Streamline your claims management process and detect and manage rejections in real-time.
Use Cases
- The submission of claims from a third-party practice management system and processing of machine-readable claim responses to that system.
- The submission of claims from a third-party practice management system and monitoring of human-readable claim responses in InstaMed Online.
- The Manual entry and monitoring of claims on InstaMed Online.
Supported Formats
| Transaction | Format(s) |
| Professional Claim | X12N 5010 X222 A1 837P X12N 4010 X098 A1 837P National Standards Format v3.01 |
| Institutional Claim | X12N 5010 X223 A2 837I X12N 4010 X096 A1 837I |
| Claim Functional or Implementation Acknowledgement | X12C 5010 X231 999 X12N 4010 X098 997 |
| Claim Acknowledgement | X12N 5010 X214 277CA X12N 4010 X167 277 |
InstaMed can automatically translate 4010 files to the 5010 format.
Data Flow
Note: InstaMed returns a TA1 Interchange Acknowledgement only in such cases where a duplicate claim file has been submitted (i.e., a duplicate ISA Control Number and Sender ID is received).
Standard Claims Edits
The InstaMed Platform supports the Workgroup for Electronic Data Interchange’s (WEDI) Strategic National Implementation Process (SNIP) edits, including the following:
- EDI syntax integrity
- HIPAA syntactical requirement
- Balancing
- Situational
- External code set (not applied in all cases)
- Product types or line of services
- Implementation guide-specific
Validation
The following prerequisite requirements apply to claims submissions in X12 in order to ensure automated delivery of claim responses:
- 837 claims must include all mandatory segments and required data elements in those segments, as defined by the WPC 005010X222A1 or 004010X098A1 Transaction Set Implementation Guide.
- All Hierarchical Level (HL) segments must be well formed (e.g., HL01 – HL04 must accurately describe the context of, and relationships between, HL segments in the claim)
- All required data elements must be populated in all 837 claims
- All data elements must conform to the correct data element types, as defined by the WPC 005010X222A1 or 004010X098A1 Transaction Set Implementation Guide (g., Numeric, String, Date)
- When situational loops are included, all mandatory segments in those loops must also be present.
Integration Options
InstaMed Online
The simplest way to connect to InstaMed requires no integration at all. Leverage InstaMed Online directly without embedding the functionality into another system.
Batch Upload
Submit claims using the X12 4010 or X12 5010 file format.
Service Templates
InstaMed supports configurable templates to expedite claim entry.
Batch
Submit claims using the X12 5010 or X12 4010 file formats via sFTP. Learn more about batch integration.