EDI Enrollment Webinar for Practice Insight Authorized Resellers

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1 EDI Enrollment Webinar for Practice Insight Authorized Resellers Martha Johnson, Payer Development Andrea Frost, Project Manager Donna Anderson, Enrollment Specialist

2 Outline Getting Started Where do I get the forms? How do I manage the forms? How do I avoid problems for my customers? ERA Enrollment Eligibility Enrollment Questions

3 Getting Started Profile your customer Single customer or CBO? New EDI or changing service? Billing as a Group or as Individuals? How many Billing NPI numbers are tied to the Tax ID#? Sharing Tax ID# with other offices or hospital?

4 Getting Started Make a list of government payers important to your customer. Identify payers from which the customer is already receiving ERA files. Medicare Part A (FQHC, Rural Health) Medicare Part B Blue Cross Blue Shield Medicaid Tricare DMERC Railroad Medicare

5 Getting Started Also list high volume commercial payers important to your customer. Many commercial payers with no claims enrollment DO offer ERA enrollment Aetna Cigna United Healthcare A few commercial payers DO require claims enrollment these tend to be regional Aultcare Lifewise Health Plan UHIN-related payers

6 Getting Started Compare list of important govt. and commercial payers to the PI payer list in your database: Login and select Admin Tools Select Payer List Search for payers by Name, Payer ID and/or by state Notify PI if you do not see the payers needed by your customer

7 Getting Started Set up Customer EDI Account! Enter customer name, address and federal tax ID Enter at least 1 billing provider record with name, address, federal tax ID and billing NPI Make sure the vendor is correct (your company!)

8 Where do I get the forms? Take your list of government and commercial payers and compare to the EDI enrollment forms at Practice Insight Use the following URL: RESELLER_Docs/Enrollment.html (This site is for Resellers, not Providers!)

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11 Where do I get the forms? Sample #1 (State) Sample #2 (UHC ERA)

12 What if I don t find forms? Government Payer if there are no forms then contact our Enrollment Dept. PI may need additional time to develop a new trading partner connection Pay attention to Professional vs. Institutional EDI enrollment Commercial Payer if no forms then there are no known enrollment requirements for claims Send an inquiry! (make an Issue)

13 How do I manage the forms? Always download a fresh set of payer enrollment forms the documents to your customer (do not give out the URL) Check first page for instructions on how to deliver forms Mail? Fax? To the payer? To Practice Insight?

14 How do I manage the forms? Fill out forms for each Billing Provider Review in person or by phone encourage accuracy and neatness! Some Resellers fill out all information for customer except for the signatures Customer must keep copies or send documents to Reseller to manage

15 How do I manage the forms? If payer sends EDI enrollment Accept/Reject message to PI, we will share with the Reseller TIP: act quickly on rejections! If payer sends Accept/Reject message to provider, please share with PI Enrollment

16 How do I manage the forms? Some payers send NO notification at all to Practice Insight or the provider Reseller must follow-up with payer Check PI instruction page for Typical processing time at payer Payer s EDI phone number Call with your copy of forms in hand

17 How do I avoid problems? Always download the latest documents Assist your customer in preparing, submitting and tracking EDI enrollments and always refer to PI instruction page In the customer EDI account, add the legacy PINs for MCR, MCD, BS, etc. as well as all provider NPI numbers

18 How do I avoid problems? Authorized signatures only (blue ink?) Send ALL pages indicated do not omit printed pages Proof tax ID #s (9 digits!) and NPI #s (10 digits!) Make sure NPI # sent out in the electronic claim for Billing Provider matches NPI # listed on the EDI enrollment document

19 Special Notice for Private Databases Some Authorized Resellers have a Private Database with DIFFERENT SUBMITTER INFORMATION than standard Practice Insight accounts. If so, Reseller must modify standard EDI enrollment documents. Check with PI Enrollment Dept. for help.

20 ERA Enrollment Payers typically deliver ERA files to one trading partner only Changing existing ERA authorization may require additional LOA (letter of authorization) Once enrolled, Payer will send ERA files for all payments, whether the claim was filed through PI system or not ERA delivery to EDI customer accounts depends on complete and accurate input of provider TAX and NPI numbers

21 Eligibility Enrollment Basic Enrollment Set up required for all providers Special Enrollment for CMS-Medicare Special Enrollment for short list of government payers

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23 Eligibility Enrollment CMS Medicare what is the CMS Agreement? Part of every Medicare claims enrollment document set If no file copy, get a new agreement from the PI forms website

24 Enrollment Questions?

25 Enrollment Summary Support your customer - they need your help! Make sure you have correct information to begin with As with all EDIinsight issues, contact Practice Insight when you need help