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)