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Set Up Professional EDI Claim Profile Rules

On the Professional tab of the EDI Claim Profile Maintenance window, you can determine how the details appear in the rendering provider loop, the service facility location loops, and the referring provider full middle name for the 837P Electronic Data Interchange (EDI) claim files of specific payers.

  1. In File Maintenance, select Libraries > EDI Claim Profile.
  2. In EDI Claim Profile List, do one of the following:
    • To add a library, select Open Menu , and then 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.
  3. In EDI Claim Profile Name, enter a descriptive name for the library.
  4. In Payer Rules for EDI, do one of the following:
    • To add payer rules, select Open Menu , and then select New.
    • To modify payer rules, select the corresponding row from the list, select Open Menu , and then select Open.
    The EDI Claim Profile Maintenance window opens.
  5. Select Professional.
  6. To generate the location loop with Place of Service (POS) 99 details in the EDI claim file, select the corresponding row in Setting for Send Service Facility Location Loop with POS 99 Details.
  7. To generate the full middle name instead of the middle initial of the referring provider in the EDI claim file, select the corresponding row in Setting for Send 2310A Referring Provider Full Middle Name.
  8. For Send 2420A Rendering Provider Loop, do one of the following in the Setting column:
    • To generate the 2420A loop with rendering provider details, select Always.
    • To generate the 2420A loop when the claim and line-level rendering providers are different, select Only if claim and line level renderings are different.
  9. For Send 2420C Service Facility Location Loop, do one of the following in the Setting column:
    • To generate the 2420C loop with service location details, select Always.
    • To generate the 2420C loop when the claim and line-level service locations are different, select Only if claim and line level locations are different.
    EDI Claim Profile Maintenance window for setting professional EDI claim profile rules

  10. Select OK.
Set Up Professional EDI Claim Profile Rules