Billing via Sunshine Health (Centene)

Sunshine Health Portal (https://provider.sunshinehealth.com/careconnect/login/oauth2/code/pingcloud&brand=sunshinehealth) will only accept Claims for the following payers: CMS Title 21, CMS Title 19 and Ambetter.

This assumes you already followed the steps on how to generate the 837P from Office Puzzle described here: https://www.officepuzzle.com/tutorials/billing/

How to Submit a Batch to the Sunshine Portal

Follow these steps to successfully upload a batch to the Sunshine Health portal.

1. Go to the Sunshine portal using the following link: 👉 Sunshine Health Portal.

2. Select the corresponding Plan Type and click Go Button.

3. Navigate to the menu and click Claims → Upload EDI.

4. In the new window titled Batch Claims Upload, go to Step 2 and select the option 837P.

5. Click Choose File and select the file you previously downloaded from Office Puzzle.

6. Finally, click the Submit button to upload the file.

How to Verify That the Batch Was Uploaded Successfully

After uploading the batch, it is important to check that the system has received it correctly.

1. In the menu, click Claims → Batch.

2. Filter by the date you uploaded the batch and click Search.

3. The system will display a list of submitted batches:

Accepted: The batch was received successfully.
Rejected: There was an error, and the batch was not accepted.

How to Check the Status of Each Claim

If you want to verify the individual status of each claim submitted, follow these steps:

1. In the menu, click Claims → Individual.

2. Filter by the date you need to check and click Search.

3. The system will display a list with the following details: client, billed amount, claim status

Paid: The claim has been paid.
Process: The claim is still being processed.

✅ Done!

By following these steps, you can successfully submit and verify your batches in the Sunshine Health portal. 😊

If you have any questions or issues during the process, check the batch status and ensure that you have followed each step correctly. 🚀

by Harold

Billing via Claim.MD

Please remember Claim.MD is offering 20% discount to all accounts using Office Puzzle as their EMR. Simply mention this during registration or send a ticket requesting the discount.

Claim.MD will only accept Claims for the Payers listed: https://www.claim.md/payer-list

This assumes you already followed the steps on how to generate the 837P from Office Puzzle described here: https://www.officepuzzle.com/tutorials/billing/

Payer Enrollment

This is the process where we make sure Claim.MD is aware of which payers we are sending to, this also ensures we configure the ERA (Electronic Remittance Advice) to receive the payments once the claims are processed. Although this step is NOT mandatory is highly recommended.

1. Go to the Claim MD portal https://www.claim.md

2. Enter your Claim.MD username and password to log in.

3. In the menu, go to Provider Enrollment.

4. In this section, locate the payers and click the Enrollment Required button.

5. Follow the provided instructions to complete the registration for each payer. This requires for you to register your Group NPI with Claim.MD for each payer.

6. Once all payers have been registered, you can proceed with the batch upload.

Note: The registration process may take some time to be completed. Make sure to check the status of each payer before proceeding.

Manually Uploading Claims

Uploading Files Manually

"Manually Uploading Claims" refers to the process of generating a batch file containing all claims for a specific provider from the Practice Management System or other software system. This file is typically in ANSI X12 format, although it may be in other formats such as PDF, CSV, XML, or others. The batch file is then saved in a local drive and uploaded into Claim.MD.

This assumes you already followed the steps on how to generate the 837P from Office Puzzle described here: https://www.officepuzzle.com/tutorials/billing/

To upload a claim:

1. Click Upload Files on the left-hand navigation menu.

2. It is recommended to leave Select Format dropdown as Automatic Format Identification first.If the document is not being automatically read, try selecting the specific format (CSV, XLS, XML etc.) in the dropdown.

More Information

Clicking on the button located next to the Select Format dropdown will result in the appearance of a window named Select Format Help. This window will contain links to assist in understanding the rules and formats required to set up a document accurately for uploading to Claim.MD. For example, if a CSV file is being used, a template will be provided indicating how to arrange the column headers.

3. Click the Select File button

4. Browse the local drive and locate the claim file to upload. Double-click on the file or click the Open button.5. Click the Upload Selected File button. A loading circle will display while it uploads.6. An Imported Data Results window will display with the number of claims transmitted, held (to be approved before transmission), and rejected.

6.a. To stay on the screen, click OK

6.b. To approve claims that are held or review rejected claims, click Manage Claims

7. The Recent Uploads section of the page is where you can quickly view information about your batch file such as quantity of claims in the file, total amount for the claims, etc.8. Click the View Claims button to see the individual claims in the file.

9. The next step will be addressing claims that need attention (such as claims needing approval, and rejected claims), which is handled in the Manage Claims page.

You can find the original for this tutorial at https://docs.claim.md/docs/uploading-and-entering-claims

by Harold

Payments & Invoice Efficient Integration

Name: Creating and Managing Invoices on the Agency’s Payment section at Office Puzzle
Description: How to create an invoice on the Agency’s Payment section.
Difficulty: Middle
Duration: Less than 10 minutes

Invoices

Summary:
Step 1- From the Agency Dashboard, access Payments shortcut.
Step 2- Click on Invoices.
Step 3- Click on +New invoice.
Step 4- Select Source: Events, Billed Events or Manual.
Step 5- If selected Events/Billed events, then choose the Range of dates and click on Submit. Also, there are Optional filters: Providers, Clients and Event types.
Step 6- Select the events to be included and hit Continue. (There you can check if there are any error on the events)
Step 7- Select Strategy: Merge all Events, Split by Provider or Split by Event Type.
Step 8- Select the Invoices to be created.
Step 9- Click on Create.

Create Invoices on the Agency’s Payments section

Invoices

Step 1: Navigate to the Agency Dashboard and access the Payments shortcut.

Step 2: Click on the "Invoices" box.

Step 3: Initiate a new invoice by clicking on "+New Invoice."

Step 4: Choose the source of the invoice: Events, Billed Events, or Manual.

Step 5: If Events/Billed Events is selected, specify the date range and click "Submit." Optional filters such as Providers, Clients, and Event types can be applied.

Step 6: Select the events to be included in the invoice and proceed by clicking "Continue." This step also allows you to check for any errors in the selected events.