Emdeon Vision for Providers User Guide

Transcription

1 Emdeon Vision for Providers User Guide August, 2014

2 This page intentionally left blank. Emdeon Vision for Providers User Guide

3 Copyright 1 Introduction 2 Registration... 2 Supported Browsers... 2 Monitor Resolution... 2 Automatic Logout Security Feature... 2 About Emdeon Vision... 3 Capabilities... 3 Benefits... 3 Emdeon Vision Fundamentals 4 Search on a Date Range... 4 Search on a Single Date... 5 Limiting Search Results... 6 Export Report... 7 Filtering a Search by Tax ID or Site ID... 8 Claim Quick Search... 9 Launch a Quick Search... 9 Search Results... 9 Allowed Search Criteria... 9 Combining Criteria Worked Claim Viewing Worked vs. Un-worked Claims Updating Claim Worked Status User Administration My Dashboard Change Date Range Landing Page and Preferred Reports Top 5 Claim Rejection Reasons Rejected Claims Work Status Claim Summary Status Top Payers by Sum of Rejected Dollar Amounts The five largest rejected claim dollar amounts by payer are displayed File Summary Status Top 5 Payers by Unconfirmed Claim Amounts The five largest unconfirmed claim amounts by payer are displayed Landing Page and Preferred Reports Access and Account Management 22 Log In First time Login Create Personal Password Answer Security Questions Main Portal Screen Profile Management Update Personal Profile Data Update Security Questions Change Your Password Using Vision Search 28 Options by Search Type Run a Search Working with Dates Date Criteria are Retained across Searches Run a Single Date Search Use Default Date Range Date Format Options Date Entry Shortcut... 32

4 Claim Quick Search Claim Quick Search Results Work Queue Search Search Types Accepted, Rejected, Requires Attachment Search Criteria Formats Requires Attachment Search Work Queue Search: Results File Summary Search File Summary Search Tips Patient Search Search Using Last Name: Results Search Using Insured ID: Results Payer Search Search without a Payer ID Search with a Payer ID Rejection since Last Login ERA Search/Payment Manager ERA Search / Payment Manager FAQ If a Session Error Occurs in Payment Manager Claims with ERA Search Patient Pay Search Run a Patient Pay Search Report Types and their Searches Payment Summary Report Search Criteria Displayed Report Data Displayed Payment Summary by Day Report Search Criteria Displayed Report Data Displayed Payment Detail Report Search Criteria Displayed Report Data Displayed Payment Details Transaction Details Top 20 Diagnosis Codes Top 20 Procedure Codes Audit History Search Audit History Report Navigating Internal Report Navigation Breadcrumb Navigation Set Preference Set up Landing Page Tile Preference Set up Report Preference Settingg Reset or Restore Preference Support Payer List Education Center Customer Service Alerts (payers and Emdeon) Access Customer Service Alerts Introduction Access Customer Service Alerts (CSAs) Set Customer Service Alert (CSA) Alerts in ON24/ Introduction Manage Payer Alerts with Preferences Reports 75 Overview Report Screen Layout Sort Report by Column... 75

5 Detail Links Search Results Claim Summary Report Claim Detail Dynamic Panel Claim Summary Column Headings Claim Summary Report List Order Access Claim Detail Report Claim Detail Report Worked Status Indicator NPI X-Walk Timely Filing Letter Patient Care Alerts ERA Linking in Claim Detail Payment Detail Report Claim Status Check in Claim Detail Eligibility Verification in Claim Detail Check Eligibility at Other Payers Payer Standard Messages in Claim Detail Workers Compensation Attachments Using the Workers Compensation Attachments Interface View/Edit Claim Get Help with This Claim Link Payer Claim ID in Claim Detail Report Format Indicator View Audit History Insured Detail Report Run a Patient Search with Insured ID Insured Detail Column Headings Summary by Payer Report Summary by Payer Report Column Headings Summary by Payer by Day Report Summary by Payer by Day Column Headings ERA Summary by Day Report File Summary Report File Summary Column Headings Reject File Details Report Reject File Data Unconfirmed Claim Summary Report Unconfirmed Claim Summary report by Payer Column Headings Account Review and Optimization 115 Service Enrollment Matrix Access Service Enrollment Matrix Payer Services Availability Status Payer Functions Listed Payers Customizable Alerts Introduction Alert Frequency Setup Alerts Receiving Alerts from Emdeon Vision Exporting and Printing Reports 122 Print a Report User Administration 124 Client Administrator Manage Users Manage User Groups Relationship Definitions User

6 Business Role User Group Responsibility Client Administrator User Capabilities Access User Administration Main Menu Managing Users 128 Add a New User Reset User Password Move a User to a Different Business Role User Groups Add or Remove User Managing User Groups 134 Add a New User Group Responsibilities and Groups Change Responsibility and Dates User Group Add/Remove Multiple Users Search for a User / Login as User

7 Copyright Contents of the Emdeon documentation and software is copyrighted as a collective work under the laws of United States and other copyright laws. Emdeon Vision for Claim Management is a trademark of Emdeon. Emdeon holds the copyright in the collective work. Microsoft and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries Emdeon, Inc. All rights are reserved. Only current Emdeon clients can reproduce these materials for internal use. Any other redistribution, retransmission, or publication of any copyrighted material is strictly prohibited without the express written consent of the copyright owner Emdeon Page 1

8 Introduction Please use this manual as a reference in understanding the functionality and best practices of Emdeon Vision for Providers. Emdeon Vision provides you with extensive information about claims submitted to your contracted payers through the Emdeon Clearinghouse. Additional information about Vision is available in context-sensitive online Help by clicking on the Help link located in the upper right of the Vision screen. Registration Registration is required prior to gaining access to the application. Please see p.22 for more information. Supported Browsers Microsoft Internet Explorer (version 8.x and higher) is the recommended browser for Vision. Mozilla Firefox and Google Chrome are also supported. Monitor Resolution Recommended monitor resolution is 1280 x 720 pixels or more. Automatic Logout Security Feature Logout occurs after 15-minutes of system inactivity Emdeon Page 2

9 About Emdeon Vision Emdeon Vision is a web-based application that provides detailed visibility into the claim life cycle, from submission to the Emdeon Clearinghouse through payer adjudication. Emdeon Vision is available in different versions, each having a customized view and functionality specific for providers, payers, and partners. Emdeon Vision includes online images of paper claims, end-to-end claim tracking, and claim status, as well as a variety of summary and detail claim reports. Capabilities Visibility into all claims (accepted or rejected) Multiple search options with user-defined criteria View up to 15 months of claims history for all payers Export to PDF and MS-Excel formats Claim data and rejection summaries Drill-down capability from customized search to claim detail Clickable dashboard graphs with easy access to reports. Benefits Claim acceptance and payment results data Access to rejected claims data is important in improving business processes User analytical data to decrease rejections and improve efficiencies Centralized management of all claims Immediate availability of future updates to product functionality (web portalbased) Emdeon Page 3

10 Emdeon Vision Fundamentals When claims are submitted to the Emdeon Clearinghouse by a practice or organization, Emdeon retains and archives all claim data as per regulatory guidelines. Through a secure internet portal, Emdeon Vision provides detailed views of the previous 15 months of claims data for your practice (or organization). The following capabilities are available: Track claims through their life cycle from first submission through payment Monitor progress according to claim status Identify claims that need rework, or that have been reworked Evaluate trends to make needed adjustments to claims administration Expedite claims payment. Search on a Date Range To optimize system performance (that is, get a faster return of data), use a single date or a date range of seven days or less, if possible. If the date fields are left blank, Emdeon Vision will set the date range to the previous seven days by default. If a date is entered in one date field and the other date field is left blank the system will do a search on that single date rather than a date range. The date range is selected using the calendar pop up or can be entered by the user. The date range is of the format MM/DD/YYYY Emdeon Page 4

11 Search on a Single Date You can search on a range of dates or on a single date (in searches that contain Start and End date fields). To run a search for a specific date enter the date in either the Start or End date field. When Submit is clicked your selected date is automatically entered to the date field that was left blank. Run a Single Date Search Step 1. If you want to run a search on a single date rather than a date range simply enter one date and leave the other date field blank. Complete all desired search criteria fields then click Submit. Run a Single Date Search Step 2. On Submit, the date entered to one field is automatically entered to the field that was left blank resulting in a search on only that date Emdeon Page 5

12 Limiting Search Results If a search returns more than 1000 rows of data, a message indicates that there are more items in the database that match the search criteria than can be displayed. If this message is displayed and your desired data is not included in the online report, return to the Search screen and re-enter more specific search criteria. (For example, consider using a narrower date range.) 2014 Emdeon Page 6

13 Export Report You can now export large reports (over 20,000 rows) by segment. Note: If the report to be exported contains less than 20,000 rows the standard export (open/save) process is in effect. The following reports include the exporting report in segments functionality: Claim Summary File Summary Insured Detail Summary By Payer Summary By Payer By Day Provider Patient Detail When you click on the Export Report link for a report that contains over 20,000 rows the main Vision screen is grayed out and a pop-up window displays. Click on the report segment to be exported. To export multiple segments, click on each segment. When you have finished exporting, click Close. Click the link for each segment of the report to be exported. When the Save As window displays consider changing the default file name. Note: The default sort order for exported reports is by the most current Received Date Emdeon Page 7

14 Filtering a Search by Tax ID or Site ID Emdeon Vision for Providers User Guide Searching against a specific Tax ID or Site ID is especially helpful for: Limiting search results to a specific provider or specialty area within a practice (by using the associated Tax ID as a search criteria) Limiting search results to a specific practice site for providers that use multiple site ids for claims submission Emdeon Page 8

15 Claim Quick Search Launch a Quick Search Enter one or more criteria in the search field, and then click the search icon at the right of the search text entry field. At least one search criteria must be entered to run a search. (Search criteria are not case sensitive.) There are no date range selection options in Quick Search. A 30-day date range is used by default. Search Results If a search results in a single matching claim only, the Claim Detail for that claim is displayed. When more than one claim matches the search criteria all matching claims for the previous 30 days are displayed in the Claim Summary report. Click View More to see claims older than 30 days. Note: Vision can search up to 15 months of claims data. Allowed Search Criteria Only those Claims that match all entered search criteria are displayed. Search criteria must match the format of at least one of the following searchable claim fields. PCN An alphanumeric string that can include up to 20 characters. Insured ID An alphanumeric string that can include up to 20 characters. Patient Name (Last Name and/or First Name) Enter patient s exact first name and/or the exact spelling of the last name. The only Claims displayed are those that match exactly the criteria entered. To search on the patient s full name use quotations as shown: John Smith. Patient DOB Use the format mm/dd/yyyy (or m/d/yy) to locate Claims. Forward slash ( / ) must be used when searching against a date. For example, to find Claims for January 4, 2008 enter either 01/04/2008 or 1/4/ Emdeon Page 9

16 Emdeon Claim ID CORN. This ID contains 17 characters (2 letters followed by 15 numbers). All 17 characters must be entered. Submitter Claim ID This ID is applied to a Claim by the Provider s submission application vendor at time of submission. Payer Claim ID This ID is assigned to a Claim by the payer. Combining Criteria Use a separator for effective searching. a space All claims that include one or more keywords are displayed; inclusive search. a comma (, ) The resulting search is inclusive (as above). a plus symbol ( + ) The resulting search is exclusive. That is, only those claims are displayed that match ALL the search criteria. the word and The resulting search is exclusive (as above). the word or The resulting search displays all those claims that match at least one of the criteria. That is, if Jones and Louie are the keywords Vision displays those claims for Jones and claims for Louie. Those claims Louie Jones are also displayed (see below). Searching for multiple keywords, phrases, etc. Use single or double quotes to search for multiple keywords, as in a name. For example, to locate claims for an individual named John Adams, place quotes on both ends of the name as in John Adams. The benefit of this type of search is that the results are limited to only those claims that match John Adams ; claims that match only John or only Adams are not displayed. (Claims for Lou Adams, or John Hancock are not displayed.) Worked Claim A claim can be marked worked at the Claim Detail level. This feature is used for rejected claims that require edits or additional information prior to resubmission. The Worked Claim feature allows for quick identification of those rejected claims that have been worked, and those un-worked claims that require attention Emdeon Page 10

17 The term Worked may be used to signify any of the following claim conditions: The claim has been accessed for corrective action (edits or additional information), but has not been completely corrected for resubmission. Required corrective action (edits or additional required information) is complete, but the claim has not been resubmitted. Required corrective action (edits or additional required information) is complete, and the claim has been resubmitted. Note: The definition of the terms Worked and Un-Worked as they relate to your practice s workflow should be understood by all Vision users within your practice/organization. Viewing Worked vs. Un-worked Claims Quickly locate worked and un-worked claims with Work Queue search. For more information on performing this search option, see Work Queue Search, (see p.40, Work Queue Search) Updating Claim Worked Status The Claim Detail Report includes a Worked check box that is unchecked by default. To mark a claim as Worked simply click once in the check box (this will place a check in the box). The Worked/Un-worked status can be viewed in the Claim Summary Report. In the Claim Detail Report the Worked status of the claim is shown by a check in the Worked/Un-worked checkbox, (see p. 85, Worked Status Indicator ). Checked Worked Unchecked Not Worked. User Administration The following options are available to Client Administrators: Set up one or more user groups; assign users to groups. Associate users and groups to a business role or a specified claim processing or rework task Emdeon Page 11

18 Reset user passwords. Delete a registered user. Note: User Administration functions are limited to Client Administrator users at sites or organizations. Please see p. 124 for more information Emdeon Page 12

19 My Dashboard Change Date Range Use the date range buttons to change the current Landing page view. The view automatically updates when date range is selected. The default setting (the range to which the page is set when you first load it) is 7 days. Landing Page and Preferred Reports The landing page displays the alerts, status tables and the dashboards based upon the user preference. Up to four tiles can be selected by the user and these tiles can be dynamically placed across the landing page as preferred. Adding Tiles The landing page can be customized as per the user preference using Set Tile Preference button, present at the bottom of the page. On clicking on Set Tile Preference, a window pops up, to set the preference of tiles to be displayed in the landing page. In the Set Tile Preference a set of six tiles will be displayed from which the user can select upto four tiles. The tiles in Set Tile Preference are listed below, you can select any four of these to personalize your landing page. My Alerts Top 5 Claim Reject Reasons Claims Dashboard File Summary Status Top 5 Payers by Unconfirmed Claim Payer Service Enrollment Matrix 2014 Emdeon Page 13

20 Select the tiles to be viewed in the landing page and click on the save button to view the selected tiles in the home page. To reset the tiles to the default four tiles click on the reset button, the default four tiles are as below: My Alerts Top 5 Claim Reject Reasons Claims Dashboard File Summary Status Save or reset your changes and click on the close button, to close the add tile window. My Alerts Alerts can be displayed depending upon your claim status, feature and the date range selected for the landing page view. Click on the alert count to drilldown and get more information about the alerts. File Level Rejection(s) Displays the count of files that have been rejected. Click on the link to view the rejected files of the file summary report Claim(s) Require Attachments If you have claims for the specified date range that require additional attachments click on the link to view those claims. The Requires Attachment Claim Summary is displayed. If there are no claims that require additional attachment(s) the alert is not displayed. Payer Services Availability Click the link to view the Service Enrollment Matrix. Use the matrix table to see which features are offered by specific payers Emdeon Page 14

21 Top 5 Claim Rejection Reasons The top five reasons for rejection of claims during the specified date range (Yesterday, Last 7 days and Last 8 weeks) are displayed. On clicking the count for the corresponding Rejection Message you can view the Claim Summary Report for the rejected claims for Emdeon and Payer. The following information is displayed: Rejection Message - Explanation of why claims were rejected. Rejected By - Rejecting organization, Emdeon or Payer. Count - Number of claims rejected. Claim Dashboard Four individual graphical representations of claims data for the selected date range are displayed. More details are available by clicking on specific areas of the chart Emdeon Page 15

22 Rejected Claims Work Status Two kinds of information, worked and the unworked claims are displayed in the clickable "Rejected Claims Work Status chart. Each segment of the chart is color-coded for ease of viewing. The counts for each section are displayed within the chart. Claim Summary Status There are 4 kinds of information displayed in the clickable "Claim Status Summary" pie chart. Each segment of the pie chart is color-coded for ease of viewing. The percentage amounts for each section of the pie are displayed within the chart. Pie chart segments: Claims accepted by both payer and Emdeon Emdeon Page 16

23 Claims accepted by Emdeon only. Claims rejected by Emdeon. Claims rejected by Payer. Top Payers by Sum of Rejected Dollar Amounts The five largest rejected claim dollar amounts by payer are displayed. Chart Construction The horizontal axis shows the payer ID per bar of data; the vertical axis shows total dollar amount rejected by a particular payer ID for the selected range of time. Mouse Over Use your mouse cursor to view the total dollar amount rejected by a particular payer during the selected date range. Create Claim Summary Click on a data bar to view a Claim Summary Report. The report displays all the rejected claims for the selected date range for the specific payer id. Click on the Emdeon Claim ID within the Summary Report to view the Claim Detail for a specific claim Emdeon Page 17

24 Claim Charge Amount The amount of claims over time for the selected provider tax ID are displayed. The horizontal axis displays date; the vertical axis displays claim amount. Data Points on the Line Clickable data points are represented on the line with a bullet/circle. The only clickable points on the Line are the data points. "Mouse Over" Use your mouse cursor to view the total claim amount for a specific data point. The number displayed is the same as that represented by the position of the data point relative to the vertical axis. Launch Claim Summary Click on a data point to view a Claim Summary for the date range of that data point. All claims associated to the selected provider tax ID (or for all providers associated with the organization tax ID of the practice) are displayed Emdeon Page 18

25 File Summary Status All batches submitted during the date range are displayed. You can readily view the number of batches, values of these batches, and if any batches are missing (based on your local knowledge of what is expected to have been submitted). This metric is essentially the same as the current File Summary Report in Emdeon Vision. Use the information displayed in the "Claim Amount" column to quickly determine which batches have the most claim dollars at risk. Click the "File ID" number to view details of any claims in the selected batch. You can also see the Accepted/Rejected status of files in the File Summary Status table. Top 5 Payers by Unconfirmed Claim Amounts The five largest unconfirmed claim amounts by payer are displayed. Chart Construction The horizontal axis shows the payer ID per bar of data; the vertical axis shows total dollar amount rejected by a particular payer ID for the selected range of time. Mouse Over Use your mouse cursor to view the total dollar amount rejected by a particular payer during the selected date range. Create Claim Summary Click on a data bar to view a Claim Summary Report. The report displays all the rejected claims for the selected date range for the specific payer id Emdeon Page 19

26 Click on the Emdeon Claim ID within the Summary Report to view the Claim Detail for a specific claim. Payer Service Enrollment Matrix Review Available/Unavailable Status of Payer Services Vision includes numerous payer services that facilitate effective information/data exchanges between providers and payers. Review the Service Enrollment Matrix to easily determine which functions a particular payer offers. Review Payer Offerings The offerings of each payer in the table are displayed in the payer row of the matrix. Review each payer and observe the Service columns corresponding to that row. One of the following terms appear in each block corresponding to a particular payer and a specific functionality/offering. Note: The terms Available and Not Available in the Service Enrollment Matrix are not indicators of current payer relationships for your practice - only theavailability of specified services Emdeon Page 20

27 Available If the payer offers this function but you are not currently using this function, "Available" appears in the applicable box in the table. Click the link to display instructions and a registration form in a separate window to setup your account for the EFT function. Note: An instructional message is displayed if you click on the Available link in the ERA or Claims columns. Not Available If this function is not offered by the payer "Not Available" appears in the applicable box in the table. Change Date Range Each and every tile in the landing page, has an option to retrieve its data using the date range of Yesterday, Last 7 Days and Last 8 Weeks. Use the date range button to view the records in the selected date range.the view automatically updates when date range is selected. The default setting (the range to which the page is set when you first load it) is 7 days. Landing Page and Preferred Reports If a Preferred Report is set up in Set Preferences, the Preferred Report displays when you login to Emdeon Vision instead of the Landing Page. To view the Landing Page instead of a Preferred Report on login, cancel the selected Preferred Report by clicking Preferences then click Reset Emdeon Page 21

28 Access and Account Management Log In Access Emdeon Vision here: A user name and temporary password will be provided to you, either through the self-registration process or by your Client Administrator. Upon initial login, you are required to change your password and define security questions/answers. If you forget your password, answer the security questions to retrieve your password. 1. Go to 2. Enter your user name and temporary password, click Login. Note: Emdeon recommends using Internet Explorer when working in Vision. 3. The Update Security Questions screen displays Emdeon Page 22

29 4. Enter required information, click Submit. The main Vision portal screen displays Emdeon Page 23

30 First time Login When you login for the first time certain required information must be entered. Create Personal Password Your password must include the following characteristics: 8-25 characters Uppercase characters (at least one) Lowercase characters (at least one) Numbers (at least one) Special characters ( *,!, etc.) (special characters are optional). Answer Security Questions Create your own questions and answers but be sure that the answers are easily remembered. Enter questions and answers as plain text. Answers are not case-sensitive. Main Portal Screen Emdeon Vision resides within the Emdeon Portal. This ensures login security and access to additional applications. Click Reporting & Analytics >Claim Management to access Vision. Emdeon Portal options Emdeon Page 24

31 Option My Profile Message Center User Administration Reporting & Analytics Description Update password/security questions and user identification information View system status messages. Client Administration functions, including add new users; group management; etc. Access Vision Emdeon Page 25

32 Profile Management Click My Profile to access the following functions: Create and update your user profile Update security questions Change password. Update Personal Profile Data 1. Click the My Profile option from the Main Portal screen. Enter all required information then click Update Emdeon Page 26

33 Update Security Questions 1. Click My Profile from the Main Portal screen. 2. Click the Update Security Questions option. 3. Select questions and answers. 4. Click Update to save your information. Change Your Password 1. Click My Profile from the Main Portal screen. 2. Click the Change Password option. 3. Enter the current and new password. 4. Click Update e. Note: Your password must be changed every 90-days Emdeon Page 27

34 Using Vision Search These searches are currently available in Emdeon Vision for Provider: Claim Quick Search (Claims Menu) Work Queue Search (Claims Menu) File Summary Search (Claims Menu) Patient Search (Claims Menu) Payer Search(Claims Menu) Unconfirmed Claim Search (Claims Menu) Rejection Since Last Login Search (Claims Menu) ERA Search (Payments Menu) - To access this search, please contact your Emdeon representative. Claims with ERA (Payments Menu) Patient Pay search (Payments Menu) Top 20 Diagnosis Codes (Analytics Menu) Top 20 Procedure Codes(Analytics Menu) Audit History (Support Menu) 2014 Emdeon Page 28

35 Options by Search Type Search Type Available Search Options Search Criteria Claim Quick Search Work Queue Search File Summary Search Quickly access claim information based on known search criteria 1. Display a summary of all claims for a specific status 2. Display a summary of all claims for Accepted, Rejected Claims with Worked or Un- Worked sub-status View all claims by claim batch that were received by Emdeon during a time frame (date range). Each claim batch is identified by a File ID (Emdeon batch identifier). Emdeon Claim ID Submitter Claim ID Payer Claim ID Insured ID PCN Patient Last Name (with optional date of birth) Patient date of birth Received Date range OPTIONAL Tax ID Site ID If Rejected status selected: All, Worked or Un-worked sub-status If Requires Attachment selected: All, Worked or Unworked sub-status Accepted Received Date range AND OPTIONALLY, either or both of the following: Tax ID Site ID Patient Search Payer Search 1. View all claims for a specific insured party and dependents (by Insured ID) 2. Locate all claims for a specific Patient Control Number (PCN) 3. Locate all claims for a specific patient 1. Display a summary of all claims 2. Display a summary of all claims for a specific payer Date range (service date or received date) AND one of the following Insured ID Patient Control Number (PCN) Patient Last Name o (optional: patient date of Received Date range AND OPTIONALLY, any combination of the following: Tax ID Site ID Payer ID 2014 Emdeon Page 29

36 Search Type Available Search Options Search Criteria Emdeon Vision for Providers User Guide Unconfirmed Claims Search View all the unconfirmed claims of the payer. Displays a summary of the details of a Payer, with the count of the unconfirmed claims associated with a particular payer. Received Date range AND OPTIONALLY, either or both of the following: Tax ID Payer ID Rejection Since Last Login View all claims that have been rejected by all payers since last user login ERA Search Launch Payment Manager within Vision. View and track your ERAs Claims with ERA Find claims that have ERAs associated with them. none required Extensive search criteria are available. Please refer to Payment Manager Help (Located in upper right corner of Payment Manager). Use (optional) Tax ID or Site ID to limit search results. If your practice is part of a large organization using your own Tax ID or Site ID will help to limit search results. Patient Pay Find payment details for patients who were provided healthcare services by your practice. Top 20 Diagnosis Codes Top 20 Procedure Codes Audit History Search Note: Access to this search requires upgrade to your account. If you do not have access to this search, please contact your Emdeon representative. Displays the 20 top diagnosis codes over a specified period of time. Displays the 20 top diagnosis codes over a specified period of time. Display claims that have worked or unworked status change during the specified date range (or on a specific date). Search by: Transaction date Patient name Patient Account Number Select Date range Optional Tax ID Select Date range Optional Tax ID Search by date Search by Emdeon Claim ID 2014 Emdeon Page 30

37 Run a Search 1. Select a Search type. 2. Enter all required data. 3. Enter any desired optional data. 4. Select a date range (if applicable).if dates are not selected, Vision will enter the default date range automatically. 5. Default date range is the last 7 days. 6. Click Submit. 7. Results can be searched and/or printed. Note: If no matches are found change the search criteria then rerun the search. 8. After the report displays click on any underlined hyperlink for further details. For more information, see Detail Links on page Emdeon Page 31

38 Working with Dates Date Criteria are Retained across Searches The date (or date range) used in your most recent search is retained across all searches (during a session). When a different search type is selected, the date or date range from the previous search is automatically entered in the date fields of the new search. (The purpose of this date retention functionality is to save time and key strokes as you navigate from search to search.) Run a Single Date Search If you enter a date in either the Start Date or End Date field the remaining open field is filled with the same date when Submit is clicked. The Start Date and End Date fields will then display the same date. The resulting search is limited to the single date only. Use Default Date Range If both date fields are left empty, the system will automatically enter a date range of the last 7 days (inclusive of today) when Submit is clicked. Date Format Options Basic syntax of manually entered dates: mm/dd/yyyy. Additional allowed date configurations: Month can be entered as either mm or m. Day can be entered as either dd or d. Year can be entered as either yyyy or yy. Date Entry Shortcut Use t to enter today s date in date field Emdeon Page 32

39 Enter t in the date field to place today s date in that field. The letter t is displayed until Submit is clicked whereupon t is replaced with today s date. Use t xx to enter a past date in the date field. For example, type t-3 in the date field to enter the date that occurred three days before the present day. t-3 is displayed in the date field until Submit is clicked whereupon t-3 is replaced with a format-compliant date (see above). Note: Claims data for the previous 15 months can be viewed in Vision Emdeon Page 33

40 Claim Quick Search When searching with IDs or any allowable data element in Quick Search only those claims that exactly match the search criteria are displayed. However, when searching by a patient first or last name, a name segment (three consecutive letters must be used) is allowed. Note: The 30-day navigation buttons display at the top of the resulting report after a Quick Search is performed. If search returns no results when the report is loaded, click on the Prev 30 days link to search for results from the previous 30 days. Claim Quick Search Results Quick Search results are delivered in a Claim Summary Report Emdeon Page 34

41 Work Queue Search Use this search to locate claims based on their Worked status. Use the Search Type drop-down list to select claim status to be searched. Search Types Accepted, Rejected, Requires Attachment If Rejected status is selected the following additional criteria are available. Only one of the following can be selected: All Accepted Rejected All Rejected Un-Worked Rejected-Worked Requires Attachment All Requires Attachment Un-Worked Requires Attachment - Worked Search Criteria Formats Tax ID 9-digit numeric string. Site ID 4-digit string (alpha and/or numeric) Emdeon Page 35

42 Requires Attachment Search All claims with status Requires Attachment that match all other entered search criteria for the specified date range are displayed. Claims that require attachments are those claims to which the payer has requested supporting documents be added. Work Queue Search: Results Results must match all entered search criteria and comply with specified Search Type. Accepted Displays only claims with an Accepted status. All Displays all claims regardless of accepted/rejected status. Rejected ( Worked and Un-Worked ) Displays all Rejected claims, Worked and Un-Worked. You can specify Rejected Worked or Un-worked, also. Requires Attachment ( Worked and Un-worked ) Displays all Worked and Un-Worked claims that require attachment(s). You can specify Requires Attachment Worked or Un-worked, also. Note: For more information on how to change the status of a claim from Un- Worked to Worked please see Worked Status Indicator on page Emdeon Page 36

43 File Summary Search A successful File Summary search displays a File Summary Report that provides details on all claim batches submitted to the Emdeon clearinghouse during the specified (or default) date range. Each claim batch is identified by a File ID (Emdeon batch identifier). For more information, see File Summary Report on page 127. File Summary Search Tips Use the (optional) Tax ID filter to refine the search so that only those claim batches that contain claims for the specified Tax ID are displayed. Tax ID format is 9-character numeric string. Use the (optional) Site ID filter to refine your search so that only those claim batches that contain claims relating to the specified Site ID are displayed. Site ID must be a 4-character string (alpha and/or numeric). Note: Both criteria above are optional however one or both can be entered. Patient Search Use the following search criteria to generate a report that lists all patient claims for a specified (or default) date range. Use the Search Date Type drop-down list: Received Date Date of Service 2014 Emdeon Page 37

44 Use the Search by drop-down list: Insured ID Patient Control Number (PCN) Patient Last Name with optional Patient DOB (Date of Birth). o o Partial last name is allowed though at least 3 consecutive characters required. For example, Smi will return not only those patients with the last name of Smith, but also Smithson, Smithfield, etc Patient DOB is optional and must be in mm/dd/yyyy format (or one of the alternative formats discussed in the Date section, p.32). The Patient Date of Birth data field displays only when Patient Last Name is your selection in the Search By drop-down list. Note that optional Patient Date of Birth field is not displayed in the default view. (See next screen shot.) Patient Date of Birth (optional field) displays when Patient Last Name is selected as the Search By drop-down list Emdeon Page 38

45 Search Using Last Name: Results A successful Last Name search displays the Insured Detail Report and includes a list of all claims for the specified patient (PCN) or patients. Search Using Insured ID: Results A successful Insured ID search displays the Insured Detail Report and includes a list of all claims for the primary insured party and all dependents under the Insured ID (subscriber ID) number. For more information, see Insured Detail Report on page Emdeon Page 39

46 Payer Search Use the Payer Search to display a report that includes all claims for a specified (or default) date range. Note: Payer ID must be a 5 character alpha-numeric string. Search without a Payer ID A successful Payer Search without a Payer ID results in the Summary by Payer Report. For more information please see Summary by Payer Report on page 122. Search with a Payer ID A successful Payer Search with a Payer ID results in the Summary by Payer by Day Report. For more information, please see Summary by Payer by Day Report on page 124. Unconfirmed Claim Search Use the unconfirmed claim search to search for all unconfirmed claims of a payer. When no dates are entered the claim received dates shall default to last 8 weeks. Note:The end date cannot be later than yesterday. Use the following search criteria to generate the unconfirmed claim summary report by payer: 2014 Emdeon Page 40

47 Claim Received Date Payer ID Provider Tax ID Rejection since Last Login Select the Rejection Since Last Login search from the Claims drop-down list to display a Claim Summary report of all claims that have been rejected since your last login to Vision. Note: There are no search criteria associated with this report. Click Submit to run the search Emdeon Page 41

48 ERA Search/Payment Manager Go to Payments>ERA Search to launch the Payment Manager application within Vision. For information on how to use Payment Manager, please click the Help link in the upper right corner of the application. You can exit the Payment Manager view at any time by selecting a different search in Vision. When you exit Payment Manager none of your search criteria and views are retained. That is, when you return to ERA Search/Payment Manager you must create your search from the beginning Emdeon Page 42

49 ERA Search / Payment Manager FAQ Q: Which users will see the ERA search feature? A: All Provider Users. Click Payments>ERA Search in Vision to access Payment Manager. Q. If I am not currently signed up to see ERA data in Vision, what should I do? A. Please refer to your Vendor for more information on accessing ERAs in Vision. Q. Is there any cost for using Payment Manager in Vision or to access ERA data in Vision? A. No. Payment Manager is another added-value and benefit that our Vision users enjoy. Q. Can I download ERAs from Payment Manager in Vision? A. No. The ability to download an actual ANSI 835 ERA is not currently available in Payment Manager in Vision. However, you can download ANSI 835 ERAs from the stand-alone version of Payment Manager. Q. What functions are available in the Payment Manager integrated in Vision? A. Search, View, and Print. Q. If I am already receiving ERAs from my Payers is there anything I need to do so that I can access them in Vision/Payment Manager? A. No further action is required Emdeon Page 43

50 Q. If I can t see ERAs for all of my Payers what action(s) should I take? A. Some Payers require enrollment for ERA viewing. Please contact your Vendor to determine if a specific Payer requires enrollment. Q: Will my Vision user account system permissions determine and A: Yes. control which Tax IDs I am able to view? Q: Does a Tax ID have to already be set up to receive 835 via CIH in A: Yes order to see ERA files for that Tax ID? Q: Under what circumstances are ERAs displayed or not displayed in Payment Manager? A: Payment Manager displays ERAs for Payers that have sent ERAs to Emdeon, usually because the practice has completed an ERA registration form for the Payer. If a practice is receiving ERAs directly from a Payer and not through Emdeon, payment information will not be displayed in Payment Manager. Q. If I have Payment Manager download capability how do I access that functionality since it is not currently included in the Vision Payment Manager integration? A. Access this feature in the standard Payment Manager application (that is, the Payment Manager application that is available external to Vision). Please enter this URL in your browser address bar to access Payment Manager: Emdeon Page 44

51 If a Session Errorr Occurs in Payment Manager For some users a session error validation error occurs when a new browser window is launched from the Payment Manager application within the Vision ERA Search window. A simple change in your browser settings is required to rectify this issue: 1. Go to Tools> >Internet Options in your browser. (See screen shot on following page.) 2. Click on Security tab. 3. Click on Trusted Sites. 4. Unclick Enable Protected Mode checkbox. Note: This checkbox must remain unclicked. 5. Click the Site es button. 6. Add *.medi.com to the Trusted Sites list. 7. Confirm thatt Emdeon.com is not listed in the Trusted Sites list. If Emdeon.comm appears in the list, please remove it. Note: If you are unable to edit the list, please refer to your IT or Network staff for assistance Emdeon Page 45

52 2014 Emdeon Page 46

53 Claims with ERA Search Vision now includes two methods for locating and viewing ERAs. In addition to the new Claims with ERA search feature, you may also view ERAs using the Payment Manager tool ( ERA Search ). While Payment Manager provides deep details about the ERA itself, the Claims with ERA search displays ERA information within the context of the claim thus clearly retaining the link between a specific claim and its ERAs. These two ERA search functions provide you with a complete picture of both the claim and the ERAs that are associated with it. Locate claims for a specified date or date range that have ERA(s) with the Claims with ERA search. Search can also be done on specific Tax ID or Site ID. The Tax ID and Site ID filters are helpful if you are part of a large organization. ERA Summary By Day report appears for successful search. Click a linked Claim Received Date to view the Claim Summary Report for that date Emdeon Page 47

54 When viewing a Claim Detail of a claim that has ERA(s) associated to it the Additional ID field in the Payer Claim Status History section of the Claim Detail includes a linked check number. Click the linked check number in the Additional IDs field of the Payer Claim Status History section of the Claim Detail report to view the Payment Detail for the selected check Emdeon Page 48

55 Patient Pay Search Note: This search requires an account upgrade. If you do not see this search please contact your Emdeon Vision representative. Patients can pay their bills with multiple methods (cash, check, credit, online, etc.) using Emdeon IXT patient bill paying system. Once a bill is paid, the provider can view the payment via Emdeon Vision. Note Please contact your Emdeon representative for more information on IXT patient pay bill payment services. Data Availability IXT patient payment information is loaded to Emdeon Vision once per day Emdeon Page 49

56 Run a Patient Pay Search 8. Select the search type by using the Search By drop-down menu: Transaction Date Date that payment occurred in the IXT payment system. Patient Name The first 3 consecutive letters of the patient first name or last name must be entered in the Patient Name data field. Results will include both first and last name matches. Search field is not case sensitive. Example Entering dav will return david, davidson, davidoff, dave, etc. Patient Account Number The entire patient account number must be entered in the Patient Account Number data field. Merchant ID Search by the Merchant ID on claims. 9. Enter the Start and End Dates manually or use the calendar tool. Date Range Search You can search up to 15 months. If the date fields are left blank the default date range is automatically entered which is the last seven days (inclusive of today). Run a Single Date Search If you enter a date in either the Start or End field the open field will be filled with the same date when Submit is clicked. The Start and End fields will then display the same date. The resulting search is limited to the single date only. 10. Enter (or select) the required data as per the type of search selected: Transaction Date search. Enter date range Patient Name search Enter at least first three letters of patient first or last name. (Field is not case sensitive.) Patient Account Number search Enter the entire patient account number. Merchant ID Select one of the Merchant IDs that are associated to your Vision account. 11. Use the Search Type drop-down menu to choose: Un-Worked Those payments without a check in the Worked column. This is the default selection Emdeon Page 50

57 Worked Those payments having a check in the Worked checkbox. All Search includes both Worked and Unworked payments. Declined Credit or debit payment by patient was declined. 12. Click Submit to run the search. Report Types and their Searches Payment Summary Transaction Search with Worked selected. Payment Summary by Day report can be accessed by clicking on a highlighted Transaction Date. Payment Summary by Day You can access this report by: o Drill down from Payment Summary by Transaction Day. o Patient name with Transaction date range. o Patient account number AND Transaction date range. Payment Detail Drill down from Payment Summary by Day report by clicking highlighted Receipt number. Payment Summary Report Search Criteria Displayed Transaction Date Range Day or date range used in search. If search was single date the date range displayed is one date only. Search Type Criteria used in search. Report Data Displayed Data displayed in Payment Summary report is sorted by descending Transaction Date. Transaction Date Date that payment was made. Click the link to view Payment Summary by Day Report for the selected transaction date Emdeon Page 51

58 Number of Payments Number of payments made on the specified Transaction Date. Each payment is listed in the Payment Summary by Day Report for the specified date. Total Amount Total amount (in US dollars and cents) of all payments made on the specified Transaction Date Emdeon Page 52

59 Payment Summary by Day Report Search Criteria Displayed Transaction Date Range Transaction Date selected in Payment Summary report. Worked Status Status of transactions for the Transaction Date selected in the Payment Summary report - All, Unworked, or Worked. Report Data Displayed Data displayed in Payment Summary by Day report is sorted by descending Transaction Date. If more than one payment occurred on a specific Transaction Date the information for that date is sorted by descending payment amount (for that Transaction Date). Worked Checkbox Click once in the checkbox to add or remove a check. When the checkbox is checked, the payment is designated as Worked. You can locate Worked payments by running a Transaction Date search with Search Type: All or Worked. Transaction Date Date that payment was made. Service Date Date of delivery of health care services referenced in the payment. Patient Name Name of patient who received health care treatment for which payment was made. Patient Account Number Provider account number for patient. Payment Amount Amount (in US dollars and cents) included in payment. Settled Yes Credit/debit Payment from patient settled. No Credit/debit Payment from patient not settled. Declined Yes - Credit/debit Payment from patient declined. No - Credit/debit Payment from patient not declined. NA Decline status of specified payment not available. Receipt Number Unique receipt number of transaction. Click the link to view the Payment 2014 Emdeon Page 53

60 Detail report for the specified payment. Note Every transaction has a unique receipt number. Payment Method Method by which payment was made. Multiple payment methods are allowed. Merchant ID Merchant ID associated with the payment described on the report row. Payment Detail Report Search Criteria Displayed Transaction Date Date of transaction. Receipt Number Receipt number for the specific transaction being viewed. Every transaction has a unique receipt number. Report Data Displayed This report contains information that is specific to a selected transaction only. The report is separated to two columns, Payment Details and Transaction Details. Payment Details Patient Name Name of patient for whom health care services were delivered. Patient Account No Provider account number for patient. Merchant ID (Only displayed for Merchant ID search) Merchant ID used in search criteria. Service Date Date that health care services were provided to patient by provider. Payment Amount Amount in US dollars and cents of payment included in the specified transaction. Note: In rare circumstances a negative number is displayed in the Payment Amount field. This signifies that a refund in the specified amount was issued by Emdeon to the patient. If, for example, a patient overpays a bill Emdeon 2014 Emdeon Page 54

61 may issue a refund directly to the patient. Please communicate with your Emdeon representative for more information. Settled Yes Credit/debit payment from patient settled. No Credit/debit payment from patient not settled. Payment Method Method of payment for transaction. Multiple payment methods are allowed. Declined Yes Payment from patient was declined. No Payment from patient was not declined. NA Decline status of the specified payment is not available. Worked The checked/unchecked (from Payment Summary by Day Report) Worked status of the Transaction is displayed. You can check or uncheck the checkbox from the Payment Detail. Note The checkbox status that is set/displayed in the Payment Detail is also displayed in the Payment Summary by Day Report. Transaction Details Transaction Date/Time Date and time of payment. Transaction ID Unique transaction identifier. Authorization Code Credit card authorization code. Receipt No Unique receipt number. Open Date Date and time that transaction started. Close Date Date and time that transaction concluded. Guarantor Name Name of person rendering payment Emdeon Page 55

62 Top 20 Diagnosis Codes The search criteria that is used in your Top 20 Diagnosis Code search determines the data that has to be displayed in the charts. Searching with Provider Tax ID If a Provider Tax ID is used in the search criteria the charts being renderred will be filtered on the basis of the Provider Tax ID enterred. Searching without Provider Tax ID If a Provider Tax ID is not used in the search criteria the bars will be filtered on the basis of the date range being submitted Emdeon Page 56

63 Top 20 Procedure Codes The search criteria that is used in your Top 20 Procedure Code search determines the data that has to be displayed in the charts. Searching with Provider Tax ID If a Provider Tax ID is used in the search criteria the charts being renderred will be filtered on the basis of the Provider Tax ID enterred. Searching without Provider Tax ID If a Provider Tax ID is not used in the search criteria the bars will be filtered on the basis of the date range being submitted Emdeon Page 57

64 Audit History Search Select the Audit History search from the Analytics drop-down menu. Run a search to display an Audit History report of all applicable/matching claims whose worked/unworked status has changed. Search for updated claims by single date (or date range) or by Emdeon Claim ID number. Note: Audit History report is not sortable by column. Audit History Report Data displayed in Audit History report is sorted by Date/Time stamp in descending order (with most recent event at the top of the table). Username Login ID/User Name of the user who made the specified change described in the table row. Action Performed One of two possible actions are displayed in this field. o Marked claim as Worked Specified user changed claim status to Worked. o Marked claim as Unworked Specified user changed claim status to Unworked. Date/Time Stamp Date and time of action. Emdeon Claim ID Specific Emdeon Claim ID of claim (CORN). Note: This column is not displayed if a specific Emdeon Claim ID was used in search criteria Emdeon Page 58

65 Navigating After a report is generated use the internal navigation controls described below; do not use the browser forward/back buttons. Internal Report Navigation Scroll Report Click the arrows in the navigation bar to scroll back and forth by page views within your report. Click the go to end arrow (> ) to display the last page of the report. Click return to beginning arrow ( <) to go to the first page in the report. Click on the circled page button to navigate to the corresponding page and the page button which is clicked will be highlighted. Click on the (>) to display the next page and click on (<) to display the previous page. The default set of Page numbers will be on clicking on the page buttons will be ordered as and so on. Note If your report has multiple pages the available scroll arrows are displayed in black and can be clicked. For single page reports scroll arrows are not clickable and are displayed in gray. Current Page The current page is shown at the bottom of every report page and is displayed in block circle. Jump to Specific Page In a multiple-page report use the current page number display box (see above) to jump to any page in the report. Type the desired page number in the display box then press Enter Emdeon Page 59

66 Search Report Enter search criteria in the navigation row search field then press Enter (or click the binoculars icon). (The search field is not case sensitive.) All matches within the report are highlighted. Run a different search or exit the report to clear search highlights. Click the arrows in the search navigation bar to search back and forth by page within your report. The current occurrence will be highlighted in green and the rest of the occurrence will be highlighted in orange. Breadcrumb Navigation Move to a previously displayed report in the current search path or return to the Search screen by selecting any of the available links in the clickable Breadcrumb path (displayed above the report title). The Breadcrumb path is a clickable display of the sequence of screens you used to arrive at your current location Emdeon Page 60

67 Set Preference Set up the default Landing Page Tiles or the Report preference using the Preference Management. The reports and the tiles in Vision can be customized according to the user s preference. The preferred tile or the report will be loaded automatically on navigating towards the home page or when you login to the application. The preferences that are available in Vision are: Landing Page Tiles Preference Reports Preference Settings Landing Page Tiles Preference The Landing Page Tiles can be selected for four different tile positions available in the home page. The positions are categorized as Position 1 Postion 2 Position 3 Position 4 An option to select the preferred date range is also available with the postions. The date range can be set for yesterday, last 7days and last 8 weeks. The default date range that will be available is last 7 days. The set of tiles that can be selected for the four tile positons are My Alerts 2014 Emdeon Page 61

68 Top 5 Claim Reject Reasons Claims Dashboard File Summary Status Top 5 Payers by Unconfirmed Claim Payer Service Enrollment Matrix Save your changes using the save button after selecting the preferred tile and the date range. Click on the reset button to reset your changes to the default landing page tiles and the default date range. Reports Preference Settings Alter the landing page view by a search easily with Set Preferences. The selected search (or system action) runs automatically upon login to Vision. Set up a default search for any of the following: Payer Search Work Queue Search File Summary Search Rejections Since Last Login Note: The preference selections remain in effect until reseted Emdeon Page 62

69 You can alter the Search Criteria of all the searches within Vision using Provider Tax ID, Site ID, and the Date range available uder Report Preference. i.e On Saving a date range as last 8 weeks, the date range for all the searches in Vision will default to last 8 weeks. The number of records to be viewed per page for all the reports in Vision can be set by the user in the Number of Rows Per Page under the report preference. i.e All the reports in Vision will limit the number of rows per page to 3, if 3 is set as the count for Number of Rows Per Page. Click on the save button, to save all the changes made in the report preference. To default your settings, click on the reset button. Saved preferences become active upon your next login to Emdeon Vision. Preferred search becomes the default login search and runs on all subsequent logins until reset (cancelled) or changed Emdeon Page 63

70 Set up Landing Page Tile Preference 1. Click Set Preferences in the navigation bar. 2. Select the desired Positions and the date range. 3. Click on the Save Button. Note: Selected search runs automatically the next time you login to Vision Emdeon Page 64

71 Set up Report Preference Settingg 1. Select a report to be viewed, instead of the landing page tiles 2. Enter a Default Tax ID 3. Enter a Default Site ID 4. Enter the number of Rows Per Page 5. Select a Date Range 6. Click on the Save Button. Note: Selected search runs automatically the next time you login to Vision. Reset or Restore Preference 4. When you access Claim Vision your previously defined default/preferred search runs. 5. After the report displays, click the Home on the Breadcrumb bar to return to the main page or select a different search with the dropdown menus. 6. To cancel the Preferred Search, click the Preferences tab to access the setup screen. 7. In the Preferences screen click Reset to restore default settings 2014 Emdeon Page 65

72 Support Payer List Access the Payer List from the Support tab. Choose display criteria in the selection drop-down lists. Only those payers that match all the selected criteria are displayed. Click View List to display the list based upon the selected display criteria. Click Help icon to view support/reference information for the Payer List. For example, if you want to display those payers that accept claims in 5010 format, click the Accepts 5010 checkbox. Refer to the 5010 column in the report to determine if the payer accepts 5010 claims; Y signifies that the payer does accept 5010 claims, N signifies that they do not accept Use the search filters to customize the Payer List display. Payer List includes a column that displays payer s acceptance status of claims in 5010 format Emdeon Page 66

73 Education Center Click link to access reference and marketing documentation. A new browser window opens. The current version of this Manual and Release Notes are available for review and download. Information about using Vision on your mobile device(s) for convenient and portable access to your claims data via cell phone or PDA is also available. The Did You Know series of concise user references provides valuable information on Vision functionality from reporting and navigation, to working with rejected claims in Vision. Customer Service Alerts (payers and Emdeon) You can access Customer Service Alerts from payers and Emdeon by clicking Customer Communications in the Support drop-down list. (Please see following section for details.) 2014 Emdeon Page 67

74 Access Customer Service Alerts Introduction ON24/7 provides you with easy access to payer and Emdeon customer communications. You can review Customer Service Alerts (CSA) within the ON24/7 window or have them sent to you by based upon criteria of your choosing. CSAs are payer communications about any outages, delays, or service disruptions from payers and Emdeon. You can customize the CSAs you receive based on your location or specific payers. Customizing notifications is easy and can be found in the Preferences section of ON24/7 (please see p. 71). CSAs are helpful in determining if you need to resubmit claims due to delays or service disruptions from payers and Emdeon. Access Customer Service Alerts (CSAs) 8. From the Support menu click on Customer Communications. (See Figure 1.) A new browser displays in which the most recent Customer Communications are listed. Customer Communications are notices from payers relating to system delays, upgrades, or any interruption in their services that might affect providers. Figure Emdeon Page 68

75 9. The Customer Communications screen displays. Click the Emdeon ON247 Customer Communications link (Figure 2). Figure If this is your first time logging into ON24/7 from Vision, the ON24/7 Welcome screen displays (Figure 3). Figure 3. If this is not your first login to ON24/7 from Vision you are automatically logged in and the Customer Communications view is displayed in a new browser window (Figure 4). Figure If this is your first time logging in to ON24/7 from within Vision and you have ON24/7 login credentials, enter your login credentials. The 2014 Emdeon Page 69

76 main ON24/7 screen displays with the most recent Customer Communications reports. (Figure 4). After ON24/7 is accessed for the first time with valid login credentials, the login screen is bypassed on subsequent logins. 12. If you do not have a login to ON24/7 (or you do not remember your username), click the If you don t have an ON24/7 login, or you don t know your username and password link (see Figure 5). Figure The Enrollment Form/ address screen displays. 14. If this is your first login to ON24/7 enter your businesss address. Click Submit. addresss must be your business address. You will receive Customer Support Announcements at this address if you have requested such notifications. The address can be different than the addresss associated to your Vision account. Username must be in standard address format. Figure Emdeon Page 70

77 15. The Customer Communications Most Recent list displays in ON24/ Result: Your identity in Vision is now linked with your identity in ON24/7. This means that a single sign-on connection now exists so that the next time you click any ON24/7 link from within Vision no login is required. Note: Use the Technical Support link in ON24/7 to request support for ON24/7 issues only (e.g., error message, unexpected system behavior, etc.). If you need support relating to Emdeon and claims management issues, please contact your software vendor. Set Customer Service Alert (CSA) Alerts in ON24/7 Introduction The Preferences screen provides you with notification options. Notifications are sent to the address that is on file with your Emdeon account. You can update your address by clicking Account Options. Choose My Account, then update your address. You can change your address at any time. This change updates your address across all Emdeon systems. Note 1: Best practice for Preferences is to search by payer name or ID, then select specific payers from which you will receive alerts. If no payers are selected CSAs for all payers are sent. Note 2: If you have selected specific payers for alerts, those payers only will be displayed in the Most Recent view. A link is available in such situations that allow you to override the specific payers view so that all payers are displayed Emdeon Page 71

78 Manage Payer Alerts with Preferences 17. Click Preferences in the navigation panel. 18. Customer Communications Preferences screen displays. 19. You can choose to receive one or more notifications from payers based on your line(s) of business and/or the type of communication. Note: If All is selected you may receive that is not applicable to your site or organization. 20. Optionally, you can set ON24/7 to you notifications from a specific payer(s). Use the Search by Payer Name or ID field to locate a specific payer Emdeon Page 72

79 21. Enter the payer name or ID number in the Search field. Click Go (do not press the Enter key. 22. All Payers that match your criteria are displayed in the Payer list. To select more than one Payer, hold down the Ctrl key and left-mouse click on each Payer name. Selected Payers are highlighted. 23. Click ADD. The selected/highlighted Payers are moved to the Selected Payers list. (A maximum of 100 payers can be entered in the Selected Payers list.) 24. You will receive alerts/notifications whenever the Payers that appear in the Selected Payers list generate a notification to their customers. o If you want to stop receiving notifications from a specific Payer(s), simply click once on the Payer name in the Selected Payers list to highlight the name then click REMOV VE Emdeon Page 73

80 25. When all selections are made, click Save. You can change your settings at any time. Note: To discontinue receiving notifications, unclick all selections then click Save Emdeon Page 74

81 Reports Overview The following reports are available: Claim Summary Claim Detail Insured Detail Timely Filing Letter (Request for Claim Review) NPI Xwalk Summary by Payer Summary by Payer by Day Additional claim attributes File Summary Payment Detail Patient Payment Summary By Day ERA Summary By Day Reject File Details Unconfirmed Claim Summary Some reports are accessed via highlighted links and are not accessible directly from the search screen. Report Screen Layout Top Left section Search criteria upon which the report is generated. Lower Left section Report criteria of the report generated is displayed. Sort Report by Column Sort a report by clicking the column header. A report is sorted on the column in which the sort arrow appears in the column header Emdeon Page 75

82 If the sort arrow is up, the sort order is ascending; if down, the sort order is descending. When the sort order is changed within a column, or the report is sorted from a different column the entire report is affected. Detail Links Most reports include hyperlinks that provide access to additional reports. Links are displayed as underlined, dark blue text Emdeon Page 76

83 Search Results Searches and their resulting Reports are displayed in the following table. The L designation displayed in the Report Result column indicates that further reports are available via links. Search Type > Search Option Work Queue > Display a summary of all claims for a specific status Work Queue > Display a summary of all claims for Rejected, accepted claims with either Worked or Un- Worked sub-status Work Queue > Display a summary of all claims Work Queue > Display a summary of all claims Patient Search > View all claims for a specific insured party and dependents (by Insured ID) Patient Search > Locate all claims for a specific PCN Patient Search > Locate all claims for a specific patient Report Result Claim Summary (sorted by status) L Claim Detail Claim Summary (for specified substatus) L Claim Detail Claim Summary (for specified substatus) L Claim Detail L Timely Filing Letter Claim Summary (for specified substatus) L Claim Detail L Timely Filing Letter L NPI Detail Insured Detail L Claim Detail Insured Detail L Claim Detail Insured Detail L Claim Detail 2014 Emdeon Page 77

84 Search Type > Search Option Payer Search > Display a summary of all claims Payer Search > Display a summary of all claims for a specific payer Payer Search > Display a summary of all claims for a specific payer File Summary Search> Displays the claim summary report if the status of the file is accepted File Summary Search> Displays a set of claims if the file status is rejected Rejections Since Last Login Patient Pay ERA Search Claims with ERA Search Claim Quick Search Audit History Search Report Result Summary by Payer L Summary by Payer by Day L Claim Summary L Claim Detail Summary by Payer by Day L Claim Summary L Claim Detail Summary by Payer by Day L Claim Summary L Claim Detail L Additional Claim Attributes File Summary L Claim Summary L Claim Detail File Summary L Reject File Details Claim Summary L Claim Detail Patient Summary by Day L Payment Detail Payment Manager delivered data ERA Summary by Day Claim Summary L Claim Detail Audit History Report 2014 Emdeon Page 78

85 Search Type > Search Option Unconfirmed Claim Search Report Result Unconfirmed Claims Summary report By Payer L Claim Summary L Claim Detail 2014 Emdeon Page 79

86 Claim Summary Report The Claim Summary Report can be generated from several areas within Vision: Run a Work Queue search for any claim status. (See graphic below.) Click a link in the Claim Received Date column on the Summary by Payer by Day report. Run a Rejections Since Last Login search. Click a link in the File ID column of the File Summary report. Run a Quick search. Click on a pie chart slice, graph bar, or graph data point in the Dashboards view. Claim details obscured in screen shot. Click an Emdeon Claim ID to view Claim Detail report Emdeon Page 80

87 Claim Detail Dynamic Panel Additional data and functionality is included in the Claim Detail dynamic panel which displays when you place your mouse over a row in the report. The detail panel eliminates the need to go back and forth between Claim Summary and Claim Detail. The Claim Detail Report is still available for each claim. Claim Summary showing Claim Detail Dynamic Panel. Claim Detail Dynamic Panel Emdeon Page 81

88 Claim Summary Column Headings Heading Worked Patient Name Insured ID Description Worked progress status; determined by the Worked check box in the Claim Detail report. You can change the worked status of the claim by adding or removing the check from the check. The status of the Worked checkbox is shown for that claim wherever you are within the system. That is, the setting of the worked check box is understood across the system. Name of the patient submitted on the claim. Insured ID submitted on the claim. Patient Control Provider s control/tracking number for patient on claim. Number Service From Date Date of service. Claim Amount Payer ID Payer Name Dollar amount (in US dollars) of the submitted claim. Payer ID submitted on the claim. Payer name submitted on the claim. Emdeon Claim ID Claim ID assigned by Emdeon for the specific claim Emdeon Page 82

89 Claim Summary Report List Order 1. Emdeon Rejected - Claims rejected by Emdeon. 2. Payer Rejected - Claims rejected by the Payer. 3. Emdeon Accepted - Claim accepted by Emdeon but no notification from the Payer received. 4. Accepted - Claim accepted by Payer and the claim is pending adjudication. Note: File ID is the 2 nd level of sorting That is, the first level is one of the 4 levels listed above, the 2 nd level sort is by File ID. ( File ID includes both Site ID and Emdeon Batch File number, where applicable.) 2014 Emdeon Page 83

90 Access Claim Detail Report There are two ways to access a Claim Detail Report. In an Insured Detail Report click a link in the Claim Received Date column. (Path: Insured Detail Report>link in Claim Received Date column>claim Detail Report.) In a Claim Summary Report click a link in the Emdeon Claim ID column. (Path: Claim Summary Report>link in Emdeon Claim ID column>claim Detail Report.) Claim details obscured in screen shot above Emdeon Page 84

91 Claim Detail Report Worked Status Indicator Use the Worked Status checkbox to mark a claim as worked. When the Worked checkbox is checked the claim is shown as worked on the Claim Summary Report. To search for worked claims use the All or Rejected/All criteria in the Work Queue Search. Note: The definition of worked is practice (or site) specific. Please be sure that all Vision users in your organization have a clear understanding of how your practice/site uses the worked feature. NPI X-Walk If your site is registered for the Emdeon NPI X-Walk service, the report shows if a match was found in the Emdeon Enrollment Database to perform the X-Walk, and whether the crosswalk was executed successfully. If executed successfully, the Provider NPI is inserted into the correct segment of the 837 file prior to submission to the payer. To view this information, click the Check Claim link. Timely Filing Letter Click Display Letter to view the Request for Claim Review Letter. The resulting screen is a printable letter that a provider can send to a payer to support assertions of proper and timely claim filing by the provider. If you are a provider print this letter, enter the appropriate information, attach any pertinent supporting documentation then send the letter (with attachments) to the payer. Click on the button Display Claim Snapshot to view the Claim Vision Snapshot report. Patient Care Alerts Click Display Alerts link to view the Patient Care Alerts by Patient report. Note This field is displayed only if your account has access to the Interactive Care Management module. This powerful add-on in Vision helps you to improve outcomes for your patients by informing you of gaps in patient 2014 Emdeon Page 85

92 care, conflicts in medical treatments, and possible prescription conflicts. For more information please contact your Emdeon Vendor representative 2014 Emdeon Page 86

93 ERA Linking in Claim Detail If your practice has ERA contracts with Payers (via your software vendor) ERA data is displayed in the Payer Claim Status History under certain conditions (listed below). The claim has associated ERA(s). Your practice has ERA contract with the Payer on the claim. If an ERA is associated to the claim a generic message is displayed in the Status Description field. If the claim has been paid (and there is an ERA associated to the claim), the check number is displayed in the Additional ID s column. Click the check number to display the Payment Detail report. Payment Detail Report If a linked check number is displayed in the Claim Detail Report access the Payment Detail report by clicking on the check number. The Payment Detail report provides key information on the claim (and the payment) including claim amount and the difference between paid amount and claim amount. Claim Status Check in Claim Detail Place your cursor over the information icon to view reference information about the Eligibility Verification functionality. Click Eligibility Verification>Check to determine eligibility of the insured at the payer. Click Claim Status to determine claim status from payer. Both functions involve direct data communication between Emdeon and payer; therefore reports may take a moment to load Emdeon Page 87

94 For users with applicable account access levels the status of the claim at the payer can be determined from within the Claim Detail report. Note: Claim Status function is available only when payer on claim supports this function and user account has appropriate setup configuration When the Claim Status link (in the Claim Status section) is clicked the Claim Status Report is displayed in a pop-up window. When you are finished reviewing the data, click Close. Note: Communication between the payer and Emdeon may take a moment Emdeon Page 88

95 Eligibility Verification in Claim Detail For users with applicable account access levels the eligibility status of the insured person on the claim can be determined from within the Claim Detail report. When the Eligibility Verification>Check link is clicked the Eligibility Report popup window displays. Note: Eligibility verification function is available only when payer on claim supports this function and user account has appropriate setup configuration. When Check link is clicked a real-time data exchange occurs between the payer and Emdeon Vision. Insured eligibility information received from the payer is displayed in the Eligibility Report window. A claim might be rejected by the payer due to inaccurate information that was submitted on the claim. If the insured is eligible at the payer, but an individual claim contains data that does not match the data at the payer, the claim will be rejected by the payer due to ineligibility Emdeon Page 89

96 Review the information displayed in the Eligibility Report. If claim was rejected, the insured may in fact be eligible and the claim rejected because of incorrect data that was submitted with the claim. If you find a field in the Eligibility Report for which incorrect information is displayed click Edit & Re-try try. The following fields are editable: Patient First Name Patient Last Name Patient DOB Insured ID Payer ID Service From date Service To date To re-submit the Eligibility Verification check click Submit in the Edit window. If the Eligibility Verification returns a message of Eligible consider re-filing/ /re-submitting the claim to the payer (being sure to confirm that all fields are correct). Check Eligibility at Other Payers Use the Edit & Re-t try function in the Eligibility Report windoww to determine eligibility of the insured on the claim at payers other than the payer on the claim Emdeon Page 90

97 In the Edit window change the Payer ID then click Submit. Your request is sent to the payer whose ID you entered. Eligibility status is displayed when information is received back from the payer. Note: The process of checking other payers does not affect the claim in any way Emdeon Page 91

98 Payer Standard Messages in Claim Detail The Standard Message is displayed in the Message Detail section of the Claim Detail report. When available, the Standard Message is displayed by default. To view the Legacy Message (the original message from the payer), place your mouse over the displayed message text. The Legacy Code is displayed in a highlighted text box. To view more information about the claim, including suggestions for resolving the claim rejection, click on the Standard Code to display the Additional Claim Attributes page. Place your mouse over the Standard Code to view the Legacy Code Emdeon Page 92

99 Workers Compensation Attachments Overview Emdeon Vision provides users with a convenient and powerful way to manage Workers Compensation claims. Functionality includes both claim management and the ability to respond directly to payers with requested attachments. Workers Compensation Attachments is available by subscription only from Emdeon Vision. Emdeon Vision provider users who have pending Workers Compensation Claims can easily find those claims and respond to payer requests for further documentation! Locate Claims Easily To locate claims for which the payer requires additional information run a Claims> Work Queue search. In the Search Type drop-down list, select the appropriate Requires Attachment selection. Enter your Tax ID or Site ID for a more specific search (both fields are optional). All claims that match the selected search criteria for which the payer on Workers Compensation claim(s) has requested additional documentation are displayed Emdeon Page 93

100 Solicited and Unsolicited When a payer requests additional documentation for a Workers Compensation claim this is called a solicited claim attachment. You can also proactively attach documents or electronic files to a claim without a request from the payer. This is called unsolicited claim attachment. Your account must be upgraded for this function. In addition, not all payers accept unsolicited claim attachments. Payer Allowed Response Period Payer on Workers Compensation claims that require attachments provides a 15-day response period during which time the provider can upload files and send them to the payer. If the provider does not respond within the 15-day response period the claim is rejected and no longer appears in the Work Queue>Requires Attachment search results report. Access Attachments Functionality In the Claim Summary report click the highlighted Emdeon Claim ID to display the Claim Detail report for the selected claim. The Medical attachment is displayed as a tab adjacent to the claim detail Emdeon Page 94

101 Workers Compensation attachments window. Click the Upload button at the upper right to display the Upload fields. Click Upload directly beneath the Attach File field for each attachment to add to the bill. After all files are Uploaded, click Commit to send your bill and files to the payer for review Emdeon Page 95

102 Using the Workers Compensation Attachments Interface 1. Click Claim Attachment tab adjacent to the Claim Detail report. The Emdeon Workers Compensation claim attachment view/upload is displayed. 2. To view an attachment, click the applicable View link. A graphic or PDF viewer displays. 3. Click Print to print a summary view. Uploaded files can be printed directly from the View window. 4. Click Upload to display the file upload window. Only PDF and TIF format files can be uploaded. 5. Click Browse to locate the file to upload. 6. Select an Attachment Type from the Attachment Type drop-down list (required field). 7. Enter a description of the file (optional field). 8. Click Upload to upload the file. Repeat A through D for each file to attach to the claim. 9. Status Conditions: PNDA Pending Attachments. Attachments are pending to be sent to the payer. PDCO Pending Commit. Files can be added while bill is in this status. Click Commit to send the bill with attachments to the payer for review. Do not click Comm mit until all files are attached. PEND All attachments and bill documents are ready to be sent to payer. This status occurs after Commit is clicked. This status is the condition prior to Sent. No action can be taken in the Workers Compensation claim attachment window while in this status Emdeon Page 96

103 SENT Bill and attachments sent to payer. Note: After bill and attachments are sent, the Upload and Fax buttons are removed. 10. View or remove uploaded files from the bill prior to clicking Commit. Once committed, uploaded files cannot be removed. 11. Review the billing image created by clicking the View Bill link (located in the Status column in the upper right of the Emdeon Vision Workers Compensation attachments window). 12. Click Commi it to send uploaded files to payer for review. Note: Click Commit to complete the bill/claim submission process. If Commit is not clicked, attached files are not sent to the payer and claim will remain in PDCO/Pending Commitment status. Faxing paper do ocuments 13. Fax documents so that they are correctly received by payer. 14. If you have paper documents to be scanned and sent to the payer, click Fax. 15. Print the Fax cover sheet, then Fax all paper documents to the payer (at the Fax number displayed on the Fax cover sheet) with the Fax cover sheet as the first document in the communication. Using the Fax cover sheet is required to make sure your faxed documents are associated to the bill. View/Edit Claim Edit Claim then Re- -File Claim to Payer Click View/Edit Cla aim in a Claim Detail report to launch the View/Edit Claim feature. A new browser window displays. View the claim in detail, make changes, then re-file the claim directly to the Payer with one button click! 2014 Emdeon Page 97

104 Levels of Access View Review the claim in detail. Claim edit or re-file is not included with this level of access. View/Edit View and edit/re-file capability. Display Guidelines View and View/Edit These guidelines explain which claims can be viewed and which cannot. Full details are not displayed for secondary claims. Medical/Professional claims only are viewable. o Hospital/Institutional and Dental claims are not viewable. Claims with Receipt Date prior to June 1, 2010 are not viewable. Compatible claim formats: ANSI or NSF+ only Emdeon Page 98

105 Data Organization and Error Display The Claim View/Edit application is organized by tabs and sections for easy navigation. A highlighted field indicates a formatting error or missing information (e.g., an empty required field). Place your mouse over a highlighted field to display a description of the error. Easily Locate Errors s and Missing Information Click the Errors tab all fields with errors and/or missing data are listed by field name and tab/section. Each error is accompanied by a description of the error. Click on a highlighted error to go directly to thatt field. Click a highlighted error to go directly to the field (so that you can then correct the error, or enter the required information) Emdeon Page 99

106 Using View/Edit Cla aim Follow these stepss to access the View/Edit Claim feature from a Claim Detail report. Note: Claim must meet the guidelines described above. 5. Click View/Edit Claim from any Claim Detail Report. A new browser window appears. View comprehensive claim details including errors by clicking View/Edit Claim (or View Claim) in a Claim Detail report. A new browser window displays. (All confidential data obscured in screen shot above.) 16. Place your mouse over any highlighted field to view a description of the error. Fields with errors or missing data are highlighted. Place your cursor over the field to display a description of the error. (All confidential data obscured in screen shot above.) 17. Click the Errors tab to view all the errors in the claim. Correct any errors Emdeon Page 100

107 Use the Errors tab to easily locate fields (sorted by tab location) with missing or incorrect data. Click on highlighted error or requirement message to go directly to that field where you can make your necessary changes. 18. When all corrections have been made, click Re-File. A confirmation message appears. 19. Click OK. The claim is re-filed if there are no errors remaining in the claim. Note: When OK is clicked all corrected errors are removed from the Error list prior to re-filing. If any errors remain the claim cannot be re-filed. 20. Click Cancel to discontinue without re-filing the claim. After the Claim is Re-filed A re-filed claim is considered a new claim by the Payer and by Emdeon. The original claim remains in Vision. Get Help with This Claim Link CSAs can be accessed in three ways from Emdeon Vision. Claim Detail report All CSAs from the payer on the claim not older than 30 days are displayed. Click Get Help With This Claim link in any Claim Detail report. (Please see next page.) Support>Cus stomer Communications All CSAs not older than 30 days from all payers are displayed. (Please see p. 68.) Support>ON2 24/7 Main Welcome screen of ON24/7 displayed. Click Communications>Most Recent to view all current Customer Service Alerts for all payers Emdeon Page 101

108 Note: If you have selected specific payers for alerts, those payers only will be displayed in the Most Recent view. A link is available in such situations that allow you to override the specific payers view so that all payers are displayed Emdeon Page 102

109 Access Customer Se ervice Alerts (CSAs) from a Claim Detail Report 6. In a Claim Detail view, click the Get Help with this Claim link. The Claim Support message window displays. 21. If there are Customer Alerts (CSAs) from the payer on the claim a link is displayed. Click the link to view the CSAs from the payer. Note: If there are no recent (last 30 days) CSAs from the payer no link appears. 22. Place your mouse over a CSA to view the description. 23. Click the CSA to view the Details screen for that CSA Emdeon Page 103

110 Payer Claim ID in Claim Detail Report If the Payer has received the claim and if the Payer issues Claim IDs to Emdeon then the Payer s Claim ID appears in the Payer Claim ID field. A blank Payer Claim ID field does not necessarily mean that the Payer has not received the claim (see screen shot above). Note: While most Payers do issue Claim IDs upon receipt of a claim (which appear in the Claim Detail report in Vision) some Payers do not. Please communicate directly with your Vendor for more information Format Indicator If the claim was submitted in 5010 format Yes appears in the 5010 Format field. If the claim was not submitted in 5010 format, No is displayed. If format information for the claim is unavailable Not Available is displayed Emdeon Page 104

111 View Audit History Click the View Audit History link to view the audit history of the claim. The Audit History window displays. The following actions are tracked in Audit History. Click on View Claim button. Click on Eligibility link. Click on Claim Status link. All Worked/Unworked status changes for the last 15 months on the claim are shown with Username and date/time stamp. If the Audit History report is longer than 1,000 rows the report can be exported in Excel format. The export will include all rows including those rows that were not displayed due to the 1,000 row display limit. When you click the View Audit History link a new window displays. The Audit History window is movable in the same manner that the Help window can be moved. Left-click and hold the mouse button down with the cursor on the top margin of the window. Your cursor becomes a cross-hair. Move the Audit History popup window while holding down your cursor Emdeon Page 105

112 Insured Detail Report The Insured Detail Report is the result of a Patient Search. This report provides a list of all claims for the specified patient for the date range specified in the Claim Date Range field. Run a Patient Search with Insured ID When Insured ID is used as search criteria in Patient Search the Insured Detail report displays a list of all claims for all patients (the insured party and their dependents) who are covered under the specified Insured ID (Subscriber ID) for the stated date range. Click an Emdeon Claim ID to view the Claim Detail report for the claim ID (specific for the date displayed in the Claim Received Date column) Emdeon Page 106

113 Insured Detail Column Headings Heading Claim Received Date Patient Name Patient Control No. Service From Date Claim Amount Claim Status Payer ID Emdeon Claim ID Emdeon File ID Description Date claim was received by Emdeon or payer. Name of patient submitted on the claim. Provider-generated control number for the patient on the claim. Date of medical service submitted on the claim. Dollar amount of the submitted claim. Current claim status with Emdeon or payer. Payer ID submitted on the claim. Claim ID assigned by Emdeon for the specific claim; click link to view Claim Detail Report. File ID assigned by Emdeon for the electronic file in which the claim was submitted. Summary by Payer Report The Summary by Payer report is displayed when you perform a Payer Search without specifying a Payer ID. The Report includes a claim summary for each payer (sorted by Payer ID). Click a Payer ID to display the Summary by Payer by Day report Emdeon Page 107

114 Summary by Payer Report Column Headings Heading Payer ID Payer Name Received Claim Quantity Emdeon Reject Quantity Emdeon Reject % Paper Claim Quantity Payer Reject Quantity Payer Reject % Claim Amount Description 5-character alphanumeric string; ID number of payers that had claims received by Emdeon during the specified date range. Click the highlighted date link to view the Summary by Payer by Day report for the selected Payer ID. Name of Payer organization. Total number of claims received by Emdeon. Number of claims received by Emdeon during the specified date range from the payer. Click the link in Payer ID to view details of these claims in the Summary by Payer by Day report. Number of claims rejected by Emdeon from the number received. Percentage of claims rejected by Emdeon. Number of claims received as paper claims from among those claims received by Emdeon during the specified date range applicable to specific Payer(s). Number of rejected claims from among those received by Emdeon during the specified date range that were rejected by the payer specified in the Payer ID/Payer Name fields. Percentage of those claims received by Emdeon that were rejected by the payer. Total amount (in US dollars) of all claims received by Emdeon for the report row. This amount includes any rejected claim amounts. The Claim Amount displayed is the totality of all Emdeon claims received from the payer for the specified date range Emdeon Page 108

115 Summary by Payer by Day Report The Summary by Payer by Day report can be generated in two ways: Perform a Payer Search with a specified Payer ID. Click on a Payer ID link in a Summary by Payer report. The Summary by Payer by Day report displays a summary of claims for the specified Payer ID. Each row in the report shows the total quantity of claims received by the payer for the displayed date for that row. The amount in the Claim Amount column is the total amount in US dollars of claims (including rejected amounts) received on the specified Claim Received Date for the specified payer ID Emdeon Page 109

116 Summary by Payer by Day Column Headings Heading Claim Received Date Received Claim Quantity Emdeon Reject Quantity Emdeon Reject % Paper Claim Quantity Payer Reject Quantity Payer Reject % Claim Amount Description This report displays a summary of all those claims received on the specific date shown per report row (per specified payer). Click the highlighted date to view details for each claim received on the claim received date. That is, if the number displayed in the Claim Received Date column is 12, then 12 claims are displayed in the resulting report. Number of claims that were received on the Claim Received Date. Note: When claim received date link is clicked those claims that are specified in the Received Claim Quantity field are displayed. Number of claims (from those that were received on the claim received date) that were rejected by Emdeon. Percentage of claims (from those that were received on the claim received date) that were rejected by Emdeon. Number of claims received in paper format (rather than electronically) from among those claims in the claims received date number. Number of claims rejected by the specified payer from among those claims in the claims received date number. Percentage of claims rejected by the specified payer from among those claims in the claims received date number. Total amount in US dollars of claims (including rejected amounts) received on the specified Claim Received Date for the specified payer ID Emdeon Page 110

117 ERA Summary by Day Report This report is generated from the Claims with ERA search. Click in a Claim Received Date to view the Claim Summary Report in which all the claims having ERAs for the selected date are displayed in summary format. Click an Emdeon Claim ID to view the Claim Detail for that claim. Heading Claim Received Date ERA Received Quantity Description Date claim was received at Emdeon. Note: Claim Summary report displays all claims with ERAs for the selected Claim Received Date. Click on an Emdeon Claim ID in the Claim Summary report to display the Claim Detail report for the selected claim. A check number is displayed in the Payer Claim Status History section of the Claim Detail report. Click the highlighted check number for more information on the payment. Number of claims for the specified date that have ERA associated to them Emdeon Page 111

118 File Summary Report The File Summary Report provides details on all claim batches submitted to the Emdeon clearinghouse during a specific date range. Each claim batch is identified by a File ID (Emdeon batch identifier). Claim details obscured in screen shot above. Click linked File IDs to view Claim Summary report for the selected file id. If File Status is Rejected, the Reject File Details report is displayed. File Summary Column Headings Heading File Received Date File ID File Status Received Claim Quantity Emdeon Reject Quantity Payer Reject Quantity Claim Amount Description Date file was received by Emdeon. File ID assigned by Emdeon for the electronic file in which claim was submitted. Click link to display Claim Summary for the date specified in the Claim Received Date column. The value in this column is determined by the rejected or accepted status of the file. Accepted - If file is accepted, click the link in File ID column to view Claim Summary. Rejected - If file is rejected no data is displayed in Emdeon Reject Quantity and Payer Reject Quantity columns. Click link in File ID column to view Reject File Details report if status is Rejected. Total number of claims received by Emdeon on the date specified. Number of claims rejected by Emdeon. Number of claims rejected by the Payer. Total dollar amount of all claims received (total dollar amount for total number of claims shown in the Received Claim Quantity column) Emdeon Page 112

119 Reject File Details Report This report provides details about the rejected file that was selected from the File Summary report. The Reject File Details report is accessible by clicking on the File ID of a rejected claim file in the File Summary report. (See previous page for more information about the File Summary report.) Search Criteria displayed at the top of the report is File ID #. All information in the report relates to the specified File ID # only. Reject File Data Emdeon File ID File ID of rejected file. This is the same number as the number displayed in Search Criteria. File Received Date Date that file was received at Emdeon. File Claim Count Number of claims in specified file. File Status Message Rejection status with code (if applicable). Submitter ID ID of submitter of claim(s). Provider Tax ID Tax ID of provider on claim(s) Emdeon Page 113

120 Unconfirmed Claim Summary Report The Unconfirmed claim summary Report provides details display the claims that has been accepted by the Emdeon but has not received any status from a payer in a prominent and conspicuous location within Emdeon Vision. Click linked Unconfirmed Claim Quantity to view Claim Summary report for the selected payer id. Unconfirmed Claim Summary report by Payer Column Headings Payer ID Heading Description Payer ID submitted on the claim. Payer Name Payer name submitted on the claim. Claim Type Unconfirmed Claim Quantity The value in this column is determined by the type of the claim P Professional Claims I Institutional Claims D Dental Claims Total number of claims received by Emdeon on the date specified Emdeon Page 114

121 Account Review and Optimization Service Enrollment Matrix Information presented in the table includes both available and unavailable payer services for your account. Click the linked term Available to view instructions and registration forms (for features that are available but that are not switched on for your account). Access Service Enrollment Matrix Click the Payer Services link in the My Practice Information section of the Home landing page. (See graphic below.) Payer-offered services that are integrated within Emdeon Vision are displayed in the Payer Service Enrollment Matrix. (Only those payers that support and sponsor EDI transactions are included.) 2014 Emdeon Page 115

122 Payer Services Availability Status Vision includes numerous services that facilitate effective information/data exchanges between providers and payers. You can easily determine which functions a particular payer supports, and review the availability of features. Review Payer Offerings The offerings of each payer are displayed in the payer row of the Service Enrollment table. Note: Available If the payer offers this function but your account is not currently configured to use it, "Available" appears in the applicable box in the table. Click link to display instructions and a registration form in a separate window to setup your account for the EFT function. Note: If you click on the Available link in the ERA or Claims columns an instructional message is displayed. Not Available If the payer does not offer this function "Not Available" appears in the applicable box in the table. Available and Not Available in the Service Enrollment Matrix are not indicators of your practice s current payer relationships - only the availability of specified services. Payer Functions The following payer offerings/functions are displayed as column headers in the Service Enrollment matrix table. Look on the row for a specific payer to determine if a particular function is available (for your account) from that payer Emdeon Page 116

123 Payer Name Payer ID ERA EFT o o o o Possible values are Available, Not Available, and Yes. ERA - Electronic Remittance Advice; an electronic version of a payment explanation which provides details about providers' claim(s) payment, and if the claim(s) is denied. If claim was denied the ERA includes the required explanations. The industry standard for sending of ERA data is the HIPAA X12N 835 standard. Possible values are Available, Not Available, and Yes. EFT - Electronic Funds Transfer; electronic receipt of funds from payers. Listed Payers The top ten payers by claims rejection percent for your practice are included in the table. (The table is sorted by Payer ID.) 2014 Emdeon Page 117

124 Customizable Alerts Introduction Use Customizable Alerts to stay informed via when your specified claim rejection amount threshold(s) are exceeded. Alert notifications are sent to the address specified in your Vision account. No PHI is included in any Alert. Note Do not reply to Vision Alerts. Alert Frequency You can receive Alerts either daily or weekly. Alerts are generated and sent only if your selected threshold is reached Emdeon Page 118

125 Setup Alerts 7. Click on Preferences>Set Alerts. The Customize Alerts popup window displays. 8. Two types of Alerts are available, individual claim-specific (Alert 1) or combined claims totals (Alert 2). Place a check in the checkbox for the Alert type you want. 9. You can select one Alert type or both. 10. Set the frequency for each Alert by selecting Daily or Weekly for each Alert. Weekly Alert s are generated every Monday morning at 6am EST and include last 7 days of claims data from claims received between yesterday (Sunday) and the previous Monday. Daily Alert s are generated at 6am EST every day and include claims data of claims received the previous day. 11. Select monetary Alert level for each Alert type by placing a check in the applicable checkbox. You can select one Alert level per Alert type. 12. Alert 1: Threshold Alert for rejected amounts (in US dollars) for individual claims. Rejected amount exceeds $500. Rejected amount exceeds $1000. Rejected amount exceeds $ Alert 2: Threshold Alert for total dollar amounts (in US dollars) for combined rejected and unworked claims. Rejected amount exceeds $5,000. Rejected amount exceeds $10,000. Rejected amount exceeds $20, Click Submit to save your Alert settings. 15. After settings are saved, your saved Alerts and their frequency are displayed in a message at the bottom of the Customize Alerts window. This information is always displayed whenever the Alerts window is accessed. If no Alert is set the following message is displayed: There are no Alerts set Emdeon Page 119

126 Receiving Alerts from Emdeon Vision Do Not Reply to Alert Alerts contain an introductory statement identifying the communication as an Alert from Emdeon. Do not reply to the Alert . Alert Format - Alert 1 Claim rejection information for individual claims (Alert 1) is organized in a table format with the following column headings: Claim ID Claim Amount Rejected by (Either Emdeon or payer - If by payer, payer ID is displayed.) Rejection Date Rejection Reason The table is limited to ten claims and the sort order is by rejected claim amount. Alert Format - Alert 2 The following message is displayed in Alert 2-type Alerts. This is an Alert from Emdeon Claim Vision. The total claim amount of your rejected and unworked claims is *value* which exceeds your *threshold value* setting. As rejected, unworked claims are worked in Vision; these changes should be reflected by this Alert. That is, as rejected, unworked claims are corrected in Vision, the claims causing this threshold to be exceeded should be reduced, eventually to the point where the threshold is no longer exceeded. Alert Identification address of Emdeon Vision Alerts is VisionAlerts@emdeon.com. Note Please do not send s to this address, or reply to Vision Alert s Emdeon Page 120

127 2014 Emdeon Page 121

128 Exporting and Printing Reports Emdeon Vision provides three ways to export a report. Excel - Formatted Report Output Click the Excel icon located at the right edge of the report navigation bar. In the File Download window click Save to save the report in.csv format. If you click Open the file will display in Microsoft Excel. Note: The resulting export can contain up to one thousand rows. Export Report link Click the Export Report link located at the top left of the report. In the File Download window click Save to save the report in Excel format. Click Open to open the report in Microsoft Excel. If Report contains more than 20,000 rows, you must export the report by segment. Please see Export Report (p. 7) for more information. Note: This export option is available in the following summary reports. o o o o o o Claim Summary File Summary Insured Detail Summary By Payer Summary By Payer By Day Provider Patient Detail 2014 Emdeon Page 122

129 Print a Report Click the Print icon located at the left edge of the report navigation bar. In the File Download window click Save to save the report in PDF format. If you click Open the report displays in the default PDF viewer. Go to File>Print in your PDF viewer to print the report. Note: This export option includes all rows in the report including any rows past one thousand. Reports displayed in the Vision interface are limited to one thousand rows. All rows in the report are included when this export/print process is used Emdeon Page 123

130 User Administration Client Administrator One person at each client site is assigned the Client Administrator role. The Client Administrator is the only user with the capability to set up or change permissions and associations for other Vision users. Generally, Client Administrator capabilities are grouped as follows: Manage Users Grant system access Perform password administration for users o Make password changes for any user at the site Associate users with a business role Delete any registered user. Manage User Groups Create new user groups for your site Associate users with user groups and work responsibility areas Remove user group Remove user from a user group Emdeon Page 124

131 Relationship Definitions User The Client Administrator sets the access levels for each user. Access can be restricted to specific data and functions depending on a user s association with business roles and user groups. Business Role A business role is a generic term used to refer to organizations and sites. A user s access is determined by the role to which he/she is associated. Roles in Vision are hierarchical. Only the data that is associated with the user s role or any role that is lower on the enrollment hierarchy can be accessed. For example, a user associated with organization A can only see data associated with organization A and all associated sites that are lower in the hierarchy structure. However, if a user is associated with a site (as opposed to an organization ), that user can only see information related to that particular site (information associated with the organization or any other site that may belong to the organization is not viewable). User Group A user group defines a group of users that can access a set of applications and features. A user must be associated with at least one user group. Responsibility A responsibility is a set of applications and features that are associated with a user group. Each user group has exactly one responsibility which defines the features that are accessible to the members of that group Emdeon Page 125

132 Note: The Emdeon System Administrator is the only person who can define a Responsibility. Emdeon System Administrator grants rights to the Client Administrator to assign (or un-assign) a responsibility to a User Group Emdeon Page 126

133 Client Administrator User Capabilities Menu Option Manage User Manage User Group Search User Add a new user; define initial user name, password and Business Role. Delete an existing user. Update address/personal information for an existing user. Reset password for existing user. Add a user to a User Group. Remove a user from a User Group. Move (reassign) user to a different Business Role. Add and define business role for new user group. Delete an existing user from a user group. Delete a user group entirely. Add a user to another User Group. Change Responsibility and/or Responsibility effective date/expiration date for a User Group. Find a user by user name. Access User Maintenance screen for the user found by the search. Search for specific user, then login as that user. Access User Administration Main Menu 16. Click Home. 17. Click User Administration Emdeon Page 127

134 Managing Users Click Manage User in the User Administration panel to access user management functions. Add a New User 1. Click User Administration in the Vision Home navigation panel. 2. Click Manage User. A screen to select business role is displayed Emdeon Page 128

135 3. Click any one of the business role to see the user listing and option to Add New User. 4. Click Add New User button and enter all required information. Asterisk (*) signifies a required field. 5. Click Submit to create the new user account. 6. If any errors or omissions occurred a message is displayed at the top of the screen to help you make corrections. Click Submit when ready Emdeon Page 129

136 7. A confirmation message appears at the top of the screen and an option to Add/Remove user to/from Group(s) by selecting the specific group. For all new provider users added should have Claim Vision Provider user group and only users who are allowed to administer users in the group should get the ADMIN_GROUP_SYSTEM_GENERATED user group. 8. A confirmation message appears at the top of the screen when update button is clicked. 9. Now the newly created user account is added to a user group. 10. Add User process is concluded. You can now navigate to another area in Vision, or logout Emdeon Page 130

137 Reset User Password As the Administrator you can reset a user s password by assigning a temporary password to their account. The user is prompted to change the temporary password when they login in to Vision. 18. Click on the user name in the Name column on the Manage Users main screen. 19. The User Maintenance screen appears. 20. Click on Reset Password. 21. Enter a temporary password in the New Password field. Enter the same password in the Retype New Password field. 22. Click Reset Password. 23. Be sure to communicate the temporary password to the person who requested the password reset Emdeon Page 131

138 Move a User to a Different Business Role 24. In the Manage Users screen click the user s name in the Existing Users list. 25. Click Move User to another Business Role. 26. Select a different Business Role from the Move to Business Role Name drop-down list. 27. Click Update Emdeon Page 132

139 User Groups Add or Remove User Emdeon Vision for Providers User Guide 28. In the Manage Users screen click the user s name in the Existing Users list. 29. Click Add/Remove User to/from Group(s). 30. To add the user to another user group, select a user group from the User Group(s) panel (click once on the group name to highlight it) then click Add. 31. The selected group moves to the right column, User in Group. The user is now added to the selected group. 32. To remove the user from a user group, highlight a group by clicking on it once in the right column User in Group(s). 33. Click Remove. 34. The group is moved to the left panel. (The user is removed from the selected group.) 35. Click Update to save your changes. Note: You can make multiple selections from this menu (add the user to one or more user groups and delete the user from one or more user groups) before clicking Update. All changes are retained Emdeon Page 133

140 Managing User Groups The Client Administrator can access user management functions by clicking the Manage User Group link in the User Administration panel menu. Add a New User Group 36. In the Manage User Group window, enter the name of the new user group in the Group Name field. 37. Choose a Business Role from the Business Role drop-down list. Note: The new group will be associated with the selected business role. 38. Click Add. 39. The new group is created and added to the Existing User Groups list Emdeon Page 134

141 Responsibilities and Groups Administrators can update group responsibility settings from the User Group Maintenance screen. Change Responsibility. Change Effective Date and/or Expiration Date for an existing Responsibility. Change Effective Date and/or Expiration Date for a changed Responsibility for the selected user group. To access the maintenance screen for a particular group click the user group name in the Group Name column in the Existing Groups list displayed on the Manage User screen. Change Responsibility and Dates 40. Go to User Administration>Manage User Groups. 41. Click on the name of the user group in the Existing User Groups list. 42. The User Group Maintenance screen appears. 43. Select the Responsibility in the Responsibility drop-down list. 44. Enter Effective Date and Expiration Date in the appropriate date fields. Date format is mm/dd/yyyy. Note: Use a date far in the future in the Expiration Date field unless a specific end date is desired. 45. Click Update to save changes. User Group Add/Remove Multiple Users 46. Go to User Administration>Manage User Groups. 47. Click on the name of the user group in the Existing User Groups list. 48. The User Group Maintenance screen appears. 49. Click the Add/Remove User to/from Group(s) link. 50. To add a user to the user group, select one or more users from the Username panel. Multiple users can be selected by pressing (and 2014 Emdeon Page 135