Background. What You Need to Do to Get Ready for Electronic Billing

Transcription

1 9645 Granite Ridge Drive Suite 230 San Diego, California dsi.com dsi.com Electronic Transactions Enrollment Step by Step A guide to the steps necessary for new clients to begin their Electronic Transactions enrollment process Background Please use this document as your checklist for the steps that must be completed by you, Data Strategies Inc. (DSI) and the carriers & clearinghouse you intend to perform electronic transactions with. If you will not be working with either direct-billing to a carrier or with a clearinghouse, please disregard the appropriate sections on this list. We will help you through the process, so that it goes as smoothly and quickly as possible. This list is complete as of the time of its creation, but all aspects of electronic transactions enrollment are subject to change without notice. What You Need to Do to Get Ready for Electronic Billing 1. Direct (Non-Clearinghouse) Electronic Connections: Review the DSI Payer List located in your Electronic Transactions Welcome Kit. Begin your enrollment process with direct-bill carriers by contacting them directly. Typically takes 3+ days to complete. Your Electronic Transactions Welcome Kit includes a DSI Payer List. This is a list of payers for which DSI provides a direct electronic connection i.e., payers with whom you can conduct certain supported electronic transactions directly, and not through a clearinghouse. Unless you indicate otherwise to DSI, we will assume that you intend to conduct any electronic billing transactions with these payers directly, and not through one of our compatible partner clearinghouses. If you see payers on the DSI Payer List with whom you d like to establish a direct electronic billing connection, contact them as soon as possible to let them know that you will be submitting your claims this way. You should inquire as to whether they support other electronic transactions such as online eligibility verification and/or electronic remittance advice (ERA) in the ANSI 4010 format if the payer does support them, be sure to complete all required enrollment paperwork for these other transactions. Contact your Technical Support representative if you have any questions about the DSI Payer List. Copyright 2002 by Data Strategies, Inc. All rights reserved. All registered trademarks and trademarks are the property of their respective owners. Page 1 E:\code\elligence\Implementation Docs\EDI Step by Step Guide.doc

2 If you have previously been enrolled to submit Medicare Part B claims, you may only need to let the carrier know that your software is changing. When you speak to the EDI Enrollment desk at your Medicare carrier, determine if you will begin working with them in Test or Production mode and have them assign a Submitter ID to your office. Contact the EDI Enrollment Desk at your Medicare if you have any questions about Medicare electronic billing enrollment. 2. Send Test Claims to All Direct Payers. Contact your DSI Technical Support representative, so that you may submit a batch of test claims to the payer(s) you will be billing directly. Submit test claims to direct payers. Contact DSI Technical Support representative to troubleshoot test claim errors, if any, reported by payer. Receive response/approval on test claims from direct payers. Contact your Technical Support representative to notify them of your approval, so that they may assist you in setting up your software for production claims the process required for you to be paid on future claims you submit to this payer. 3. Clearinghouse Enrollment via Data Strategies. Review the Clearinghouse Payer List -- begin your enrollment process with clearinghouse by completing the Clearinghouse Batch Claims Provider Set-Up Form, and sending it to Data Strategies. Your Welcome Kit includes a Clearinghouse Batch Claims Provider Set-Up Form. If you plan to submit any commercial (sometimes called participating ), or Medicare Part B, Medicare Railroad, Medicaid, Blue Cross, Blue Shield and Champus (typically called government or nonparticipating ) claims through the clearinghouse, complete this form. Note: Even if you do not plan on submitting commercial claims electronically immediately, we strongly recommend that you complete the enrollment process anyway, to save time later on. Page 2

3 On the Clearinghouse Batch Claims Provider Set-Up Form, if you see a payer to whom you do not wish to submit claims via the clearinghouse (i.e., they are listed on the DSI Payer List, or you will be sending them claims on paper), then do not check the payer s name on the form. By checking the payer s name on the Clearinghouse Batch Claims Provider Set-Up Form, you are indicating that you will be submitting claims to them via the clearinghouse. In the event there are any additional enrollment requirements for each commercial payer, they will most often be listed on the Clearinghouse Payer List. For some payers, the additional enrollment requirements may not be listed instead, you will receive a rejection notice from the payer the first time you submit a test or production claim file to them. On the rejection notice, there will be a note to indicate that additional enrollment requirements must be met. Also note that if you have more than one provider number due to multi-state or multi-location submissions, you must complete one form for each set of provider numbers. Fax one completed Clearinghouse Batch Claims Provider Set-Up Form for each set of provider numbers in your organization to: Data Strategies, Attn: Barbie Lass, FAX: (858) If you have any questions about your enrollment, please call Barbie (our EDI enrollment coordinator) at (858) then press 0 for the operator. It typically takes 2-3 business days for your Clearinghouse Batch Claims Provider Set-Up Form(s) to be processed by DSI, and forwarded to the clearinghouse for their processing. If your office has previously been submitting claims to Envoy through another Practice Management System, you should also submit an Envoy Change of Vendor letter as specified at the end of this Step by Step Guide. If you are going to be submitting to Envoy for the first time, you do not need to complete one of these letters. Envoy will take about 5 to 7 working days to process your Vendor Change request if you do send one to them, so do not submit the form to Envoy until you are about one week away from the date you wish to submit your first Envoy claim file through DSI's software. Once Envoy has processed this letter from you, you will no longer be able to submit claims through your previous Practice Management System so please time this form s submission carefully. When Envoy has completed their processing of your request, they will send a confirmation to you directly letting you know that this part of the process is completed. 4. Processing of Your Clearinghouse Batch Claims Provider Set-Up Form(s): Commercial Payers. Upon receipt of your Clearinghouse Batch Claims Provider Set-Up Form(s) from DSI, the clearinghouse registers you in their system. First, you will be enrolled in the Commercial Payer processing system this typically takes 3-5 business days from the date on which they receive your completed form(s) from DSI. DSI will be notified by from the clearinghouse that you were successfully enrolled in the Commercial Payer processing system, and we will fax a copy of this confirmation to you specifically, to the contact person listed in your Clearinghouse Batch Claims Provider Set-Up Form(s). Page 3

4 Along with your Batch Enrollment confirmation, you ll receive via fax a Submitter Information Sheet, which will contain all of the identification numbers, etc. you will need to enter into your DSI practice management software system. If you have been using another practice management system to submit claims to Envoy, you should have submitted your Vendor Change Request letter to Envoy by now. The claims you generate in DSI's software cannot be received by Envoy if this form has not been processed in their enrollment system. You should receive a confirmation from Envoy within 5 t o7 days of the letter s submission. If you do not, please contact Envoy directly to follow up on your request. Upon your receipt of the Batch Enrollment confirmation (and the Vendor Change confirmation, if appropriate), you may immediately begin submitting commercial claims to the clearinghouse. Note that you may not submit any government claims (except for Blue Cross/Blue Shield plans that are listed as participating in the Clearinghouse Payer List) until those processes are also successfully completed (see below). Receive faxed copy from DSI confirmation of Commercial Payer enrollment. Contact DSI s EDI Enrollment Coordinator, Barbie Lass, at (858) x201 if you have any questions. Receive confirmation of Vendor Change from Envoy (if you had to submit a Change request to them). Contact Envoy s Enrollment Department at (800) (option 1) if you have any questions. Receive faxed copy from DSI Submitter Information Sheet. Contact DSI s EDI Enrollment Coordinator if you have any questions. Prepare a list of your most important commercial payers. Review the Clearinghouse Payer List, and match it up against your list, to see if the payers you normally work with: (1) Are available for electronic claims submission via the clearinghouse. If they are not available, you may enroll with the clearinghouse for print-andmail services, so that the clearinghouse will mail a printed copy of claims for all payers with whom they do not provide an electronic connection; and (2) List any special enrollment requirements on the clearinghouse Payer List. If they do, contact the clearinghouse s Enrollment Desk a.s.a.p. to find out what additional requirements there are for the payer(s), since you will not be able to submit claims to such payer(s) until the enrollment requirements are met. Page 4

5 5. Begin Submitting Commercial Claims. Please refer to the Clearinghouse User s Guide contained in your Electronic Transactions Welcome Kit, or contact your DSI Technical Support representative, for assistance in configuring your software system to enable the transmission of commercial claims. Work with the Clearinghouse User s Guide or your DSI Tech Support representative, to set-up the practice management system. Contact your DSI Technical Support representative, so that you may schedule a time for them to help you submit a batch of test commercial claims to the clearinghouse. This step is performed only in the case of payers who are identified on the clearinghouse s payer list as requiring a test claim file prior to submission of production claims. If you do not plan to submit commercial claims to payer(s) who require test claims, proceed directly to the step below that says Contact your Technical Support representative to notify them of your approval, so that they may assist you in setting up your software for production claims For payers identified in the clearinghouse payer list that require you to send a Test Claim File, submit test commercial claims to clearinghouse, which represent your line of business (your usual CPT and ICD9 codes) and the high-volume commercial payers you normally work with. If you perform any of the following claim types, be sure to include several of them in your test file: radiology (mammogram), EPSDT/family planning, DME, ambulance, chiropractic, optometry. Typically takes 1-2 business days often a response to a test claim file will be made the day following your submission. Clients are encouraged to call the clearinghouse s Help Desk, or the DSI Technical Support representative, to inquire as to the status of the test claim file. Contact DSI Technical Support representative to troubleshoot test commercial claim errors, if any, reported by the clearinghouse. Typically takes 1-10 business days, if any errors exist in your test file. Receive response/approval on test commercial claims from clearinghouse. Typically takes effect as soon as the clearinghouse receives a clean commercial test file, and notifies you of this fact. Page 5

6 Contact your DSI Technical Support representative to notify them of your approval, so that they may assist you in setting up your software for production claims the process required for you to be paid on future claims you submit to this payer. 6. Processing of Your Clearinghouse Batch Claims Provider Set-Up Form(s): Government Payers. Simultaneous with your enrollment in the clearinghouse s Commercial Payer processing system, you will be enrolled in their Government Payer processing system. This enrollment will include only government payers (Medicare Part B, Medicare Railroad, Medicaid, Blue Cross, Blue Shield, Champus) you have requested in your Clearinghouse Batch Claims Provider Set-Up Form(s). Note that this may be a lengthy process it typically takes 3-9 weeks from the time you submit your Clearinghouse Batch Claims Provider Set-Up Form(s) to DSI, until you can begin submitting government claims via the clearinghouse. For this reason, we strongly recommend that you submit government claims on paper while you await the completion of your government payer enrollment. This is so your accounts receivable with government payers do not accrue to an unmanageably high level in the intervening 3-9+ weeks it will take to complete the entire government payer enrollment and testing process. Clearinghouse processes Government Payer enrollment information contained in the Clearinghouse Batch Claims Provider Set-Up Form(s). Typically takes 1-2 business days. Contact the clearinghouse s Enrollment Help Desk (number listed on the cover sheet for each government enrollment form) with any questions, or to check status. Clearinghouse mails additional enrollment paperwork for each government payer requested in the Clearinghouse Batch Claims Provider Set-Up Form(s). This is to accommodate each payer s specific enrollment requirements -- the payer-specific enrollment is entirely independent of the clearinghouse enrollment process. Typically mailed within 5-7 business days from the date on which the clearinghouse receives the Clearinghouse Batch Claims Provider Set-Up Form(s), until the provider receives the payer-specific enrollment forms. Complete each set of enrollment forms. For each payer, there will be a cover sheet with all payer-specific enrollment requirements. Note that any failure to adhere strictly to the enrollment requirements will cause your enrollment with the government payer to be delayed, so be sure to follow all requirements listed in the cover sheet. Page 6

7 Mail originals of all government payer enrollment forms to the clearinghouse s (not the payer s) delivery address indicated on the cover sheet to each payer s forms. We strongly urge that you send these forms with a delivery method that allows you to verify the receipt of the package (e.g., USPS with return receipt, UPS or FedEx). You may send a copy of these enrollment forms to your DSI Technical Support representative, if you d like, so that they will be on hand in the event an inquiry needs to be made on your behalf. Clearinghouse forwards original copy of each government payer enrollment form to the appropriate payer(s). Typically takes 1-2 business days. Government payer enrollment form(s) are processed by the appropriate payer(s). Payer(s) send written confirmation of successful enrollment directly to the provider. Typically takes 3-9 weeks. Successful government payer enrollment: Govt Payer #1: Govt Payer #2: Govt Payer #3: Govt Payer #4: Govt Payer #5: Within approximately 3 weeks of receiving your Clearinghouse Batch Claims Provider Set-Up Form(s) from DSI, DSI will be notified by from the clearinghouse that you were successfully enrolled in the Government Payer processing system, and we will fax a copy of this confirmation to you specifically, to the contact person listed in your Clearinghouse Batch Claims Provider Set-Up Form(s). Note that you may not submit government payer claims via the clearinghouse until the entire process is completed (see below) this notification merely means that once you receive government payer approvals, you are in the system for the clearinghouse. For each government payer approval, contact the clearinghouse at the number listed on the cover sheet to the government payer enrollment forms. This is to indicate that you have been approved for claim submission. The clearinghouse does not guarantee that they will process your government claims until you have provided them with this Page 7

8 they will process your government claims until you have provided them with this notification. Government payers may or may not provide this information directly to the clearinghouse, or to the software vendor, so be sure to contact the clearinghouse to notify them of your successful government payer enrollment. Notification to clearinghouse of successful gov t payer enrollment: Govt Payer #1: Govt Payer #2: Govt Payer #3: Govt Payer #4: Govt Payer #5: As you provide confirmation to the clearinghouse of your successful government payer enrollment, you may immediately begin submitting test claims to the clearinghouse but only in connection with government payers for which the clearinghouse has received your indication of a successful enrollment. We strongly urge you to continue sending paper claims to government payers for which you cannot yet submit claims via the clearinghouse, even if you have received approvals from other government payers. For example, if you have enrolled with Railroad Medicare and Blue Cross/Blue Shield, and you have only received approval for Railroad Medicare, then we would recommend that you begin the electronic billing process with Railroad Medicare, and continue the paper billing process to Blue Cross/Blue Shield. To check on the status of your government payer enrollment, please contact the clearinghouse at the Help Desk number listed on the cover sheet to your enrollment form, or your DSI Technical Support representative so we can inquire on your behalf. When inquiring as to the status of any enrollment direct connection, commercial via clearinghouse, or government via clearinghouse be sure to have a copy of your enrollment forms and your Submitter Information Sheet handy for reference. Page 8

9 7. Begin Submitting Government Claims. Please refer to the Clearinghouse User s Guide contained in your Electronic Transactions Welcome Kit, or contact your DSI Technical Support representative, for assistance in configuring your software system to enable the transmission of government claims. Work with the Clearinghouse User s Guide or your Tech Support representative, to setup the practice management system. Contact your DSI Technical Support representative, so that you may submit a batch of test government claims to the clearinghouse for each government payer that has given you approval. Typically takes 1-5 business days. As with commercial payers, this step is required only for government payers identified in the clearinghouse payer list that a Test Claim File is required. If you plan to submit claims to any government payers via the clearinghouse, submit test government claims to clearinghouse, which represent your line of business (your usual CPT and ICD9 codes) and the high-volume government payers you normally work with. If you perform any of the following claim types, be sure to include several of them in your test file: radiology (mammogram), EPSDT/family planning, DME, ambulance, chiropractic, optometry. Typically takes 1-2 business days often a response to a test claim file will be made within 2 hours. Clients are encouraged to call the clearinghouse s Help Desk, or the DSI Technical Support representative, to inquire as to the status of the test claim file. If you do not plan to submit claims to government payer(s) that require test claim submission prior to your sending production claims, proceed directly to the step below For each approved government payer, switch settings in software to production mode for claims... Test claim submission to government payers: Govt Payer #1: Govt Payer #2: Govt Payer #3: Govt Payer #4: Govt Payer #5: Page 9

10 For each approved government payer, contact DSI Technical Support representative to troubleshoot test government claim errors, if any, reported. Typically takes 1-10 business days, if any errors exist in your test file. Contact your DSI Technical Support representative for assistance. Troubleshooting of errors in test file: Govt Payer #1: Govt Payer #2: Govt Payer #3: Govt Payer #4: Govt Payer #5: For each approved government payer, receive response/approval on test government claims. Typically takes 1-10 business days from the date on which the payer receives a clean test file approval often received within 2 hours. Contact your DSI Technical Support representative for assistance. Approval of test files for government payers: Govt Payer #1: Govt Payer #2: Govt Payer #3: Govt Payer #4: Govt Payer #5: For each approved government payer, switch settings in software to production mode for claims, and begin submitting these claims to clearinghouse. Contact your DSI Technical Support representative for assistance. Page 10

11 Switch to production mode ready for billing! Govt Payer #1: Govt Payer #2: Govt Payer #3: Govt Payer #4: Govt Payer #5: # # # Page 11

12 Important Contact Information Software Developer: EDI Enrollment Coordinator: Data Strategies Data Strategies 9645 Granite Ridge Drive, Suite 230 Attn: Barbie Lass San Diego, CA (858) then press 0 for operator (858) FAX: (858) barbie@e-dsi.com sales@e-dsi.com or support@e-dsi.com Software Developer Technical Support: Your Vendor s Technical Support: (leave blank if you purchased your system directly from Data Strategies) Data Strategies (858) FAX: (858) support@e-dsi.com Clearinghouse for Commercial Claims: Name: Enrollment Tel #: (refer to your Welcome Kit, or call Data Strategies) Enrollment (refer to your Welcome Kit, or call Data Strategies) Other Info: Direct Payers: (refer to your DSI Payer List) Name: EDI Enrollment Tel #: Government Payers via Clearinghouse: Name: EDI Enrollment Tel #: Name: EDI Enrollment Tel #: Clearinghouse for Government Claims: (leave blank if same as clearinghouse for commercial claims) Name: Enrollment Tel #: (refer to your Welcome Kit, or call Data Strategies) Enrollment (refer to your Welcome Kit, or call Data Strategies) Other Info: Name: EDI Enrollment Tel #: Name: EDI Enrollment Tel #: Name: EDI Enrollment Tel #: Page 12

13 Your Electronic Transaction Project Folder We strongly urge our clients to put together a project folder or three-ring binder, so that all of the important information you need to have handy will be in one place. Here are some of the things that might go in your Electronic Transaction Project Folder: (1) Electronic Transactions Welcome Kit, which consists of: a. An original copy of the checklist b. An original copy of the Clearinghouse Batch Claims Provider Set-Up Form c. Clearinghouse Payer List d. DSI Payer List e. User s Guide (2) A copy of this project checklist (3) A copy of your completed enrollment forms for direct payers (4) A copy of your completed Clearinghouse Batch Claims Provider Set-Up Form(s) (5) A copy of your Submitter Information Sheet (6) A copy of your completed government enrollment forms (7) Notes from conversations with Tech Support, clearinghouse help desk, payer EDI enrollment desk, etc. Page 13

14 Envoy Change of Vendor Procedures A change of vendor letter is required when an existing WebMD/Envoy provider/site changes vendors. The letter is required when the provider/site changes from their existing ENVOY certified vendor (submitter id) to a different WebMD/ENVOY certified vendor (submitter id). Claims testing may be required in addition to the change of vendor letter to ensure the new set up works correctly. Any new enrollment or ACD sent to WebMD/ENVOY that requires a change of vendor letter will be considered incomplete without the accompanying letter. WebMD/ENVOY will notify the provider/site if the change of vendor letter is required but not received and classify the account as rejected until the letter is received. Following are steps required for a provider/site to change WebMD/ENVOY certified vendors: Step #1 Step #2 Step #3 Complete a change of vendor letter using the template provided (ENV003). The letter must be on the provider s /site s letterhead and contain all of the information listed in the template (ENV003). Sign the change of vendor letter. The letter must be signed by a representative from the provider/site. Fax the change of vendor letter to: Fax: (615) Attn: Batch Enrollment Dept. Change of Vendor Step #4 Step #5 Step #6 Do not submit claims for 5 business days from any software old or new! WebMD/ENVOY will make the changes in the appropriate WebMD/ENVOY systems and send confirmation to the individual indicated on the letter when the new set up is complete. Confirmation will be sent within 5 business days. Submit claims through the new vendor. If testing is required, the claims must be sent as test and approved by a WebMD/ENVO Y Representative. Once approval is received, production claims should be sent and accepted claims will be forwarded to the payers. If testing is not required, claims should be sent as production and all accepted claims will be forwarded to the payers. Page 14

15 Envoy Vendor Change Request letter template Remember - this must be printed on your company s letterhead to be accepted by Envoy! [Date] WebMD/ENVOY Corporation Attn: Batch Enrollment P.O. Box Nashville, TN Dear WebMD/ENVOY Representative, I would like to start submitting my electronic claims through Web/ENVOY Corporation using Data Strategies elligence, effective immediately. Currently, I am submitting through [Name of OLD vendor/product here]. I would not like to send our electronic claims through both vendors. Please accept this letter as my request to change vendors. Following is specific information regarding my practice: Name: Practice: Address: Phone #: Contact: Address: Tax ID: Site ID: [Name of Doctor] [Name of Practice] [Address of Practice] [City, ST ZIP] [Phone Number of Practice] [Name of Contact at Practice] [ of Contact at Practice] [Tax ID of Practice] [4 digit ID - Required when submitting to more than one vendor] I will not submit claims for a period of 5 business days. This period of time will allow WebMD/ENVOY to make this change in the appropriate WebMD/ENVOY systems. When the change is completed, I will receive a confirmation from WebMD/ENVOY to notify me that I can submit claims. Please send confirmation of set up to my attention via [ , fax, phone call]. I understand testing may be involved for a new set up. If you have any questions, or need additional information, please contact me at [(XXX) XXX-XXXX]. Sincerely, [Your Name] [Your Title] Page 15