Zirmed Interface. 716 Newman Springs Road Lincroft, NJ Tel Page 1 of 9

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1 Zirmed Interface The Zirmed interface provides agencies with the ability to send and receive files via Zirmed from within the HBS application. Multiple insurances can be submitted via one claim file, reducing the amount of time required to create, transmit files and check on claim status. To contract for the Zirmed Interface, contact HAS Sales at Set-up: FILE>FILE MAINTENANCE>ENTITY, click Change Type and select Insurance Select an insurance to be configured for Zirmed submission and go to the Insurance tab Set the Clearing-House to Zirmed. In the Payer dropdown, select the Zirmed Payer name for the selected insurance (check Payor ID field to search on Payor ID instead of name). Note: when the Zirmed clearing house is selected, the Payer/Submitter# field will be grayed out and is automatically populated with the Payer ID from the Zirmed list. Use the Billing Unit Override to override claim Units chosen in the billing option sets if needed. For example, if only UHC requires all Skilled Nursing Visits reported as 2 units on the claim, instead of making a new bill option set just for the UHC claims, enter the override value here. Important: In Payor Type, click on the drop-down to select the appropriate type. 716 Newman Springs Road Lincroft, NJ Tel Page 1 of 9

2 Click Save to save changes. Repeat the above steps for all insurance whose claims will be submitted via Zirmed. BILLING>ELECTRONIC CLAIMS Upon completion of the interface setup, Zirmed option sets will be installed by HAS Support. Dependent upon billing needs, several Zirmed option sets will be provided. Separate options are required for Institutional (UB04) vs. Professional (1500) formats as well as for Home Health PPS, Home Health non-pps and Hospice billing. Contact HBS Support if additional option sets are needed. To update your Zirmed Option sets with your Zirmed client ID, select the Option set and click Options. Enter the ID in the ISA*06 Interchange Sender ID field. Option Clearing House should be set to Use Zirmed Clearing House. 716 Newman Springs Road Lincroft, NJ Tel Page 2 of 9

3 Electronic Claims Process: Electronic Claims gives the user the ability to create batch claims in ANSI X12 professional and institutional formats for transmission to Zirmed. Go to BILLING>ELECTRONIC CLAIMS Set Selection Type to Insurances and/or Patients and select specific insurances/patients on the Specific Includes tab. Submitted Bills should be set to Un-Submitted Only unless claims are being re-submitted in which case All Bills should be chosen. In the Bill Date Selection, enter the Bill Date from the Billing Audit run as the From and To Date. For agencies with multiple units, check the Active box under Unit Selection and select the particular unit for which the claim file is being created. Select the appropriate Zirmed Option Set in the Option Set Selection dropdown (Institutional, Professional, Home Health, Hospice, etc.) For the Filename, enter a unique filename with an.x12 extension. Click on the on screen for additional information regarding selection criteria options or refer to Help > Help, Billing > Electronic Claims. Click Preview after selections have been made. Review the Electronic Claim Submission report for accuracy. Claims with an EXCEPTIONS FOUND message (see below) will not be exported until corrections are made and the file re-created. After the exceptions have been corrected the electronic claim file is ready for transmission to Zirmed. 716 Newman Springs Road Lincroft, NJ Tel Page 3 of 9

4 Sample Electronic Claim Submission Report: After previewing the Electronic Submission Report, click Submit Claims to Zirmed if ready for transmission or click Do NOT Submit Claims if corrections are still needed. 716 Newman Springs Road Lincroft, NJ Tel Page 4 of 9

5 After submitting claims, access Claims Status to confirm the files were accepted. Claims Status Process: The Claims Status menu provides access to the 999 and 277 response reports to determine if claim were accepted or rejected by Zirmed. Go to BILLING>CLAIMS STATUS Note: If this menu is not available, the menu option needs to be enabled in File>File Maintenance>User Security. Set the Clearing-House to Zirmed. 716 Newman Springs Road Lincroft, NJ Tel Page 5 of 9

6 Click Get 277 or Get 999 to retrieve response files from Zirmed. 716 Newman Springs Road Lincroft, NJ Tel Page 6 of 9

7 Highlight a file and click Preview or double-click to view the response report: Click Yes to view the Electronic X12 File Report if the File Status is Rejected. Rejections will appear in bold on the report. Click No if the File Status is Accepted. (Click in the State column to manually mark accepted files as Discarded). After the 277 or 999 report is previewed or printed you will be prompted to mark the file as Discarded. Files should be marked Discarded if they are no longer needed for reference. Discarded files can be viewed by checking the Include Discarded box. Click the Save button to save the 999/277 file to your local drive (optional). Click the button to access the Zirmed website. Electronic Payment Process: Electronic Payments allows the user to post ERA/835 payment files within HBS. Go to A/R>ELECTRONIC PAYMENTS Set Clearing-House to Zirmed. Click Get 835. Set the Payment Type and Adjustment Types to Ensure the Payment and Adjustment Types are set correctly and a Payment Date or Use Check Date is specified. Report Bad Payments: This should be checked to include payments that will NOT be posted. Bad Payments may occur if processing a remit file that includes payments for claims that were not generated in HBS. Include Discarded: After a payment file has been posted you will be prompted to mark it as Discarded. Check this option if you still wish to have discarded files listed in the grid. Payment Date: Defaults to Today's Date. Can be changed to a different date, or can select Use Check Date as the payment posting date. Use Check Date will default the payment date to the check date from the ERA file. 716 Newman Springs Road Lincroft, NJ Tel Page 7 of 9

8 Double-click the remit to be processed and click Yes to process the file now. 716 Newman Springs Road Lincroft, NJ Tel Page 8 of 9

9 Sample Electronic Claim Submission Report: Note: The Bill Master not found! message will appear if there is no bill record in HBS to post the payment to. This will occur when the claim was billed out of different software or if the claim was un-billed and the A/R record deleted. Once previewed or printed you will be prompted to Post the file. Previously posted records will NOT be double-posted these records will be listed as bad payments. Once payments are posted the State field changes to discarded and the file will not appear in the grid unless the Include discarded checkbox is marked. You can also click in the State field to mark the ERA as Discarded and click Yes at the confirmation prompt: Click the Save button to save the 835 file to your local drive (optional). 716 Newman Springs Road Lincroft, NJ Tel Page 9 of 9