In File Maintenance, select Libraries > EDI Claim Profile.
In the EDI Claim Profile List window, do one of the following:
To add a library, select open menu and select New.
To modify a library, select the corresponding row from the list, select open menu , and then select Open.
The EDI Claim Profile Maintenance window opens.
In the EDI Claim Profile Name field, enter a descriptive name for the library.
In the Payer Rules for EDI section, do one of the following:
To add payer rules, select open menu and select New.
To modify payer rules, select the corresponding row from the list, select open menu, and select Open.
The EDI Claim Profile Maintenance window opens.
Enter an effective date and an expiration date for the payer rules.
Note: Dates cannot overlap between payer rules for the same payer. If you enter overlapping dates and select OK, the application displays a message indicating that the effective and expiration dates overlap for an existing payer rule.
Enter a descriptive name for the payer rule.
Do one of the following:
To define default payer rules for all payers that do not have specific rules defined, select the Use as default EDI rules for all payers check box.
The Valid Payers section becomes unavailable.
To define EDI rules for specific payers, leave the Use as default EDI rules for all payers check box blank and then do the following:
In the Valid Payers section, double-click open folder .
In the Payers window, select one or more payers and select OK.
Set up professional, institutional, and dental rules for the payers on the corresponding tabs as applicable.
