Exporting a Merged Health Care Claim

Overview

Many clearinghouses (such as Availity, Waystar, Office Ally, etc.) and state portals (Georgia, Missouri, etc.) allow uploaded EDI files for fast billing. Once an Ankota specialist has configured the environment for this process, the correct EDI file can be created ready for upload at the click of a button.

Pre-Export

To prepare to export an EDI file for billing, perform the usual visit review and billing processes in Ankota. After ensuring visits are closed, reviewing the Visit Approval Dashboard, calculating billing, and completing draft invoices, export the Merged Health Care Claim.

Multiple Visit Types on the Same Day with the Same Client

Sometimes the same client receives the same visit type at multiple times per day. For example, they may receive Personal Care T1019 at breakfast (assistance with dressing, grooming, breakfast, etc.) and again in the evening (assistance with their evening routine) from the same or a different caregiver. If all visits for that client and that visit type on that day are not billed on the same 837, subsequent claims for that day's visit type will be rejected.

To bill these separate same-day visits successfully in 837P files—and to prevent billing one completed morning visit while a second visit remains unapproved in the Visit Approval Dashboard—ensure all visits are ready to bill for the selected date range before billing. All visits in the selected date range should be in Passed Screening or Approved status (i.e., out of Needs Action status) in the Visit Approval Dashboard.

For an extra safety net, Ankota has an optional feature that can be turned on by request. This safety net prevents invoices from moving to completed status if their "partner" visit or visits are not ready to bill.

Exporting the Claim

To export the merged health care claim:

1. Go to the Billing Report page.
2. Filter for the appropriate completed invoices.
3. Select the invoice or invoices by checking the boxes next to them.
4. Click the Export Merged Health Care Claim button.
5. The file or files will save to your computer, usually to the Downloads folder, with the name Claims_Merged_Year_Month_Day_Time_Seconds.edi (for example, Claims_Merged_2020_11_05_08_12_52.edi). Depending on your needs, the output may render as one or more files.
6. Open the portal (clearinghouse, state portal, etc.) where the EDI file can be uploaded, and upload the appropriate file or files.