EDI Enrollment Webinar

for Practice Insight Authorized Resellers

Martha Johnson, Payer DevelopmentAndrea Frost, Project Manager

Donna Anderson, Enrollment Specialist

Outline

Getting Started

Where do I get the forms?

How do I manage the forms?

How do I avoid problems for my customers?

ERA Enrollment

Eligibility Enrollment

Questions

Getting Started

Profile your customer

Single customer or CBO?

New EDI or changing service?

Billing as a Group or as Individuals?

How many Billing NPI numbers are tied to the Tax ID#?

Sharing Tax ID# with other offices or hospital?

Getting Started

Make a list of government payers important to your customer. Identify payers from which the customer is already receiving ERA files.

Medicare Part A (FQHC, Rural Health)

Medicare Part B

Blue Cross Blue Shield

Medicaid

Tricare

DMERC

Railroad Medicare

Getting Started

Also list high volume commercial payers important to your customer.

Many commercial payers with no claims enrollment DO offer ERA enrollment

• Aetna• Cigna• United Healthcare

A few commercial payers DO require claims enrollment—these tend to be regional

• Aultcare• Lifewise Health Plan• UHIN-related payers

Getting Started

Compare list of important govt. and commercial payers to the PI payer list in your database:

Login and select Admin Tools

Select Payer List

Search for payers by Name, Payer ID and/or by state

Notify PI if you do not see the payers needed by your customer

Getting Started

Set up Customer EDI Account!

Enter customer name, address and federal tax ID

Enter at least 1 billing provider record with name, address, federal tax ID and billing NPI

Make sure the vendor is correct (your company!)

Where do I get the forms?

Take your list of government and commercial payers and compare to the EDI enrollment forms at Practice Insight

Use the following URL:

http://www.practiceinsight.net/RESELLER_Docs/Enrollment.html

(This site is for Resellers, not Providers!)

Where do I get the forms?

Sample #1 (State)

Sample #2 (UHC ERA)

What if I don’t find forms?

Government Payer – if there are no forms then contact our Enrollment Dept.

PI may need additional time to develop a new trading partner connection

Pay attention to Professional vs. Institutional EDI enrollment

Commercial Payer – if no forms then there are no known enrollment requirements for claims

Send an inquiry! (make an Issue)

How do I manage the forms?

Always download a fresh set of payer enrollment forms

Email the documents to your customer (do not give out the URL)

Check first page for instructions on how to deliver forms

Mail?

Fax?

To the payer?

To Practice Insight?

How do I manage the forms?

Fill out forms for each Billing Provider

Review in person or by phone—encourage accuracy and neatness!

Some Resellers fill out all information for customer except for the signatures

Customer must keep copies or send documents to Reseller to manage

How do I manage the forms?

If payer sends EDI enrollment Accept/Reject message to PI, we will share with the Reseller

TIP: act quickly on rejections!

If payer sends Accept/Reject message to provider, please share with PI Enrollment

How do I manage the forms?

Some payers send NO notification at all to Practice Insight or the provider

Reseller must follow-up with payer

Check PI instruction page for• Typical processing time at payer

• Payer’s EDI phone number

Call with your copy of forms in hand

How do I avoid problems?

Always download the latest documents

Assist your customer in preparing, submitting and tracking EDI enrollments and always refer to PI instruction page

In the customer EDI account, add the legacy PINs for MCR, MCD, BS, etc. as well as all provider NPI numbers

How do I avoid problems?

Authorized signatures only (blue ink?)

Send ALL pages indicated—do not omit printed pages

Proof tax ID #s (9 digits!) and NPI #s (10 digits!)

Make sure NPI # sent out in the electronic claim for Billing Provider matches NPI # listed on the EDI enrollment document

Special Notice for Private Databases

Some Authorized Resellers have a Private Database with DIFFERENT SUBMITTER INFORMATION than standard Practice Insight accounts.

If so, Reseller must modify standard EDI enrollment documents.

Check with PI Enrollment Dept. for help.

ERA Enrollment

Payers typically deliver ERA files to one trading partner only

Changing existing ERA authorization may require additional LOA (letter of authorization)

Once enrolled, Payer will send ERA files for all payments, whether the claim was filed through PI system or not

ERA delivery to EDI customer accounts depends on complete and accurate input of provider TAX and NPI numbers

Eligibility Enrollment

Basic Enrollment Set up required for all providers

Special Enrollment for CMS-Medicare

Special Enrollment for short list of government payers

Eligibility Enrollment

CMS Medicare –what is the CMS Agreement?

Part of every Medicare claims enrollment document set

If no file copy, get a new agreement from the PI forms website

Enrollment Questions

?

Enrollment Summary

Support your customer –- they need your help!

Make sure you have correct information to begin with

As with all EDIinsight issues, contact Practice Insight when you need help