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Last Modified: 2/8/2024 Location: FL, PR, USVI Business: Part A, Part B

The SPOT User Guide

Section 7 – Claim Submission / ERA

The Claims Submission / ERA option allows you to submit electronic claims via batch files (837) and retrieve the electronic reports through TIBCO PartnerExpress. 837 claim files submitted using this feature must be in the ASC X12 version 5010.
This feature is only available for organizations that have completed a recent portal enrollment form or the claim submission agreement form.
Open Claim Submission / ERA feature
To open the Claim Submission / ERA feature:
Select Claim Submission / ERA from the top menu
Click the Claim Submission / ERA link.
aim Submission/ERA
Figure 1: Claim Submission/ERA
A new browser window will open. If the new window does not open automatically, you may need to turn off your internet browser’s pop-up blocker or add the website address to list of the allowed sites.
BCO PartnerExpress home page
Figure 2: TIBCO PartnerExpress home page
Claim File Submission
To submit an 837 claim file and retrieve reports:
Click on the Inbox tab.
rtnerExpress inbox tab
Figure 3: PartnerExpress inbox tab
Click on the New button.
ew button
Figure 4: New button
Select Interchange.
nterchange option
Figure 5: Interchange option
Click Choose File and then navigate to the claim file. The location will depend on where your claim creation software saves the file. If unable to locate the file, please contact your software vendor. If you are using the PC-ACE software available through SPOT, navigate to the WINPCACE folder and look for the file named BCTRANS.DAT for Part A and BSTRANS.DAT for Part B files.
hoose File button
Figure 6: Choose File button
Select the file(s) and click Open. The selected file will display in “Upload file” textbox.
Click Upload to submit the file. “A new upload working” pop-up message will be displayed briefly.
Retrieve the 999 Acknowledgement Report
This report will display in the Inbox a few minutes after submitting an 837 claim file. This report will tell you if the file is initially accepted or rejected. If rejected, the report will give the reason for rejection. To retrieve the 999:
Click on the Inbox tab and look for the Transaction ID starting with 999.
9 report
Figure 9: 999 report
Select the report from the Inbox list and click Download.
wnload button
Figure 10: Download button
Change the File name ending from .dat to .txt.
ile name change before
ile name change after
Figure 11: File name change
Change the ‘Save as type’ field to ‘All Files (*.*)’.
ave as type change
Figure 12: Save as type change
Navigate to the proper location on your computer and click Save.
Open and interpret the 999 Acknowledgement Report. This report is not reader-friendly and will require software to interpret.
Retrieve the 277CA Claims Acknowledgement Report
This report will display in the Inbox a few minutes after a 999 Acknowledgement Report without any errors. This report will tell you if each claim was accepted for processing or was rejected. If rejected, the report will give the reason for rejection. To retrieve the 277CA:
Click on the Inbox tab and look for the Transaction ID starting with 277CA.
7CA report
Figure 13: 277CA report
Select the report from the Inbox list and click Download.
ownload button
Figure 14: Download button
Change the File name ending from .dat to .txt.
ile name change before
ile name change after
Figure 15: File name change
Change the ‘Save as type’ field to ‘All Files (*.*)’.
ave as type change
Figure 16: Save as type change
Navigate to the proper location on your computer and click Save.
Open and interpret the 277CA Claims Acknowledgement Report. This report is not reader-friendly and will require software to interpret.
Retrieve the 835 Electronic Remittance Advice (ERA) Report
This report will display in the Inbox when claims finalize if the ERA is assigned to your SPOT submitter ID. That assignment is done with the ERA request section of the SPOT Enrollment Form.
. This report will tell you the processing decisions after a claim in finalized. If the claim was approved and paid, payment details will be included. If the claim rejected, the report would give the rejection/denial code details. This report may be used in some software programs for auto-posting (if relevant, details would need provided by your software vendor).
To retrieve the ERA:
Click on the Inbox tab and look for the Transaction ID starting with 835.
35 report
Figure 17: 835 report
Select the report from the Inbox list and click Download.
Change the File name ending from .dat to .txt.
ile name change before
ile name change after
Figure 18: File name change
Change the ‘Save as type’ field to ‘All Files (*.*)’.
ave as type change
Figure 19: Save as type change
Change the File name ending from .dat to .txt.
Change the ‘Save as type’ field to ‘All Files (*.*)’.
Navigate to the proper location on your computer and click Save.
Open and interpret the 835 ERA. This report is not reader-friendly and will require software to interpret.
Identifying crossover claims on the electronic remittance advice (ERA)
If the insurer has a Coordination of Benefits Agreement (COBA) with Medicare, then Medicare will crossover and transmit enrollee eligibility data and Medicare adjudicated claim data to the supplemental insurer. Using the SPOT Claim Submission/ERA feature, the crossover information can be found on the ANSI 835 ERA in the "TRANSFER TO (COB)" field. The Trading Partner's ID will be located in the "ID CODE" field on the ERA. If the claim crossed over to multiple Trading Partners, only the first one will be listed on the ERA. Using the Trading Partner ID, you can look up the other insurer that the claim crossed over to here: COBA Trading Partners Customer Service Contacts - June 2022 external pdf file (list of automatic crossover Trading Partners in production).
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.