AUGUST 10, 2016 Presented by: Anne Havlina. Optimize Electronic Remit Posting

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1 AUGUST 10, 2016 Presented by: Anne Havlina Optimize Electronic Remit Posting

3 Payerpath Education Track TIME TOPIC PRESENTER Tuesday August 9 th 1:30 2:30 Keep your finger on the pulse using Practice Performance Wednesday August 10th Amber Civitarese, RemitData 8:30 9:30 Patient Responsibility Solutions - Maximize Patient Payment Revenue Opportunities Lisa Temporale 9:45 10:45 Allscripts Payerpath: Roadmap to a Healthy Financial Core Steve Mueller 1:30 2:30 Optimize Electronic Remittance Posting Anne Havlina Nicole Beulah 2:45 3:45 Integrating Allscripts Payerpath using Office Manager Paola Turchi 4:00 5:00 Payerpath Pre-visit solutions: A Healthy Revenue Cycle before Patient Visits Anne Havlina Thursday August 11th 1:30 2:30 Payerpath Tools and Techniques for Effectively Reconciling and Tracking Claims Carrie Murphy 2:45 3:45 The 15 Most Common Allscripts EDI Support Questions Nicole Beulah Copyright 2016 Allscripts Healthcare Solutions, Inc. 3

6 AUGUST 10, 2016 Overview

7 Allscripts PM iremit Overview ENABLES retrieval of insurance payments electronically (ERA). PAYMENTS are posted as receipts and write-offs. ALLOWS transfer of claims for secondary billing both electronically or on paper within Allscripts PM. Remittance files are similar to an electronic explanation of benefits. FILES are unique to individual states and insurance carriers. FILES utilize HIPAA compliant formats and codes. Copyright 2016 Allscripts Healthcare Solutions, Inc. 7

8 Allscripts PM iremit Overview iremit report downloaded automatically into EDI reports folder of file name, check number and amounts. Some carriers, such as Medicare, will not send paper EOB s once you start receiving electronic remittances. iremit can auto-post valid line items and split off rejected claims and/or line items. Copyright 2016 Allscripts Healthcare Solutions, Inc. 8

9 Authorization Required Prior to using iremit you must obtain authorization with the carriers. If using Payerpath, clients have access to Authorization enrollment forms on-line via Maintenance-Payer Listing screens. Copyright 2016 Allscripts Healthcare Solutions, Inc. 9

10 AUGUST 10, 2016 Benefits of Use

11 Benefits of Use Benefits of Electronic Remittance PROCESS ALL insurance payments at once! ELIMINATE time and cost of manually posting! ELIMINATE posting errors! Easily IDENTIFY denials and zero payments! Copyright 2016 Allscripts Healthcare Solutions, Inc. 11

12 AUGUST 10, 2016 Electronic Remittance Setup

13 HIPAA Compliant Codes Must use the HIPAA-compliant Adjustment Codes Example: CO-45; PR-3; CO-18 Complete listing of Codes can be found at: Claim Adjustment Reason Codes Claim adjustment reason codes communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code. Copyright 2016 Allscripts Healthcare Solutions, Inc. 13

14 HIPAA Compliant Codes Must use the HIPAA-compliant Remark Codes Example: MA01; N365 Complete listing of Codes can be found at: Remittance Advice Remark Codes Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List. Copyright 2016 Allscripts Healthcare Solutions, Inc. 14

15 Setup: Categories - Defaults Reimbursement Comment Category (F9-RCC) Examples: CO, CR, PR, PI, OA Create a Category called NEW and set as Default Reimb. Comment Category in Practice Options (F9-POP) on the Payment Entry tab. Create a Category called DENIAL and check Denial box. Remark Code Category (F9-RKC) Examples: Standard, Missing, Noncov Create a Category called NEW and set as the Default Remark Code Category in Practice Options (F9-POP) on the Payment Entry tab. Default Adjustment codes in Practice Options (F9-POP) on the Payment Entry tab Co-insurance PR-2 Co-pay PR-3 Deductible - PR-1 Copyright 2016 Allscripts Healthcare Solutions, Inc. 15

Setup Practice Options (F9-POP) Confirm these 2 boxes are filled in Confirm these have 3

17 Setup Steps Step #1 Electronic Remittance Format Maintenance record for each payer (F9 ERM) Step #2 Electronic Remit Style Maintenance record for each payer (F9 ESM) Step #3 Confirm Reimbursement Style Maintenance record is setup correctly for the corresponding payer (F9 RSM) Step #4 Select Electronic Remit Style on the Insurance Carrier Maintenance record for each corresponding carrier (F9 ICM) Copyright 2016 Allscripts Healthcare Solutions, Inc. 17

Step #1 Electronic Remittance Format (F9-ERM) 2 3 4 5 6

Step #2 Electronic Remit Style 1 Complete the Electronic Remit

Step #2 Electronic Remit Style (F9 ESM) 1 1 Complete the Import

Step #2 Electronic Remit Style (F9 ESM) 1 1 Complete the Reason

23 Step #3 Reimbursement Style (F9-RSM) Verify both boxes are checked Verify Adjustment Default Reimbursement Comment and Allow Edit Verify Withheld Default Reimbursement Comment Copyright 2016 Allscripts Healthcare Solutions, Inc. 23

Step #4 Insurance Carrier (F9-ICM) 1 1 Verify Reimbursement Style is selected (RSM) 2 2

26 Retrieval of Files Navigate pathway Retrieve electronic remittance files from within each payer s folder contained within the iremit folder. iremit folder found in pathway of NtierFiles/Database/iRemit Each payer will have a separate iremit folder. Example: FLBCBS, FLMDCR The payer s folder is automatically created inside the iremit folder when the first electronic remittance file from a payer. Highlight selected files to be retrieved. Copyright 2016 Allscripts Healthcare Solutions, Inc. 26

Retrieve Files in Payer folder Double-click Test Payer

31 Retrieve Checks Listed List sortable by column heading selected Check List Displays: Payment Date Check # (batch ref) Payer Name Amount of check Status Copyright 2016 Allscripts Healthcare Solutions, Inc. 31

Workflow to Retrieve Multiple Remit Files 1 1 Click Retrieve

37 Retrieve Completed 1 1 Green check-mark appears as each file is retrieved 2 Shows Completed when all files have been retrieved 3 Click the OK button 2 3 Copyright 2016 Allscripts Healthcare Solutions, Inc. 37

38 Retrieve Checks Listed List sortable by column heading selected Check List Displays: Payment Date Check # (batch ref) Payer Name Amount of check Status Copyright 2016 Allscripts Healthcare Solutions, Inc. 38

40 NEW Codes ADDED Reimbursement Comment Codes (F9- RCM) Update Description Update Category Remark Codes (F9-RKM) Update Description Update Category UPDATE ESM (Electronic Remit Style) for each new Reimbursement Comment and Remark codes added Copyright 2016 Allscripts Healthcare Solutions, Inc. 40

42 Import Listing/Report Transactions identified into 1 of 3 sections in this sequence on the listing/report: Postable/Fully Adjudicated Postable and NOT Fully Adjudicated NOT Postable Each section has total $ s for both Posted and Not Posted. All sections added together equals the amount of the check. Able to exclude Postable/Fully Adjudicated detail on Preliminary Listing/report only only displays total $ s Posted. Copyright 2016 Allscripts Healthcare Solutions, Inc. 42

46 Post the Check Import Report created - Select Preview click PRINT icon to print the report verify that report has printed completely before closing preview screen. (not able to be recreated) Report shows Batch# - Payment Date All detail transactions Payment Batch is automatically created appears on Transaction screen. Following transactions posted on vouchers: Payments Adjustments Transfers Rebill Check is automatically deleted from AUT Import Remit screen. Manually post all in NOT Postable section and needed transactions in Postable and Not Fully Adjudicated section Copyright 2016 Allscripts Healthcare Solutions, Inc. 46

Review Voucher Financial Inquiry (F9-FIN) Payment Options By Service Detailed

Review Voucher View Elec Remit History Able to view/print Voucher Detail EOB: Check#

51 This presentation has been sponsored by our partners at To learn more about the Contract Audit & Recovery suite and MCAG s unique revenue generating solutions visit the HUB, or go to Copyright 2016 Allscripts Healthcare Solutions, Inc. 51