CONNECTICUT DSS ELECTRONIC VISIT VERIFICATION (EVV): TPL UPDATE. ABN Detail Entry

Transcription

1 CONNECTICUT DSS ELECTRONIC VISIT VERIFICATION (EVV): TPL UPDATE ABN Detail Entry

2 AGENDA 1. Program Updates 2. Third Party Liability Security Group Permissions Manually Importing Payers Ranking Payers Add ABN Detail Information Creating Invoices Posting Payments Adding Claim Adjustment Reason Codes (CARC) Transfer to Medicaid Slide 2

3 Program Updates Effective 7/1/2017 for all clients who have Medicare coverage, ABN information is required to be entered into the Santrax system Applies to all dates of service (DOS) on or after 4/3/2017 Any claim exported without the ABN detail information will deny Slide 3

4 BILLING MODULE Slide 4

5 Setup Security group permissions must be assigned System Administration Oversight TPL Functionality System is pre-populated with two (2) payers CT Medicaid Clinical CT Medicaid Non Clinical All third party payers must be manually imported Slide 5

6 Import a New Payor From the Billing menu select Payors Click Import Slide 6

7 Import a New Payor Search for the required payer either by using the Carrier Name or Carrier Code field. Note: When searching using the Carrier Code field, the exact 3-digit code must be entered for successful results. Click Save. When searching using the Carrier Name field, the result list will display all results containing the information entered in the field. Be sure to choose the carrier that applies to you. Slide 7

8 Adding Payer & Ranking Once you have received notification (via your customary method) that a client has a TPL responsibility, use the steps below to set up this functionality. Search for the desired client. Double-click on the client s profile. Click General, in the navigation pane's Chart folder. Click the green plus sign ( ), at the Payor section Slide 8

9 Ranking Select the appropriate payer. Select the Rate Plan. Select the Rank. This reflects the order in which the payers listed should be billed. Slide 9

10 Ranking Paste/Enter the CT Medicaid Customer No into the Cust. No. field. Click Save. A message displays informing you that you are trying to add a duplicate rank. Click Yes. Slide 10

11 Adding Pre-denial Information The pre-denial function is used to automatically create the denied claim record for the primary payer and transfer the amount to Connecticut Medicaid. 1. Select Requires Pre-Denial checkbox Slide 11

12 Adding Pre-denial Information 2. Click the Pre-Denial tab 3. Click Add ( ) Slide 12

13 Adding Pre-denial Information 4. Enter pre-denial information a) Group Code category in which the CARC belongs b) CARC claim adjustment reason code c) Type option to identify the denial value d) Amount total as stated on ABN or EOB e) Begin f) End Period as defined on the ABN or EOB Slide 13

14 Adding Pre-denial information 5. Click Save. Note on the Payments & Credits tab the automatically created invoice write-off and transfer. The new invoice number is also indicated. The new invoice is now ready to export to CT Medicaid. Slide 14

15 Billing Review If the Requires Pre-Denial checkbox is selected and no information is input, it results in Not OK to Bill, with reason of Missing Pre-Denial Slide 15

16 Creating Invoices 1. Select Show Only Items OK to Bill 2. Select Billing period 3. Click Update to ensure visits have the most current rate information 4. Click Create Invoices 5. Set Invoice Date 6. Select Print A Summary Report 7. Click Create Invoices Slide 16

17 Posting Payments Use your current procedure to determine the TPL payment that must be applied to the newly created TPL invoice and follow the process below to apply the applicable payment amount. 1. Click Billing > Invoices 2. Select the necessary filters 3. Click Refresh 4. Double-click the desired invoice Slide 17

18 Posting Payments 5. On the Payments and Credits tab click the green plus sign ( ) to add a payment. 6. Enter the payment information at the General section of the Payment screen. Slide 18

19 Posting Payments 7. Click Post. The new line item on the Payments and Credits tab now reflects the posted payment. Slide 19

20 Posting Payments Note: A denied line item must be posted separately using Type Denied and a posted value of 0. The Payment Balance must be zero once all payments have been applied using the Posted column or the Auto Post button. Date: Date affiliated with the Payment Apply As: Select the appropriate option Type: Select the appropriate option Comment: Any notes regarding the payment (do not use any special characters) Check/Ref No.: Check or reference number affiliated with the payment Amount: Total payment value Note: Once posted, fields cannot be changed. Confirm all desired information is entered before posting. Slide 20

21 Claim Adjustment Reason Code (CARC) To add the CARC: 1. Click Billing > Invoices 2. Select the necessary filters 3. Click Refresh 4. Double-click the desired invoice 5. On the Payments and Credits tab click the green plus sign ( ) to add a payment. 6. Enter the payment information at the General section of the Payment screen. Slide 21

22 Claim Adjustment Reason Code (CARC) 7. In the CARC column, right-click and select Add CARC. Slide 22

23 Claim Adjustment Reason Code (CARC) 8. In the Category column, right-click and select the appropriate category. 9. In the CARC column, right-click and select the appropriate reason code. Slide 23

24 Claim Adjustment Reason Code (CARC) 10. Click Save. Slide 24

25 Transfer to CT Medicaid 11. Click Transfer and select the desired payer. Transfer the invoice to and apply payment from all additional TPL payers as ranked before the invoice is transferred to CT Medicaid. Repeat steps 5-7 to apply payments to invoices transferred to additional TPL payers. Slide 25

26 Transfer to CT Medicaid 12. Confirm the invoice transfer details and click Transfer. This will transfer the balance to a new invoice for the selected payer. When transferred to CT Medicaid, the new invoice will give them visibility to the TPL amount paid. Slide 26

27 Transfer to CT Medicaid 13. Click Save. Note the new line item on the Payments and Credits tab reflects the invoice write-off and transfer. The new invoice number is also indicated. The new invoice is now ready to export to CT Medicaid. Slide 27

28 LET S REVIEW Slide 28

29 What You Have Learned Third Party Liability Manually Import Payer Add a New Payer to a client s chart Rank Payers in payment processing order Add ABN Pre-denial Information Create TPL Invoices Post TPL Payments (including any denials) Transfer Invoices to CT Medicaid Slide 29

30 Questions Slide 30

31 How to Stay Connected We look forward to working with you. Please do not hesitate to reach out with questions, comments or suggestions as we move forward. Website Telephone Slide 31