837P Billing

The 837P (Professional) is the standard format health care providers and suppliers use to send health care claims electronically.  Some customers may use this as their main or one version of how they bill for services.  iCM enables the creation of a batch file that customers can provide to their third party billers or clearinghouse to send the billing data to various payors which may include state Medicaid provider and/or various Managed Care Organizations (MCO)s.  

Using the 837P format requires the following data, settings and features in iCM:

Diagnosis Setting

• From iCM-Settings, select Diagnosis Settings and ICD10 - Diagnosis.  This will enable a drop down listing to appear in the Manage Funding Stream area.  Please note that this will also provide the same drop down listing in the Individual's Diagnosis & Allergy tab.

Funding Streams

• From Admin Tools, select Manage Funding Streams.  When entering a new or updating a current Funding Stream, these additional fields will be required.

Individual Profile

• From the Individual Profile, select the Administrative Tab.  Then the Insurance tab.  Some states may use MCOs.  If so, the MCO information should be entered and updated if any changes occur.  If your state or Individual is not using an MCO, the state's Medicaid name, Member ID and Effective date should still be entered in this location so iCM pulls the correct data for the 837P generation.

Manage Programs

• In the Organizational Hierarchy, select the Top Node and then check the box for "is this a Primary Node?".  Select Edit and the additional fields of Billing Provider Tax ID Type and Billing Provider Tax ID will appear.  Enter the required data and Save.