EDI and Broker Billing

RoutingBox offers several billing file formats that are common to electronic medical billing and specific to individual brokers.

Billing for NEMT Brokers

RoutingBox is compatible with a number of transportation brokers across the United States. Follow these steps in order to create billing files specific to those brokers.

Navigate to the Billing tab, then select the Broker Billing icon.

2021-10-13 08_32_13-Window 2021-10-13 08_28_36-Window

1. Select the Date Range for the trips we would like to bill.
 
2. Start typing the name of the Account and then select the name of the Account from the drop-down.
 
3. Select the Billing Status of the trips you would like to view in the grid. The default status is Ready. Claims that were billed on an earlier date can be rebilled if the Billed status is selected.
 
4. Select to Mark Trips Billed or Batch in Invoice. Marking the trips Billed will change the billing status. If Batch in Invoice is checked, an invoice line will be created, visible on the corresponding Account screen.
 
5. Check the trips you would like included on the billing file. The checkbox in the column header will check all trips in the grid. Please note, any trip with information highlighted in pink requires attention prior to creating a broker billing file.

6. Click Create.

7. Choose the desired file format from the drop-down. You will be prompted to enter a name for the file and save it on your computer. This file may be uploaded to the broker portal.

  • Access2Care CSV will produce a spreadsheet that can be uploaded to the Access2Care portal. This format may require a late reason should the Actual Pick Up Time timestamp on the trip occurs after the scheduled Pick Up Time. For this format to work, driver and vehicle information in RoutingBox must match the information present on the Access2Care portal.
  • Fidelis Care and Fidelis Care (Medicaid #) produce files specific to billing Fidelis through one of their affiliated clearinghouses. If a transporter is billing with an NPI number, choose the Fidelis Care option. If the transporter does not have an NPI and is billing with a Medicaid Number only, Choose the Fidelis Care (Medicaid #) option.
  • ModivCare Atms and ModivCare CSV are formats specific to to ModivCare and should be used only if the ModivCare API integration is not active. If ModivCare Atms is selected, you will be prompted to enter your ModivCare credentials and the trips in the grid will be sent to ModivCare's portal. The ModivCare CSV produces a file that may be uploaded to the ModivCare provider portal. If this option is selected, the transporter will also need to submit a ModivCare Driver Trip Log to complete the batch. 
  • MTM formats are specific to the MTM broker. These files export as CSV files but may need to be saved as an Excel file in order to submit through the MTM portal. Like ModivCare, the MTM Driver Trip Log report will need to be submitted with this spread sheet in order to complete a billing packet on the MTM portal.
  • Additional formats may be available from this drop down for brokers not mentioned above. This may include custom broker formats. Please contact your CSM for information on how to add a broker to this feature.

EDI Billing for Insurance and Medicaid

RoutingBox can also produce HIPPA 5010/837p files for submitting claims to various insurance entities. These formats are common for most medical billing.

Navigate to the Billing tab, then select the EDI Billing icon.

2021-10-13 08_32_13-Windowa

2021-10-13 09_23_13-Window-1

1. Choose the Date Range for the trips you would like to bill.

 2. Start typing the name of the Account and then select the name of the Account from the drop-down.

3. Select the Billing Status of the trips you would like to view in the grid. The default status is Ready. Claims that were billed on an earlier date can be rebilled if the Billed status is selected.

4. Select to Mark Trips Billed or Batch in Invoice. Marking the trips Billed will change the billing status. If Batch in Invoice is checked, an invoice line will be created, visible on the corresponding Account screen.

5. Check the trips you would like included on the billing file. The checkbox in the column header will check all trips in the grid.

6. Select the Create button.

7. Choose the desired 837p format. After the file is generated, you will be prompted to save the newly created file on your computer. This file may be uploaded to a billing entity to submit claims for reimbursement.

  • The first 837p (HIPPA 5010) option was created with New York State Medicaid in mind and includes driver and vehicle information.
  • If you are unsure what option to choose, select the second option for 837p (HIPPA 5010, Advanced) and move on to the next step. 

8. If the 837p (HIPPA 5010, Advanced) option is selected, you will be presented with an additional screen that will ask you to specify what data should be included in the billing file.

2021-10-13 09_26_19-Window

  • If you are unsure what options need to be selected, uncheck all of the options, and click OK to generate the file.

Troubleshooting

Please contact your CSM for any instances where claims are being rejected. Rejection errors will include loop and segment information that is vital to addressing the core problem. Please provide your CSM with a description of the error, a copy of the file that was submitted, and any relevant insurance or clearing house information.