August 11, 2016 Presented by: Carrie Murphy Payerpath 101 ... · Payerpath 101- Tools & Techniques for Effectively Reconciling and Tracking Claims August 11, 2016 Presented by: Carrie

Payerpath 101- Tools & Techniques for

Effectively Reconciling and Tracking Claims

August 11, 2016 Presented by: Carrie Murphy

Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2

Healthy Financial Core• Allscripts provides solutions that streamline workflows across clinical, financial

and operational processes


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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


Introductions & BackgroundGoal: Provide knowledge necessary to correctly work, track, and manage claims

within Payerpath for a healthy financial core!

Agenda for Today’s Session:

• Walkthrough Payerpath Claims Editing

• Full Reconciliation Workflow and Functionality

• Understand Claim List and Fixing Claims

• Review Payer Reports and Remittances

• Discuss 277 Claim Notes Integration

• Additional Tools/Tricks

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Claims Management Workflow

August 11, 2016


Claims Workflow - Upload Detail Report • Upload Detail Report is a “snapshot” of how claims were

initially received from PM system by Payerpath.

• Indicates the claims that were processed by Payerpath and their

performance against the Payerpath claims and coding scrubber.

• Provides detailed information for passed, failed, and warned

claims broken down by payer.

• Can be utilized as a tool to start reconciliation process.

• Information is integrated in Claims Notes for clients on Allscripts

PM.


Upload Detail Report – View results of claim file Select Reports > Upload Detail


• Upload Detail List

• Summary Information

• Payer Breakdown

Upload Detail Report – View results of claim file

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• Parsed By Payer

• Claim Level Information

• Description of Edits

Upload Detail Report

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Full Reconciliation• Comprehensive reconciliation functionality embedded into Payerpath

Claims Management allowing clients to reconcile batches of claims or

individual claims.

• Matches claims to individual payer responses, payer reports, and

remittances.

• Should be primary workflow for clients related to claims submission,

follow up, and reconciliation.

• Provides transparency into the claims submission and adjudication

process.

• Allows clients to easily identify claims that have been rejected or

denied by the payers.


• Reconcile By Batch

• Reconciliation Filter

Full Reconciliation - Workflow

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Full Reconciliation – Batch Reconciliation

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• Batch Level Reconciliation

• Payer Breakdown

• Totals

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Full Reconciliation – Batch Reconciliation

Each unique Batch ID

represents a

corresponding UDR


Full Reconciliation - Reconcile by Batch, cont.

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Reconcile by Batch allows a user to review all information pertinent to the

individual claim from the Transmitted Claims List.

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V – View Claim Form

H – View Claim History

R – Access Payer Report

$ – Access Patient EOB4

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Dashboard – Claim Status Summary

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• Quick Links

• Claim Status

• My Filters

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Claim Status-ReconciliationUntransmitted - Claims within Payerpath Product

• Passed

• Failed

• In Process

Transmitted - Claims outbound to the Payer from Payerpath

• In Transit

• Acknowledged

• Accepted

• Rejected

• Remit

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• Sort by Payer

• Sort by claim type

• Select Timeframe

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Untransmitted Claims - Failed

Untransmitted Claims will

be deleted after 90 days!


1. Select Date Range (Today, This Week, last 30 days)

2. Click on Rejected Claims Status

3. Review/Work Rejected claims

Transmitted Claims - Rejected

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Payerpath Claim Form

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• Form Views

• Toolbar

• Functions

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Electronic Fields View

• Electronic Fields

• Categories

• Details

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Secondary COB/EOB View1

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• Secondary Fields

• Adjustment Details

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Auto ReplaceWhat is it?:

• When the Auto Replace setting is turned any claim that is in a Failed or

Warned status (and ONLY in those two statuses) will be deleted when a

replacement/new claim with the same claim number and payer are

uploaded to Payerpath.

Workflow Benefits:

• Users don’t have to go back into Payerpath and manually delete claims

that have been corrected and resent from their PM system. This allows

tighter integration between PM and Payerpath. A user can fix all of their

issues in the PM system and have minimal need to spend more time in

Payerpath doing additional manual steps.


• Field Description

• Payer Edits

• Application Reference

Application Field MappingWhile working claims in Payerpath users can click on blue field names to gather

valuable information that can be used in working claim rejections. The Application Field

Mapping provides guidance on correcting information in the practice management

system.

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Full Reconciliation – Claim History

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3• Claim History

• Claim Statuses

• Payer Reports/Remittance Access

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Claims Scrubbing, Coding, and Compliance• Proprietary multi-level editing Claims and Coding Scrubber is

embedded into Payerpath Claims Management

• Payer Services team makes weekly updates to codes, edits, and

logic. Also include custom edits and maps that have been

requested by clients.

• Claim Scrubber also includes Coding and Compliance Tools

– Coding Tool-

• Scrubs Medicare Claims for CCI, LCD/NCD, Medical

Necessity, Modifier Usage

• Scrubs All-payers for CCI

– Coding/Compliance Tool – comprehensive and robust online

coding reference tool


Coding and Compliance Tools

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• CodeCheck Edit – Verify Modifier used for accuracy

• “I” for Information

• Knowledge Source Pro - Library

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Coding Defaults

Payerpath Knowledge Source users can setup CCI Edits for

commercial payers. CCI/LCD/NCD Edits are applied for

Medicare Payers.


Coding Defaults

Informational: Claim Edit Message shows up in green in Payerpath and no action is required. Claim

will pass without manual intervention

Warning: Claim Edit Message appears in Payerpath in Yellow and requires the user to correct the

information or acknowledge the warning

Error: Claim Edit Message will Fail the claim in Payerpath and will not allow correction from within

Payerpath. The claim would need to be corrected in your practice management system and re -filed

to Payerpath.

Payer Reports

AUGUST 11, 2016


Payer Reports • Payer reports are responses sent (typically 24-72 hours) by a payer’s EDI

department indicating how they are handling claims sent by Payerpath

• No standard across payers regarding reports and responses leads to:

• Inconsistencies across payers

• Perceived missing information from payers

• Large Quantities of Reports

• 277CA and 277B Payer Report Types

• 277 Claim Acknowledgement – Individual Claim Acknowledgements, there

may be various statuses within one report

• 277 Batch – “277 Reject Report” Batch Level Rejection, all claims in batch

are rejected, typically file related issue such as NPI, Tax ID, Enrollment

• The first step of managing your payer reports is to… Let the Full Reconciliation

Features in Payerpath help you!


Reports That Reconcile

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• Payer Report List

• Payer Reports

• Matched Column3

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Insurance Follow-up Process/Timely Filing

• If the claim was submitted to a payer that

Payerpath does not reconcile then review

Payer Reports under Reports Payer report

Filter• Payer

• Exclude RCM – Matched Rpts

• Apply Filter

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Payer Reports

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• Payer Report

• Claim Level Examples

• Example Denial

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Payer Rejects Report• Provides same claims that show up in Reconciliation features

• Can be used as a secondary or supporting reconciliation workflow


Remittance Detail Reports • Electronic Remittance Advice (ERA) received from payers provides an

electronic version of the EOB

• Standardized into template across all payers

• Payerpath provides online presentation with reporting functionality

• Raw Files are sent back to the PM applications for automatic payment posting

• Make sure to work with implementations/support to ensure that PM system is

setup correctly for auto-posting features


Remittance Detail Reports

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• Payment Information

• Provider Information

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Remittance Detail Report

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• Patient Information

• Service Information

• Payment Information

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Full Reconciliation – Single Patient EOB

• Patient Information

• Reports (R) / Remittances ($)

• Single Patient EOB3

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277 Claim Notes

AUGUST 11, 2016


What are 277 Claim Status Messages

• 277 Transactions are the EDI response to the inquiry about

the current status of a specific claim or claims.

• These transactions utilize claim status categories to

communicate if the claim has been acknowledged, pended,

finalized or if additional information is being requested.

• These transactions utilize claim status codes to further

explain the status of the claim.

• Payerpath has created custom transactions to communicate

the status of the claims.


Where Can I Find Claim Status Messages

1. Under Financial Inquiry (FIN) &

Account Ledger right click on the

voucher

2. Select View Claim Status2

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Where Can I Find Claim Status Messages

1. Under Claims Review (CRE) &

Office Manager right click on the

voucher

2. Select View Claim Status2

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277 Claim Notes Examples

1. Source - Payer

2. Action Code - Status

3. Claim Category

4. Claim Status

5. Description

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Additional Features/Tips

AUGUST 11, 2016


New Eligibility in Payerpath


New Eligibility Demo

• Demo


Payerpath Call results now in Payerpath!!

1. Appointment Reminder

Report (AN)

1. Appoint Reminder

Processing Report (AP)

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Patient Payment Solution Reports

Payerpath Statements - SP/SN reports

Epay/Estatement Reports

Payerpath Receipt Reports

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Preferences

Set the amount of time you want

Payerpath to keep you logged in

(5min- 60 mins).


Preferences – How can I change my password without calling support?

Having the correct email address on file will allow you to reset

your password yourself without having to call support.


Email Campaign – Password Reset• Enter Valid Email Address

• Submit and Verify

• Check Email box to complete verification

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Search for Payers

Download Claim/Remit Forms

ICD-10 Readiness dates

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Copyright © 2015 Allscripts Healthcare Solutions, Inc.

Coming Soon

AUGUST 9, 2016


New ‘Done’ Feature


New ‘Done’ Feature


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

Documents

August 11, 2016 Presented by: Carrie Murphy Payerpath 101 ... · Payerpath 101- Tools & Techniques for Effectively Reconciling and Tracking Claims August 11, 2016 Presented by: Carrie