Medisoft not automatically splitting EDI claims

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cxz0808
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Medisoft not automatically splitting EDI claims

Post by cxz0808 » Fri Dec 11, 2015 10:53 pm

I am having issues with limiting the number of transactions per EDI claim. I set a max amount for the individual insurance carriers when I submit the claims, Medisoft doesn't seem to be splitting them. I have the max number of transactions set to 4, so if I send in a claim with 16 transactions, I would expect medisoft to split it into 4 claims with 4 transactions each, but it doesn't do that. I am currently just manually splitting the claims, but that is really time-consuming. Any idea what I did wrong or how to fix this? Thank you, any help is appreciated.

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Gavin Walker
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Re: Medisoft not automatically splitting EDI claims

Post by Gavin Walker » Mon Dec 14, 2015 3:55 pm

I believe the default is 50 transactions per claim for professional claims. Where are you setting the limit and why do you want it to be so low?
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cxz0808
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Joined: Fri Dec 11, 2015 10:42 pm

Re: Medisoft not automatically splitting EDI claims

Post by cxz0808 » Tue Dec 15, 2015 8:21 pm

Hi Gavin,
I wanted to set the limit to 4 is because when the transactions are processed, they are split up into 6 transactions per page. This becomes a problem because the insurance companies count the transaction on the following page as a separate visit even if the date of the claim is the same. So if I submit a claim for 2 days that has 4 transactions each (8 total transactions), there would be 6 on the first page, and 2 on the second page. Instead of counting that as 2 visits, the insurance companies would count it as 3 visits. The only solution I've been able to find for this was to split the claims up by day, but that has been extremely time-consuming.

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Gavin Walker
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Re: Medisoft not automatically splitting EDI claims

Post by Gavin Walker » Wed Dec 16, 2015 2:22 pm

In Claims Management, you can create your claims 1 day at a time. Just be careful not to forget generating claims for a day. You might follow up by generating claim with an open begin date just to make sure you have everything generated into claims.

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