guide Electronic Payments & Statements User Guide

Transcription

1 guide Electronic Payments & Statements User Guide

2 Contents 2-5 Welcome to Electronic Payments & Statements (EPS) 6-10 View and Print Remittances Search Remittance Multiple EOB View and Print 1 18 How to Use Your Claim Mapping Report Balancing Provider Level Adjustments (PLBs) Balancing Secondary Payer Claims

3 Welcome to Electronic Payments & Statements (EPS) What is EPS? Electronic Payments & Statements (EPS) is a practical solution to provide the delivery of electronic claims payments and remittance advice information. Hospitals, laboratories, physicians and other health care professionals receive and reconcile thousands of claims payments and paper explanation of benefits (EOBs) each year, creating countless stacks of checks and paperwork resulting in hours of staff time spent on manual processing and reconciliation. With UnitedHealthcare's Electronic Payments & Statements, claim payments transfer electronically via the Automated Clearinghouse (ACH) network to the financial institution you designate. This will dramatically reduce the time and effort you currently spend administering paper checks and EOBs. Enjoy the many benefits of EPS, including the elimination of bank fees for depositing paper checks or lockbox processing, improved cash flow, online access to your EOBs at automated posting capabilities, elimination of mail processing and check clearing float, and many more! EPS allows for easier reconciliation, less paperwork and greater efficiency - improving the way we do business. This guide will show you how to secure the remittance advice that corresponds to your payments by: Downloading an electronic version of your remittance advice from which can easily be integrated into your office s computer billing software; Viewing and printing hard copies of your remittance advice from to use for manual payment posting; Receiving your remittance advice electronically from your clearinghouse vendor. To learn more about these options, please refer to this User Guide. Easier reconciliation, less paperwork, and greater efficiency - improving the way we do business. 2

4 Login to UnitedHealthcare Online UnitedHealthcare Online is UnitedHealthcare's secure Web site that provides access to Electronic Payments & Statements (EPS). From viewing your payments, searching remittance, and multiple EOB printing, UnitedHealthcare Online offers the tools that make the transition from paper EOBs and checks to the transfer of claims payments electronically simple. 3 Login to UnitedHealthcareOnline.com using your existing UnitedHealthcare Online Web site ID and password. To obtain a UnitedHealthcare Online Web site ID and password, call UHC-FAST ( ) and select option 1. UnitedHealthcare Online Web site Select icon for Electronic Payments & Statements from the post login page.

5 Accessing Electronic Payments & Statements through Exante Bank Exante Bank, an affiliate of UnitedHealthcare, is a statechartered financial institution that UnitedHealthcare uses to administer EPS payments and related services through a connection provided by UnitedHealthcare Online. Select the link Login to Exante Bank 4 Electronic Payments & Statements Welcome Page Offers you links to view payments, search remittance, and multiple EOB printing.

6 5 How to Get More Information about EPS From the EPS Welcome Page, you have access to links for more information: EPS Frequently Asked Questions (EPS FAQs) Learn More About Exante Financial Services EPS Help - Electronic Payments & Statements - Customer Service - EPS Home Page - Change EPS Selections - View and Print Documents - View Individual EOBs - Print Remittance/ ERA/Claim - Multiple EOB Printing - Tax Identification Number - Payment Number - Account Number - Codes - Adjustment Reason Code - Remark Code - Search Claims - Search Zero Payment Claims - Download 835 file - Reconciliation - UnitedHealthcare Online Service Site - Learn More about Exante Financial Services - Help on Other Topics Closing EPS Welcome Page Select either the UnitedHealthcare Online Logo located in the upper left corner or the Close Window X box located in the upper right corner of the EPS Welcome page to logout of Exante Bank After closing the EPS Welcome Page, you will be returned to the UnitedHealthcare Online Home Page.

7 View and Print Remittances View Payments Review summary level information for payments made from UnitedHealthcare. Select the link View Payments to display the Payment Summary Payment Summary Payments display from the past 30 days as a default Select the Quick Search drop-down box to change payments display to the last 60 days or 90 days. Sort payments by selecting the arrow icon next to the column header. Arrow up indicates ascending order and arrow down descending order. View Remittance Details for a payment by locating the payment row and selecting the link for the corresponding Payment Number. Download a HIPAA 835 file for a particular payment by selecting the link Download for the corresponding payment row. Print an electronic remittance advice (ERA) for a particular payment by selecting the link Print for the corresponding payment row. Adobe Reader is required to use this print feature. To download Adobe Reader, select the Adobe Reader icon. Print the entire Payment Summary page by selecting the button Print Payment Summary. From print preview, right click your mouse and choose the print command. 6

8 7 Remittance Detail After selecting the link Payment Number for a payment row, the Remittance Detail page will display all claims that are included in a particular payment. Download a HIPAA 835 file for a particular payment by selecting the button Download 835. Print an electronic remittance advice (ERA) for a particular payment by selecting the button Print ERA. Return to Payment Summary by selecting the button Return to Payment Summary. View Additional Details for a specific claim by selecting the Claim Number link for that claim. View the Explanation of a specific Adjustment Reason or Remark Code by selecting the code link for that claim. View a complete list of all Adjustment Reason and Remark Codes by selecting the column header link Adj Reason Code or RMK Code. Print either the Adj Reason Code or RMK Code list by right clicking on the page and selecting print. View any Provider Level Adjustments (PLBs) associated with a payment by selecting the last page and scrolling to the bottom of the page. View PLBs by scrolling or to view full list without scrolling, select the button Print ERA and print the last page.

9 Print Electronic Remittance Advice Print an electronic remittance advice (ERA) by selecting the link Print from the Print ERA column. Download dialog box will appear and select the button Open. Adobe Reader will open and display the ERA. Select the Print icon to print the ERA. Adobe Reader is required to use this print feature. To download Adobe Reader, select the Adobe Reader icon. 8 Download 835 File Save 835 File Download the HIPAA 835 file by selecting the link Download from the Download 835 column. Download dialog box will appear and select the button Save. The HIPAA 835 file is now available to upload to your Practice Management System.

10 Open 835 File Download the HIPAA 835 file by selecting the link Download from the Download 835 column. Download dialog box will appear and select the button Open. 9 Caution dialog box will appear and select the button Open With.

11 Windows dialog box will appear stating that it cannot open the (.dat) file. Select the radio button for Select the program from a list, and then select OK. 10 Open With dialog box will appear, under Recommended Programs, select Notepad, and then select OK.

12 Claim Detail After selecting the link Claim Number for a payment row, the Claim Detail page will display all service level and adjustment information for a single claim. Each adjustment will display on a row corresponding to the appropriate service. Print the Claim Detail by selecting the button Print Claim Detail. Return to the Remittance Detail by selecting the button Return to Remittance Detail. 11 Search Remittance Multiple EOB Search Using Electronic Payments & Statements Select the link Search Remittance to display six search options.

13 Search for payments and claims by Date(s) of Service, Account Number, Subscriber ID, Patient Name, Payment Number, or Zero Payment Claims. Use Search Remittance to look up claim data for the past 13 months. Select the radio button for the search option desired. Search Criteria Definitions are available for more information by selecting Click here link. 12 Search by Date(s) of Service Select the radio button for Date(s) of Service Select Calendar icon to enter the Start Date and End Date. Optional Secondary Search is to enter the Rendering Provider Last Name. Reset/Clear Search at anytime by selecting a different radio button or by selecting the button Search Remittance.

14 Search by your Patient Account Number Select the radio button for Account Number Enter Account Number Optional Secondary Search options available by Date of Service or Payment Date. 13 Search by Subscriber ID Select the radio button for Subscriber ID Enter Subscriber ID (Note: The alpha character "A" must be entered before the Subscriber ID number in most instances - for example A ) Optional Secondary Search options available by Date of Service or Payment Date.

15 Search by Patient Name Select the radio button for Patient Name Enter Patient Last Name and First Name Optional Secondary Search options available by Date of Service or Payment Date. 14 Search by Payment Number Select radio button for Payment Number Enter Payment Number

16 Search by Zero Payment Claims Zero Payment Claims refers to adjustment claims or denied claims. Select the radio button for Zero Payment Claims Select the radio button for either Date of Service or Payment Date. Select Calendar icon to enter the Start Date and End Date. Optional Secondary Search is to enter the Patient's Last Name 15 Search Results Displays claims that match the chosen search criteria. Select the link Payment Number to view the Remittance Details. Select the Claim Number link to view the Claim Details. Select button Print Search Results to print information. Print preview page displays and then right click and choose the Print Command. Select button New Search to begin a new search.

17 Multiple EOB View and Print From the Explanation of Benefits Search page, select the link to Exante Bank You may view and print up to 500 EOBs at a time Individual EOBs for the past 15 business days are available using the Multiple EOB printing feature. 16 Exante Bank Explanation of Benefits (EOBs) Printing Locate the desired payment date Select the link segment to open the EOB files for that payment date (EOB files are available for the past 15 business days)

18 Multiple EOB processing screen displays while EOBs are downloading from the server. Upon completion of download, Adobe Reader will launch containing up to 500 EOBs. 17 Select the Print icon and 'OK' to print the EOBs. To close Adobe Reader, select the Close Window X box on the upper right corner. The Print All EOB page is still open behind in a separate window. You can print additional EOB files, if required.

19 How to Use Your Claim Mapping Report Reconcile Provider Level Adjustments (PLBs) by using your Claim Mapping Report. Locating the Payer Claim Control Number/PLB Number In the column labeled Payer Claim Control Number/PLB Number, locate the adjustment you want to reconcile. Locating the Unconsolidated Payment Trace Number In the column labeled Unconsolidated Payment Trace Number, identify the corresponding trace number. 18 Claim Mapping Report Definitions Column Heading Payer ID Provider ID Consolidated Payment Amount Consolidated Payment Date Consolidated Payment Trace Number Unconsolidated payment amount Unconsolidated payment date Unconsolidated payment trace number Payer Claim Control Number/PLB Number Patient Control Number Claim Charge Amount Claim Payment/Adjustment Amount Claim date Definition UnitedHealthcare's Tax ID Number Provider's Tax ID Number Total amount deposited in your organization's bank account. Date the payment is deposited into your organization's bank account - generally the same date as the unconsolidated payment date. Trace/Payment number assigned to the payment. Dollar amount associated with the unconsolidated (or original) EOB. Date the payment is deposited into your organization's bank account - generally the same date as the consolidated payment date. Trace/Payment number assigned to the unconsolidated (or original) EOB in order to view the original EOB at UnitedHealthcareOnline.com Number assigned by UnitedHealthcare for a specific claim or reference number for a specific PLB adjustment. This allows your organization the ability to reference a specific claim or PLB adjustment. Patient account number assigned by your organization to identify a patient. Total amount billed to you for a specific claim. Amount paid to your organization for a specific claim (based on a fee schedule) or Adjustment. The total of this column will tie to the deposit. Date of Service

20 Balancing Provider Level Adjustments Locate the Electronic Payment ID number/unconsolidated Payment Trace Number from your Claim Mapping Report for the associated explanation of benefit (EOB) that contains the Provider Level Adjustment. Select icon for Electronic Payments & Statements from the post login page. 19

21 Select the link Explanation of Benefits Search 20 Corporate Tax ID Selection - select appropriate Tax ID number from the menu, then select Continue

22 Explanation of Benefits Search - search by either: - EOB status and Date Range - Electronic Payment ID Number/Trace Number 21 EOB Search by Date Select the radio button for EOB Status and Date Range To view today's EOBs, enter a date that is three (3) days in the future - If today is August 1st, enter August 4th Select the type of EOB to view, and then select Search EOBs

23 EOB Search by Electronic Payment ID Number Select the radio button for Electronic Payment ID Number Enter the Electronic Payment ID Number/Tracer Number Electronic Payments and EOB Summary Electronic Payment Status refers to the status of the claim - Deposited - EOB Only (Zero Payment Claims) Payment Status Date is the date the claim was paid Electronic Payment ID Number refers to the claim or trace number from your Claim Mapping Report View EOB allows you to see and print your EOB - Select View EOB to display your EOB - Adobe Reader Required 22

24 Individual EOB View and Print View and print individual EOBs by selecting the button Print Explanation of Benefits. 23 Contacting UnitedHealthcare Claims Center If the EOB does not include all the detailed history for the COB (Coordination of Benefits) in question, please call , option 1 to reach the UnitedHealthcare Claims Center and ask for the Electronic Payment Numbers associated with the adjustment(s).

25 Balancing Secondary Payer Claims When coverage offered through UnitedHealthcare is primary on a claim, payment is made at the service level. When coverage offered through UnitedHealthcare is secondary on a claim, it is processed differently and is paid at the claim level, indicated by a 2 on line 18. Locate the Electronic Payment ID number/unconsolidated Payment Trace Number from your Claim Mapping Report for the associated explanation of benefit (EOB) that contains additional information pertaining to this secondary payer claim. This information will assist you with balancing. Claim Level Adjustment Level Claim Payment Information (2100) 18 CLP* *2*95*10.78**15* *31~ 19 CAS*OA*23*43.11~ is the Primary Responsibility 20 NM1*QC*1*DOE*JANE****MI* A NM1*IL*1*DOE*JOHN****MI* A ~ 22 NM1*82*1*NAME*PHYSICIAN*M***FI* ~ 23 DTM*050* ~ 24 DTM*232* ~ Service Payment Information (2110) 2 indicates UnitedHealthcare is the Secondary Payer 95 is the Total Dollar Amount of Claim is the UnitedHealthcare Payment Amount SVC*HC:99312*95*53.89**1~ 26 DTM*472* ~ 27 CAS*CO*A2*41.11~ is the Contractual Adjustment 28 REF*6R*001~ 29 AMT*B6*53.89~ Total Amount of Claim = Contractual Adjustment + Primary Responsibility + UnitedHealthcare Payment 95 = (41.11) + (43.11) + (10.78) Possible Solutions Create Separate Secondary Payer Payments file - flag all claim level payments (CLPs) within your Patient Accounting System indicated by 2 and move CLPs from the batch file to a separate secondary payer payments file. Auto post batch payments file and manually post separate secondary payer payments file.

26 Select icon for Electronic Payments & Statements from the post login page. 25 Select the link Explanation of Benefits Search

27 Corporate Tax ID Selection - select appropriate Tax ID number from the menu, then select Continue 26 Explanation of Benefits Search - search by either: - EOB status and Date Range - Electronic Payment ID Number/Trace Number

28 EOB Search by Date Select the radio button for EOB Status and Date Range To view today's EOBs, enter a date that is three (3) days in the future - If today is August 1st, enter August 4th Select the type of EOB to view, and then select Search EOBs 27 EOB Search by Electronic Payment ID Number Select the radio button for Electronic Payment ID Number Enter the Electronic Payment ID Number/Tracer Number

29 Electronic Payments and EOB Summary Electronic Payment Status refers to the status of the claim - Deposited - EOB Only (Zero Payment Claims) Payment Status Date is the date the claim was paid Electronic Payment ID Number refers to the claim or trace number from your Claim Mapping Report View EOB allows you to see and print your EOB - Select View EOB to display your EOB - Adobe Reader Required 28 Individual EOB View and Print View and print individual EOBs by selecting the button Print Explanation of Benefits.

30 29 Contacting UnitedHealthcare Claims Center If the EOB does not include all the detailed history for the COB (Coordination of Benefits) in question, please call , option 1 to reach the UnitedHealthcare Claims Center and ask for the Electronic Payment Numbers associated with the adjustment(s).

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32 Visit us at M / United HealthCare Services, Inc.