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Electronic Billing

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The Electronic Billing form will need to be used to create the actual file that contains NCPDP roll-up charges. This file is created on the server to be picked up and processed by DayTech.

NCPDP Billing

Checklist prior to billing:

  • Ensure the client has a diagnosis filed within myAvatar.
  • Confirm that the program's location has the NCPDP Patient Residence extended attribute defined.
  • Confirm that the client's Subscriber Policy Number is filed within Financial Eligibility.
  • Confirm that the client's Subscriber Policy Suffix # is filed within Financial Eligibility.

 

  • Create an Interim Billing Batch for Medicare Part D.
  • Close charges for the batch. These are rolled-up charges.
  • The Electronic Billing form is used to create the NCPDP billing file that will be generated on the server and then transmitted to DayTech.
  • Select NCPDP from the drop-down for the type of form. The Billing form to select will be "NCPDP." Only rolled-up NCPDP claims will be picked up.
  • Guarantor Type "Medicare D." This is the Financial Class.
  • Select All or Individual Guarantor. Same process as for an 837.
  • Sort the file. Select No to Create Claims so the user can review the report and dump.
  • Correct any errors.
  • Sort the file again and select Yes to Create Claims and enter the Claim Date.
  • Create the file on the server.
  • The file created will be placed in the folder as per the Output Path on Server for NCPDP Files field on the NCPDP System Defaults form. 
  • CE2000 will pick up the file once the permanent file is saved on the server. The user does not download and submit the file.
  • The file is sent to the Switch for disbursement.
  • The response file is sent back to CE2000 within a minute to be reviewed and errors to be worked and rebilled.