Transmit X12 Data to AudaPro via Secure FTP

Transcription

2 Create an AudaPro Lookup Database Using X12 Data This guide describes how to provide HealthPort with medical claim data through a Secure File Transfer Protocol (SFTP) interface. HealthPort can create a lookup database from 837 / 835 files submitted by your facility. Each time you start a new request in AudaPro, the application will attempt to find a match in the database; if it finds a match, AudaPro will automatically populate several data entry fields in the new request. This Data Import process reduces the time needed to create AudaPro requests and improves accuracy. About This Guide This guide covers these topics: Overview File Naming Maximum File Size File Transmission Rate Claim / Remit Matching Criteria X12 Transaction Set Format Multiple Remits Per Claim Set Up an SFTP Account with HealthPort Upload Files Manage Account View Logs Create an Audit Request with Imported Data 2 Technical Specifications

3 TECHNICAL SPECIFICATIONS Overview This picture shows how 837 / 835 data already collected by your facility can be used to streamline the creation of audit requests in AudaPro. Technical Specifications 3

4 File Naming HealthPort recommends that you name your files using this convention, which provides us with the information needed to help troubleshoot any problems that may arise with the file itself or the SFTP transmission: Name Component SITEID.TYPE.DATE.SEQUENCE Format Length Details Example SITEID Numeric 5 characters AudaPro Site ID Provided by HealthPort TYPE Alphanumeric 4 characters Identifies the type of information contained in the file. 837I: 837 Institutional Claims 837P: 837 Professional Claims 835I: 835 Institutional Remits DATE Numeric 8 characters, MMDDYYYY The date on which you extracted the information from your system and created the file being sent to HealthPort. SEQUENCE Numeric Any Sequence for the files submitted by your site. 835P: 835 Professional Remits ?????? Start with 0001 Original File Names We can also accept your original filenames (maximum length of 250 characters), Example File Names Files from SITEID to be processed on 3/12/2013: I P I P Technical Specifications

5 TECHNICAL SPECIFICATIONS Maximum File Size Any one claim or remit file cannot contain more than 2,500 records. Files larger than this can cause a failure of the upload/import procedure; processing large files is not simply inconvenient or time-consuming. File Transmission Rate Submit no more than 100 files per hour to avoid possible throughput problems. Uploaded Files 100 / hour A rate of more than 25 per hour will normally be needed only when you begin creating the lookup database by uploading historical data. Updating the database with new information will typically not require so many transmissions. Technical Specifications 5

6 Claim / Remit Matching Criteria AudaPro attempts to match the data between your Claim and Remit files using Primary and Secondary Criteria. Primary Matching Criteria The initial lookup is based on these five fields. A claim and remit can only be matched if the data for each field matches; if the lookup does not locate a 100% match of the Primary Criteria, the system moves to the Secondary Criteria. Claim Patient Account Number Admission Date Discharge Date Total Claim Charges Mailbox Remit Patient Account Number Admission Date Discharge Date Total Claim Charges Mailbox Secondary Matching Criteria The lookup must locate a total match for all four of the Secondary Criteria in order to link a Claim and Remit. Claim Patient Account Number Patient First Name Patient Last Name Mailbox Remit Patient Account Number Patient First Name Patient Last Name Mailbox No Match? If neither the Primary nor Secondary Criteria produce a 100% match, AudaPro cannot import data for the new audit request. You can complete the request manually, upload revised 837 / 835 files, or upload new 837 / 835 files. 6 Technical Specifications

7 TECHNICAL SPECIFICATIONS X12 Transaction Set Format HealthPort accepts these X12 formats: X X91A X96A X96B X98A X X221A X221A X X222A X222A X X223A X223A2 Technical Specifications 7

8 Multiple Remits Per Claim HealthPort can only match one claim to a single remit. For this reason, you should ALWAYS submit the claim file before the corresponding remit. Some claims may be associated with multiple remits, such as a claim that was rebilled. When you create a new request for these type of claims, AudaPro shows you all the remits. You can then choose the remit that will populate the greatest number of, or most useful, data entry fields in the new request. Any additional remits associated with the claim cannot be imported. Data from those remits must be manually entered in the request if you need to capture it. 8 Technical Specifications

9 TECHNICAL SPECIFICATIONS Set Up an SFTP Account with HealthPort When you are ready to begin transmitting files to HealthPort through SFTP, follow these simple steps: Step See Page Setup Step 1: Identify SFTP Administrator / Contact 10 Setup Step 2: Receive Welcome 11 Setup Step 3: Request a Password 12 Setup Step 4: Receive Password Link in 13 Setup Step 5: Create a Password 14 Setup Step 6: Verify Password 15 Technical Specifications 9

10 Setup Step 1: Identify SFTP Administrator / Contact A HealthPort representative will ask your facility or group to identify the person responsible for handling the SFTP tasks. You must provide the following information: Full Name Address Phone Number 10 Technical Specifications

11 TECHNICAL SPECIFICATIONS Setup Step 2: Receive Welcome 1. HealthPort personnel will configure a new SFTP account using the contact information you provided in Step Your designated SFTP Administrator will then receive a Welcome from HealthPort. 3. This lists your user name (in the example below, jeff.nold) and includes a link to HealthPort s web interface for the SFTP process. 4. Click the link to open the web interface. Your SFTP Administrator must use the link in the Welcome within 48 hours after it was sent by HealthPort. The link will expire if not accessed within 48 hours and you will be forced to request another. Technical Specifications 11

12 Setup Step 3: Request a Password 1. The web interface opens to a page on which you can request a password for your account. 2. Enter your user name, provided in the Welcome , in the Username field. 3. Click Request Password. 12 Technical Specifications

13 TECHNICAL SPECIFICATIONS Setup Step 4: Receive Password Link in 1. You will receive a second from HealthPort. 2. This contains a link that allows you to define a password. 3. Click the link in the to return to the SFTP web interface. Technical Specifications 13

14 Setup Step 5: Create a Password 1. The My Account page in the SFTP web interface appears. 2. Following the rules listed on the My Account page, enter and re-enter a password for the account. 3. Click Set Password. 14 Technical Specifications

15 Setup Step 6: Verify Password The Home page appears, notifying you that the password has been accepted. Password Expiration Passwords expire every 90 days. You will be notified in advance via . Permanent Password Option If you would like to prevent the password from expiring, you must provide HealthPort with your public SSH key. Contact your HealthPort Implementation Specialist for more information about this option. 15 Technical Specifications

16 Upload Files 1. The target URL is SECUREFTP.HEALTHPORT.COM. 2. As noted earlier, any one file CANNOT exceed 2,500 records. 3. Select the auto_import folder. This folder receives 837 files.! You must upload the 837 files before submitting the associated 835 files! 4. Upload your 837 files. 5. Select the 835 folder (835 files). 6. Upload your 835 files. 7. Do not send more than 100 files per hour. 8. Notify your HealthPort Implementation Specialist. This specialist will closely monitor the upload / import process. 9. HealthPort adds the mailbox name to the front of the file name. We append a timestamp to the end of the file name, indicated when our parser picked it up. 10. HealthPort processes incoming files on a first-in, first-out basis. 16 Technical Specifications

17 TECHNICAL SPECIFICATIONS Manage Account Click the My Account link to open a configuration page. You can change your password, notification settings, and display settings here. Technical Specifications 17

18 View Logs Use the Logs link to view your upload history. The logs also show any action taken on your uploaded files by HealthPort personnel. 18 Technical Specifications

19 TECHNICAL SPECIFICATIONS Create an Audit Request with Imported Data 1. Start a new request. 2. On the Import Criteria screen, enter the search criteria. In this example, the lookup was configured to use Patient First Name and/or Patient Last Name, but each facility can choose search fields in consultation with your HealthPort Implementation Specialist. 3. The AudaPro Import screen lists all possible matches from the imported data. 4. Click the appropriate select link. Technical Specifications 19

20 5. The AudaPro Import Details page appears. 6. The label at the top of the page shows whether the data available for importing describes the Claim (MRN, Account Number, Admit Date, etc.) or the Claim and Remit (payment) information. 7. Click Continue. 20 Technical Specifications

21 TECHNICAL SPECIFICATIONS 8. All available information will be imported to the new request. Verify the data on the Basic Information, Request Information, Reconciliation, and Billing & Coding tabs. Technical Specifications 21