Electronic ClaimsRLISYS and McKesson Corporation have teamed up to provide cost-effective electronic claims submission. This page contains the following information on electronic claims:
While there are several transaction sets, RLISYS customers submit their claims in the ANSI 837 Healthcare Claim: Professional (with Addenda). McKesson provides clearinghouse submissions to thousands of commercial insurance companies and most government insurance programs. To view a list of commercial carriers, click here. To view a list of state carriers, click here.
The RLISYS electronic claims software was specifically developed and designed for those entities that are considered Small Providers. According to the Federal Register, Volume 68, 424.32(d), Provisions of the Interim Final Rule, a Small Provider is defined as “a provider of Services with fewer than 25 full-time equivalent employees; or a physician, practitioner, facility, or supplier (other than a provider of service) with fewer than 10 full-time equivalent employees.” Provider of Service generally describes hospitals, nursing facilities, and other institutional providers that are paid through Medicare fiscal intermediaries. Physician, Practitioner, Facility, or Supplier generally describes entities that furnish Medicare services and are paid through Medicare carriers. Note: One full-time equivalent employee is any combination of people who work 2080 hours per year.
Please review the documents linked below, as they will provide you with the necessary information to make electronic claims completion a smoother process. If you do not have Adobe Reader on your computer, click here to download it for free.
- Payor Change Requirements – Describes the responsibilities of the office when an insurance company makes a change, such as assigning a new provider number.
- Payor Report Documentation – Payor report instructions.
For more information regarding your responsibilities under HIPAA, go to www.hhs.gov/ocr/privacy.