Gateway EDI Client Website Help Document

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1 Gateway EDI Client Website Help Document Learning your way around a new website can be tricky we know that! This document will serve as a cheat sheet for questions that may arise as you maneuver around our website. If you can t find the answers here, please feel free to contact us. We re only a call or away! 1

2 Click on any of the Client Website Help Document Options below to see a description of the option. My Work Flow (Default) New Messages Send/Receive Files and Confirm File Delivery Work Rejected Claims Primary Work Rejected Claims Secondary New Remittances Check Patient Eligibility Accept Patient Payments NPI Look-Up Customize Your Work Flow Reports Run Safety Net Report Analyze Rejections Run Transaction Summary Monitor Staff Productivity Manage Claims Send/Receive Files and Confirm File Delivery Work Rejected Claims Primary Work Rejected Claims Secondary Search Claim Status Work Suspensions View Claim File Reconciliation Manage Payments View Insurance Payments (Remittances) Accept Patient Payments Manage Patients Check Patient Eligibility Bill Patients Resources Customer Service Provider Look-Up Payer List Additional Products Preferred Software Vendor List Link Library Best Practices About Gateway EDI My Account Message Center Manage Users Manage Products Manage Providers Monitor My Account Balance 2

3 New Messages Communication from Gateway EDI will be found here. These messages are to keep you informed about payer changes, new payer connections, submission errors, industry news, holiday hours, etc. Click on the subject of the message you would like to view. The contents of the message are displayed on the right. Your messages will be automatically archived once read. In the future if you wish to view archived messages, simply check the Include previously viewed messages box. You also have the option to permanently delete any messages you choose. However, once deleted, a message cannot be viewed again. You will know you have a new message when you login to your client home page and there is a number in front of New Messages. Send/Receive Files and Confirm File Delivery Check the box next to the file type you would like to send or receive, then click Send/Receive Files. Depending on your Practice Management System, you may be required to use the Alternate Send Method. 3

4 After clicking Send/Receive Files you will receive a box showing the File Transfer Progress. Click Send and Receive to continue. After sending a file you can click Confirm File Delivery to see that the file has arrived. If you click Confirm File Delivery it will take you to the same page as clicking Confirm File Delivery from the home page. By going to Confirm File Delivery, you can verify we received a file, that there was an adequate file size to be a valid file (not 0 ), or if another file was picked up and processed. Verify the number of claims and the dollar amount against your Practice Management System to make sure we are receiving all the claims you should be sending to us. Notice the Status Code Legend in the upper right. There are four file statuses. The first status, Received, means that your file has been received by Gateway EDI. The second status is Processed which appears in blue and means that your file is going through necessary edits. The third is Processed which appears in green and indicates that the file has completed the edit process and you can click on the file name for details. The final is Not Processable which appears in brown and indicates that the file could not be processed. 4

5 Work Rejected Claims Primary In this report the Date Created column indicates the day the rejection report was created but not necessarily the day you submitted the claims. To work your rejections, click the highlighted number under To Be Worked. To show previously worked batches, click Show Worked Rejection Batches. Click anywhere on the claim line to see more detail about the claim. To work your rejections, you may print this page, go back into your Practice Management System (PMS), and correct the claims. Or you can minimize the windows to go back and forth between our website and your PMS to make corrections. After working rejections, you may either individually mark them as Worked or mark the entire batch as worked by choosing the Mark Entire Batch Worked button. You also have the option to export this report to Excel by clicking the green X in the top right hand corner. We recommend you mark the claim as Worked on our website, but make sure you are correcting the claim in your PMS and flagging the claim to re-file. Need to see worked rejection batches again? Click the box Show Worked Rejection Batches to see 24 months worth of data. 5

6 Work Rejected Claims Secondary You can also work your secondary rejections. Working these rejections is the same as primary rejections with one exception: When working your secondary rejections, you are allowed to correct and re-file the claims online. To work your secondary rejections, click the highlighted number below To Be Worked. The screen will appear just like new primary rejections. Click anywhere on the claim line to see more detail about this claim. Click Correct/Resubmit Claim in order to edit and submit a corrected secondary claim directly from our website. Not all secondary rejections will have this option, but most will. 6

7 Enter the information indicated in red. Please see our online help document called Secondary On-line Claim Correction (SOCC) Help Document for more details. You can find this document under Online Help or by clicking on the question mark in the upper right hand corner. New Remittances/ View Insurance Payments (Remittances) The remit search will always default to a date range of one week. You may continue with these dates or select your own and click Search. This will list your current remits waiting to be posted, printed or reviewed. If you need to see archived checks, simply click the box in front of Show Archived (Previously Downloaded) Remittances and enter your date range. 7

8 To view a remit, click anywhere on the row you would like to view. If you prefer to view Medicare Style for printing click the bullet under Choose a View Option. This option is only meant for Medicare remits. There is a list of claim adjustment reasons and remittance advice remarks in the upper right for your convenience. An example of the Standard Style view is below. To print the entire remit, click the printer icon in the upper right. To select the entire batch to print one patient, per page, at a time (if you want to attach to secondary claims), click the Add entire remittance to print batch. To print only one or a few selected patients remits for printing, select the box Add to print batch. 8

9 To download remits, select the remit you need or click Select All, and click Download Selected. Once you have clicked Download Selected you will come to this screen and should click the blue words click here to download existing remits. 9

10 The next screen will default to Remittance Files. Select Send/Receive Files. Click Send and Receive and your remits will download to your Practice Management System (PMS) according to your vendor s instructions. Not all PMS vendors will be able to download remits or auto-post. Please check with your vendor for more information. Check Patient Eligibility To run an inquiry, select the payer you would like to search, fill in the applicable information, which may vary by payer. Please note that some payers may have a transaction fee, which will be noted in the middle of the screen. Once you have entered in all of the information, click the Submit Eligibility Inquiry button and your results will appear. Depending on the payer, you will receive a tracking or trace number for proof of eligibility. 10

11 Part of efficiently running Eligibility inquiries is customizing your payer and provider lists. To edit your payer list, select the Edit Payer List button. First, choose the type of payer by clicking on the gray box, then select all the payers you wish to initiate eligibility inquiries from. Once you have made your selections, scroll to the bottom of the page and save your list by clicking the Save Payer List button. To edit your provider list, click the Edit Providers button after selecting an Eligibility Payer. Add the provider s name in last name, comma, first name format, as well as provider ID and NPI and then click Add Provider. The provider s name now appears in the drop-down list. Click the blue question mark in the upper right for a complete Eligibility Help Document to walk you through set up and using the eligibility product. Another option is to view the Eligibility Video Tutorial which can also be found under the blue question mark. 11

12 Accept Patient Payments Gateway EDI enables you to take credit card payments and accept checks in your office or over the phone through our payment processing partner. Select the appropriate transaction type, enter the patient s billing information and click Submit. Within this section, you can also access the proper forms to sign your patients up for the billing methods you offer. We also offer a credit card authorization form or auto deduction form for checking accounts. This is a real time saver and great for reducing those collection problems in your office. Below are some screen shots and if you are interested, please call us for this value added service. 12

13 Credit Card entry screen: Check entry screen: 13

14 NPI Look-Up The NPI Look-Up tool links you to the National Plan and Provider Enumeration System (NPPES). Here you will be able to verify any NPI information on a provider. You will be able to select whether you are looking for an individual or an organizational provider. Enter the provider s name and click Select. Customize Your Work Flow My Work Flow is designed to make it quick and easy to access all of the powerful tools offered by your Gateway EDI website. The default structure of My Work Flow represents our recommendations for tasks that should be completed on a daily, weekly or monthly basis to help your practice run smoothly and to allow you to effectively manage your revenue cycle. While we recommend this format, Gateway EDI realizes that each practice is unique. Our website is designed to work with the way that you do business, and we have given you the power to customize it to work exactly how you want. On the home page, at the bottom of My Work Flow is a tab to Customize Your Work Flow. 14

15 By clicking Customize Your Work Flow you will be taken to the Gateway EDI Manage Products screen. Within this customization panel, you have the ability to move tasks between daily, weekly and monthly tabs, depending on how and when you use them. You also have the option to remove tasks altogether if you wish. Once you have grouped tasks according to how you work, click the Save Work Flow button. At any time if you would like to reset your My Work Flow tasks, simply return to this page and click the Restore to Default button. 15

16 Run Safety Net Report This report enables you to make sure rejected claims are dealt with and no claims are lost. We recommend running your Safety Net Report once a week to make sure you are correcting the claims with rejections and that nothing is being overlooked from the rejection reports. This report will display any claim that has been rejected, but has not been re-filed. Enter beginning and ending dates, or use the calendar. To show previously matched (worked) claims click the box next to Show Client Matched Claims. Click Create Report. If a claim is checked, the box in the worked column indicates that someone has previously marked the rejection as worked, but may have overlooked corrections to the claim or forgotten to re-file electronically through Gateway EDI. A claim marked as worked can also appear if it has just recently been worked, as it can take up to three days to be removed from your Safety Net Report. If there is no check mark, the claim was not marked as worked and the claim has not been re-filed or it has been rejected again. Some examples of claims that could be marked as Client Matched are ones in which the patient has different insurance than submitted on the original claim, the carrier needs an attachment and you will need to submit the claim by paper or the patient has no insurance and the claim should not have been submitted. In the upper right corner of this page is the Status Code Legend which allows you to verify the status of that claim. Click the blue question mark in the upper right to access our Safety Net Help Document for more detailed instructions. 16

17 Analyze Rejections The Analyze Rejections report will give you the top rejections for the date range selected. You can select a preset range from our Select Range option, enter a beginning and ending date range, or select from the calendar icons. We recommend running this report at least once a month or as often as you choose. Below is a list of all rejections by description beginning with your top rejections. This report is informational only and should be used as a teaching tool to educate your staff to proactively eliminate the same rejections from reoccurring in the future. The errors will be listed by Contents. Use this report to clean up rejections so you submit clean claims the first time. Some offices use this data as an incentive tool for billers and coders. This will help your office identify where in the office the errors are generated: front office, billers, coders, etc., so that you may use it as a training tool. The yellow post-it icon at the left side of the report allows you to add or view notes pertaining to 17

18 a particular claim. The check-boxes in the Worked column indicate whether or not you have previously marked the rejection as worked. Click on an individual claim to view additional details. Run Transaction Summary Run Transaction Summary allows you to view a summary of your transactions received and processed by Gateway EDI. You can select a preset range from our Select Range option, enter a beginning and ending date range, or select from the calendar icons. Try the different sort options to find your favorite. 18

19 The report is divided into 2 sections. The top gray section gives you the totals for the entire site, whereas the bottom section separates the information per provider. Information presented in this report includes how many Gateway EDI errors, paper and electronic claims, payer errors and a percentage and charges for each. This is a great tool to use to track your monthly transactions. You also have the ability to export this information to Excel. If there is a particular search that you would like to run each month, you can simply choose your options, click the Save button, enter a name for your search and click save. When you come back out the following month to run your report, you can simply enter your date range, select your saved search from the drop down list and go. For more detailed instructions you can view our Saved Searches Help Document under Online Help in the top right hand corner of the screen. Monitor Staff Productivity If you have one or multiple users working on our website, you can monitor their productivity here. You can select a preset range from our Select Range option, enter a beginning and ending date range, or select from the calendar icons. 19

20 Each user will have his or her own log in name, which will be broken out here. The example below has one user, You can see the number of Rejected Claims Worked, the Claim Charges Worked, Average Days to Work Claims, Re-Rejected Claim Worked and Claims Corrected/Resubmitted for each user. Search Claim Status Look up any patient, submission dates or date of service to see if your claim has been accepted by the carrier or rejected and why. Many carriers will accept an acknowledgement of acceptance from claims status as proof of timely filing. The following search options are available: Patient Payer Secondary Provider Advanced Real-Time 20

21 Select which option you would like from the Search By drop down menu. Enter as much information as you can and then click Create Report. This will list every claim you have filed for this patient or the date of service you entered. Try the different searches. Advanced Search will allow you many options including tracking files between dates so you can run it against your accounts receivables to track your claims. You may change your sort in the Advanced Search by using the sort option boxes. Remember, less is more when searching so if you can t find the patient you are looking for, try last name and first initial. Claim Status can be used for proof of timely filing if there is an acceptance report from the 21

22 payer. Click anywhere on the row of the claim you would like to view if it is Payer Received to open the detail window. Print and include with the detail from your Practice Management System. This serves as proof that the payer received your claim. Work Suspensions Here you can manage any claims that were suspended due to coding warnings. Once claims arrive here they need to either be selected to be sent, or rejected and resubmitted. Simply place a check mark in the box under the Select column, or the box next to Select in order to select all. Then choose Send Selected or Reject Selected to keep the claims moving. 22

23 View Claim File Reconciliation The View Claim File Reconciliation report will give a breakdown of the different insurance payers and the status of each claim submitted within the selected claim file. You can select a preset range from our Select Range option, enter a beginning and ending date range, or select from the calendar icons. Select Create Report. This takes you to a list of files submitted within the date range entered. Notice the Status Code Legend in the upper right. There are four file statuses: Received which means that your file has been received by Gateway EDI. The second status is Processed appearing in blue which means that your file is going through necessary edits. The third is Processed appearing in green which indicates that the file has completed the edit process and you can click on the file name for details. The final is Not Processable appearing in brown which indicates that the file could not be processed. To view the Claim File Reconciliation report, select the row of the file you would like to view. In order to view the file, the status will need to be Processed in green. This report allows you to view files as far back as 2 years and allows you to track the claim all the way to the payer. 23

24 Once you re in the file, you ll be able to verify the number of claims submitted within that file, as well as how many were paper, how many were accepted or rejected by Gateway EDI, and how many were received, accepted or rejected by the payer. The most important column of this report is the No Reply from Payer column. After 7-10 business days from the file date, this column should have all zeros, meaning all of the payers have responded to each claim by accepting or rejecting the claim. If after 7-10 business days the payer has not responded to the claim, please contact Gateway EDI customer service for further research. By clicking any of the blue underlined numbers you can drill down even further to see which patients these claims belong to. 24

25 Bill Patients Bill Patients can be found under Manage Patients. It can also be found in My Work Flow under Weekly Tasks. These functions include patient statements and recall letters which free up staff time and save you money. In this section you have the ability to send files, access sent statements and view reports through our patient communications partner. Statistics show a professional statement gets paid much faster than one that gets printed on plain paper. You will be able to confirm a list of patients who have received statements and the total dollar amount billed with the number of statements sent. The post office will send address corrections to this site and you will be able to correct them here if you choose to do so. The recall letters are very versatile and can be used as a last notice prior to turning over to a collection agency. View a sample statement here and then call us for more information about our statement process. 25

26 Customer Service There are more items under Customer Service than just phone numbers. Check it out! Do you prefer ? Type in your question and we will call you back as soon as possible or give us your and we ll contact you that way. We have 24/7 service and the numbers are on this page as well as our address. 26

27 The Tech Support and Vendor Toolkit are for the people who support your software or hardware. There is lots of helpful information should your system need to be modified. We have trainings year round in our office and off-site. To find out more about attending one of our trainings, whether in person or by WebEx, fill out this page. 27

28 Need to send a file but don t want it to be picked up for production? You can Send Special File through this section of our website. This may be requested by a Customer Service Representative or a Client Testing Representative. Suggestions? We love to hear from you so let us know if you see something we have missed. 28

29 Provider Look-Up If you need to search for an NPI or UPIN number, you can do so on the Provider Look-Up tab under Resources. Or, if you want to Validate an NPI Number we have a tool for that as well. Finally we have a place where you can load Referring Provider names and numbers to be entered on your outbound claims. For more information on the NPI Look-Up, click here https://nppes.cms.hhs.gov/nppes/welcome.do To use the Validate an NPI Number tool, enter the NPI number into the box and click Validate. This will check to make sure the NPI number is properly formatted. 29

30 The View Referring Provider NPI Table is a helpful tool if you are unable to send this information on your claims. Anything entered on this screen and saved will override the data sent on your claims. For detailed instructions, check out our online help document. You can click on the blue question mark at the top right hand corner to access it. The document is called Referring Provider NPI Table Help Document. The UPIN database is updated quarterly. Enter as much information as you can and then click Search. 30

31 Payer List The Payer List will give you a list of all the payers that we submit to electronically, both professional and institutional. Once here, you can search Gateway EDI payers by name, Payer ID, or by state. Once you select your state and your payer Name, click Create Report to view a list of payers that meet those criteria. 31

32 32

33 Your search results will include Payer Name, Payer ID, Available Transactions, Enrollment Requirements, and Contact Information. Here are a few tips to help you with this page: If the Payer Name appears in blue, it means you can access that payer s website by clicking on the Payer s Name. For Available Transactions, look in the upper right corner of the screen for the Transaction Types Legend which will help you determine which are available for that payer. Under Enrollment Required, if there is a red Y, additional enrollment is required for that payer and Gateway EDI should be contacted. Because the Payer List is updated on a regular basis and is quite large, we do not recommend printing it. 33

34 Additional Products We offer a lot of services - have you checked them out lately? Follow the links from our web site to find out how these services could help your office. Preferred Software Vendor List Preferred vendors are partners with Gateway EDI. Our staff works very closely with them and with their systems, enabling us to maximize the effectiveness of the customer service we offer to you. Check out the full list under the Resources tab, Preferred Software Vendor List. Link Library The Link Library is also another resource. By clicking Link Library under the Resources tab, you will see a plethora of industry-specific information, from Vendor Partner to Continuing Education, coding and conferences. This is the place to find links to everything you re looking for. Simply click the link you d like to read about and it will open in a new browser window. Best Practices Best Practices are suggestions developed from client comments which we think can be helpful to most offices. Check the reports on a daily, weekly or monthly basis according to the suggestions, or what you decide is best for your office. 34

35 About Gateway EDI There are four links available under About Gateway EDI. Browse through them to get directions to our office, learn about Gateway EDI Speakers, the annual Scholarship Program & upcoming Tradeshows. 35

36 Message Center The Message Center is used to communicate with our clients, and will keep you informed about payer changes, new payer connections, submission errors, industry news, holiday hours, etc. It directs you to your New Messages. Manage Users This feature allows you to assign permissions for certain tools and users to best fit your practice needs. 36

37 Up top, you will see your user information along with areas to edit and change it. Below, you see all of the users and sets you have created. To toggle between showing and hiding any inactive users, click the Show Inactive/Hide Inactive button. Adding a user or set is easy. Simply select Add a User or Add a Set and follow the steps for completion, filling in all required information. Once you have successfully completed the steps your setup will begin automatically. For more detailed instructions click the blue question mark in the top right hand corner of the screen. This will take you to our Gateway EDI Help Center where you can access the Manage Users and Permissions help document. Manage Products Here you are able to perform multiple functions such as changing and updating your file paths, adding your RSS Feeds, and adding or modifying your Note Status Codes. For more details on what kinds of changes you can make to each area, select a product you wish to update and it will display available changes. Manage Providers Here you are able to view the details of your providers and their enrollment status. You are also able to add providers and get enrollment forms here. Click on View Provider Details and Enrollment Status to view the full list of providers on your site. When the following page comes up, click on the row of the provider you would like to view. 37

38 Once your provider is pulled up you can view the payers that require enrollment and their status. Any unique provider numbers and NPIs will be listed here. Sent and approved dates for Claims, Electronic Remittance Advice, and Eligibility will be here as well If you would like to add a payer but notice that in the Payer List it requires enrollment, you can get the paperwork right from our site. Under Manage Providers select Get Enrollment Forms. 38

39 Follow each step in selecting the transaction types, and state/regional/national agreements you would like to view. After going through the steps to pull up the correct agreement you will be able to print out the form. Please complete the form and send it to our Provider Enrollment team to process. If you are gaining a new provider in your office, please click the link to Add a Provider. Simply fill out the form and fax it back to our Provider Enrollment team. For credentialing information click the View Credentialing Information link and you will arrive at the CAQH website 39

40 Monitor My Account Balance This allows you to keep track of your Gateway EDI invoices and payments in an easily accessible view of your account history. Information provided includes your invoice date, invoice amount as well as your payment amount and your account balance. You can also sign up for Auto Deduction from your account for your Gateway EDI invoice. Select Authorize ACH Payment, complete that information and mail it back to our Accounting Team here at Gateway EDI. 40

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