Availity Clearinghouse Claims Creation & Submission – TherapyMate

This document will show you how to create and submit electronic claims that can be uploaded to the Availity Clearinghouse.

Clinician Practice Information Page Settings

Before you can create and submit a Clearinghouse Claim Files, you must make sure you have two fields set on your Clinician Practice Information settings. Click on your name in the upper righthand corner of the Dashboard and choose Settings from the drop down.

At the bottom of the Settings page you’ll see a link to Clinician Practice Information.

Click on the link and scroll down to the bottom of the Clinician Practice Information page. You will see two fields called Interchange ID Qualifier and Clearinghouse ID. Set them to the values shown below and save the page when done.

If there are multiple clinicians in your Practice, be sure to make these settings on each of their Clinician Practice Information pages if you want to bill through the same clearinghouse.

This completes the settings changes for Availity in TherapyMate.

Creating a Clearinghouse Claims batch file

1. Click on the main Billing option at the top of your Dashboard as shown:

2. Click on the Clearinghouse Claims tab. The default page is Clearinghouse Claims-Batch Files.

3. If you've never submitted any Clearinghouse Claims-Batch Files the page above will be blank. If you have submitted these types of claims in the past, they will be listed

Please Note: Be careful not to delete claims on this page after you create them unless you have a reason to do so. When claims get deleted the status of an invoice(s) will return to “pending” in the patient’s chart. If you need to make corrections to a batch you can delete the claim file, make the corrections in the patient’s chart and create a new version of the file. Otherwise, just let them accumulate so you can maintain a history of your claims.

4. To create a new Clearinghouse Claims-Batch Files, click on the + Create button as shown below:

5. Check the boxes on the left hand side of the page for the claim(s) that you wish to include in the batch file. (see below)

6. Click the blue “Select” button to create a billing file. You will be return to the previous page where the batch file you just created will be shown.

7. In this example, we created a Clearinghouse Claim file for Warren and Jim. To download the file, click on the disk icon where the red arrow is located. The system will perform some error checking and attempt to download your batch file to your computer.

Please Note: Make sure your browser’s popup block is turned off. If it is turned on this will prevent you from downloading and saving the claim file to your computer.

8. When you click on the floppy disk icon, TherapyMate is going to do some checking to see if any of the billing information is missing. If it finds something missing it will show you what needs fixing as in following example:

In this example the patient’s date of birth is missing. Click on the underlined error to fix the problem. When you do this a new browser window opens. Once you correct the error in the new browser window you can close it and return to the original browser window and click the “Try Again” button.

When all of the errors are corrected the file will download and will get saved to your “downloads” folder or other location depending on how you set this up on your computer.

The file name that gets saved will be similar to the following example: edi_file_10492.txt. The numbers will increment each time you create another file.

Uploading the Batch File into Availity

To upload the batch file into Availity you will need to register for a free account. Go to www.availity.com. When you receive your user name and password proceed as follows:

Login to Availity at www.availity.com
Click on Claims & Payments on the main menu bar and then click on Send and Receive EDI File

3. Select your organization from the drop down and click Submit.

4. Click on Send Files folder as shown below:

5. Click on the browse button and locate the clearinghouse batch file you created and save to your computer. It may be saved in your downloads folder or on your Desktop depending on your browser’s settings.

6. When your batch file is ready to upload, it will appear next to the Browse button. Click Upload File to complete this process.
7. Your batch file has been submitted.

Checking Submitted Files for Errors or Acceptance

Availity will check your batch file for errors and report back in the Receive Files folder as shown below:

In the Receive Files folder there can be several different responses from Availity and the Insurance Providers. Here is an example so you can see what they look like:

To read the contents of one of these files, click on the icon in the File Options column and then click on Download as: Text/Plain. You’ll be able to read the contents of the file. DPT and EPT files are acknowledgements from the insurance companies and IBT or acknowledgements that the claims were rejected or accepted. The ERA’s are harder to read, but they are payment advices. For more information about the different file types, please contact Availity.

Please Note: TherapyMate's role is to help you create industry standard batch files so you can upload them into Availity. TherapyMate does not offer any support after that for the Availity website or their billing processes.

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