Emdeon Vision Payment Manager Integration. User Guide

Transcription

1 Emdeon Vision Payment Manager Integration User Guide Version 1 November, 2010

2 This page intentionally left blank. Vision - Payment Manager Integration Guide

3 Copyright 1 Searching for ERAs 2 Sorting Columns... 2 Viewing ERA Details... 2 ERA Search Criteria... 2 Screen Element Description... 3 Search by Batch - Search Criteria Definitions... 4 Search Method By Batch (Default): Search for ERAs by batch details Search by Batch - Results Screen Column Definitions... 5 Search Payment... 5 Search by Claim - Search Criteria Definitions... 6 Search Method By Claim: Search for ERAs by claim information Search by Claim - Results Screen Definitions... 7 Working with Work Status (Batch Search Results)... 8 View ERAs 10 Viewing ERAs By Batch Search Method Viewing ERAs By Claim Search Method Viewing Transaction Summaries Viewing Claim Transaction Level Summaries - By Batch Viewing Claim Transaction Level Summaries - By Claim Printing ERAs 16 Overview Printing a Transaction-Level Statement Printing a Claim-Level Statement... 17

4 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

5 Searching for ERAs 1. Select Search Payment from the Payment Manager Main Menu. 2. Select either the By Batch or By Claim radio button in the Search Method section. 3. Select from among the available criteria. 4. Click the Search button. 5. The search results display in the lower section of the screen. If the search results exceed this number, the results will display on multiple pages. Additional paging details display at the bottom of each page and include the ability to navigate from page to page by selecting individual page numbers or by selecting the Next or Last links. Sorting Columns To sort columns, place your mouse cursor over the column heading. If the column heading displays an underline, it can be sorted. Click the column heading and the sort toggles between ascending order and descending order. Viewing ERA Details To view links on the screen, click on the link. For example: Click on any link under the Check # column to view the ERA associated with that check. Click the Additional Info icon under the Documents column to view the.pdf file of the document. Click on any status link under the Status column to view the Work Status ERA Search Criteria These search criteria exist in both Search Methods, By Batch and By Claim Emdeon Page 2

6 Screen Element Description Export to Excel click this icon to export the search results listing, to a file called 'SearchERA.xls' into a user-specified drive location. This file does not provide transaction details. Create a Posting File click this icon to create a posting file for your Hospital Information System. This icon works in conjunction with the check box in the 835 Retrieval column in the search results listing. Provider Name select from the drop-down list the name of one or more providers who rendered services to the patient. Leave the field as -Any- to choose all providers. To search a list of provider names, click the Show Provider Name List icon. Click the Show Provider Name List icon again to place your selections into the Provider Name text box. Payer Name select from the drop-down list the name of the payer organization. Leave the field as -Any- to choose all payers. To search a list of payer names, click the Show Payer Name List icon. Click on the desired Payer Name to place your selection into the Payer Name text box. Time Period select an incremental time period to select ERAs. --Any--, In Past 2 Weeks, In Past Month, In Past 3 Months, Future Dates. If you need a more specific time span, use the Payment Date From-Thru fields. In some cases, Payers will send future date RAs. To view these RAs, set the Time Period to Future Dates. Payer Group create a new Custom Payer Group by selecting New from the pull-down list box and clicking Edit. This activates the Custom Payer Group Setup screen. Enter the new Group Name, select the payers from the Payer Option list box, click the Add button to move them to the Payer Selected list box, and then click the Save button. Select a previously-defined Custom Payer Group from the Payer Group pull-down list box. This eliminates the need to select multiple payers every time. Edit an existing Custom Payer Group by selecting the group from the Payer Group pull-down list box and clicking Edit. Complete the Custom Payer Group Setup screen and then click the Save button. Note: When an existing Custom Payer Group is changed a new Group Name is entered, the Save function on the Custom Payer Group Setup screen performs like a Save As function. The original Custom Payer Group remains intact, and the newly created Custom Payer Group, with any changes that were made, is also saved. The original Custom Payer Group can be deleted when it is no longer needed. Source select source where the 835 originated (i.e., Emdeon, Manual, Keyed, AccuPost, WLB (ALL), WLB (EXCP). To include all sources, select -ANY-. Results Per Page enter the number of search results to be included on each search results page. If the search results exceed this number, multiple pages will display. Additional paging details at the bottom of each page include the ability to navigate from page to page by selecting individual page numbers or by selecting the Next or Last links. Reset clears all user selections and set the fields to the default settings. Search initiates a search after you have selected the criteria you desire Emdeon Page 3

7 Search by Batch - Search Criteria Definitions These search criteria exist only in the By Batch Search Method. Search Method By Batch (Default): Search for ERAs by batch details. Payment Date (From Thru) enter a From and Thru Payment Date range. To search a graphical month-level calendar from which to select a date, click the Calendar icon. Note: The Payment Date is the date when the payer issued the payment. Load Batch ID enter the Emdeon ID number assigned when the ERA batch was received in the system. Provider Number enter the number assigned by the payer, regulatory authority, or other authorized body or agency to identify the provider. Many times, this is the organization's Tax ID number. NPI enter the National Provider ID (NPI) which is a 10-digit number. This is the standard unique identifier for health care providers. Check/EFT Trace# enter the check number or Electronic Funds Transfer (EFT) number that is unique within the ender/receiver relationship. Payment Method indicates the payment method. Select the appropriate check box: o ACH - Automated payment via Clearinghouse o BOP - Payment via Financial Institution o CHK - Check can be an Electronic Funds Transfer check process or paper check. o FWT - Federal Reserve Funds - Wire Transfer o NON - Non payment Pay Amount (From Thru) enter a minimum and maximum range of dollar amounts to be included in the search. To search for an exact dollar amount, enter the minimum dollar amount and tab to the maximum dollar amount which automatically populates with the same dollar amount. The Pay Amount range fields now have an automatic populate function. When you enter a dollar amount in the minimum Pay Amount field and then press the Tab key, the system automatically populates the maximum Pay Amount field with the same dollar amount. This makes it easier to search for an exact dollar amount. The cursor is left in the maximum Pay Amount field so that a different dollar amount may be entered if necessary Emdeon Page 4

8 ERA Status (Retrieval) select the appropriate radio button: Vision - Payment Manager Integration Guide Non-Retrieved 835 -displays 835s that have not been downloaded into payment posting files. Non-Printed Documents -displays documents that have not been printed. All - displays all documents indicated by the radio button selections. Work Status Select the appropriate radio button: Unworked- displays only ERAs that have been not been worked Worked- displays only ERAs that have been worked All - displays all ERAs, both Worked and Unworked You may use this search function in conjunction with other search criteria. The 'Status' column on the Search Results screen displays pending actions concerning a particular payment (e.g., Processed as Primary, etc.). This column relates directly to the Work Status search criteria settings above. Search by Batch - Results Screen Column Definitions These search results exist only in the By Batch Search Method. Search Payment Payer Name the name identifying the payer organization. Payer ID the number identifying the payer organization. Batch ID the unique tracking number for the transaction assigned by the clearinghouse. Payment Date the date when the payer issued the payment. Check # the check number or Electronic Fund Transfer (EFT) number for paid claim(s). If a paper check was issued, the check number begins with a zero. If the payment was issued through an EFT, the number begins with "EFT". If a provider has a no-pay remittance produced (i.e., no payment is being issued for the ERA), a sequential remittance number is displayed in this field. Clicking on the Check# link will display all claim transactions that pertain to that particular check Emdeon Page 5

9 Payment Method indicates the payment method. Select the appropriate checkbox: o ACH - Automated payment via Clearinghouse o BOP - Payment via Financial Institution o CHK - Check can be an Electronic Funds Transfer check process or paper check. o FWT - Federal Reserve Funds - Wire Transfer o NON - Non payment o Provider# the number assigned by the payer, regulatory authority, or other authorized body or agency to identify the provider. Many times, it is the organizations Tax ID number. o NPI # the National Provider ID (NPI) which is a 10-digit number. It is the standard unique identifier for health care providers. o Provider Name the name of the provider who rendered services to the patient. o Total Chg the total charges, for all claims, submitted to the payer for payment. o Total Pay the actual dollar amount that the provider receives as a result of claims processed on an ERA. If a negative amount is displayed in this field, the amount is withheld from payment on the provider's next ERA. Search by Claim - Search Criteria Definitions These search criteria exist only in the By Claim Search Method. Search Method By Claim: Search for ERAs by claim information. Patient Name: Last, First enter the last and/or first name of the individual to whom the services were provided. You may enter partial names in either field. For example, you can enter WAL in the Last field and the display will include Walters, Walford, Walman, etc. Patient Ctrl # enter the Patient's unique alpha-numeric identification number for this claim assigned by the provider to facilitate retrieval of individual case records and posting of payment. Subscriber ID enter the Insured's or Subscriber's unique identification number assigned by the payer Emdeon Page 6

10 Payment Date (From, Thru) enter a From and Thru Payment Date range. To search a graphical month-level calendar from which to select a date, click the Calendar icon. Note: The Payment Date is the date when the payer issued the payment. ICN/DCN enter the Internal Claim Number/Document Control Number (ICN/DCN). The control number assigned to the original bill by the payer or the payer's intermediary to identify a unique claim. Status enter one or more status numbers. To search a list of statuses by number and description, click the Show Status List icon. Click the Show Status List icon again to place your selections into the Status text box. Service Date(From, Thru) enter a From and Thru range for the Date of Service (DOS). To search a graphical month-level calendar from which to select a date, click the Calendar icon. Reason Code enter one or more Adjustment Reason Codes. To search a list of Reason Codes by number and description, click the Search icon. CPT/HCPCS Code enter one or more CPT/HCPCS Codes. To search a list of CPT/HCPCS Codes by number and description, click the Search icon. REV Code enter one or more Revenue Codes. To search a list of Revenue Codes by number and description, click the Search icon. Remark Code enter one or more Remark Codes. To search a list of Remark Codes by number and description, click the Search icon. Search by Claim - Results Screen Definitions These results definitions exist only in the By Claim Search Method. Patient Name the first and last name of the individual to whom the services were provided. Patient Ctrl # patient's unique alpha-numeric identification number assigned by the provider to facilitate retrieval of individual case records and posting of payment. Subscriber ID insured's or subscriber's unique identification number assigned by the payer. Date of Service (DOS) the start date of the service, the end date of the service, or the single day date of the service. Provider Name name identifying the provider who rendered services to the patient. Payer Name name identifying the payer organization. Batch ID unique tracking number for the transaction assigned by the clearinghouse Emdeon Page 7

11 Payment Date date when the payer issued the payment. Vision - Payment Manager Integration Guide Check # the check number or Electronic Fund Transfer (EFT) number for paid claim(s). If a paper check was issued, the check number begins with a zero. If the payment was issued through an EFT, the number begins with "EFT". If a provider has a no-pay remittance produced (i.e., no payment is being issued for the ERA), a sequential remittance number is displayed in this field. Total Chg the total charges, for all claims, submitted to the payer for payment. Total Pay the actual dollar amount that the provider receives as a result of claims processed on an ERA. If a negative amount shows in this field, the amount is withheld from payment on the provider's next ERA. Status the status of the claim as rendered by the payer. You may place your mouse cursor over the status ID to view the status code description. Working with Work Status (Batch Search Results) The Status column on the Search Payment - By Batch screen provides information concerning any pending actions that must be completed for a payment. This information, including any notes that are added, is internal and is used only within Payment Manager. When new payments arrive in the system the Status column displays the Unworked link. 1. To change the status, click on the Unworked link. The Work Status History Report popup screen displays Emdeon Page 8

12 Perform one of the following actions: Enter internal notes if necessary, and click the Add notes/set Status to Worked/Unworked button. Enter internal notes and click the Add Notes Only button. This action does not change the current status. The Status column displays the Worked link or the Unworked link, depending on the button selected Emdeon Page 9

13 View ERAs Viewing ERAs By Batch Search Method To view an ERA from a particular batch transaction, perform the following steps: From the Payment Search Results screen, select a particular batch transaction by clicking on the check # in the Check # column. A list of all claims involved with the transaction displays. To view an ERA from a particular batch transaction, perform the following steps: 1. From the Payment Search Results screen, select a particular batch transaction by clicking on the check # in the Check # column. A list of all claims involved with the transaction displays Emdeon Page 10

14 2. Sort all the claims in the transaction by ASG, Patient Control Number (PCN), or Patient Last Name by clicking on the Sort icon. 3. Click on the + sign or the Display/Hide Service Line Information icon to view the service line items for each claim. Each line item contains the dates of service, charge amount, payment, adjustment, and other important information. An explanation of the ERA is displayed in the last two columns on the page, the Claim Adjustment Reason Code and the ERA Remark Code. 4. Place your mouse over some of the codes on this screen to display additional explanations on how the claim was adjudicated. Viewing ERAs By Claim Search Method To view an ERA from a particular transaction, perform the following steps: 1. From the Payment Search Results screen, select a particular transaction by clicking on the Patient Control# in the Patient Ctrl # column. A list of all claims involved with the transaction displays Emdeon Page 11

15 2. Click on the + sign or the Display/Hide Service Line Information icon to view the service line items for each claim. Each line item contains the dates of service, charge amount, payment, adjustment, and other important information. An explanation of the ERA is displayed in the last two columns on the page, the Claim Adjustment Reason Code and the ERA Remark Code. 3. Place your mouse over some of the codes on this screen to display additional explanations on how the claim was adjudicated. Viewing Transaction Summaries Claim Transaction Summaries provide a Financial Summary and details about a particular ERA Claim. Viewing Claim Transaction Level Summaries - By Batch 1. From the Search Payment screen, using the By Batch Search Method, perform a search using selected criteria. A list of claims that match the selected search criteria displays. 2. Select a particular transaction by clicking on the check # link in the Check # column. A list of all claims involved with the transaction displays Emdeon Page 12

16 3. Select the Display/Hide Summary icon located at the very top of the Electronic Remittance Advice screen. A standard Financial Summary displays along with Reason Code descriptions and claims involved in the transaction Emdeon Page 13

17 Viewing Claim Transaction Level Summaries - By Claim 1. From the Search Payment screen, using the By Claim Search Method, perform a search using selected criteria. A list of claims that match the selected search criteria displays. 2. Select a particular transaction by clicking on the patient control # link in the Patient Ctrl # column. A list of all claims involved with the transaction displays. 3. Select the ERA Tools icon located at the very top of the Electronic Remittance Advice screen. 4. If available, select the 835 Viewer option from the menu drop down. The 835 Viewer displays at the bottom of the screen. Select the 835 IG, 835 Hybrid, or Raw Data view by selecting the appropriate radio button Emdeon Page 14

18 5. In the 835 IG view, display detailed information (i.e., Field ID, Description, and Value) for any row in the Loop & Segment column by hovering your mouse cursor over that row Emdeon Page 15

19 Printing ERAs Overview ERAs may be printed from Payment Manager at the Transaction Level or the Claim Level. A transaction contains one or more claims associated with a particular payment. Note: To print ERAs, you need to have the free Adobe Acrobat Reader software installed on your computer. We recommend using reader software versions 4.0 or above. Please contact your System Administrator to install the software or go to Printing a Transaction-Level Statement 1. From the Payment Search screen, perform a search using selected criteria. A list of claims that match the selected criteria displays. 2. Select a particular transaction by clicking on the check # in the Check # column. A list of all claims involved with the transaction displays Emdeon Page 16

20 3. Click the Transaction PDF icon located at the top of the Electronic Remittance Advice screen. The Transaction PDF menu options display. 4. Select the desired printing method from the list. You may print the entire listing with no page breaks (Transaction PDF) or have claims print on their own individual pages (Single Claim Per Page). Note: When the Single Claim Per Page option is selected, each patient s information is preceded by the initial header that contains the Facility Name, Address, Tax ID, NPI, etc. Summary information, for the transaction, appears at the end of the printout. Printing a Claim-Level Statement 1. From the Payment Search screen, perform a search using selected criteria. A list of claims that match the selected criteria displays. 2. Select a particular transaction by clicking on the check # in the Check # column. A list of all claims involved with the transaction displays Emdeon Page 17

21 3. Scroll down the ERA listing, and select a claim you wish to print. 4. Click the Claim PDF icon located at the top of the individual claim listing. The 835 PDF menu option displays. 5. Click the 835 PDF selection. The Electronic Remittance Advice displays in a.pdf file. 6. Click the Print icon to print the.pdf file Emdeon Page 18