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Getting Started With Insurance Claiming (US)

This article provides an overview of the Zanda claiming feature we provide to our customers located in the US.

In this article: 

Setting Up Your Insurance Information

You are able to set up your Zanda account with insurance information which will allow you to automatically populate claiming data. Here is what you can add to your account prior to generating individual claims:

  1. Insurers you work with (via User Menu > Account Settings > Payments > Insurers); 
  2. Your Tax ID and preferred Claims Billing Address (appointment location address or practice billing address) - (in User Menu > Account Settings > Practice > Business Info);
  3. Preferred Claims Billing Address (appointment location address or practice billing address) to populate in box 33 in claims (in User Menu > Account Settings > Practice > Business Info);
  4. Your Practice Billing Provider Information (in User Menu > Account Settings > Practice > Business Info);
  5. Insured Place of Service for your locations (in User Menu > Account Settings > Practice > Locations);
  6. Your practitioners' Tax ID and NPI Numbers and Taxonomy Codes (in each practitioner's profile is User Menu > Account Settings > Team > Practitioners);
  7. Your Service CPT codes (in User Menu > Account Settings > Billing > Services);
  8. Add Claim Code Modifiers
  9. Add Client Authorizations
  10. Your clients insurances details (in each client's profile).

💡 The detailed instructions for setting up your insurance information can be found here. 

Generating Claim Forms

The Zanda claim form is designed to capture the claim information that will be used for printing the CMS-1500 form and submitting claims to clearing house.

 

🗒️ We have provided the detailed information about each claim form field and how it is populates in this separate article. 

Creating CMS-1500 Forms

Zanda enables you to create, print and download CMS-1500 forms to submit claims for medical services and supplies.  

🗒️ Using the current Zanda functionality, you can generate a CMS-1500 form from the relevant client claim, and we step you through this process here. 

Frequently Asked Questions

❓ What should I check if an Ensora Clearinghouse (formerly Apex EDI) claim fails because the provider is not recognized?

Start by reviewing the provider-identifying details on the claim, then save and submit the claim again. Check that the practitioner linked to the invoice has the correct NPI Number and Taxonomy Code under User Menu > Account Settings > Team > Practitioners, and check the practice NPI Number, Taxonomy Code, and Claims Billing Address under User Menu > Account Settings > Practice > Business Info.

On the claim form, review the Diagnoses and Service section and the Biller Information section before submitting again. The rendering provider details are taken from the first claim item, while billing provider details can come from the practice or practitioner setup depending on what has been entered. If the claim has already been submitted and needs to be replaced, use Create Copy to Resubmit and enter the required resubmission details.

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