Apex
NOTE:
The numbers provided in this configuration guide are subject to change without notice. It is your responsibility to maintain the accuracy of these numbers in your system.
Electronic Document Interchange (EDI) is a way to exchange data using a standard format and communication protocol. ChiroTouch supports a subset of EDI standards for Health Care that is mandated by HIPAA. This standard is created and maintained by the ANSI X12 committee. The current version of ChiroTouch includes support for the 837 (claim) and 835 (remittance advice) EDI transactions. The process of exchanging the EDI documents is called “document trading” and the parties involved in that process are called “trading partners”.
Before you can start trading EDI documents with Apex you need to complete the following tasks:
- Enroll with Apex EDI
- Configure ChiroTouch for EDI
These tasks are described in greater detail later on in this document.
NOTE:
Please note that this document should be used as a supplement to the ChiroTouch User's Manual because it describes elements specific to Apex EDI.
Apex EDI Enrollment
To enroll with Apex EDI clearinghouse, please contact them at:
Phone: 1-800-840-9152
At the end of the enrollment you should received your user name, and password for the web and / or OneTouch application.
Apex Configuration
EDI makes use of several data identifiers that define key entities included on the exchanged documents. These include site, doctors, patients, payers, and trading partners. Using of the identifiers instead of names greatly reduces data entry mistakes and removes naming discrepancies between different organizations. The following section describes all data elements that need to be configured for successful EDI. Please refer to the ChiroTouch Manual for more information on how to use the EDI configuration screens.
Trading Partner Configuration
Apex EDI is considered an electronic document trading partner for your organization. A trading partner in ChiroTouch is defined by few data elements that are specified on the Trading Partners screen.
The table below shows all data elements that need to be specified for Apex EDI. It does not show any elements that can be left with their default values.
|
Partner Name and Identifier: |
|
|
Organization Name (1000B NM103) |
ApexEDI |
|
Identifier Qualifier (ISA07) |
Mutually Defined [ZZ] |
|
Identifier Value (ISA08) |
ApexEDI |
|
ETIN (1000B NM109) |
ApexEDI |
|
Application Code (GS03) |
ApexEDI |
|
Site Name and Identifiers |
|
|
Organization Name (1000A NM103) |
Site name is used automatically and it cannot be changed here |
|
Identifier Qualifier (ISA95) |
Mutually Defined [ZZ] |
|
Identifier Value (ISA06) |
Use Site Tax ID |
|
ETIN (1000A NM109) |
Use Site Tax ID |
|
Application Code (GS02) |
Use Site Tax ID |
|
Transaction Options |
|
| Usage Indicator | Production |
|
ERA 835 File Name Mask |
*.* |
|
Control Characters |
|
| Segment Terminator | “~” Tilde |
| Element Separator | “*” Asterisk |
| Component Separator | “:” Colon |
| Repetition Separator | “^” Caret |
|
Registered Payers |
|
|
Primary Identifier |
Use http://www.apexedi.com/support/payer-lists to get Payer ID for your payers |
|
Secondary ID Qualifier |
Leave it blank |
|
Secondary Identifier |
Leave it blank |
|
Claim Filing Indicator |
Selected the value that matches the payer type. It is important to use “Medicare B” for Medicare and “Blue Cross/Blue Shield” for BCBS. Other payers may use “Commercial Insurance” or whatever matches their type. |
|
Designated Partner |
ApexEDI |
Site Configuration
Your site in many cases will be used as EDI Billing Provider and Pay-To Provider for claims and remits. The table below shows all data elements that need to be specified on the Site screen. It does not show any elements that can be left with their default values.
|
Billing Name and Address |
|
|
Name |
Your site billing name (same as in ChiroTouchMaintenance) |
|
Address Line 1 |
Your site billing address line 1 (same as in ChiroTouchMaintenance) Note: PO box is no longer accepted as a valid billing address |
|
Address Line 2 |
Your site billing address line 2 (same as in ChiroTouchMaintenance) |
|
City, State, and Zip |
Your site billing address city, state, and zip code |
|
NPI (type 2) |
A type 2 (organization) NPI assigned to your practice / site |
|
Employer Number / Tax ID |
A Tax ID assigned to your practice / site |
|
Taxonomy Code |
Leave blank |
|
EDI Administrative Contact |
|
|
Name |
The name of the contact person in your office for EDI transmissions |
|
|
The e-mail of the contact person in your office for EDI transmissions |
|
Phone |
The phone of the contact person in your office for EDI transmissions |
|
Fax |
The fax of the contact person in your office for EDI transmissions |
Provider Configuration
Each provider that appears on the claim must be configured for EDI using the Providers screen. Other practitioners do not need to be configured. The table below shows common data elements that need to be specified for each provider. It does not show any elements that can be left with their default values.
|
EDI Rendering Provider |
|
|
Last Name |
Provider last name |
|
First Name |
Provider first name |
|
Middle Name |
Provider middle name (optional) |
|
Suffix |
Provider suffix |
|
NPI (type 1) |
A type 1 (personal) NPI assigned to the provider |
|
SSN |
Social Security Number of the provider |
|
Taxonomy Code |
A specialty code. |
Upload and Download File Location Configuration
Apex EDI exchanges files using several options such as OneTouch for 837 claim and Web site for 835 ERA files.
When uploading claim files, pick them from the path specified below (replace “servername” with the actual server name):
\\yourservername\CTData\EDI\ApexEDI\OUT
When downloading ERA and report files, place them in path specified below (replace “servername” with the actual server name):
\\yourservername\CTData\EDI\ ApexEDI\IN
Please ask your IT professional if you don’t know your ChiroTouch server name.
Testing
Testing is not required.
5010 Readiness
ChiroTouch has already been tested and approved to use 5010 claims.