AUGUST 10, 2016 Presented by: Anne Havlina Optimize Electronic …€¦ · •ENABLES retrieval of...

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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


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


Payerpath Knowledge Resources

1. News, Featured Videos,

Knowledge Resources

• Client Connect

1. Payerpath Knowledge

Center

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2

3

2

3

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Agenda

• Overview

• Benefits of Use

• Electronic Remittance Set Up and Workflow

Process

• Reviewing the Import Remittance Listing/Report

• Questions

Overview

AUGUST 10, 2016


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.


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.


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


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


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.


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.


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


Setup – Practice Options (F9-POP)

Confirm these 2

boxes are filled in

Confirm these have 3 correct

Default Adjustment codes


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)


Step #1 Electronic Remittance Format (F9-ERM)

2

3

1

4

6

5


Step #2 Electronic Remit Style

1

Complete the Electronic

Remit Style tab1


Step #2 Electronic Remit Style (F9 – ESM)

Complete the Import

Options tab

1

1



Complete the Reason

Options Tab

1

1



1

Complete the Remarks

Options Tab1


Step #3 Reimbursement Style (F9-RSM)

Verify Adjustment Default

Reimbursement Comment

and Allow Edit

Verify Withheld Default

Reimbursement Comment

Verify both boxes are

checked


Step #4 Insurance Carrier (F9-ICM)

• Verify Reimbursement

Style is selected

(RSM)

• Select Electronic

Remit Style (ESM)

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2 2

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** Note: Payerpath iRemit Workflow Guide

can be printed from within Payerpath in the

Knowledge Center


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.


Single Retrieval

• Click Retrieve1

1


Pathway to iRemit Folder

Double-click iRemit

Double-click Sample Clinic


Retrieve – Files in Payer folder

Double-click Test Payer


Retrieve Files

Click the Open button


Retrieve Checks Listed

Check List Displays:

• Payment Date

• Check # (batch ref)

• Payer Name

• Amount of check

• Status

List sortable by column

heading selected


Import New Codes

1

• Check Import New Codes boxes

• Highlight Remit File

• Click RUN

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2

2

3

3


Workflow to Retrieve Multiple Remit Files

• Click Retrieve Multiple Files

1

1


Retrieve – Select Files

1

• Click Select Files1


Pathway to iRemit Folder

Double-click iRemit

Double-click Sample Clinic


Retrieve Files

Click the Open button


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


Retrieve Checks Listed

Check List Displays:

• Payment Date

• Check # (batch ref)

• Payer Name

• Amount of check

• Status

List sortable by column

heading selected


Import New codes

1

• Check Import New Codes boxes

• Highlight Remit File

• Click RUN

1

2

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3

3


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


Workflow - Run Preliminary Listing

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1

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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.


Postable and Fully Adjudicated


Not Postable


WORKFLOW post the check

12 3


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


Review Voucher Financial Inquiry (F9-FIN)

Payment Options

• By Service

• Detailed Reimbursement Information


Workflow Review the Voucher (F9-FIN)


Review Voucher View Elec Remit History

Able to view/print

Voucher Detail

EOB:

• Check#

• Payer control#

• Check Date

• EOB detail


Questions?


This presentation has been sponsored by our partners at

To learn more about the Contract Audit & Recovery suite and MCAG’s unique revenue generating

solutions visit the HUB, or go to www.mcaginc.com

AUGUST 10, 2016 Presented by: Anne Havlina Optimize Electronic …€¦ · •ENABLES retrieval of...

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