WorkSafeBC Provider Portal - Amazon S3...Introduction and Overview 1. From the provider’s business...

WorkSafeBC Provider Portal

Access to Invoice and Payment Information

User Guide (Version 5.1; 2012.04.11)

WorkSafeBC Provider Portal User Guide ACCESS TO INVOICE AND PAYMENT INFORMATION

TELUS Health Solutions – Restricted Use 2

Table of Contents Table of Contents .......................................................................................................................... 2

1 Introduction and Overview ................................................................................................. 4

2 Business Process Overview ............................................................................................... 5

3 Functions and Features ..................................................................................................... 7

3.1 Introduction ................................................................................................................. 7

3.2 Check Invoice Status .................................................................................................. 8

3.3 Access To Payment Information............................................................................... 17

4 Usability Suggestions – Factors & Considerations .......................................................... 20

5 Organizing Your Work ...................................................................................................... 22

5.1 Access to Invoice and Payment Information – Practices and Procedures .............. 22

5.2 Change Management Considerations ...................................................................... 22

6 Major Business Processes ............................................................................................... 25

6.1 Introduction ............................................................................................................... 25

6.2 Referrals - Core Main Line (Happy Path) ................................................................. 25

6.3 Invoicing - Core Main Line (Happy Path).................................................................. 25

6.4 Access to Invoice Information Core Main Line (Happy Path) ................................... 26

6.5 Access to Payment Information Core Main Line (Happy Path) ................................ 28

7 Summary of Key Points .................................................................................................... 30

8 Resources ........................................................................................................................ 31

Appendix A: Summary of Revisions ............................................................................................ 32



Document Revision Log

Revision Number

Revision Date Changes Requested By

Reason for Change Author

Version 5.0 Aug 10, 2011 Final – Stage 1 THS

Version 5.1 Apr 11, 2012 Enhancement for Portal v2.1. More details in Appendix A.

THS



1 Introduction and Overview 1. From the provider’s business perspective, the system allows the provider to

access the portal and determine the status and specific details of both invoices and payments;

2. As example, a provider has submitted invoices to WSBC for payment and wants to determine their status – the system can be used to deternine:

• Has the invoice been received?

• Has the invoice been processed/adjudicated? o Where is the invoice in it’s process lifecycle?

• If the invoice has been processed: o What amount has been paid? o What amount has not been paid? o What line items have been fee’d up or fee’d down?

• Which invoice line items have problems?



2 Business Process Overview 1. Life cycle of an invoice end to end from creation through to payment – major

events and associated states and statuses as they relate to Access to Invoice and Payment Information;

2. Core main line process – key steps and workflow to access invoice or payment information:

• Search using variable selection criteria;

• Display the returned invoices (in a list – allowing filtering);

• Select specific invoice: o Confirm the correct invoice number and confirm the case (patient’s

(worker’s) identity);

• Display the invoice as submitted – header and line items;

• Display / view the line items – showing the line item status and the results of the adjudication process including the problems identified with the EOBs;

o Print the invoice using the PDF; o Similar for payments;

3. Access to payment information – summary of business functionality:

• Aligns with the provider’s business processes for cash application, accounts receivable payments application/posting of paid invoices and invoice/payment reconciliation (where NOT paid in full);

• Provides the functionality to retrieve and review the remittance statement in electronic format (for both cheques and EFTs) using two selection criteria:

o For a specific cheque or EFT; o For multiple remittance statements using a date or accounting period

range;

• Displays each invoice line item that is being paid: o Using the same format in which they were entered and also grouped

with other line items from the same invoice with sub totals;

• High lights invoice line items not approved for the invoiced amount and shows the EOB:



• Highlights incentives and penalties: o Only includes the total penalty or incentive amount for a payment

related to an invoiced line item…it does not break down the amounts of each type of penalties/incentives;

o Penalties incurred from proof and invoice deadlines not met; o Incentives rewarded for early submission of proof and other artifacts;

• Displays any adjustments.



3 Functions and Features 3.1 Introduction

The key functions and features are listed below followed by specifics and examples for each:

• Access to Invoice Information o Check Invoice Status Screen;

Search Options; Return Results;

o View Invoice Status Details Screen; Invoice Header; Invoice Line Items;

o Portal Submitted Invoices Work List; Submitted Invoices Work List; Draft Invoices Work List;

o Portal Submitted Invoice Details Screen; o Portal Submitted Invoice PDF;

• Access to Payment Information o Check Payment Status Screen;

Search Options; Return Results;

o View Payment Status Details Screen; Payment Line Items; Adjustment Line Items;



3.2 Check Invoice Status

Check Invoice Status is a function that is used to search for a specific invoice, or a group of invoices within a specific time period. In order to check the status of invoices, one of these three combinations of information must be provided:

• Invoice #;

• Pre-defined Time Period and Clinic Work Location;

• Calendar Month and Clinic Work Location;



3.2.1 Invoice Search Result

Displays all invoices that match the search criteria submitted. • If one or more invoices are found, the search results will display an

overview of invoice information for each returned invoices, including: o Invoice Number (if available); o Invoice Date; o Invoice Status;

• If no matching invoices are returned, user is notified that there are no matching results;

• Default sort order presents invoices with the most recent Invoice Date positioned at the top of the search results;

• The Invoice Search Results may be filtered by different columns: o Most of the columns in the grid support filtering to provide easy

access to a subset of information; o Multiple filters may be applied at one time;

3.2.1.1 Exporting Invoice Search Result Export the Invoice Search Result using the “Download as CSV” function, found at the top left hand corner of the grid.



Only data elements displayed in the grid will be included, with the addition of EOB Code Descriptions and Fee Code Descriptions, if available.



3.2.2 Invoice Status Details Screen

The Invoice Status Details Screen displays invoice and line item details and consists of three parts: Invoice Header

Provider Information Panel (portal submitted invoices only)



Invoice Line Item Details o Fee code; o Service amount; o Approved amount; o EOB codes (if any); o Invoice line item status (i.e. Processing, Processed, etc.); o Date paid (if applicable);

The default sort order presents invoice line items with the most recent Date of Service positioned at the top of the list.



3.2.3 Invoice Work Lists

Invoice Work Lists can be accessed from the Invoices tab on the portal’s top navigation bar. All Invoice Work Lists support filtering by one or more columns.

• Draft Invoices Work List

o Displays a list of all invoices that are a ‘work in progress’; o The invoices in the Draft Invoices Work List have not yet been

submitted to WorkSafeBC; o The invoices in the Draft Invoices Work List can be modified before

they are submitted to WorkSafeBC; Invoices in the Draft Work List can also be deleted.

o Sort order of this list is determined by the Invoice Date that was entered on the invoice; Draft invoices with the most recent Invoice Date appear at the

top of the list; • Submitted Invoices Work List

o Displays a list of all invoices that have been submitted through the portal;

o Displays an overview of invoice information as it was submitted; o The invoices in the Submitted Invoices Work List can not be modified

or deleted; o Displays the most recently submitted invoices at the top of the list;



3.2.3.1 Exporting Invoice Work Lists Export the Invoice Work List using the “Download as CSV” function, found at the top right hand corner of the grid.

Both Drafts and Submitted Work Lists can be exported. Only information seen in the Work List will be exported.

3.2.4 Portal Submitted Invoice Detail Screen

The Portal Submitted Invoice Detail Screen displays invoice details as it was submitted to WorkSafeBC through the portal.



• Invoice header includes: o Referral header; o Invoice number; o Invoice date;

• Invoice line item details include: o Date of service; o Fee code and description; o Service amount; o Taxes;

• Link to auto-generated PDF of the invoice;



3.2.5 Portal Submitted Invoice PDF

PDF representation of the submitted portal invoice. May be printed for offline or future reference.



3.3 Access To Payment Information

3.3.1 Check Payment Status Screen

Check Payment Status is a function that is used to locate a specific payment, or a collection of payments within a specific time period. In order to check the status of payments, one of these three combinations of information must be provided:

• EFT # or Cheque #;

• Pre-defined Time Period and Clinic Work Location;

• Calendar Month/Year and Clinic Work Location;



3.3.2 Payment Search Results

Displays all payments that match the search criteria submitted. • If one or more payments are found, the search results will display an

overview of payment information for each returned payment, including: o Payee number; o Payment status; o Payment amount;

• If no matching payments are returned, user is notified that there are no matching results;

• Default sort order presents payments with the most recent EFT/Cheque Number positioned at the top of the search results;

• The Payment Search Results may be filtered by different columns: o Most of the columns in the grid support filtering to provide easy

access to a subset of information; o Multiple filters may be applied at one time;

3.3.2.1 Exporting Payment Search Results Export the Payment Search Result using the “Download as CSV” function, found at the top left hand corner of the grid. Only information displayed in the grid will be exported.



3.3.3 Payment Status Details Screen

The Payment Status Details Screen displays payment details, including: o Payment line items detail, including:

Invoiced and approved amounts; Taxes, penalties, and interest;

o Adjustment line item details The default sort order presents payment and adjustment line items with the most recent Date of Service positioned at the top of the list under each of the tabs.



4 Usability Suggestions – Factors & Considerations

From a usability perspective, we list a number of considerations below.

1. Accounting / financial users should access the portal when they need to determine the status of an invoice and the adjudication results and when they need to apply payments and reconcile invoices/line items that are being paid;

2. Managing the selection criteria:

• A search by Invoice Number will return a result only if the Invoice Number exists in CMS:

o Partial matching is not supported, therefore the Invoice Number must be entered exactly as it had been submitted;

o Provider must ensure that the Invoice Number entered is unique to the Clinic Work Location and has not been used before;

o Search criteria using timeframe (by month/year, or period) searches based on Date Received, not the Invoice Date; Search results display invoices in the order of Invoice Date,

but the search itself is driven by Date Received; o Paper submitted invoices may not have an Invoice Number;

Invoice line item details cannot be displayed for invoices that do not have an Invoice Number;

3. High volume response lists:

• Search results for both invoices and payments can return a maximum of 500 records;

o Therefore, timeframe and location search criteria must be constrained enough to ensure a full record set is returned;

o Returned results are not trimmed in a predictable manner if search results exceed more than 500 records;



4. Portal security:

• Login considerations; o Single Provider Organization context; o Display of currently logged in user’s credentials;

Username; Provider Organization Context;

o Changing the Provider Organization context while in the portal;

• Any user with access to the portal has the ability to search for invoice and payment information for the Clinic Work Locations they are associated to;

• The importance of logging out;

• Accessing the portal on public computers – or public wi-fi connections;

• Session time-outs – how often will the user need to login;

• The importance of not sharing user login credentials;

5. Access to payment information constraints (Stage 1):

• No capability to access source documents for adjustment line items;

• Incentives and penalties are available as a line item; o Interest – similar context to incentives and penalties;

• Search by Cheque or EFT # requires a corresponding date range;

• Search for payments by payment period is delimited to two or three typical time windows defined in the dropdown;

o Defined based on business processes/practices and being sensitive to the amount of information that can be returned in a single query;

• Payment and invoice queries cannot be for a date range that precede CMS implementation;



5 Organizing Your Work 5.1 Access to Invoice and Payment Information –

Practices and Procedures

5.1.1 Managing timeliness

Practices and procedures regarding the timeliness of invoice submission and access to invoice and payment information are governed by WorkSafeBC contracts with the Providers, as well as the Provider’s own practices and procedures.

• Access to invoice status and details is available almost immediately after an invoice has been submitted through the portal;

o Normal functionality may introduce short delays; o Periodic system maintenance or other technical factors may

introduce a longer delay;

5.1.2 Managing the workflow

Invoices may be submitted at any point in the lifecycle of a Referral or Case after the Provider has accepted the Referral;

• Invoices cannot be submitted through the portal for a Referral that the Provider has not acknowledged and accepted;

5.2 Change Management Considerations

5.2.1 Business process change and information availability

• Data is now in electronic form (i.e., as compared to paper); o Referrals are provided electronically; o Clinical reports are submitted electronically; o Invoices are submitted electronically;

All examples of moving from paper to electronic invoicing; o Electronic information is available in real time / any time;

• Portal submitted invoices vs. paper submitted invoices; o Access and display differences in the portal;



5.2.2 Automated system functions; as example:

• Prepopulating the invoice with known data;

5.2.3 Key principals

• “Do it now” concept; o Timeliness and accuracy of the information maintained in the Portal

is important;

• Collaborative communications, especially for exceptions;

• Workarounds for any limitations and/or constraints: o Provider must have detailed knowledge of contract and fee schedule

obligations and requirements to ensure invoicing is accurate; o Search by Invoice Number will support only one Invoice Number at a

time; Paper Invoices may not have an Invoice Number available in

CMS, in which case they cannot be retrieved by search for Invoice Number;

o Invoice line item details cannot be displayed for paper invoices in some circumstance, such as: The paper invoice does not have an Invoice Number in CMS; There are no line items associated to the paper invoice;

Portal submitted invoices require an Invoice Number and at least one line item entry before it can be submitted;

o Invoice queries using the Check Invoice Status functionality use Date Received when retrieving matching records, not Invoice Date; Invoice Date is displayed in the search results;

• Special considerations for access rights (i.e., visibility): o Users can see all invoices and payments associated to the Clinic

Work Locations they have been granted access to: Users are restricted to the context of the Provider

Organization they are currently logged in under; o All users can see all areas of the Portal:

Referrals; Cases; Invoicing; Access to Invoice and Payment Information;



o Users are not restricted from seeing any area of the portal, regardless of their role in the Provider organization; All users can use any of the functions, and perform any tasks

in the Portal within the context of the Provider Organization they are logged in under, and the for the Clinic Work Locations they have access to;

• For example, anyone can create an invoice for a Referral that is associated a Clinic Work Locaiton they have access to;

o Only users requiring access to the Portal to perform specific functions, or access Referral or Case information should be provided access to the Portal;



6 Major Business Processes 6.1 Introduction

• Referral core main line– happy path (high-level review only to establish context);

• Invoicing core main line – happy path (high-level review only to establish context);

• Access to Invoicing Information core main line;

• Access to Payment Information core main line;

• Special cases – typical problem and error situations;

• User experience - potential challenged/problem areas;

6.2 Referrals - Core Main Line (Happy Path)

• Acknowledge Referral;

• Accept Referral;

• Schedule Worker;

• Worker shows up;

• Move Referral to Active Cases; * See Referrals and Cases User Guide for more details;

6.3 Invoicing - Core Main Line (Happy Path)

• Access Referral;

• Create Invoice;

• Submit Invoice; * See Invoicing User Guide for more details;



6.4 Access to Invoice Information Core Main Line (Happy Path)

• Starting point: o Portal Main Navigation – Invoices Tab; o Select “Check Invoice Status” Command;

6.4.1 Check Invoice Status screen:

• Description: To allow Provider to check the CMS processing status for a particular invoice or invoices, and associated line item detail;

• Actions: o Enter and submit search criteria; o Confirm search results are as expected; o Locate invoice in grid; o Click to open Invoice Status Details screen for selected invoice;

• Practices and rules: o Credit invoices do not have a negative amount;

For example, payment adjustment o For the three different search options:

Criteria to be entered for each search option is mandatory; Timeframe for search is based on Received Date, not Invoice

Date; The number of records that may be returned in a single inquiry

is limited; Search criteria must be restricted sufficiently to ensure a full

record set is returned in the search results;

• Search fewer locations at one time;

• Search a smaller timeframe at one time; o Paper invoices may not have information to be displayed, this will

happen if: The invoice has no Invoice Number in CMS; The invoice has no line item details in CMS;



o For non-portal submitted invoices (i.e., pre portal and paper invoices): Invoice line item details are not available from CMS due to:

• No invoice number;

• Systems issue; o Provider information and referral information are only available for

portal submitted invoices; o Invoice PDF and Invoice submission history is only available for

portal submitted invoices;

6.4.2 Invoice Status Details screen

• Description: Display invoice line item detail information for a specific invoice;

• Actions: o Confirm worker and claim details; o Confirm referred program/services and clinic location information; o Click EOB code for details; o Confirm invoice details (i.e. approved amount, status, date paid); o Select Check Invoice Status command to search again;

• Practices and rules: o Only invoice line items that have been paid will have a value in the

Date Paid column; o Only portal submitted invoices will display the Invoice Header with

Worker and Provider information; Portal submitted invoices are in the context of a single

Worker, single Claim Number, and single Referral; o Paper submitted invoices will not display Worker and Provider

information in the Invoice Header: Paper submitted invoices may have line items for one or more

workers, claims, and referrals Paper submitted invoice detail specifies worker name and

claim number for each line item;



6.4.3 Submitted Invoices Work List

• Starting point: o Portal Main Navigation – Invoices Tab; o Select Submitted Invoices Work List from left navigation;

• Description: Display list of invoices submitted through the portal;

• Actions: o Filter to locate invoice; o Click to open Submitted Invoice Details screen;

On Submitted Invoice Details screen:

• View invoice line item details as originally submitted through the portal;

• Click link to open PDF version of submitted invoice;

6.5 Access to Payment Information Core Main Line (Happy Path)

• Starting point: o Portal Main Navigation – Payments Tab; o Select “Check Payment Status” Command;

6.5.1 Check Payment Status screen

• Description: To allow Provider to check for payments;

• Actions: o Enter and submit search criteria; o Confirm search results are as expected; o Locate payment in grid; o Click to open Payment Status Details screen for invoices / line items

paid;

• Practices and rules: o For the three different search options:

Criteria to be entered for each search option is mandatory; Timeframe for search is based on Received Date, not Invoice

Date;



The number of records that may be returned in a single inquiry is limited;

Search criteria must be restricted sufficiently to ensure a full record set is returned in the search results;

• Search fewer locations at one time;

• Search a smaller timeframe at one time; o Paper invoices may not have information to be displayed, this will

happen if: The invoice has no Invoice Number in CMS; The invoice has no line item details in CMS;

6.5.2 Payment Status Details screen

• Description: Display payment details for paid invoices / line items (i.e., the invoice detailed information associated to a specific invoice);

• Actions: o Click on Payment Line Items tab to view payment line items:

Locate payment line item in grid; Confirm payment details including:

• Claim Number;

• Worker;

• Approved Service Amount;

• Penalty/Incentive;

• Interest; o Click on Adjustment Line Items;

Locate adjustment line item in grid; Confirm adjustment details including:

• Adjustment amount;

• Practices and rules: o Any adjustment line items have a negative amount.



7 Summary of Key Points 1. As a suggestion, users should summarize the key points in the module (i.e., as

a characterization of the business process and functionality that are pertinent to them or their organization’s processes) including:

• Key points and considerations;

• Practical guidelines;

2. As a suggestion, users should consider “Applying what you learned” as follows:

• Ask “what would you now do differently back on the job?” o Relate back to their experience discussed as part of the course;

• Suggest recording 3-5 key ideas, success factors or action steps;

• Suggest reviewing the Business Processes and write a short summary of the process and deliverables or key points for themselves;

3. As a suggestion, users now have expanded their network of contacts (i.e., both within their own organization and externally with other providers) and they should be sure to use them.



8 Resources The Resources section in the Portal contains training materials and documents, including this user guide, for easy reference by users.



Appendix A: Summary of Revisions

Revision Changes to document V5.1 Addition of 3.2.1.1 Exporting Invoice Search Result

Addition of 3.2.3.1 Exporting Invoice Work Lists Addition of 3.3.2.1 Exporting Payments Search Result Addition of section 8 Resources

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