What triggers generation of an 837 claim file from Resolute?

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Multiple Choice

What triggers generation of an 837 claim file from Resolute?

In Resolute, the 837 claim file is created when the encounter is marked as ready for billing and there are posted charges. This billing-ready state means all the necessary billing data—charges, patient, provider, payer, diagnoses, procedures, dates, and modifiers—are in place and stable, so the system can generate a complete claim to send to the payer. If charges haven’t been posted or the encounter isn’t finalized for billing, there’s nothing to submit, so no 837 is produced. The other options don’t fit because: submissions aren’t created automatically after every service—claims are typically generated once the data is complete and the encounter is finalized, often queued for batching or further validation; 837s aren’t limited to inpatient encounters—outpatient and other billable encounters can generate claims when billed; and pre-authorization verification, while important for certain payers, does not by itself trigger the creation of the 837 file.

In Resolute, the 837 claim file is created when the encounter is marked as ready for billing and there are posted charges. This billing-ready state means all the necessary billing data—charges, patient, provider, payer, diagnoses, procedures, dates, and modifiers—are in place and stable, so the system can generate a complete claim to send to the payer. If charges haven’t been posted or the encounter isn’t finalized for billing, there’s nothing to submit, so no 837 is produced.

The other options don’t fit because: submissions aren’t created automatically after every service—claims are typically generated once the data is complete and the encounter is finalized, often queued for batching or further validation; 837s aren’t limited to inpatient encounters—outpatient and other billable encounters can generate claims when billed; and pre-authorization verification, while important for certain payers, does not by itself trigger the creation of the 837 file.

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