Downloading Claim Files

Regardless of the payor that is associated with a submitted claim (i.e. Medicare, Medicaid, Commercial), all corresponding claim files will be available for download within the Download Claims screen at some point. Claim files may be downloaded to a specific folder on the local drive of your computer. Follow the simple process outlined further below to download a claim file.

Be aware that the availability of claim files in the Download Claims screen will depend on the settings that are established for the corresponding receiver ID records. The specific method the software uses for each claim file is dependent upon the File Transmission and/or firstREV Claim Editor settings established for the corresponding receiver ID record. These receiver ID settings are used to determine how the software handles claim files for each payor. Learn more about setting up receiver ID records.

File Transmission setting

The File Transmission drop-down field (in Master Files | Receivers) indicates how the software handles claims for payors associated with the receiver ID. Each receiver ID record can be setup with one of the following file transmission options:

● HCF Transmits: Enrolled in firstREV — Indicates that claims associated with these payors are edited using firstREV. HEALTHCAREfirst will submit completed claims for this payor from firstREV.

● HCF Transmits: Not enrolled in firstREV (Medicare only) — Indicates the payor associated with the receiver ID is Medicare and is not enrolled in firstREV (not required for Medicare payors). If this is selected and the “firstREV Claim Editor” box is checked, claims will be sent to firstREV (for editing).

o Users will edit these claims in firstREV (if applicable) and transmit them within the EE software.

o After editing and successfully validating claims in firstREV, users can retrieve clean claims in the Download Claims screen by clicking . A “Send” option will then display in the Action column at the far left of the display grid.

o When “Send” is clicked, the software will automatically submit the clean claims to Medicare via the ABILITY tunnel using the provider’s own Submitter ID.

o For claims that have been sent, a “Resend” option will display in the Action column at the far right of the grid. When “Resend” is clicked, the software will resend the claims to Medicare.

o After clean claims are sent to Medicare, a “Download” link will display in the Action column at the far left of the display grid. Users can click “Download” to manually download the 837 electronic claim file. This is optional, as agencies are not required to download the claim file.

● User Download Only — Enables the software to automatically return claim files to Download Claims so users can manually download the claim files and send them to another clearinghouse or directly to the appropriate payor.

o If the firstREV Claim Editor box is checked (Refer to section below), users will be able to send claims to firstREV (for editing) and then retrieve the claims by clicking in the Download Claims screen. Clean claims retrieved from firstREV will display in Download Claims and users can click the "Download" link to download the corresponding claim files. Users can then upload the files to the appropriate vendor.

o If the firstREV Claim Editor box is not checked, claims will not be sent to firstREV and will immediately display in Download Claims after they are submitted (in Post Batches tab). Users will not be able to edit claims with this setup.

firstREV Claim Editor setting

The firstREV Claim Editor checkbox (in Master Files | Receivers) indicates that claims associated with this payor are edited using the firstREV interface. The software automatically sends corresponding claims for this payor to firstREV (after they are submitted in Accounts | Billing | Post Batches):

● This is checked by default (and cannot be edited) if “HCF Transmits: Enrolled in firstREV” is selected in the File Transmission field.

● This is not checked by default (but is editable) if “User Download Only” or “HCF Transmits: Not enrolled in firstREV (Medicare only)” is selected in the File Transmission field.

4. Find the corresponding record in the display grid for the claim you want to download. If the file is available, a "Download" link will display in the Action column to the far left of the grid.

5. In the Action column, click the Download link for the desired claim record in the grid. A notification will display in your browser window, indicating the file has been downloaded to your local computer.

6. Non-billing clients: Once downloaded, non-Medicare claim files must be submitted to the appropriate clearinghouse, payor portal, etc., if this process has not already been completed.