Practice Insight Instructional Webinar Series Advanced Claim Manager

1. Practice InsightInstructional Webinar SeriesAdvanced Claim Manager Presented by: Shaun McAnulty – Product Training Specialist

2. Topics to Cover • Transfer Files • Claim Status Use • Selection Criteria • Right Click Functionality • Editing a Claim

3. Transfer Files Response Files Repost to SFTP using Right Click if File is missing on PM. (Integrated users) Download file to repost to PM (Manual) Full EOB View Mark ERA responses as Received once they are pulled into PM (Best tracking) Upload Files • View complete file in the format is was sent to PI in. • See who uploaded claim file. • See claim files original uploaded file name. • View error messages if Claim File fails to load. • File break down showing claim basic stats. • Download file if you need.

4. File ID:used in selection criteria to locate this group of claims Staff Name: who uploaded the file. File Name: the original file name for the upload. If the claims have any issue loading there will be a message displayed File Type: what file was uploaded and what format. Multi Select Responses Mark ERA responses Received (organizational) See when a response was viewed & who by, when mark received & who by.

5. Filter List Responses • Locate responses by File Type, File Name, Date ranges, Description, Status, File ID (File responses came in on), Retrieved ID (What file responses came in on) and Perform a Check Search using the Check Number.

6. Statuses Green= Commonly expected Statuses Red= Error or Workable Statuses Yellow= Additional Statuses

7. Common Working Statuses Green= Commonly expected Statuses Red= Error or Workable Statuses Yellow= Additional Statuses

8. Common Working Statuses

9. Additional Statuses Green= Commonly expected Statuses Red= Error or Workable Statuses Yellow= Additional Statuses

10. Additional Statuses

11. Organizational Statuses

12. How we get Invalid Claims TESTER rejections 1st level of testing Rule-based edits are used to stop claims with missing or invalid data or to flag claims that meet a particular criteria. Double click on rejection to take you to field in error for easy correction Once the claim is corrected in Practice Insight it will retest as VALID then Ready the claim. EDIFECS rejections • 2nd level of testing • Runs after claim has batched but before it’s sent to the payer, further tests claims to assure they are ANSI compliant. • Correcting the claim WILL NOT make it VALID, Correct then Ready Claim!

13. How we get Rejected Claims. • Payer/Trading Partner Rejections • The same rejection message does not always have the same reason. • Look for clues in the rejection message to determine the cause: • Example: Rejection message A7:562:85is an enrollment rejection. The 85points to the billing provider. In the ANSI file the billing provider name has a qualifier of 85. See below example of an ANSI file billing provider loop: • EDI ID# 131415021 in Demo Database • Loop 2010AA Billing Provider Name • NM1*85*2*GROUP MEDICAL*****XX*1234567890

14. How we get Rejected Claims. • Payer/Trading Partner Rejections • View the ANSI file to see which qualifier the rejection message is referring to: Using the Right Click to View Batch File! • Example of common qualifiers referenced in rejection messages: • NM1*85= billing provider • NM1*82 = rendering provider • NM1*IL= subscriber • NM1*77= service facility • NM1*DN= referring provider

15. Selection Criteria Vendor/ CBO Level only: specify customer. Give age buckets, or calendar dates. Then select what date should be used for the selection. Specify an uploaded claim file from Transfer Files. Can narrow selections to specific Providers as well.

16. Narrow claim selections by staff member assigned to. (Hotkey: A on claim) Name or range search, also can use Wildcard Searches. (EX: %%ith) Unique Id for specific claim in EDI If Clinical Scrubbing (Extra Service) Edit Id can be entered to locate all claims with error. Returns all claims based on Responsible Payer.

17. If Payer or CH sends back their ID number for the claim it is also searchable. Selects claims using PI Payer ID. The Outbound ID # for a Payer Narrow by Type of Payer. Can group claims with the same Response ID Select claims that contain the same Retrieved ID.

18. RIGHT CLICK OPTIONS Standard Functions Claim Related Functions Status Message View Claim Selection View Views of Claim Reports Functions for All Claims

19. Claim Related Functions

20. Editing Claim • Have the capability to pass change log back to PM. • Eliminating dual work • Easy, logical layout to work claims. • Change transaction sequence easily moving their order. • Hover text displays ANSI coordinates. • Assisting you in locating the potential problem the payer or tester may be flagging.

21. Views of Claim Reports

22. Inbound or Outbound Files?

23. Functions for ALL SELECTED Claims

24. Status Message View Options

25. AdditionalFunctionality • Ctrl+C: With a line item (Claim list view, or Status message view) highlighted, the user can copy and paste values. When CTRL+C is used a clipboard of the data will appear, to copy data simply double click on value desired. • Ctrl+B: Displays what the claim would look like on a potential batch. Allowing you to view the potential Ansi data you would send to the payer. • Delete Key: If user has permissions, using the delete key can delete highlighted selection (i.e. Claim, Uploaded File). • Space Bar:Clears radio selections when no radio selection is needed. • F4:(for use in Selection Criteria fields) Displays search tool or multi select dialogue box for fields.

26. Question and Answer