Support
Home > Support > FAQ > Submit Claims Under HIPAA

Prepare for Submitting Electronic Claims Under HIPAA

HIPAA requires quite a few new items of information that older formats did not need.  If you upgraded from the DOS MD VersaForm, your old information was imported, but of course the new items were not.  Thus you must make sure everything is filled in before you try to create electronic claims.  Otherwise you will get lots of errors, but no claims.

The Error Log

If you upgraded from MD VersaForm, read the error log from the upgrade process.  It may help to print it first; it is in your VersaForm folder (usually Program Files\VersaForm 3.0\ on C:  It may be very long, but read it anyway.  It is telling you what was wrong with your old DOS files.  The only thing it is safe to ignore is the Social Security numbers, if you don't care about them.  The new claims format is very unforgiving, and will often reject claims for tiny errors. 

Consider making corrections in the old MD VersaForm system, then importing again.  This may be the easiest and best way.

Claims Processors

Edit each Claims Processor. This holds the numbers that identify you to the processor.  They must be on your claim for it to be accepted. Click OK--the program will let you know if anything is missing.

Insurance Plans

Edit each insurance plan to which you submit electronically.  Make sure that the Payer ID, the Claims Processor, and all ID numbers and qualifiers are filled in.   Click OK--the program will let you know if anything is missing.

Payer IDs can be obtained from the processor.

Facilities

Edit each facility that you might refer to--especially those that might be a place of service.  Make sure all the IDs and qualifiers are there. And the Entity Identifier. Click the Edit IDs button to check the ID for each insurance plan.  Each one should have a qualifier.  Click OK to exit.

Providers

Edit each provider who will be either a primary provider or a rendering provider (i.e., a provider on a charge line).  Make sure all the IDs and qualifiers are there. If a provider is not the Billing Provider (as in a group practice), that provider needs to have a Submitter designated (usually the group), who will get paid. Click the Edit IDs button to check the ID for each insurance plan.  Each one should have a qualifier.  Click OK to exit.

Referring Providers

Edit each referring provider who is active.  Make sure all the IDs and qualifiers are there. Click the Edit IDs button to check the ID for each insurance plan.  Each one should have a qualifier.  Click OK to exit.

Submitters

Edit each Submitter. Make sure all the IDs and qualifiers are there. Click the Edit IDs button to check the ID for each insurance plan.  Each one should have a qualifier.  Click OK to exit.