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ADL Data Systems, Inc

ADL Data Systems, Inc. 835 Electronic Remittances. Presented by Steve Levine. October 8, 2013. Frequently Asked Questions. What is the 835 remittance and how can it save time? What is the procedure to start using the 835?

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ADL Data Systems, Inc

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  1. ADL Data Systems, Inc 835 Electronic Remittances Presented by Steve Levine October 8, 2013

  2. Frequently Asked Questions • What is the 835 remittance and how can it save time? • What is the procedure to start using the 835? • Which tables need to be set up to accommodate insurances and multiple paysources? • What are the reports and posting files generated by the 835 program?

  3. What is the 835 Electronic Remittance? • An 835 is an electronic version of a remittance advice (ERA) which provides details about providers' claims payment, and, if the claims are denied, would then contain the required explanations.

  4. How can using the 835 save time? 835 electronic remittances can be run through Optimum Financial programs which: • Create reports that include paid, unpaid, and pended claims • Create cash receipt posting files, including separate w/o posting files related to 2% Medicare sequestration and Medicaid bed retention reduction. • Option to automatically update claim reference number in billing history.

  5. More time-saving features of the 835 • Automatically produces a cash receipt posting file to match payments- No need to manually enter payments. • For most facilities, no program changes are required. • The “Extract 835” program features options to include or exclude retro payments, billing adjustments, and allows user to create separate reports and cash receipt posting files for each option selected-

  6. How Do I Get Started? • Facilities may receive 835’s from individual insurance companies or from clearinghouses • Get the Companion Guide- Apply to Insurance company, intermediary or to clearinghouse • Call ADL for assistance with setting up the tables

  7. Steps to create 835 reports and cash receipt posting file 1) Download the zipped .TAR 835 from insurance company or clearinghouse website 2) Move the zipped .TAR file to your user folder 3) Unzip the file with program such as WinZip, Zip Genius, etc. 4) Rename the extracted file(s) to unique, shorter name. 5) Run the PTR835 program using the renamed file as input filename

  8. Move .TAR file to user folder

  9. Unzipped 835 File • ISA*00* *00* *ZZ*GENERIC-INS *ZZ*E0B *080525*0602*U*00401*146000098*0*P*:~GS*HP*GENERIC-INS*E0B*20080525*06025000*146000098*X*005010X091A1~ST*835*160500098~BPR*I*250477.56*C*CHK************20080526~TRN*1*000000033081331*1141797357~REF*EV*E0B~REF*F2*005010X091A1~DTM*405*20080526~N1*PR*AETNA~N3*OFFICE OF MEDICAID MANAGEMENT*CORNING TOWER, EMPIRE STATE PLAZA~N4*ALBANY*NY*122370080~N1*PE*DALEVIEW CARE CENTER*FI*113365914~REF*PQ*01719626~LX*1~CLP*005304*4*6921.6*0**MC*0813800092311822*21*7~CAS*CO*22*6921.6*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0632200010276420~REF*9A*3839~DTM*232*20060601~DTM*233*20060630~QTY*CA*30~CLP*005304*4*7152.32*0**MC*0813800092313822*21*7~CAS*CO*22*7152.32*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0632200010278120~REF*9A*3839~DTM*232*20060701~DTM*233*20060731~QTY*CA*31~CLP*005304*4*7152.32*0**MC*0813800092316522*21*7~CAS*CO*22*7152.32*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0632200010278120~REF*9A*3839~DTM*232*20060701~DTM*233*20060731~QTY*CA*31~CLP*005304*4*7144.57*0**MC*0813800092317322*21*7~CAS*CO*22*7144.57*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0636100055361420~REF*9A*3839~DTM*232*20060801~DTM*233*20060831~QTY*CA*31~CLP*005304*4*6914.1*0**MC*0813800092318222*21*7~CAS*CO*22*6914.1*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0636100055364320~REF*9A*3839~DTM*232*20060901~DTM*233*20060930~QTY*CA*30~CLP*005304*4*3917.99*0**MC*0813800092318822*21*7~CAS*CO*22*3917.99*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0635300025805120~REF*9A*3839~DTM*232*20061201~DTM*233*20061217~QTY*CA*31~CLP*005304*4*7152.32*0**MC*0813800092319522*21*7~CAS*CO*22*7152.32*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0632200010285320~REF*9A*3839~DTM*232*20061001~DTM*233*20061031~QTY*CA*31~CLP*005304*4*3399.75*0**MC*0813800092320022*21*7~CAS*CO*22*3399.75*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0705000050981520~REF*9A*3839~DTM*232*20070201~DTM*233*20070215~QTY*CA*15~CLP*005304*4*4759.65*0**MC*0813800092320722*21*7~CAS*CO*22*4759.65*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0708800057914120~REF*9A*3839~DTM*232*20070101~DTM*233*20070121~QTY*CA*21~CLP*005304*4*4267.44*0**MC*0813800092321622*21*7~CAS*CO*22*4267.44*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0707800086321920~REF*9A*3839~DTM*232*20070301~DTM*233*20070318~QTY*CA*18~CLP*005304*4*3556.2*0**MC*0813800092322422*21*7~CAS*CO*22*3556.2*0~NM1*QC*1*SMITH*FRED*A***MI*WB12345X~NM1*82*1******MC*01719626~NM1*PR*2*GHI GNY:MEDICARE HMO*****PI*DS~REF*EA*005304~REF*F8*0710700010461020~REF*9A*3839~DTM*232*20070401~DTM*233*20070415~QTY*CA*15~CLP*005304*4*3319.12*0**MC*0813800092323122*21*7~CAS*CO*22*3319.12*0~NM1*QC*1*SMITH*FRED*A***

  10. Extract 835- Enter input filenames

  11. Report Options

  12. 835 reports

  13. Sample 835 Report THE BEST REHAB --- Processed Remittance 835 Report --- Spool=PTR835. Pgm=PTR835 05-28-13 Page= 1 • File name is $PTPOST_1866BEST.1812239987 Opr=adl 10:40:10 Term=windows • Facility: THEBEST REHAB RHCF INC SNF ID=1812239987 Additional ID: TJ=133676681 • [FINANCIAL INFORMATION] Transaction Handling: (I) Remittance Information Only, Total Actual Provider Payment Amount: 13556.79, • Credit/Debit Flag: (C) Credit, Payment Method: (ACH) ACH, Depository Financial Institution Identification (DFI) Number Qualifier: • (01) ABA Transit Routing Number, Sender DFI Identifier: 023949387, Account Number Qualifier: (DA) Demand Deposit, Sender Bank • Account Number: 320932222265, Payer Identifier: 1143337357, Depository Financial Institution (DFI) Identification Number • Qualifier: (01) ABA Transit Routing Number, Receiver or Provider Bank ID Number: 021464688, Account Number Qualifier: (DA) Demand • Deposit, Receiver or Provider Account Number: 076943207, Check Issue or EFT Effective Date: 20120612 • [REASSOCIATION TRACE NUMBER] Trace Type: (1) Current Transaction Trace Numbers, Check or EFT Trace Number: 023948273645039, Payer • Identifier: 112039457 • COINS • PAT # NAME PAY FROM THRU DAY BILLED PAID COPAY CONTRACTUAL OTHER CONTROL NUMBER M.REC# • ------ -------------------- -- -------- -------- --- ---------- ---------- ---------- ----------- ---------- -------------- ------ • THE BEST REHAB --- Processed Remittance 835 Report --- Spool=PTR835. Pgm=PTR835 05-28-13 Page= 2 • File name is $PTPOST_1866BEST.1812239987 Opr=admin 10:40:10 Term=windows • Facility: THEBEST REHAB RHCF INC SNF ID=1812233387 Additional ID: TJ=133676681 • COINS • PAT # NAME PAY FROM THRU DAY BILLED PAID COPAY CONTRACTUAL OTHER CONTROL NUMBER M.REC# • ------ -------------------- -- -------- -------- --- ---------- ---------- ---------- ----------- ---------- -------------- ------ • 148587 ARNOLD, MARIE A D 05/16/13 05/19/13 4 218.04 218.04 0.00 0.00 0.00 13140001021946209102487 • >>> NAME CORRECTION <<< TOB: 212 RATE CODE: 3836 • 188428 BENT, ROBERT A D 05/13/13 05/19/13 7 4200.00 2942.03 0.00 1257.97 0.00 13140001021947201702428 • TOB: 213 RATE CODE: 3767 • 194828 BENT, ROBERT A D 05/13/13 05/19/13 7 381.57 381.57 0.00 0.00 0.00 131400010219482017702428 • TOB: 213 RATE CODE: 3836

  14. Sample 835 Unprocessed Claims Report

  15. Tables To Be Modified • PT835S- Maps using paysource letter • PT835SX- Maps using paysource letter and rate code These tables map the payment information to specific paysources and rate codes, and can be edited in the Code Tables of Optimum Financials

  16. PT835S - 835- Remit Map

  17. Table PT835SX - Remit Rate Map

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