Electronic Claims Testing

The THERAPIST Pro supports three electronic claim formats:

  • ANSI X12 837 X4010A1
  • NSF 3.01
  • CMS-1500 Print Image

The THERAPIST EZ supports only the CMS-1500 Print Image format.

HIPAA is a law that, among other things, mandates a format for electronic health care claims. The required format is the ANSI X12 837 X4010A1 and applies to all providers and receivers. There is one exception in the law and that is that when sending claims via a clearing house, the claims sent from the provider to the clearing house can be in any agreed-upon format. When the clearing house sends them on to the payers, they must be in the HIPAA required format.

Usually, when you begin sending claims to any receiver, whether a clearing house or directly to a payer, you have to go through a series of tests to verify that the claims you send are acceptibly formatted. This can be a simple matter of sending a test claim or can be a long and involved process depending on the receiver.

The Beaver Creek Software policy on testing is that we will assist you in the testing process with normal technical support charges if applicable. With the new HIPAA claims, we are doing the testing directly with receivers on the new claim format. Many receivers require this before they will allow you to send them ANSI X12 claims. You may still be required to send one or more test claims to be sure that your settings are correct.

We will not directly test any of the other claim formats, though we will continue to assist you in your own testing.