Submitting Claims

Practices have two options to submit claims through Zaya from the Claims page:

• Upload HCFA PDF: Upload a pre-filled CMS-1500 (HCFA) form as a PDF
• Manual submission: Enter claim details directly into the portal

Navigate to the Claims page and press Create claim.

Upload HCFA PDF

1. From your EMR, generate and download the HCFA CMS-1500 forms for the claims you'd like to submit. Make sure each form includes all required information for processing, including:

• Patient and subscriber details
• Payer name and Member ID 
• Diagnosis codes
• CPT codes, Modifiers, and Pointers
• Rendering provider name and NPI
• Service facility details
• Prior Auth Number (If applicable) 

Note: Zaya will automatically update each claim with our medical PC’s billing provider information and apply our chargemaster rates before submitting to the payer.

2. To upload a file, you can drag and drop PDFs into the upload section or select them directly from your computer. You may upload multiple claims within a single file, or one claim per file, depending on your preference. Note: We accept PDF file formats only, with a maximum size of 250mb.

3. Once you've selected all the files you want to submit, press Upload. 

4. Within a week, HCFA PDF files will be processed by the Zaya team and will appear on the main Claims page. Each claim will appear as a new row with the status Pending. Under the Action column, click View original column to view the HCFA claim file you submitted. 

Manual claim

1. To create a claim manually, select an existing patient from the dropdown or click Add New Patient to enter a new one. Once a patient is selected, press Next.

2. Complete the claim form with all required details, then click Create.

3. Manually created claims will appear on the Claims page immediately. Each claim will appear as a new row. Under the Action column, click View original claim to view the claim you created.

4. If you have an prior auth number. Please email support@zayacare.com so we can ensure it is added to the claim. This will be updated shortly to be included on all manual submissions in the near future.  

Submitted a claim in error?

If you accidentally submitted a claim or need to make a correction, please email support@zayacare.com with the claim details, and our team will assist you.