Crystal sends and receives electronic billing information

[peter@crystalpm]

Did you know that Crystal can send electronic claims information?  Probably.
Did you know that Crystal can import the claim payment information?  Maybe not.

    Claim payments are sometimes called 835 files, or remittance files, or ERA, or EOB files.  They contain detailed information about which patients are included in this payment and what was paid for each product or service that was billed.  If you are already familiar with the Mass Insurance Check process in Crystal, then this is the next big step forward.  Use the import button to pull in one of these files and you won't have to type all the amounts in by hand. 

    If you don't have any claim payment files, ask your clearing house or insurance company how to get one, as sometimes there is a fee for this file.

[peter@crystalpm]

Exactly how do I do this?

Good question, here is a quick run down of the process:

Step 1) go to Admin->Reports and run the Insurance Receivables report.

Step 2) select the insurance company in the drop down box to limit the list to the payment you are importing

Step 3) Select the Mass Insurance Check button to open up the new window (this might take a while to run)

Step 4) On the bottom right of the Mass Insurance Check window, select the Import button and choose the file you wish to import. This should read the file of payments and match them against the outstanding payments in the window. When it finds a match, it fills out the line with the correct payment and write-off information, etc. You can choose to send the rest to the patient or to a secondary insurance.

NOTE: You may test the system and repeat steps 1-4 over and over without affecting the patients invoices. If you do not wish to save any changes, simply close the window at this point.

Step 5) When you are happy with the numbers, press the save payments. This will add the payment information to each of the patients invoices. This step is not reversible, so any changes after this step will need to be done in each patient invoice separately.

[joek817]

Eyemed uses pdf format for their RA. Any chance of being able to include that format in reading RA's in an update as i noticed it only accepts txt, era, or rmt formats?

[Kristen]

The PDF is the printable EOB and cannot be imported into Crystal. The electronic remit file that can be imported must be an ANSI data file. Some clearinghouses may charge for the data filetype (TXT, RMT, ERA) and others allow you to download one or the other (PDF vs. RMT). Talk to your clearinghouse and see how you can access this type of file.