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| Field | Description |
|---|---|
| Submitter Profile | Select the submitter profile that you want to apply to 1500 or form template claims. |
| Electronic Transmitter ID | Enter the payer-assigned electronic transmitter ID to generate a claim with an electronic transmitter ID.
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| Practice Payer Opt Val | Enter the practice/payer-specific value. |
| Payer Alias | Enter an alternative payer name when a name that differs from the name that appears in the Payers master file is required. |
| Primary, Secondary, and Tertiary Media Types | Enter the primary media type accepted by the clearing house as being electronic or paper. If you set it as electronic, then you can also set how the secondary and tertiary claims should be submitted. |
| When Primary, force Secondary claims to paper | Enable this check box if you want the claim being sent to the secondary insurance to be generated on paper after payment from the primary insurance has been received. This action overrides the Electronic Secondary Media Type setting. |
| When Secondary, force Tertiary claims to paper | Enable this check box if you want the claim being sent to the tertiary insurance to be generated on paper after payment from the primary and secondary insurance have been received. This action overrides the Electronic Tertiary Media Type setting. |
| Suppress Claim | Enable this check box to suppress claims for this payer when creating claims in batch mode only. |
| Exclude Patient Paid Amount from Claim | Enable this check box to exclude any amount from the claim the patient paid. Whether you use this check box is dependent on the Payer's requirements. Enabling this check box does not affect claims already processed and pending. If you disable the check box after creating a claim, you have to rebill the visit to show patient payments on the claim. |
| Flag All Prior Claim Line Items for Rebill | Enable this check box to include line items with a $0.00 amount with the other line item charges when you rebill an archived claim. |
| Suppress Claim for Non-Qualifying Encounter | Enable this check box to suppress claims for this payer when creating claims for non-qualifying encounters to a federally qualified health center. |
| Populate Ordering phys 2400 E Loop (professional only) | Enable this check box to populate the ordering physician name and NPI number in the 2420E loop for all clinical laboratory and imaging services. This feature only applies to 1500 claims. It does not apply to 837 Dental Claims. |