Claims Submission

Claims Submission Via 837 File Guidelines (Alliance Behavioral Healthcare)

Claims Submission Via 837 HIPAA compliant EDI file is available for poviders, including hospital facilities. Once an agency is EDI Certified, a secure FTP login and password will be assigned. 837s may be submitted using this Claims Submission method or by uploading the file through the provider portal using the instructions below.

  1. Using the menu, choose Transactional Upload Q
  2. Click on “Upload file”
  3. Choose the file to upload
  4. Click Save

Retrieval of 835

Agencies submitting 837s will be able to retrieve 835s on checkwrite dates. The 835s can be retrieved using the agency assigned secure FTP or via the provider portal using the instructions below.

  1. Using the menu, choose Download Q.
  2. Files will be listed. The user may select the applicable file and click on download.

Transactional upload and download Q

Transactional Upload: The Claims Submission instructions below will assist you with uploading an 837 file. If your agency does not upload files via 837, proceed to the Download Que instructions. The Transactional Upload Q module allows you to upload files, such as 837 files which contain the claims you want the MCO to process, into their system.

  1. Click the Upload File button, choose the file from your local computer and click the Save button. The Download Q module allows you to download files your MCO has waiting for you.
  2. Files that will be available are:
    • Response files – 999’s, 824’s and 277’s
    • 835’s
    • Current Client Dumps (Current_Client_) – runs daily. This shows all clients for which the provider has submitted claims, has an authorization, has an enrollment, has an appointment, has a SAR, has a client update request, or is marked as the clinical home.
    • Current Auth Dumps (Current_Auths_) – runs daily. This shows info for authorizations that have not ended within the last 90 days.
    • Current Claims Dumps (Current_C).

Exporting from the Download Queue

To export from the Download Q, click on the checkbox to the left of the document you want to download, then click the Download button.laims_) – runs daily. This shows all claims inserted within the last year. The MCO that the file is from is listed in the file name right before the ‘.txt’. If you are contracted with multiple MCO’s you will receive the same file (in this case, the client dump) daily from each MCO.

  1. When you click the Download button, it will may ask you if you want to leave the page or not. Click Leave this Page. After the file has been downloaded, it will either show at the bottom of your screen or a pop-up will display asking if you want to open or save it. Click Open. If it asks what you want to open it in, choose Excel. If you’re not given the option, you can open the file in it’s .txt version. When it’s open, go to File on the menu bar and choose Save As.
  2. You’ll want to resave the file name by taking out the .txt and putting in .xls instead. When you’re done, click Save. Don’t worry about the Save as type dropdown.
  3. Make sure to save the file somewhere you’ll remember, like My Documents.
  4. Go to where you saved the file and open it. Click on the A column, then go to your Menu Bar and click Data.
  5. Next, click the Text to Columns button.
  6. There will now be a series of pop-ups. Select Delimited from the screen and click Next.
  7. In the following screen, uncheck Tab and check Other. Then enter a solid vertical line in the text box. This line can be found on your keyboard just above the Enter key. Click Shift and this key to enter the line into this text box, then click Next.
  8. On the next screen, select General, then click Finish. You will now see the report in a more easy to read format.

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