Get 837i Outpatient - Dhs State Mn

Completing the 837I Outpatient claim form is essential for requesting reimbursement from Minnesota Health Care Programs. This guide will provide you with detailed, step-by-step instructions to effectively fill out the form online, ensuring that you meet all necessary requirements.

Follow the steps to complete your claim form accurately.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Log in to MN–ITS if you haven't done so. Navigate through the left menu and select MN–ITS, then Submit Interactive Claims (837), and finally choose Institutional (837I).
3. In the Subscriber tab, enter recipient information. This includes: the recipient's MHCP identification number, birth date in MMDDYYYY format, last name, first name, gender, street address, city, state (MN), and zip code.
4. Move to the Providers tab. The Billing Provider section should auto-populate. If needed, verify or enter the required information for the attending physician in the Other Provider Type section.
5. Access the COB tab, which is important for reporting third-party liability information. Input details such as payer name, carrier ID, total amount paid by the other payer, and claim adjustments.
6. Proceed to the Claim Information tab. Enter the Type of Bill, statement dates, admission details, patient account number, diagnosis codes, and any necessary attachments.
7. In the Services tab, input the details of the services provided, including the date of service, revenue code, procedure code, and charge amounts.
8. After filling out all required fields across tabs, click the Validate button to ensure there are no errors in your submission.
9. Upon validation, click the Submit button to send your claim. You will receive a Claim Response with the PCN number confirming submission.
10. You can copy your claim for future submissions by selecting the Copy Claim button and following the prompts to streamline new claims with similar information.

Start filling out your 837I Outpatient claim form online today to ensure timely reimbursement.