ChiroUp business rules for claims generation

This breakdown explains the ChiroUp fields that are required to have stored values in order for an 837 claim to be generated from a Payor’s invoice.


  • Patient Information (Patient Record>General)
    • Name (first and last)
    • Patient DOB
    • Sex
    • Patient address (address, city, state, zip)
  • Rendering Provider Information
    • Provider name (first and last)
    • NPI
  • Service Facility Information
    • Name
    • Address (address, city, state, zip)
    • Place of service code
  • Billing Provider Profile Information
    • Profile type
    • Name
    • Address (address, city, state, zip)
    • NPI
    • Taxonomy code
    • Tax ID number and type
    • Submitter ID
  • Insurance & Payor Information
    *required for each insurance policy/payor combo attached to the purchase
    • Member ID number 
    • Primary insured 
    • Primary insured address (address, city, state, zip)
    • Primary insured sex
    • Release of information
    • Insurance policy payor name 
    • Insurance policy payor address (address, city, state, zip) 
    • Insurance policy payor ‘insurance program’
    • Insurance policy payor ‘payor ID’
  • Purchase information 
    • Date of service
    • At least 1 service that has at least 1 diagnosis (diagnosis pointing locked) 
    • A total for services (billed amount x units added together for each service)
       

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