Post on 22-Jun-2020
Optimize Electronic Remit
Posting
AUGUST 10, 2016 Presented by: Anne Havlina
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2
Healthy Financial Core• Allscripts provides solutions that streamline workflows across clinical, financial
and operational processes
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 3
Payerpath Education TrackTIME TOPIC PRESENTER
Tuesday August 9th
1:30 – 2:30 Keep your finger on the pulse using Practice PerformanceAmber Civitarese,
RemitData
Wednesday August 10th
8:30 – 9:30 Patient Responsibility Solutions - Maximize Patient Payment Revenue Opportunities Lisa Temporale
9:45 – 10:45 Allscripts Payerpath: Roadmap to a Healthy Financial Core Steve Mueller
1:30 – 2:30 Optimize Electronic Remittance Posting Anne Havlina
Nicole Beulah
2:45 – 3:45 Integrating Allscripts Payerpath using Office Manager Paola Turchi
4:00 – 5:00 Payerpath Pre-visit solutions: A Healthy Revenue Cycle before Patient Visits Anne Havlina
Thursday August 11th
1:30 – 2:30 Payerpath 101 - Tools and Techniques for Effectively Reconciling and Tracking Claims Carrie Murphy
2:45 – 3:45 The 15 Most Common Allscripts EDI Support Questions Nicole Beulah
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 4
Payerpath Knowledge Resources
1. News, Featured Videos,
Knowledge Resources
• Client Connect
1. Payerpath Knowledge
Center
1
2
3
2
3
1
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 5
Agenda
• Overview
• Benefits of Use
• Electronic Remittance Set Up and Workflow
Process
• Reviewing the Import Remittance Listing/Report
• Questions
Overview
AUGUST 10, 2016
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 7
Allscripts PM iRemit Overview
• ENABLES retrieval of insurance payments electronically (ERA).
• PAYMENTS are posted as receipts and write-offs.
• ALLOWS transfer of claims for secondary billing both
electronically or on paper within Allscripts PM.
• Remittance files are similar to an electronic explanation of
benefits.
– FILES are unique to individual states and insurance carriers.
– FILES utilize HIPAA compliant formats and codes.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 8
Allscripts PM iRemit Overview
• iRemit report downloaded automatically into EDI reports folder
of file name, check number and amounts.
• Some carriers, such as Medicare, will not send paper EOB’s once
you start receiving electronic remittances.
• iRemit can auto-post valid line items and split off rejected claims
and/or line items.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 9
Authorization Required
• Prior to using iRemit you must obtain authorization with
the carriers.
• If using Payerpath, clients have access to Authorization
enrollment forms on-line via Maintenance-Payer Listing
screens.
Benefits of Use
AUGUST 10, 2016
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 11
Benefits of Use
Benefits of Electronic Remittance
• PROCESS ALL insurance payments at once!
• ELIMINATE time and cost of manually posting!
• ELIMINATE posting errors!
• Easily IDENTIFY denials and zero payments!
Electronic Remittance Setup
AUGUST 10, 2016
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 13
HIPAA Compliant Codes • Must use the HIPAA-compliant Adjustment Codes
– Example: CO-45; PR-3; CO-18
• Complete listing of Codes can be found at:
– http://www.wpc-edi.com/codes/claimadjustment
• Claim Adjustment Reason Codes
– Claim adjustment reason codes communicate an adjustment, meaning that they
must communicate why a claim or service line was paid differently than it was
billed. If there is no adjustment to a claim/line, then there is no adjustment reason
code.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 14
HIPAA Compliant Codes • Must use the HIPAA-compliant Remark Codes
– Example: MA01; N365
• Complete listing of Codes can be found at:
– http://www.wpc-edi.com/codes/remittanceadvice
• Remittance Advice Remark Codes
– Remittance Advice Remark Codes are used to convey information about
remittance processing or to provide a supplemental explanation for an
adjustment already described by a Claim Adjustment Reason Code. Each
Remittance Advice Remark Code identifies a specific message as shown in the
Remittance Advice Remark Code List.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 15
Setup: Categories - Defaults • Reimbursement Comment Category (F9-RCC)
– Examples: CO, CR, PR, PI, OA
– Create a Category called NEW and set as Default Reimb. Comment Category in Practice
Options (F9-POP) on the Payment Entry tab.
– Create a Category called DENIAL and check Denial box.
• Remark Code Category (F9-RKC)
– Examples: Standard, Missing, Noncov
– Create a Category called NEW and set as the Default Remark Code Category in Practice
Options (F9-POP) on the Payment Entry tab.
• Default Adjustment codes in Practice Options (F9-POP) on the Payment Entry tab
– Co-insurance – PR-2
– Co-pay – PR-3
– Deductible - PR-1
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 16
Setup – Practice Options (F9-POP)
Confirm these 2
boxes are filled in
Confirm these have 3 correct
Default Adjustment codes
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 17
Setup StepsStep #1
• Electronic Remittance Format Maintenance record for each payer (F9 – ERM)
Step #2
• Electronic Remit Style Maintenance record for each payer (F9 – ESM)
Step #3
• Confirm Reimbursement Style Maintenance record is setup correctly for the corresponding
payer (F9 – RSM)
Step #4
• Select Electronic Remit Style on the Insurance Carrier Maintenance record for each
corresponding carrier (F9 – ICM)
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Step #1 Electronic Remittance Format (F9-ERM)
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Step #2 Electronic Remit Style
1
Complete the Electronic
Remit Style tab1
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Step #2 Electronic Remit Style (F9 – ESM)
Complete the Import
Options tab
1
1
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Step #2 Electronic Remit Style (F9 – ESM)
Complete the Reason
Options Tab
1
1
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Step #2 Electronic Remit Style (F9 – ESM)
1
Complete the Remarks
Options Tab1
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Step #3 Reimbursement Style (F9-RSM)
Verify Adjustment Default
Reimbursement Comment
and Allow Edit
Verify Withheld Default
Reimbursement Comment
Verify both boxes are
checked
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Step #4 Insurance Carrier (F9-ICM)
• Verify Reimbursement
Style is selected
(RSM)
• Select Electronic
Remit Style (ESM)
1
2 2
1
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 25
** Note: Payerpath iRemit Workflow Guide
can be printed from within Payerpath in the
Knowledge Center
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 26
Retrieval of Files Navigate pathway• Retrieve electronic remittance files from within each payer’s folder contained within the iRemit
folder.
– iRemit folder found in pathway of NtierFiles/Database/iRemit
• Each payer will have a separate iRemit folder.
– Example: FLBCBS, FLMDCR
• The payer’s folder is automatically created inside the iRemit folder when the first electronic
remittance file from a payer.
• Highlight selected files to be retrieved.
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Single Retrieval
• Click Retrieve1
1
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Pathway to iRemit Folder
Double-click iRemit
Double-click Sample Clinic
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Retrieve – Files in Payer folder
Double-click Test Payer
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Retrieve Files
Click the Open button
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Retrieve Checks Listed
Check List Displays:
• Payment Date
• Check # (batch ref)
• Payer Name
• Amount of check
• Status
List sortable by column
heading selected
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Import New Codes
1
• Check Import New Codes boxes
• Highlight Remit File
• Click RUN
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2
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3
3
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Workflow to Retrieve Multiple Remit Files
• Click Retrieve Multiple Files
1
1
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Retrieve – Select Files
1
• Click Select Files1
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Pathway to iRemit Folder
Double-click iRemit
Double-click Sample Clinic
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Retrieve Files
Click the Open button
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Retrieve Completed
1
• Green check-mark
appears as each file
is retrieved
• Shows Completed
when all files have
been retrieved
• Click the OK button
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2
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3
3
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Retrieve Checks Listed
Check List Displays:
• Payment Date
• Check # (batch ref)
• Payer Name
• Amount of check
• Status
List sortable by column
heading selected
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 39
Import New codes
1
• Check Import New Codes boxes
• Highlight Remit File
• Click RUN
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2
2
3
3
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 40
NEW Codes ADDED
• Reimbursement Comment Codes (F9- RCM)
Update Description
Update Category
• Remark Codes (F9-RKM)
Update Description
Update Category
• UPDATE ESM (Electronic Remit Style) for each new
Reimbursement Comment and Remark codes added
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 41
Workflow - Run Preliminary Listing
2
1
1
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 42
Import Listing/Report• Transactions identified into 1 of 3 sections – in this sequence on the
listing/report:
– Postable/Fully Adjudicated
– Postable and NOT Fully Adjudicated
– NOT Postable
• Each section has total $’s for both Posted and Not Posted.
• All sections added together equals the amount of the check.
• Able to exclude Postable/Fully Adjudicated detail on Preliminary
Listing/report only – only displays total $’s Posted.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 43
Postable and Fully Adjudicated
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Not Postable
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WORKFLOW post the check
12 3
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Post the Check• Import Report created - Select Preview – click PRINT icon to print the report – verify that report has printed
completely before closing preview screen. (not able to be recreated)
– Report shows Batch# - Payment Date – All detail transactions
• Payment Batch is automatically created – appears on Transaction screen.
• Following transactions posted on vouchers:
– Payments
– Adjustments
– Transfers
– Rebill
• Check is automatically deleted from AUT Import Remit screen.
• Manually post all in NOT Postable section and needed transactions in Postable and Not Fully Adjudicated
section
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 47
Review Voucher Financial Inquiry (F9-FIN)
Payment Options
• By Service
• Detailed Reimbursement Information
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 48
Workflow Review the Voucher (F9-FIN)
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 49
Review Voucher View Elec Remit History
Able to view/print
Voucher Detail
EOB:
• Check#
• Payer control#
• Check Date
• EOB detail
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 50
Questions?
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 51
This presentation has been sponsored by our partners at
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