin -> Lists -> List Item Entry -> Billing Auto Post Reason Codes 

• You can review this lists which determines the behavior in Auto Posting for each Reason Code. For example, you may want CO-45 (45 in this list) Contractual Adjustment to automatically post as an adjustment, however, you might want CO-96 (non-covered charge) to NOT post at all, so you will be alerted to this AR as claim will still have a balance and you can work on it. 
• If a claim has a reason that is skipped due to the way the reason code behavior is set - the claim will be placed in the ?AP Skipped" claim status. 

8. Admin -> Billing -> Payor Entry

• Be sure all payors are entered from this screen with the appropriate Payor ID and Claim format for sending electronic claims. You can review the help document here:

https://relimed.happyfox.com/kb/article/209-adding-a-new-insurance-payor-in-the-system/

NOTE: remember you will have to also enroll each payor through your Clearinghouse in order to send electronic claims (EDI), receive Electronic Remittance Advices (ERA), perform eVerification (Eligibility) and even to receive funds directly (EFT).