Required prep steps for claim submissions

Read on for a step-by-step overview on how to set up an insurance claim with ApexEDI on Luminello, or watch a webinar about this process:

1. Make sure your Office Address and NPI information have been added to Account>Practice Info and Licensure.

2. Go to Financial>Insurance Information>Settings to select the practice information you entered in step 1, that you want to set as a default for all insurance claims. If needed, you can change this while submitting an individual claim.

3. Go to Chart>Billing>Insurance Info to input the required insurance information for each patient/client you plan to bill insurance for ( Note: you can have the patient/client complete their part of the insurance information in their portal Account).  For tips on how to enter this info, see this article.

4. If you want to bill contracted rates (including add-on code breakdowns) to each patient's/client's respective insurance company, go to Charts>Billing>Settings to make sure the correct rate table is being pulled - learn how to do this here.  For example, if you have unique rates with Blue Cross, make sure you have a billing table for Blue Cross and that this patient's/client's default rate table is the Blue Cross table.  Learn how to do this here.  This is especially important to make sure the add-on codes are being correctly billed to insurance.

5. Make sure you've recorded a diagnosis for the patient/client by either signing an intake or follow-up/SOAP note with a diagnosis in it as illustrated here

  • If there is no diagnosis, you cannot submit a claim.

6. When it's time to submit a claim, read this article.

NB If Apex rejects your claim, DO NOT RE-SUBMIT FROM APEX - Luminello cannot pick up on any changes you have made in Apex, and when the claim is processed, that info will not come into Luminello.  Instead, create a new billing item in the chart and submit the claim fresh from Luminello.

That's it! If you have any questions, please contact us.

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