Technical Details of Importing

Here is everything you need to know about the technical aspects of importing ANSI 837's in EZClaim

Patient Matching

Updating Patient Information

Physician/Facility Library Matching

Creating Claims

Service Lines

Procedure Code Lookup

Payments and Disbursements

Patient Account Numbers

ANSI 837 Importing Limitations

---

Patient Matching

When searching for a match, patients are matched based on their first name, last name, and date of birth (middle name is not considered).

If more than one patient is found, EZClaim will try to match based on the patient's Account Number (if available in the incoming data).

If a patient is manually matched, the incoming patient ID number is compared to EZClaim's internal patient ID and stored for future imports.

This eliminates the need for manual matching on subsequent imports.

Back to Top

Updating Patient Information

Certain interfaces offer the option to update patient information. If this feature is available, users can enable or disable it using a checkbox.

• When updating patient Information, certain rules apply:
  • The patient's name (first and last) and date of birth (DOB) will not be updated.
    • However, the middle name can be updated if necessary.
  • Patients who are marked as Locked will not be updated.
• When updating patient-insured records:
• • • If the incoming data does not include any insured information, the existing data will not be deleted.
    • If the incoming data matches the sequence (primary, secondary, etc.), payer name, insured ID, and group number of an existing insured record, EZClaim will update the existing record.
    • If the incoming payer name, insured ID, or group number does not match, the insured record will be deleted and a new one will be created. 
      • If EZClaim is set up to use an automatic patient template, the insured record will be initialized with the template data first. 
      • Refer to the Automatic Patient Templates section of Patient Templates for more information.
    • If the incoming insured data is primary only and the existing insured data is primary and secondary, only the primary will be updated or replaced. The secondary will not be affected.
    • If the existing patient has both primary and secondary insureds, and the incoming data only contains primary, the patient's secondary insured will remain unchanged.

Back to Top

Physician/Facility Library Matching

EZClaim will try to find a matching entry in the Physician Library using the NPI (National Provider Identifier) and Classification provided in the incoming data.

• If the NPI is not available, it will attempt to match by using the First and Last Name
• If no match is found, a new entry will be created in the Physician Library

For more specific information on variations in this logic, we recommend contacting EZClaim.

Support will be able to provide you with detailed information based on the specific interface you are using.

Back to Top

Creating Claims

When importing claim data, EZClaim will automatically assign the claim status based on the Initial Claim Status setting in Program Setup.

The initial claim values are automatically assigned to the newly created claim object before any interface data is applied. This means that the initial claim values set in EZClaim will be prioritized unless there is interface-specific data that overrides them.

During claim creation, EZClaim incorporates the program-level settings (found in Tools > Program Setup) into the initial claim values.

The process for creating claims through import follows a specific code:

Blank Claim > Patient Physicians and (in most cases) Patient Level Default Diagnosis > Program Level Settings > Patient’s Initial Claim Values > Imported Claim Data > Physician Overrides.

Back to Top

Service Lines

The location where the service was provided will be determined by the Initial Place of Service setting in the Program Setup.

If the number of units for the service is 0, it will be automatically imported as 1 unit. 

Back to Top

Procedure Code Lookup

If the service line data being imported does not include a charge amount (either it is blank or $0.00), EZClaim will perform a procedure code lookup and fill in any missing fields (such as the NDC code and co-pay amount due).

In this case, the incoming data takes precedence over the procedure code lookup. The fields populated from the lookup are the same as if you were manually entering a claim and using the procedure code library.

If a procedure code lookup occurs (when a charge value is not explicitly defined in the import file), EZClaim can set the allowed amount and create a contract adjustment.

Back to Top

Payments and Disbursements

Payments received will be allocated to the first service line. If the service line already exists as a duplicate and was not created, the payment will still be generated but will not be allocated.

This may potentially lead to duplicate payments.

Back to Top

Patient Account Numbers

If the Automatic Patient Template option is enabled in the Patient section of Program Setup and the patient template includes an account number, the newly created patient will have the same account number as the patient template.

This will occur even if the Automatic Account Numbers option is checked in the Patient section of Program Setup and the incoming data does not include a patient account number.

Back to Top

ANSI 837 Importing Limitations

There are limitations that should be taken into account when importing an existing ANSI 837 into EZClaim. 

For more information on these limitations, see the Import Limitations section of the ANSI 837 article. 

Back to Top