STOP HERE UNTIL AFTER THE WEBINAR

Transcription

1 TRANSITIONING TO ZIRMED CHECKLIST Review this Checklist, Appendix A & B before starting your transition to Zirmed. Perform each step in order, completing each step before continuing to the next. 1. Enroll for Zirmed training via Webinar. Go to Select Support then, under Quick Links, click on Zirmed Webinar Registration. Your ZirMed Account Number. Your Domain Administrator (main user) we set up for you will find this at the very top of your ZirMed website when he/she logs on. It is the number displayed in parenthese after the clinic name. The Webinar is approximately 1 ½ hours in length and may be taken at any of these times: 10:30 a.m. EST on Tuesdays or Thursdays 2:00 p.m. EST on Fridays In the Date field of the Webinar Registration Form, enter the calendar date (i.e., June 15, 2007) you wish to take the Webinar. ZirMed Training will confirm this date with you via and will provide you with instructions for participation in the Webinar. See Appendix A. 2. Join Live Meeting for Webinar Training. Go back to your Zirmed Training and click on the Click Here to Join Live Meeting link within the . See Appendix B for a sample of the Join Meeting window. STOP HERE UNTIL AFTER THE WEBINAR Instructions for performing steps 3 through 6 are included in this document. We recommend you review the instructions referred to for each step before you begin. When calling CCA Medical Support for help, you will be asked to supply your ZirMed EMC Password, which can be found within this documentation. 3. Setup Control Records: Setup for Professional Claims (HCFA 1500/CMS-1500) Refer to the Control File Maintenance Professional Claims section on page 5. Setup for Institutional Claims (UB-92/UB-04) Refer to the Control File Maintenance Institutional Claims section on page 6. Checklist 1

2 4. Enrollment status for Non-Par payers: Your non-par paper work will be mailed to ZirMed upon completion of the Webinar. Don t move these payers to ZirMed yet. You can begin checking enrollment status in about 2-3 weeks. Once show complete the payer can be moved to ZirMed. Professional Claims Institutional Claims Complete Not Complete Complete Not Complete Medicare BC/BS Medicaid Tricare RR Medicare 5. Convert Per Se ID s to ZirMed ID s (Refer to page 7). Exclude the form types for the insurance companies listed in Step Correct insurance companies not automatically converted in Step 5. Refer to the sample report on page 9 and Appendix 1 (page 20) for additional help. 7. Send first file or files to ZirMed. Prepare an insurance batch (Automatic Insurance Selection) as you normally do prior to sending electronic claims a. Do you send Professional claims (CMS-1500)? Go to page 10, Process Claims Professional b. Do you send Institutional claims (UB-92/UB-04)? Go to page 15, Processing Claims Institutional 8. Congratulations! You have completed the setup and transmission to ZirMed! Take time to familiarize yourself with the ZirMed website & Training Manual. A copy of the ZirMed Training Manual can be found on our website. Log in to your ZirMed account and begin managing your claims. Check for rejections on the Rejected Claims Dashboard. Fix and resubmit the rejected claims. 9. Continue to monitor your Payer enrollments if any were pending in Step 4. Refer to Step 6 as their enrollment completes. A complete copy of CCA s Practice Express ZirMed Electronic Claims manual is available on our website at Click on Support then select from the Documentation dropdown. Don t forget the password when calling support. Checklist 2

3 Appendix A When: Tuesday, Jun 12, :00 AM (EDT) Where: Confirmation of the date & time of your Webinar. If not correct, please notify CCA Medical Support. *~*~*~*~*~*~*~*~*~* ZirMed Training has invited you to attend a Live Meeting. Test this the day before Webinar to make sure Microsoft Office Live Click Here to Join Live Meeting Meeting is installed on your pc. See ZirMed Screen Shot next page. Subject: CCA Customers Only - Claims Management Training Meeting URL: Meeting ID: DGT5MB Meeting Key: QFQHJ3)hG Role: Attendee Audio Conferencing (Toll): +1 (913) Audio Conferencing (Toll-free): +1 (888) Participant Code: Phone number and code needed for the ability to ask questions (voice) during webinar. Call the phone number and enter code when prompted. FIRST TIME USERS: To save time before the meeting, check your system to make sure it is compatible with Microsoft Office Live Meeting. This Live Meeting invitation is a personal invitation; it should not be forwarded. For assistance, visit Live Meeting Help and Support: Appendix A 3

4 Appendix B This window is your lead in to the Webinar. 1. Type your Name as you would like it to display during the meeting. 2. The Meeting ID should already be filled in for you. If not, refer back to your Zirmed Training and key the Meeting ID exactly as it is shown (it is case sensitive). 3. Meeting Key should already be filled in for you. If not, refer back to your Zirmed Training and key the Meeting Key provided in your exactly as it is displayed (it is case sensitive). 4. Click Join Meeting. If you try to Join Meeting too soon, a message will appear indicating the meeting has not yet started. Wait a few minutes and try again to Join Meeting. 5. Dial the Audio Conferencing phone number from your Zirmed Training . Enter the Participant Audio Code when prompted. Refer to Appendix A for help. Note: You may be prompted to install Microsoft Office Live Meeting software prior to seeing this screen. Appendix B 4

5 Setup Control File Maintenance Professional Claims From Practice Express Modules select: Insurance Billing Send EMC Claims ZirMed ANSI EMC Professional Control Records and Payers Control File Maintenance This record contains login information used during claims file transmission to ZirMed s website for professional (cms-1500) claims. Fill in the information in these fields as follows. FTP Site EMC Login EMC Password Transmit Seq# Enter the letters ftp.zirmed.com lower case as above. Enter the ZirMed Account number assigned to your clinic during enrollment. Enter the letters cca100 ( cca is lowercase and 100 is the number 100). This is also the password you need when calling support for help with this product. Enter the number 1 (one). The system will increment the number automatically from this point forward. Setup 5

6 Test/Production EDI Contact Contact Phone# Update / Cancel The default is P for production. Do not change. Enter the name of your clinic s Insurance Billing Contact. Enter the phone number of your clinic s Insurance Billing contact. Do not punctuate; key numbers only. Choose Update to save changes. Choose Cancel to exit without adding the record. When finished click Exit to leave the Control File Maintenance Professional setup. Question: Do you plan to process Institutional Claims electronically? Yes Click End 2 times and Continue with the Control File Maintenance Institutional Claims section below. No Go to Step 4 of your checklist. Step 3 a. & b. is complete. Control File Maintenance Institutional Claims From Practice Express Modules select: Insurance Billing Send EMC Claims ZirMed ANSI EMC - Institutional Control Records and Payers Control File Maintenance Fill in the information in these fields as follows. Setup 6

7 FTP Site EMC Login EMC Password Transmit Seq# Test/Production EDI Contact Contact Phone# Update / Cancel Enter the letters ftp.zirmed.com lower case as above. Enter the ZirMed Account number assigned to your clinic during enrollment. Enter the letters cca100 ( cca is lowercase and 100 is the number 100). This is also the password you need when calling support for help with this product. Enter the number 1 (one). The system will increment the number automatically from this point forward. The default is P for production. Do not change. Enter the name of your clinic s Insurance Billing Contact. Enter the phone number of your clinic s Insurance Billing contact. Do not punctuate; key numbers only. Choose Update to save changes. Choose Cancel to exit without adding the record. When finished click Exit then End 2 times to leave the Control File Maintenance Institutional setup. Go back to Step 4 of your Checklist. Convert Per Se ID s to ZirMed ID s If you were transmitting claims to Per Se prior to changing to ZirMed, this option will automatically convert all insurance companies setup for Per Se to ZirMed. From Practice Express Modules select: Insurance Billing Send EMC Claims ZirMed ANSI EMC - Professional Control Records and Payers Convert Per Se ID s to Zirmed ID s Setup 7

8 You are first given the option to exclude one or more form types from being converted. Form Types, setup in Insurance Form Types maintenance, are linked to one or more insurance companies. If you choose to exclude a form type, all insurance companies linked to that form type will be excluded from this setup process. Excluding form types is optional. To exclude a form type, choose from the list and click Select. The selected Form type will display under Selected list to exclude. If you make a mistake, click Clear and start over with the selection. Use the CTRL key to highlight and select multiple companies at one time or hold the left mouse button and drag to select a range. Click Exit when finished. The system displays the form types you selected to exclude and prompts: OK to start? Yes/No If you are satisfied with your selection, choose Yes. Choosing No cancels the conversion of insurance companies from Per Se ID s to Zirmed ID s. Go to Step 6 of the checklist. Setup 8

9 Conversion Report Sample Once the conversion is finished, a report is generated listing the companies selected. ICO# Name... PerSe Information -> ZirMed Information 169 AMERICAN MEDICAL SECURITY PS2 YCI Not Converted 100 CIGNA PS2 YCI ZM1 YCI CIGNA PS2 YCI ZM1 YCI CONNECTICUT GENERAL PS2 YCI ZM1 YCI CONNECTICUT GENERAL PS2 YCI ZM1 YCI CORPORATE SYSTEMS PS2 YCI ZM1 YCI FIRST HEALTH PS2 YCI Not Converted 196 GHI PS2 YCI ZM1 YCI GOLDEN RULE INSURANCE PS2 YCI ZM1 YCI INDEPENDENT HEALTH PS2 YCI ZM1 YCI SX MEDICAL MUTUAL OF OHIO PS2 YCI Not Converted 111 PRINCIPAL HEALTH CARE PS2 YCI ZM1 YCI PRINCIPAL MUTUAL LIFE INS PS2 YCI ZM1 YCI PRINCIPAL MUTUAL LIFE INS PS2 YCI ZM1 YCI PRINCIPAL MUTUAL LIFE INS PS2 YCI ZM1 YCI PROVIDENT LIFE & ACCIDENT PS2 YCI ZM1 YCI TRUSTMARK PS2 YCI ZM1 YCI IP TRUSTMARK PS2 YCI ZM1 YCI IP TYSON FOODS PS2 YCI ZM1 YCI UNITED HEALTHCARE PS2 YCI ZM1 YCI UNITED HEALTHCARE PS2 YCI ZM1 YCI UNITED HEALTHCARE PS2 YCI ZM1 YCI VYTRA HEALTHCARE PS2 YCI ZM1 YCI WORLD INSURANCE COMPANY PS2 YCI ZM1 YCI Insurance companies the system could not automatically convert to ZirMed are indicated by the message Not Converted under the ZirMed Information column. You will need to manually change these companies in Insurance Company Maintenance in order to file them to ZirMed. Refer to Appendix 1 of this documentation for information related to Insurance Company Maintenance. CCA strongly advises that you review the list and payer ids for accuracy before filing. Failure to do so could result in claim denial and delay in payment. When finished, go to Step 7 of the Checklist. Setup 9

10 From Modules select: Processing Claims - Professional Insurance Billing Send EMC Claims ZirMed ANSI EMC - Professional Transmit and Update Claims Perform each item on this menu in order beginning with Select Claims to Transmit ending with Update Transmission. The Re-Transmit option is rarely used and is explained later in this section. Select Claims to Transmit This is the first step in preparing a batch of professional claims to file electronically. This function selects transactions from the Insurance Proof Report whose insurance companies and CPT codes have been setup to file electronically. Select Form Types to file: Branch Selection Process Claims Default is All. Leave the default or select the form type(s) to file. For normal filing of electronic claims leave the default. Leave the default All. The default is Primary Claims Only Other options are: All Claims (Primary & Secondary) Professional Claims 10

11 Secondary Claims Only OK Cancel Choose OK to continue this process or Cancel to end without selecting claims to transmit. Print Selected Claims Edit List This function performs a preliminary check for claim errors in the file and prints a report indicating whether or not errors were found. An error is indicated by one or more $ dollar signs on the report. If errors are reported, they MUST be corrected and another edit list printed before continuing. If no errors are found, the report is totaled based on the format selected with the phrase NO ERRORS IN FILE at the end of the report. The Edit List must contain the phrase NO ERRORS This date/time should always match the current date unless the insurance process is being carried over from a previous day. IN FILE before continuing to the next step. Print file totals only. Prints a grand total of number of claims and dollar volume being filed. Print batch totals and file totals only. Subtotals by batch number the total number of claims and dollar amount filed by batch with a grand total at the end. The batch number is system generated. Print detail claim total line, batch totals and file totals. Prints each claim total subtotal by batch then grand total. This is the recommended selection. Print All detail record information. This prints a detail listing of each ANSI record for each claim in the file. Not normally used unless instructed by CCA personnel. Professional Claims 11

12 Selected Claims File Maintenance This option can be used to correct most of the errors reported on the Claims Edit List above. A sequence number is located in the far right column of the edit list. Use this sequence to access the error line. After errors are corrected, the Edit List must be reprinted. If you corrected any errors by exiting the ZirMed ANSI EMC menu, you must start over with the Select Claims to Transmit option above. Create a Transmission File and Transmit Once you have a clean Edit List, run this option to continue creating the electronic claims file and transmit it to ZirMed. This step is divided into two parts: The first part completes the building of the file to be transmitted. The second part transmits/uploads the file to ZirMed. Click Yes to continue and upload the file or No to end without uploading. Professional Claims 12

13 This window indicates whether or not the Claims File Upload was successful. It also displays the file name assigned to the batch of claims. Print Transmission Log Once the transmit/upload is complete and successful, you will need to print the Transmission Log. The EMC File Build date and Time and Transmit date and Time is important information. The dates should match unless the Insurance process is being carried over from another day. Professional Claims 13

14 Choose the printer and print the Log. Be sure the last line of the report contains the OK stamp and it reads the transmission was successful. Keep this log as a record of your transmission. Update Transmission This selection completes the ZirMed claims processing. It creates a claim history for the charges filed, flags the charge transaction as filed and places a memo in each patient s history that the charge was filed. Omitting this step can cause duplicate claim filing. If you will process Institutional claims electronically go back to Step 7b. If you don t process Instutional claims, go to Step 8. Professional Claims 14

15 From Modules select: Insurance Billing Send EMC Claims ZirMed ANSI EMC - Institutional Transmit and Update Claims Processing Claims - Institutional Perform each item on this menu in order beginning with Select Claims to Transmit ending with Update Transmission. The Re-Transmit option is rarely used and is explained later in this section. Select Claims to Transmit This is the first step in preparing a batch of professional claims to file electronically. This function selects transactions from the Insurance Proof Report whose insurance companies and CPT codes have been setup to file electronically. Select Form Types to file: Branch Selection Process Claims For institutional claims, select each form type of the insurance company required to file as UB-92/UB-04. Leave the default All. The default is Primary Claims Only Other options are: All Claims (Primary & Secondary) Secondary Claims Only OK Cancel Choose OK to continue this process or Cancel to end without selecting claims to transmit. Institutional Claims 15

16 Print Selected Claims Edit List This function performs a preliminary check for claim errors in the file and prints a report indicating whether or not errors were found. An error is indicated by one or more $ dollar signs on the report. If errors are reported, they MUST be corrected and another edit list printed before continuing. If no errors are found, the report is totaled based on the format selected with the phrase NO ERRORS IN FILE at the end of the report. The Edit List must contain the phrase NO ERRORS IN FILE before This date/time should always match the current date unless the insurance process is being carried over from a previous day. continuing to the next step. Print file totals only. Prints a grand total of number of claims and dollar volume being filed. Print batch totals and file totals only. Subtotals by batch number the total number of claims and dollar amount filed by batch with a grand total at the end. The batch number is system generated. Print detail claim total line, batch totals and file totals. Prints each claim total subtotal by batch then grand total. This is the recommended selection. Print All detail record information. This prints a detail listing of each ANSI record for each claim in the file. Not normally used unless instructed by CCA personnel. Selected Claims File Maintenance This option can be used to correct most of the errors reported on the Claims Edit List above. A sequence number is located in the far right column of the edit list. Use this sequence to access the error line. Institutional Claims 16

17 After errors are corrected, the Edit List must be reprinted. If you corrected any errors by exiting the ZirMed ANSI EMC menu, you must start over with the Select Claims to Transmit option above. Create a Transmission File and Transmit Once you have a clean Edit List, run this option to continue creating the electronic claims file and transmit it to ZirMed. This step is divided into two parts: The first part completes the building of the file to be transmitted. The second part transmits/uploads the file to ZirMed. Choose Yes to continue and upload the file or No to end without uploading. Institutional Claims 17

18 This window indicates whether or not the Claims File Upload was successful. It also displays the file name assigned to the batch of claims. Print Transmission Log Once the transmit/upload is complete and successful, you will need to print the Transmission Log. The EMC File Build date and Time and Transmit date and Time is important information. The dates should match unless the Insurance process is being carried over from another day. Choose the printer and print the Log. Be sure the last line of the report contains the OK stamp and it reads the transmission was successful. Keep this log as a record of your transmission. Institutional Claims 18

19 Update Transmission This selection completes the ZirMed claims processing. It creates a claim history for the charges filed, flags the charge transaction as filed and places a memo in each patient s history that the charge was filed. Omitting this step can cause duplicate claim filing. Go to Step 8 of the Checklist. Institutional Claims 19

20 Appendix 1 Insurance Company Maintenance From Modules select: System Management Codes Maintenance Insurance Companies Maintenance Complete the following fields for each insurance company to be filed electronically to Per Se in the ANSI format: Emc Submittable Enter Y for Yes for any company that will have claims submitted electronically to Per Se. Emc Claim Type Enter the 2 character code from the list below denoting the type of insurance to be filed. Automobile Medical... AM Blue Cross/Blue Shield... BL Champus (Tricare)... CH Commercial Insurance Co.... CI Disability... DS Health Maintenance Organization... HM Liability... LI Liability Medical... LM Medicare Part A... MA Medicare Part B... MB Medicaid... MC Other Federal Program... OF Title V... TV Appendix 1 20

21 Veteran Administration Plan... VA (Refers to Veteran s Affairs Plan.) Workers Compensation Health Claim... WC Mutually Defined (Unknown)... ZZ Self-pay (# zero) Central Certification (1 + zero) Other Non-Federal Programs Preferred Provider Organization (PPO) Point of Service (POS) Exclusive Provider Organization (EPO) Indemnity Insurance Health Maintenance Organization (HMO) Medicare Risk Emc Carrier Cod NOT USED FOR ANSI. EMC Info.Rec # ZM 1 ( 1 is the number one not the letter L) Primary Carr.ID ZirMed payer number assigned to the carrier. Press F2 and key the insurance company name (or part of the name) to lookup the ID number. If you are not sure which ID# to use, log in to your Zirmed account at If the Primary Carrier ID # is not correct, the claims will be rejected. If you need to add a ZirMed payer ID to the CCA Medical Software, refer to Appendix 2, ZirMed Payer ID Maintenance. When you are finished making changes go to Step 7 of your Checklist. Appendix 1 21

22 Appendix 2 ZirMed Payer ID Maintenance This option is used to add a new ZirMed payer ID to the system or change an existing payer ID. From Modules select: Insurance Billing Send EMC Claims ZirMed ANSI EMC - Professional Control Records and Payers ZirMed Payer ID Maintenance Click New to add a new payer or search for an existing payer by entering the payer ID or Name. Information for the fields shown below is obtained from the Professional Claims, Payers tab or Institutional Claims, Payers tab within your account at ZirMed. Payer ID Payer Name ProfessionalClm Enter the Payer ID indicated by ZirMed for this payer. Enter the Payer Name as showing on ZirMed s website Options are: Blank Not valid for filing Professional claims O Valid for filing Professional claims. Does not require enrollment. X Valid for filing Professional claims. Requires enrollment Appendix 2 22

23 InstitutionalClm Remits Eligibility Max Lines/Claim Options are: Blank - Not valid for filing Institutional claims O Valid for filing Institutional claims. Does not require enrollment. X Valid for filing Institutional claims. Requires enrollment. Options are: Blank Not valid for Remits (ERAs). O Valid for Remits (ERAs). Does not require enrollment. X Valid for Remits (ERAs). Requires enrollment. Options are: Blank Not valid for Elegibility checking online. O Valid for Elegibility checking online. Does not require enrollment. X Valid for Elegibility checking online. Requires enrollment. Enter the maximum # of lines/claim if applicable. Appendix 2 23