Submitting Claims through Zaya

Summary

You can submit claims through the Claims page using one of two methods:

• Upload a CMS-1500 (HCFA) PDF

• Enter claim details manually in the portal

Option 1: Upload HCFA PDF

Step 1: Create a Claim

1. Go to the Claims page.

2. Click Create Claim.
   

Step 2: Generate and Upload CMS-1500 (HCFA) Forms

• In your EMR, generate and download the CMS-1500 (HCFA) form for each claim.

• Confirm each form includes all required information:

  • 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 authorization number (if applicable)

Step 3: Upload the PDF by dragging and dropping it into the upload section or selecting it from your computer.

• PDF format only

• Maximum file size: 250 MB

• Multiple claims may be combined into a single PDF

• Click Upload after selecting all files

• Confirm all files are uploaded in the 'View HCFA PDFs' page 

Zaya will automatically:

• Update each claim with our medical PC’s billing provider information

• Apply our charge rates before submitting to the payer

After upload:

• Claims are processed by the Zaya team

• Once extracted, each claim appears on the Claims page with a Pending status

• Processing typically takes 48 hours, but no more than one week

• Click View original claim under the Action column to view your submitted HCFA file

Option 2: Manual Claim Submission

Step 1: Select or Add a Patient

1. Click Create Claim.

2. Select an existing patient from the dropdown or click Add New Patient.

3. Click Next.

Step 2: Enter Claim Details

1. Complete all required fields in the claim form.

2. Click Create.

After submission:

• The claim appears immediately on the Claims page

• Each claim displays as a new row

• Click View original claim under the Action column to review the claim

Submitted a Claim in Error

If you submitted a claim by mistake or need to make a correction:

• Email support@zayacare.com with the claim details

• Our team will assist with the correction