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)