Auto Posting ERAs Premier

Transcription

1 Auto Posting ERAs Premier EZClaim Medical Billing Software February 2017

2 Auto-Posting 835 Files Overview View EDI Reports Icon Auto Posting Overview Please review the detailed instructions for each step before applying payments. 1. Retrieve ERA reports. 2. Double click on an ERA report to view payment data. 3. Set Adjustment Options. See Step 3, page Click on Apply Payments and Adjustments. 5. Select and run ERA reports to view or print. When you double click on an 835 file from the EDI Reports screen, Premier will analyze the file and display the following screen. From this screen you can set Adjustment Options, apply Payments and run various ERA reports. IMPORTANT: The 835 Adjustment Grid will be displayed below the claim service line information. Review and determine whether the adjustments should be Applied, Tracked or Ignored before applying payments. Adjustment Options Apply - Adjustments will be posted with the dollar amount the payer has indicated on the ERA file. The balance WILL be reduced by the adjustment amount. Track - Adjustment will be posted with a $0.00 dollar amount to allow adjustment tracking allowing for easy claim follow-up. The description will contain the adjustment dollar amount from the 835. The balance will NOT be reduced by the adjustment amount. Ignore - Adjustment is ignored. No posting or tracking is processed. Note: Once 835 Options have been selected, they will remain for all ERA s but may be edited at any time. Optional: To set adjustment defaults, click the Options button to view your initial posting options. The Options screen allows you to set how you want adjustments to be flagged when analyzed (before posting). You can change individual adjustment settings for each adjustment on the 835 Adjustment grid. 2

3 Limitations Claim Level Adjustments are not posted. When analyzing an 835 with claim level adjustments, a screen will appear showing the information. Claim level adjustments are an exception and must be processed manually. The EDI File Analyzer processes claims with the following Claim Status Codes: 1 Processed as Primary 2 Processed as Secondary 3 Processed as Tertiary 4 Denied - Claim payments with a status of 4 (Denied) are not posted. The claim posting status will be flagged as PROCESSED but the payment posting status will be set to IGNORED. Any adjustments from claims with a status of 4 will be listed on the adjustment posting grid so they can be set to Track for follow-up purposes. 19 Processed as Primary, Forwarded to Additional Payer(s) 20 Processed as Secondary, Forwarded to Additional Payer(s) 21 Processed as Tertiary, Forwarded to Additional Payer(s) 22 Reversal of previous payment ** Note: Claims with other statuses will be ignored. 3

4 Analyzing and Auto Posting 835 Payments Step 1 Retrieving ERA Reports View EDI Reports Icon Use the EDI reports search feature to quickly find reports. Enter a keyword such as a Provider or Patient Name or other report data and click on Search For Keyword. - Get Reports Only active if a SFTP connection has been selected. This button will activate the connection and download reports into the company file. - Add Reports Add reports from your computer into the company file. When clicked a browse window will appear allowing you to select a file. - Refresh Reports If others have downloaded reports, this button will reload the grid and show any new reports. 4

5 Step 2 - View Payment Data Double click an 835 file to open. When opening an 835 file, the program will ask you to confirm the payer. If the payer displayed does not match your payer library entry for that payer, use the drop down box to select the payer you have selected on your claims. The payer chosen does not have to match the 835 payer information. As long as the payer you assigned on the claims is the payer you select, the 835 will post correctly Click OK to continue. If the 835 has multiple payments, the program will display the following screen that shows individual payment information Available options are: Select Click the Select button to process the single payment, Split into Individual Reports Click this button to split the 835 into individual reports making it easier to manage payments and reports. 5

6 835 Warning Messages When analyzing a file, you may receive one of the following messages, One or more service lines lack a Reference ID# or Payer Not Linked. One or more service lines isn t linked to the selected payer for this 835. One or more service lines lack a Reference ID# When opening an 835 file, the program will check if all the service lines can be found to apply payments and adjustments. If a service line cannot be found, the following message will appear. This warning typically happens when a Payer has not returned the linking codes EZClaim uses to link payments to service lines. The 835 preview screen will then have red cells with the words SRVC LINE NOT FOUND. Double click the service lines that are not found to manually match them to the correct service line. TIP: If you accidentally match the service line incorrectly, right click the service line and select Remove Service Line Reference this will cause the SRVC LINE NOT FOUND status to reappear. Payer Not Linked When opening an 835 file, the program will check if all the claims have a matching payer (based on the payer ID). If the payer associated with the selected 835, does not exist on a claim or the Payer ID does not match, the following message will appear. 6

7 The 835 preview screen will then have red cells with the words PAYER NOT LINKED. This typically happens when the payer library is not populated with payer IDs. If you have duplicate payers in your library, make sure the duplicates all have matching payer IDs. Otherwise, the program will not understand that the payers are the same entity. To fix the issue, open the payer library and enter the correct Payer IDs. This may also happen in automatic crossover situations when the secondary payer was not entered on the claim. To fix this issue, open the claim by double clicking the Claim Invoice number to open the claim, add the payer then save and close the claim. 1. To fix this issue, open the claim by double clicking on the Claim line to open the patient s claim. 2. Click on the button to bring up the Insurance information for this claim. 3. Click New to add Payer/Insurance information, click Save. 4. Save & Close the claim. Return to the 835 window, click the disappear. button. The PAYER NOT LINKED message will 7

8 Step 3 - Set Disbursement Options You have the option to select which service lines you would like to post or not post disbursements to. You may also choose service line adjustment disbursement using the adjustment grid. 8

9 Step 4 - Set Adjustment Options Confirm Line Item and Adjustment posting options are correct. (See page 15 for additional Adjustment Options information.) To review adjustment information, click on + to view patient claim information and the amount of the adjustment that will be applied. Choosing the View Adjustsments Ungrouped button permits making Apply / Track / Ignore to individual service lines instead of treating all adjustments with the same reason code the same. To review patient information for each adjustment, click on + to view information for that adjustment. To preview how payments will be applied before importing the payments into Premier, click on the Run Report button. The report will show how payments will be applied. You will also be able to view this report after you have Applied Payments. Note: If you preview the report before you apply payments, it will display the warning message Not Transferred because you have not yet applied payments into Premier. 9

10 Step 5 - Apply Payments and Adjustments Click on the Apply Payment and Adjustments button. Confirm line item information is green. If not, the status will show the reason why. Applied Status Definitions After the program has applied payments and adjustments, the Payments grid will reflect the Status of each Payment and Adjustment: Payment and Adjustment Statuses MATCHED (Green): The payment or adjustment already exists. APPLIED (Green): The payment or adjustment dollar amount was applied. TRACKED (Green): The payment or adjustment was entered with a $0.00 dollar amount. IGNORED (Green): The payment or adjustment was not entered. MISMATCH (Red): The program found an existing value but it does not match the incoming 835 data. SRVC LINE NOT FOUND (Red): Service Line ID returned in the 835 (REF*6R) is invalid or missing (does not match any record in database). Reversal of Previous Payments Claims with a status of 22 (Reversal of Previous Payment) will be posted unless the option to not post them is turned on. See 835 Auto-Posting Options on page 15 for more information on posting options. Denied Claims Claim payments with a status of 4 (Denied) are not posted. The claim posting status will be flagged as PROCESSED but the payment posting status will be set to IGNORED. Any adjustments from claims with a status of 4 will be listed on the adjustment posting grid so they can be tracked for follow-up purposes. Original Reference Number The original reference number found in segment CLP07 (Payer Claim Control Number) of the 835 will populate the claim field Original Ref Number if the field is currently blank. This facilitates secondary billing with some payers who require a reference number or for claim resubmission. 10

11 Editing Posted Adjustments If an adjustment was NOT posted and should have been, you may reset your adjustment options. Return to Step 3 and repeat the Auto-Posting steps. If an adjustment WAS posted and should not have been, use on of the following editing options. Option 1: If an adjustment was posted and should not have been, you will need to go to the Claim screen, double click on the Adjustment column and remove the adjustment. Option 2: Go to Find Adjustment under Find on the menu bar. If necessary, use filters to select the reason code to be removed. Highlight adjustments to be removed, right click and select Delete Adjustments. Step 6 Run 835 Reports Once payments have been applied, you will have the option of printing reports from the Reports dialog box. Use the dropdown arrow to select a report. All Data - This report will show all data from the downloaded 835 file. Denied Claims Only - This report will only show claims with a Claim Status of Denied. Items With Transfer Warnings This report will only show claims with Transfer Warnings. Posting Results grid - This report will show the status of applied disbursements. See Apply Payments and Adjustments. (Step 4) 11

12 Warning Messages on Report Not Transferred The payment or adjustment has not been transferred. This message may be cleared once you click on Apply Payments and Adjustments. Mismatched Payment/Adjustment Entered This is reported when a payment or adjustment exists in Premier but does not match the amount in the 835 file. Service Line Already Paid The service line already has a balance of $0.00 (or a negative balance). Option Set to Skip Adjustment The adjustment has been skipped because the posting option was set to Ignore. Could Not Find Service Line The 835 Analyzer attempted to find the service line by matching the Claim ID, Procedure Code, and Date. The service line to apply the payment or adjustment could not be found in Premier. 12

13 Creating Tasks Tasks can be created from both the service line grid at the top or the adjustment grid at the bottom. Right click the service lines or adjustments and select Create Tasks Linked to Claims. 13

14 Exporting data Once the 835 has been auto-posted you can run reports and export that information into various formats. 14

15 835 Auto-Posting Options Click on the Options button to open the ANSI 835 Posting Options screen. Options are set to Ignore by default. Select Apply, Track or Ignore, to choose how your Adjustments will be processed. To set multiple reason codes to an Option, hold down the Ctrl key and select reason codes. Once highlighted, click on the Apply Selected, Track Selected or Ignore Selected button to apply. Options that have been changed with be displayed in Pink Available Actions Apply - Adjustments will be posted with the dollar amount the payer has indicated on the ERA file. The balance will be reduced by the adjustment amount. Track - Adjustment will be posted with a $0.00 dollar amount to allow adjustment tracking and ease claim follow-up. The description will contain the dollar amount in the format $X.XX from the 835. Ignore - Adjustment is ignored. 15

16 Additional Options Check Overwrite existing allowed amounts when posting the 835 to apply the following: Use 835 Payment Date as Posting Date Apply Zero Dollar Disbursements Allow Payments and Adjustments greater than the balance to be applied Don t apply reversals of previous payment and adjustments 16