Checking Status of 837

After invoices are created in OnTarget, an 837 claim file is created based on the automation schedule setup for each payer. An 837 claim file is submitted to the payer electronically via file transfer protocol (FTP) or by uploading in a payer website. This electronic version replaces the CMS 1500 HCFA or UB04 paper claim. Once an 837 claim file is submitted to the payer, the payer is required to send a response that indicates the file is HIPAA compliant. This response will have one of 3 statuses; Submitted, Accepted or Rejected. (Explained later in the course)

It is important to understand if a file is accepted in time for a payer cutoff to ensure processing of claims. Here are the steps to check the status of an 837 file:

1. Click on Billing Desktop

2. Click on Claims

3. Click on 837 Status button (bottom right of claims window)

Helpful Hint: If you do not see this button, please reach out to your Security Admin to have access granted. If you are a Security Admin, please see “Configure Securities” section of this course.

4. Check the Status column in the 837 Status window:

• Submitted= OnTarget has submitted the file to the payer; no response from payer yet.
• Accepted= The payer has received the file, and the file has passed all front end HIPAA edits.
• Rejected= The payer has received the file, and the whole file rejected for a HIPAA edit, OR the file has errors and/or warnings.

5. Optional: Enter Search filters to pinpoint a file or set of files.

• File name- Includes date, time, payer name, who exported the claims and the name of the file type (837P/837I)
• Payer Name-Payer the file was submitted to.
• Date-Includes month, day, year, hour and second file was created and submitted to the payer.
• Serial Number-A unique number included in each 837 file as required by HIPAA compliance.

The next part explains what steps to take based on status

1. Submitted= The payers can take up to 2 hours to respond to a file. Aym’s processes notify you, as well as our account analyst team by email if a file is still in Submitted status based on a predetermined schedule. An Aym expert will work that file if more than 2 hours have passed with no response.

Helpful Hint: Please submit a ticket to support if a file is still in Submitted status after 2 hours, or you have not heard from Aym.

2. Rejected= All rejected files are worked by our account analyst team immediately upon notification.

Helpful Hint: Please submit a ticket to support if a file is in Rejected status after 2 hours, or you have not heard from Aym.

3. Accepted= Nothing further for you to do! Your claims are in the payer’s hands for processing!

Helpful Hint: An accepted file does not mean the claims will pay. It is only an indication the file is compliant and they have received it.

Configuring Securities for Checking Status of 837

• Note: These steps are for Security Admins ONLY.

1. Go to Configure > Security > Configure Roles

2. Select the user(s) role.

3. Go to Desktop Security tab

4. Expand Claims

5. Check 837 status.

6. Click Save