How To Use An Ehr For A Patient

Transcription

1 DuxWare Practice Management User Guide Page 1 of 45

2 Table of Contents Patient Registration...5 Finding a Patient...5 Quick Appointment Add...5 Adding a New Patient...6 Completing the Patient Add Process...9 Choosing or adding the correct Responsible Party...9 Choosing or adding the correct Insurance Policy...10 Choosing or adding a Prior Authorization...10 Setting up Patients for Recall Reminders...10 Printing Patient Superbills...10 Special Patient Circumstances...11 Adding a Workers Comp Patient...11 Adding an Occupational Medicine Patient...11 Scheduling...11 Adding a New Patient to the Schedule...11 Rescheduling or Canceling Appointments...13 Charge Entry...13 Page 1 Header...14 Page 2 Extended Header...14 Page 3 Services...15 Charge Entry when using an EHR bridge interface...16 Payments...17 Types of Payments...17 Posting Patient Co-Pays at the time the patient visit...17 Payment Posting at the time of charge creation...19 Payment Posting from the patient ledger...19 Payment Posting from an EOB...20 Payment Posting automatically with ERA (Electronic Remittance Advice)...20 Payment Screen explanation...20 Adding an Insurance payer...22 Payer Add/Edit...23 General Page Billing Page Adding an In-house Physician...24 Editing an In-House Physician...24 Adding Provider Numbers for In-house Physicians...25 Adding a Referring Physician payer Link (Provider numbers)...27 Claims Management Procedures...27 Anatomy of a claim...28 Claim Information...28 Claim Filing Information...28 Claim Service/Payments...30 Claim Sequence...30 Understanding a bit more about Filing Status or Sequencing...30 Claim Filing Status...31 Claim Filing History...31 Payer File...31 How to send claims...33 Batch Claim Filing...33 Page 2 of 45

3 How to print and send Paper Claims...33 How to send Electronic Claims Directly to the payer...34 How to send Electronic Claims Clearinghouse...35 User Management...36 Add a User to DuxWare...36 Program Access...37 User Program Access...37 DuxWare Mobile...38 DuxWare Reports Summary...40 Accounts Receivable Reports...40 Accounts Receivable...40 Aged Accounts Receivable...40 Accounts Receivable Patient...40 Accounts Receivable Payer...40 Collections Reports...40 Patient Statements...40 Statement History...41 Dunning Report:...41 Occupational Statements...41 Daily Reports...41 Daysheet...41 Reconciliation Daysheet:...41 Superbill Recap...41 Printed Superbills Review...42 Claims Filing Status Report...42 Practice Daily Summary Report...42 Recalls and Letters...42 Referring Physician...42 Recall Manager...42 Patient Dunning Letters...42 Listing Reports...42 Payer List...43 Referring Physician Labels...43 Patient...43 Patients by Procedure...43 Patients by Diagnosis...43 Patients by Payer...43 Patient Demographics...43 Patient Payment/Adjustment...43 Patient Inactivity...43 Demographics Export HL Prescriptions...44 Prescription List...44 Procedure /Diagnosis...44 Procedure Listing Report...44 Diagnosis Listing Report...44 Fee File Listing Report...44 Encounters Report...44 Revenue Analysis...44 Procedure Productivity...44 Facility Productivity...44 Page 3 of 45

4 Referral Source Productivity...45 Physician Productivity...45 Physician Group Productivity...45 Payment/Adjustment Report...45 Insurance Report Card...45 Monthly Activity Report...45 Payment Variance Report...45 Practice Reports...46 Practice Activity...46 Scheduling and Appointments...46 Chart Pull Report...46 Superbills by Appointment...46 Facesheets by Appointment...46 Appointment No-Shows...46 Appointment Recap...46 Appointment Status Report...46 Appointment Type Report...46 Appointment Tracking Report...47 Print Schedule...47 Appointment Recap Report...47 Eligibility...47 Eligibility by Appointment...47 Billing...47 Direct Submission Claims Review...47 Clearinghouse Submission Claims Review...47 Submission File Review...48 Electronic Remittance File Upload with auto-post...48 Electronic Remittance File Upload and review without auto-post...48 Review Posted Remit Files...48 List Reports...48 Procedure List...48 Diagnosis List...48 Payment / Adjustment List...48 Fee schedule...48 Management...49 Change / Audit Log...49 User Program Access...49 User Activity...49 Page 4 of 45

5 DuxWare Practice Management Best Procedures DuxWare is a full-featured practice management program that has many wide ranging features to handle almost any practice situation. When you started using DuxWare, your practice was trained in one or more personal sessions that are designed to familiarize you with the features of DuxWare. That training is also designed to teach the users how to use DuxWare on a daily basis to add patients, schedule, enter charges, send claims and print reports. The following pages should be used as a reference for users that have been through DuxWare training and have a question about a particular feature. It is not designed as a complete manual covering everything DuxWare does. Any questions not addressed here should be answered by one of our qualified support technicians by phone or . You might find the info-lite found within DuxWare to be helpful as well. The info-lite is highlighted in the screen example below. Patient Registration Finding a Patient Patients can be found by several search criteria. Select the method of search and enter the information in the box to find you patients by your selection. To find by Name enter all or part of the last name in the search box. To include the first name in the search, after entering all of part of the last name insert a comma (,) and type all of part of the first name. NOTE: There should be no spaces between any characters in the search box. If the patient is found click the name in the list below to access the Patient Information Screen. IF the patient is not found you may click Add to add the patient or Quick Appointment Add to add brief information about the patient in order to add them to the appointment scheduler. Quick Appointment Add To add a patient to the scheduler without filling out all of the patient demographics, choose Quick Appointment Add and fill in the boxes with the information given to you by the patient. The information listed in the boxes can be modified by your DuxWare software support representative to add or remove any information gathered at the time of scheduling. Once you have entered the information about the patient, you will be brought to the default physician schedule to schedule the patient. When the patient arrives for their appointment, you can have the patient fill out the paperwork that will be entered into DuxWare to complete the patient registration. Page 5 of 45

6 Adding a New Patient Proper Patient Registration When registering a new patient, there are several important areas of information that must be recorded. Proper patient registration insures that insurance claims get created and filed properly, patient statements get sent ontime and to the correct person, authorizations and referral numbers get recorded and sent properly, recall appointments help your practice keep track of patients thus aiding in the practice of good medicine. Proper registration is the key to a well-run and efficient practice. It is the first and most important step in good practice management. Demographics- Demographics for the patient is contained within the patient record. The Add Patient or Edit Patient feature allows access to personal demographic information for the patient. The list below details specific and required fields (listed in italics) contained within the Patient record in order of entry. Self explanatory fields have been omitted from this list. Page One Demographics Last Name Required field. Enter the patients last name First Name Required field. Enter the patients first name Alias Used for a patient's maiden name or nickname. It is included in the last name search so if the patient is registered under their maiden or nickname they will be found Zip Code- Required field Enter the Zip Code for the patient and the City and State will automatically be entered on the screen. Date of Birth Required Field: enter the patients birth date without dashes or slashes in this format : (month,day,year). The program will add the proper slashes when it saves Deceased Date- The date listed here will appear on the patient information page in large red letters to alert the staff as to the status of this patient. Social Security Number-Require field for proper claims filing and payment assignment. Student Status- Select from the drop-down list. Appears in box 8 on HCFA form Marital Status- Select the proper Marital Status of the patient from the drop-down list. Gender Male-Female-Organization. Use Organization if the patient you are adding is not a patient but a nursing home, workers comp or attorney's office. Page 6 of 45

7 Home Phone Required Field: enter the patient's home phone or primary phone number If the patient's primary phone is the cell phone, enter it as the Home Phone Employment Status- Choosing either full or part time employment will allow entry of the patients employer in the Employer field. Employer- Search the database of employers or add a new one for this patient Employer Phone Enter the employer's phone if different from the employer phone on record Occupation Record the patient's occupation at work Page Two - Billing Questions Primary Location- Required field indicating which location default will be used in both the claim creation and appointment scheduling screens. Primary In-House Provider Required field indicating which physician default will be used in both the claim creation and appointment scheduling screens. Referring Provider- Choosing the referral source here is defaulted to the Referring Physician in the claim creation process. If the claim being created was the result of another referring physician it may be changed at the time of posting. Check if Primary care is also Referring Physician by checking this box, you are saying that the referring provider is also the patient's PCP Primary Care Provider-If the box was not checked indicating that the referring provider is also the PCP, choosing the patient's PCP here. Defaults the Primary Care Physician in the claim Billing Codes- Required field This field simply indicates whether or not a patient will receive a statement if they ever have a patient due balance. Select from the drop-down list the billing method for this patient. The default is Billing Code G in which the person listed as the patient s responsible party (Guarantor) will actually receive the statement. Billing codes are found in the support menu under the General menu Financial Class- Optional field to categorize patients into distinct financial or grouping classes. This field may be used in special reporting to sub-categorize patients by financial class. Payment Terms- List any specific payment arrangements made with regards to any balances owed by this patient. This information appears only in the Patient Information Screen. Page 7 of 45

8 Medical Records Release-Require field Checking this box prints Signature on File in block 12 of the HCFA form and enters the proper Yes designation in the ANSI 837 electronic claims format. Payment Release- Require field Checking this box prints Signature on File in block 13 of the HCFA form and enters the proper Yes designation in the ANSI 837 electronic claims format. Permission to leave - HIPAA required question to designate whether or not your practice may leave a message on Patient s message on the patient s answering machine. Checking this box means the patient Answer Machine has given permission. Permission to discuss- HIPAA required question to designate whether or not your practice may speak to Medical Condition a third party person about this patient s medical condition as well as the name of the person you are authorized to speak with and the relationship of that individual to the patient. Checking this box means the patient has given permission. Page Three- Messaging Show Message on Patient Checking this box allows Patient Message to appear on the Patient Information Information Screen Screen. If the box is unchecked the message will be recorded but will not pop-up on the Patient Information Screen. Patient Message- Pop-up message specific to this patient. Shows up on the Patient Information Screen if the box is checked. Statement Message- Enter a message to be printed on the patient statement for only this patient which will override the current, 30, 60, or 90 day messages which are automatically printed on statements with regards to the age of their patient balance. Guarantor Only- Checking this box signifies that the person being entered is considered a Guarantor Only and will not be a patient. The Guarantor Only patient is colorized in Blue on the Patient Search list and may be hidden from the list by checking the box Show Guarantors NO in the Patient Search Page. A person who was added as Guarantor Only may become a patient and may be changed by un-checking the Guarantor Only box in the Patient Demographics screen. NOTE: If a person was added as a Guarantor Only they may have not had the Assignment of Release of Medical Records and Release of Payment authorizations checked. It is important to check these boxes if the patient has signed the proper release forms. Other Deleted- The Deleted box will delete the patient from the patient database and they will not show Page 8 of 45

9 on the Patient Search Page unless the option Show Deleted has been checked in which case the deleted patient will appear in Red. To un-delete a patient that has been deleted, un-check the Deleted box and save the patient. No patient is ever erased from the system. Patients with ledger entries can not be deleted. You must first move all of the ledger transactions to the proper patient before a deletion can be made. Page Four Medical History Chief Complaint Allergies Medications To use the optional Med Notes from the Patient Information Screen to give non-ehr doctors a form to write the review of systems on, you would fill in the chief complaint to appear on the form here. Enter the allergies for the patient here Enter any medications the patient is currently on here Completing the Patient Add Process Choosing or adding the correct Responsible Party Responsible Party- The Responsible Party or Guarantor is the person to whom you will mail the bill to if the patient has a patient-due balance and a statement is sent for payment. When the patient was added the Responsible Party was listed as Self meaning that the patient is the Responsible Party and will receive the bill. If the patient has a Responsible Party other than themselves, the proper Responsible Party must be added. This person may or may not be the same person as the Policy Holder for the patient s insurance. Do not confuse the Responsible Party with the Policy Holder as the Policy Holder will be chosen in the Insurance Policies section of the Patient Information Screen. From the Patient Information Screen click on the EDIT bar in the box titled Responsible Party. The Guarantor (responsible party) and Policy Holder search page will appear. Enter the name of the Guarantor to see if the person is already entered into the system. If so, simply select the proper person from the list. If they are not in the list choose Add New and enter the information for the patient s Guarantor (responsible party), save the record and select the proper Responsible Party from the list. To change or edit the Responsible Party, from the Patient Information Screen click on the EDIT bar in the box titled Responsible Party. The person designated as the patient s Responsible Party will appear in the list. Click the EDIT bar and correct the information. Save the record and re-select the Responsible Party. Page 9 of 45

10 Choosing or adding the correct Insurance Policy Insurance Policy- The patient s Insurance Policy information may be added after the demographics have been entered. To add a plan and policy choose ADD NEW on the Insurance Policy bar at the bottom of the Patient Information Screen. You must first choose the Filing Order of this insurance for the patient. This Filing Order will be the default order in which claims will be filed to all of the insurances listed for this patient. During the claim creation process, the defaults will file the claims to the insurances in order of their Filing Order. The order may be changed at the claim creation time if necessary. Enter the appropriate search criteria to link the patient to an existing insurance payer or add a new one. The box Policy Holder is the person who is listed on the insurance card for this patient. You will be prompted to enter the Relationship of the patient to the Policy Holder before making your search selection. Once you enter your search selection, a list of people (both patients and guarantor only) will appear on your screen. If the person you are looking or appears in the list, select them and they will become Policy Holder for the insurance you are entering for this patient. If they do not appear in the list they may be added by selecting Add New at the top. Repeat this step for each valid insurance for the patient. To edit an existing policy for a patient simply select the View or Edit Policy Information bar at the bottom of the Patient Information Screen. The Standard Co-Pay entered at the bottom of the screen will appear both on the Patient Information Screen and on the patient s Superbill. Choosing or adding a Prior Authorization Authorizations- Prior Authorizations and Referral Numbers are recorded under the Authorizations section of the Patient Information Screen. Selecting Add from the Authorizations bar will enable the user to enter proper Authorization numbers to be used when entering claims for patients. Each authorization is linked to an insurance company in which the patient has a policy and may only be used when entering claims for that insurance company. Only one authorization may be displayed in the Patient Information screen although a patient may have an unlimited number of simultaneous authorizations from the same or different payers. By selecting Display in Patient View will allow the user to see the details for this authorization in the Patient View Screen. If more than one authorization exists and they are all checked to appear in the Patient View Screen, the authorization with the latest expiration date is the one that will appear on the screen. Authorizations that have no remaining allowed visits will not show up on the Patient View Screen. To see all active and expired authorizations, select VIEW ALL from the Authorizations Bar. Each authorization will be displayed and may be accessed by clicking on it. Active Authorizations (authorizations with remaining allowed visits) will be accessible during claim creation to be linked to the claim being created. Simply choose from the list and the authorization number will automatically be included on the claim in the proper place both on HCFA forms and in the ANSI file. The number of remaining visits will automatically decrease in count each time it is used in a claim. Setting up Patients for Recall Reminders Recalls- Patient Appointment Recalls are recorded under the Recalls section of the Patient Information Screen. Recalls are reminders that let the practice know that the physician has indicated that the patient should be contacted in order for them to schedule an appointment usually far off into the future. If the patient needs to see the physician in a relatively short time frame a practice may choose to go ahead and schedule the appointment instead of recording a recall. Recalls will be displayed on the Patient View Screen with the next recall in line being the one displayed on the screen. Once the recall is used in an appointment by checking the recall box while scheduling will no longer display on the Patient View Screen. Recalls expired by date will also not appear on the Patient View Screen. Only un-used, future recalls will be displayed. Recalls are accessed off of the Patient Information Screen in the Recall section. The Recall Manager is accessed from the main menu under Appointments Recalls Recall Manager. Printing Patient Superbills The DuxWare program has been designed to generate custom superbills or charge tickets for each patient to be filled out by the physician at the time of the visit. Each superbill has a unique number that should be recorded in the claim creation process. Once recorded, the Superbill Recap Report may be run that will allow the practice to reconcile all superbills printed as well as linked to a claim for the day. Under the Reports menu choose Daily Reports Superbill Re-cap. The report will list all superbills printed for Page 10 of 45

11 the day and list the claim number that was produced using each superbill. Also, any un-used or un-linked superbills that have been issued but for which no claim has been recorded will be listed at the bottom of the report. Only superbills that have been issued and are awaiting posting into the system should be listed at the bottom of the screen. Superbills can be printed three ways in DuxWare. From the bottom of the Patient Information Screen select Print Superbill which will print a single superbill for the patent. The second way to print a single superbill is from the appointment schedule by rightclicking on the patient and choosing Print Superbill. The third way to print is actually a batch print method which prints a superbill for each patient on the appointment schedule for the day. The batch superbill program is accessed from the Appointments Printing Superbills by Appointment. Special Patient Circumstances Adding a Workers Comp Patient Following the above instructions add the patient in the normal manner. Link the patient to the responsible party as self. (See responsible party above). The workers comp insurance company must be added an insurance company and added to the patient s demographics under Policy Add. Be sure that the workers comp company is flagged as a workers comp under payer Type when adding it as a payer. List the patient as the named insured. In this scenario, the patient will be seen by the physician and the workers comp insurance company will be billed for services. There should never be a patient balance on these claims since the workers comp company pay s the full contracted amount and the balance is credited off. Adding an Occupational Medicine Patient Patient s that are seen on behalf of corporations and designated as Occupational Medicine Patients are handled differently. DuxWare allows the patient to be added only once and handled both as an Occ-Med patient as well as a standard fee for service patient. The separation is handled within each claim filed for the patient. Claims that are filed under the Occ-Med payer will be handled separately from those filed under the patient s regular insurance or patient due amounts. To add an Occ-med patient, follow the instructions for adding a patient linking the patient as self under Responsible Party. Add the Occ-Med payer as an insurance company in the patient s demographics under Policy Add. The Occ-Med payer must be added to the payer file and the payer Type will be flagged as Occupational medicine. Furthermore, your will have the choice on how you wish to bill the OccMed company when the patient is seen. Under the Billing Form Type, you may choose Statement or HCFA. Claims for OccMed services with Statement as the billing form type will be sent on a monthly statement similar to the patient monthly statement. You may also choose to have services print on a statement as well as a HCFA form by choosing Statement and HCFA as Billing Form Type. Scheduling Adding a New Patient to the Schedule When a new patient calls for an appointment and Appointment Quick Add is selected, once you fill in the patient information requested you will be sent over to the scheduler. Once on the scheduler you have several options with which to schedule the appointment. Page 11 of 45

12 Simply find an open slot to schedule the patient in, click the slot and choose the proper classifications for the patient. It helps to add in the appointment comment as to why the patient is coming for a visit which will be available on the printed schedule. Once the patient is saved into the schedule, hovering over the name with the mouse reveals other information about the patient. Page 12 of 45

13 Schedules can be viewed one day and up to two weeks at a time on the screen. The most common view is This Week which starts the scheduler on today and out six days to cover the entire week. Multiple providers and/or locations can be viewed together on the single screen as well by choosing MultiDoc from the top of the scheduler and selecting the providers you wish to see on the view. You may also Show Only one day to help patients that can only come in on a particular day every week by using Show Only. The Quick Jump allows you to jump ahead any given amount of time such as 6 weeks, 3 months, 6 months, etc. Simply change the Quick Jump days and interval to meet your criteria and hit the right facing arrow next to the Quick Jump to move forward or the left facing arrow to move backward. Another handy feature is the Find button. This is used to help you find the next available appointment of a particular type such as the next new patient slot available. Or the next complete eye exam slot for practices that use a pre-defined schedule template. Rescheduling or Canceling Appointments Appointments can be Canceled, Re-scheduled by right-mouse clicking on the patients appointment from the schedule. Simply right click, choose Reschedule Appointment and click the patient into another slot that works for them. Canceling is the same except you will need to enter a reason for canceling that will be recorded in the patient record. Charge Entry Proper claim creation and filing is key to whether or not your practice gets paid for services and how promptly payment is made to your practice. The following procedure outlines proper claims creation and filing. From the Patient Information Screen click on the Enter Charges box at the bottom of the screen. The Claim Entry screen will appear with pre-defined defaults already populating the entry boxes. Remember, the defaults come from the patient s demographics screen and may be changed in this claim and/or in the patient demographics to affect any future claims. An alternative way to get to the Charge Entry screen is from the Appointment Schedule itself. Right-click on the patient and select Go To Patient View once there you can click on Enter Charges to create claims. The following fields are available when entering charges; Page 13 of 45

14 Page 1 Header Section 1 payer Information PrimarySecondaryTertiary- The insurance payer you are filing this claim to first Where the claim goes after the primary payer pays and the claim is transferred to secondary. After the secondary payer remits payment, this is where the claim will be sent. Authorization- Select the proper authorization number for this claim SuperbillSelect the proper superbill number for this claim. Only superbills printed for this patient will be available in the drop-down list Section 2 Physician Information (defaults come from the patient s demographics screen) PerformingLocationNOTE: FacilityReferring- Physician performing the services listed on this claim The Physical location of your billing office for these services The Physician and Location chosen here will be the daysheet this service will be included on. If the services were performed in a facility other than your office Name of the referring physician for this claim (this field is a search field and the entire list may be accessed by typing in a? and touching the TAB key to search the database) Primary Care- Name of the patient s PCP (this field is a search Physician field and the entire list may be accessed by typing in a? and touching the TAB key to search the database) Page 2 Extended Header (optional questions accessed by clicking the Extended Header box at the top of the Charge Entry screen) Section 3 Condition Related to Employment- Check if complaint is employment related Auto Accident-Check if complaint is the result of an automobile accident State- Enter the appropriated state code if auto accident Other Accident-Check if complaint is the result of any other accident AbuseCheck if complaint is the result of physical abuse Section 4 payer Classification Accept Assignment- Yes indicates your practice will accept the payer s allowed amount for the billed services (the default is the answer to the accept assignment question in the payer File for this insurance Page 14 of 45

15 Outside Lab?- Yes indicates that this claim includes charges billed to your practice by an outside lab FeeIf Outside Lab is YES, enter the amount of the fee your practice paid for the outside lab services. Section 5 Related Dates (appropriate on select claims only) AdmitDate admitted to the hospital DischargeDate discharged from the hospital First Symptom-Date complaint for this claim first occurred Similar Symptom- Date symptom similar to complaint occurred No Work From-Date patient begins absence from work No Work To- Date patient is able to return to work Last SeenSystemic Date of last visit (specialists only) AccidentDate of accident that caused complaint Section 6 Block 19 Message- Enter any required message to appear in block 19 of the HCFA form only Section 7 Notes- ANSI 837 NTE Segment containing any information required by the Payer. 837 file only Page 3 Services Diagnosis (ICD-9 Codes)- searchable by code or description 1-4 Enter up to four diagnoses for this claim (this field is a search field and the entire list may be accessed by typing in a description and touching the TAB key to search the database) Procedures (CPT-4 Codes)- searchable by code or description From Date To Date ProceduresModifiersDx PointersFees Units POSMessageNDC- Enter the from date of service Enter the to date of service Enter the CPT-4 Code Enter the appropriate modifiers for the procedure code selected Enter the corresponding number(s) of the related diagnoses code at left that matches service Enter or accept the proper fee for this CPT code Enter or accept the number of units of service for this code. Resulting calculation will be the Fee X Units Enter or accept the proper Place of Service Code from the drop-down list NTE segment enter any required service line notes for this service If the selected service requires NDC information, enter it here according to your NDC instructions Page 15 of 45

16 Once the above information has been completed, click the Add Service button and continue to the next procedure for this claim. When you have completed entering your procedures you may review the claim on the screen before Saving. If you find any errors you may click on the service line at the bottom to bring it back to the entry section of the screen for editing. When completed click Save Charges to continue. Next you will be presented with Claim Summary with several options. Click Print HCFA if you want to print the claim, Post Payment to record a co-payment amount collected at the time of service, Create Claim Message if you wish to add a message to the claim, Mark Claim as Manual if you do not want the claim to ever be sent to the selected primary payer or you can Add Recall if you want to schedule a recall appointment reminder for this patient. Charge Entry when using an EHR bridge interface Charges being automatically entered in DuxWare follow the same format as manual claim entry above except the EHR makes all of the entries automatically. To access charges entered by your EHR select Claims Pending Claim Search from the top menu. The Incoming Claim Manager (ICM) will display all un-billed charges that have been sent over by your EHR and allow you to select and create your claims right from the screen. Picture the ICM as a holding pen for charges not yet entered into DuxWare for patients charted in your EHR. Listed on the screen is the service date, Provider, Location and Facility where the service was rendered, Patient Name and Account Number, Diagnosis Codes, Procedure Codes with Modifiers and number of services, as well as Primary and Secondary insurances for the patient. The ID of the incoming charges is listed to the far left of the screen and is an ever increasing number each time a new charge hits the ICM. On the right of the screen there are three select boxes, Create Claim, View Patient and Delete. NOTE: It is recommended that you always View Patient before entering charges to see if there are any special pop-up messages for the patient prior to entering charges. When you first enter the ICM you will be given a list of ALL Incoming Claims for ALL patients, providers, locations, facilities and dates of service. To filter the list by any of the select criteria, enter your selection into the proper field and check the checkbox as indicated. Selecting Show Completed Only to Yes will display only charges that HAVE been entered into DuxWare and claim created. To include any Incoming Claims that may have been deleted, check Show Deleted Yes. Page 16 of 45

17 Payments Types of Payments Payment Posting- there are several ways to enter payments into the DuxWare system. They are; Payments received by patients at the time of service for Co-Pay amounts from their insurance. Payments received at the time of the charge creation Payments received in the mail from Patients Payments received in the mail from Private Insurance, Medicare, and Medicaid The payment posting process is very similar in all cases, however, the way that you find the claim that you wish to pay varies by need. The illustrations below will help you in deciding which method to use when posting payments. Posting Patient Co-Pays at the time the patient visit Co-Payments made by patients when they arrive at the office can be entered by accessing the Patient Information screen either directly from the Patient Search screen or by right-clicking on the patient in the schedule and selecting Goto Patient View. Once on the Patient Information screen, select Pre-Payment at the bottom of the screen and enter the payment amount, type and check number if appropriate. The payment is now held in an un-applied state within the patient's ledger and will be applied when the patient checks out after services are rendered. Page 17 of 45

18 Upon Patient Check-out, once a claim has been entered and saved, pre-payments may be applied to the proper service line by selecting Pre-Payment at the bottom of the Charge Entry Option Screen. Simply use the appropriate drop-down box next to the amount of each service to apply the payment to that line. NOTE: Pre-payments can only be applied to one line item on a claim and must be applied in full. Illustration 1 By selecting Pre-Payment from the Patient Information Screen you can choose the type of payment and enter the amount to be applied once the charge is created. Illustration 2 After saving the charges, you will see the amount of the pre-payment taken earlier in the Pre-Payment section of the screen below. Illustration 3 To apply the pre-payment, select the drop-down to the right of the service you wish to apply the pre-payment to and click Save at the bottom of the screen. NOTE: Only one service line can be selected for pre-payment posting. Page 18 of 45

19 Payment Posting at the time of charge creation At the time of entering the charges you have the option to Post Payment. Answering YES will allow the user to enter the copayment from the patient into the ledger for this claim if the pre-payment or co-payment has not already been taken and applied to the account as seen in illustrations 1,2 and 3.. Payment Posting from the patient ledger From the Patient View Screen, select Access Ledger. Once the patient s ledger items are listed simply click on the claim you wish to pay to highlight it, and from the items at the bottom of the ledger choose Pay Claim. Page 19 of 45

20 Payment Posting from an EOB From the Menu Bar at the top of the screen, choose Claims, select Payments, then Payments by Claim. You will be prompted to enter a claim number in order to make your EOB entries. In most cases the EOB will give you the proper claim number as the Patient s account number. On the HCFA form and appropriate area in electronic claims, the DuxWare program prints the Claim number in the Patient Account Number field. When the number is put on the EOB it may have some other numbers added depending on how your system is setup. For instance the number may appear as; #SLI or #1. What you are looking for is the actual claim number which, in this case is The - after the claim number and the number following the dash is the Claim Sequence Number. This number, starting with the number 1 is the filing order of this claim. Primary filings will get sequence #1, secondaries are sequence # 2, if the claim still has balance after both the primary and secondary pay and you transfer the claim to the patient for payment that would be sequence # 3. To continue posting your payment you would enter the claim number which would be 4356 and select OK. Payment Posting automatically with ERA (Electronic Remittance Advice) If your office is able to download an Electronic Remittance Advice from your clearinghouse, DuxWare will automatically post the payments, make the proper write-offs and even prepare the secondary claim (if there is one) for filing. This is by far the easiest way to post payments! Enrollment and configuration is required. Check with your DuxWare service center for details. Payment Screen explanation Page 20 of 45

21 The following fields are in the Payment Screen; Payment Information (EOB/Patient) Claim- The system generated claim number (sequential one higher than the last used claim number). This number is not editable. Paying Carrier-Choose the source of this payment selectable from the available policies owned by the patient or the patient them self. (Sequence)- The number in (parenthesis) after the payer designates the order of filing from the patient insurance policy screen. Physician Name- The name of the physician for which the claim was generated (cannot be changed) LocationThe location where the services were rendered (This location cannot be changed) NOTE: The Physician and Location listed here will be the daysheet this payment will be included on. Transfer- Check this box if you wish to forward the remaining balance of this claim after this payment has been posted to the next payer or to the patient as an item on their statement for further payment. Note: this box will not be checked when entering patient co-pays at the time of service entry but will be used when entering mail or EOB payments. Mark as Mailed- If the Transfer box has been checked, selecting this box will record the transferred filing of this claim as being marked or filed without actually sending or printing a claim. This feature is used to record claims that have been automatically filed to the next payer by the primary insurance company. An example would be Medicare automatically crosses-over claims to the secondary and there is no reason for you to actually mail or electronically send the claim to the secondary. Note: this box will not be checked when entering patient co-pays at the time of service entry but will be used when entering mail or EOB payments New Primary- If the Transfer box has been checked, select the payer (or patient) next in line to pay the remainder of this claim after the payment has been posted. Note: this box will not be checked when entering patient co-pays at the time of service entry but will be used when entering mail or EOB payments New Secondary- If the Transfer box has been checked, select the payer (or patient) second in line to pay the remainder of this claim after the payment has been posted. Note: this box will not be checked when entering patient co-pays at the time of service entry but will be used when entering mail or EOB payments Payment Type-Select from the choices the type of payment being posted. Adjustment Type- Select from the choices the type of adjustment (write-off) that will be used during this payment posting if there will be any write-offs taken at this time. Check Date- Date listed on the check being posted Check Number- Number listed on the check being posted DeductibleDuring EOB posting, if there was any portion of this payment credited to the patient s deductible enter it here. Note: deductible will not be used when entering patient co-pays at the time of service entry but will be used when entering mail or EOB payments Proportionate?- When entering a payment in full or a payment for a claim with only one line of services, choosing proportionate will apply the payment entered in the total payment line to the service line listed below. As well, if the patient has a 20% co-pay, you may allow the system to enter the payment proportionately to all service lines in the claim. It is recommended that this feature be used only in cases outlined above. Page 21 of 45

22 PaymentWrite-offWithholding- Interest- Balance- Enter the total amount of the payment for this claim. In the case of a patient payment posted at the time of the service, enter the entire amount of the check to be posted to this claim. Enter the amount of the write-off to be credited to this claim. Most cases not used at the time of posting a patient payment at the time of the charge entry but will be used when entering mail or EOB payments. Enter the amount of withholding held by the insurance company to be credited against this claim. Most insurance companies no longer withhold monies from providers for payment at year end after insurance companies goals have been met. If they do, this is where the withholding amounts are recorded. This amount will be deducted from the patient s claim ledger. This feature will not be used at the time of posting a patient payment at charge entry but will be used when entering mail or EOB payments During EOB posting, if there was any interest payable to the provider included in this payment. The interest entered here will be recorded as a payment to the provider but not be reflected as a payment in the patient s account. Note: deductible will not be used when entering patient co-pays at the time of service entry but will be used when entering mail or EOB payments The remaining balance of the claim. This amount has already been modified by any previous payments and adjustments and reflects only the actual remaining balance of this claim. Services being paid Services are the CPT or Procedure codes filed on the claim with their respective charges. DuxWare is a line-item accounting system meaning each service line will have a payment posted to it as well as any appropriate adjustments. The claim is considered satisfied when all lines have been paid and/or adjusted to a balance of zero. From DateCptModsDescriptionUnitsChargePaymentWrite OffWithholdingInterest- Date of service on this claim Procedure code billed on this claim Modifiers used on this procedure Description of charge Number of Units billed on this line item for this claim Original Billed fee for this procedure Enter the amount of payment to this procedure line (if the claim only had one service the amounts will automatically filled in from the entries above) Enter the amount of write-off to this procedure line (if any) Enter the amount of withholding to this procedure line (if any) Enter the amount of interest paid on this procedure line (if any) Enter each payment on the appropriate line and any contract write-off amounts. If the claim has a message that was entered previously, there will be a spinning star on the left side of the screen. Hovering the mouse over the Msg star icon on the left side of the screen. When you have entered all of the payment information you may save the payment in one of two ways. Clicking on the Save button will simply save the payment and exit the program. If you are posting an EOB with many claims you will need to select the box labeled Save and Do Another. This method will retain all of the previously entered information about the Check Date, Check Number, and Insurance company and allow you to continue posting payments from that EOB. This will save you from having to re-type that information. Selecting Change to a Different Claim Number will allow you to switch claims a wrong claim number is entered. All payments will be printed on the Daysheet or Daily Reconciliation Report for the date that they are entered into the system. Adding an Insurance payer Insurance Payers may be added from the Patient Policy Add page or directly from the payer menu located under Support General - Payer Setup. From the Payer Search screen, type in the insurance company name and click Search to see if it is already in your database. Searches may be made by Name, ID, Address, City, State, or internal payer Code. If your payer is not found, click Add New. Page 22 of 45

23 Payer Add/Edit General Page 1 Payer Name- the name for this payer Code- Use this field for an internal code for this payer (i.e. Blue Cross may be BCBS) Payer Group this field allows you to add this payer to a group of payers that will be grouped within certain reports. Payer groups are assigned under the support menu, General, Payer Group Setup. Choose None or pick an existing Payer Group. Payer Type- This field allows the user to choose under which reporting bracket charges and adjustments for this payer will appear. Special claim and billing formatting is also handled based upon payer Type. Address, Zip, City, State- Billing address for payer Primary Phone Primary phone that shows in the patient information screen Secondary Phone - Alternate phone number for this payer Fax Fax number for this payer Web Address payer web address Contact Person name of a person who is helpful at this payer that will appear on dunning report Notes notes about this payer that only appear on this screen Superbill Message this message will show up on the Superbill for all patients with this payer as primary. Patient Message this message will show up on Patient Information Screen for all patients with this payer as primary. Billing Page 2 Billing Form Type Select the proper type of form for services to be billed to this payer. Note: some occ-med payers require both HCFA and Statement billing which is one of your options. Accept Assignment Choose whether or not your office accepts assignment for this payer (defaulted to yes) Capitated Carrier - Choose Yes if it is a capitated health plan Electronic Claims Options Submit Claims Electronically - Choose Yes if this payer will be filed electronically. Choose No if paper claims EMC Submission Method Select the proper EMC submission method (Direct, Clearinghouse, Other or None) Page 23 of 45

24 Allow Secondary Filing Electronically Selecting Yes sends secondary claims to your clearinghouse batch HIPAA carrier indicator Required for some payer plans. Select from the drop-down menu Claims Payer ID Enter the National Payer ID Number (Required by some clearinghouses) Eligibility Payer ID For electronic eligibility checks, some payers require this ID Allow Eligibility Request Payers that allow instant eligibility checks need to have Yes checked Eligibility Request Setup - This option links the eligibility request to the correct 270 setup necessary for quick check eligibility requests. Eligibility setups are configured under the electronic send configuration accessible from the Claims menu Electronic Send Send Configuration. (You will need help from MPS for this setup) HCFA-1500 Fields Special in Block 19 Enter information if this payer requires special information to be present in block 19 Secondary Payer code - Add the Medicaid Secondary Payer Code Medigap code - Add the Medicare crossover (Medigap) code if available for Block 9 Print Payments on HCFA Choosing Yes makes payments to the claim appear on the HCFA form Last Updated By User that last updated this record Entry Date Date this record was added or last modified Deleted Choose Yes to delete this provider number Adding an In-house Physician If you have a provider that needs to be added to your system, call Medical Practice Software at for assistance. Editing an In-House Physician Once a provider has been added by MPS you can manage the data by selecting Support Provider Provider Setup. Select the provider from the list and make the necessary changes. Name/Setup Information Code The internal physician code used on some reports and data screens Entity Signifies whether physician is an individual or an organization Selection Order In the dropdown list where physicians are selected, the order can be controlled by the selection order. Items are ordered with the lowest number first starting with 0, 1, 2, etc Last,First,Mid,Suffix Physician information as listed Internal Name In the appointment scheduler providers are often used multiple times such as when a nurse practitioner sees a patient but must be billed out as the primary provider. When an internal name is entered, that is the name you will see in the scheduler for that provider. Contact information Self explanatory Page 24 of 45

25 Numbers Information: State License number not used in DuxWare but may be listed for your internal records State Narcotics License - not used in DuxWare but may be listed for your internal records DEA Number used only in the RX printout Taxonomy Enter the 10 digit taxonomy code assigned to this providers specialty (required) Personal NPI used for billing for this provider (required) Group NPI If this provider is part of a practice group that has been issued a Group NPI UPIN no longer used Federal ID (tax) enter the providers Tax ID or SSN whichever is used for billing purposes check the box Other Information: Supervisor Code If the provider you are editing requires supervision from one of the practices other providers. select from the dropdown list the supervising provider. Superbill By default, which paper superbill does this physician use Allow Appointments Choosing Yes allows this provider to have a schedule Notes not used by DuxWare, enter configuration notes for your internal use Adding Provider Numbers for In-house Physicians Providers that are assigned individual provider numbers by specific payers must have matching entries in the Provider File. The NPI number was designed to eliminate the use of provider numbers and will eventually make the need for this file obsolete. Access the provider file by selecting Support Physician Provider from the menu bar. Search for existing provider numbers either by Physician Name, Physician Code, payer Name, or Location Name. To add a new provider number choose Add New. Physician Select the physician whose provider number you are entering Location Select the location this provider number is valid. Selecting ALL means that this provider number applies to all locations. payer Choose ADD to select from the payer List for this provider number Provider Number The number assigned by this payer for this provider Group Name If this provider is part of a group for this payer and the group is assigned a group name Group Number - If this provider is part of a group for this payer and the group is assigned a group number NPIN Overrides the NPI or Group NPI numbers in the Physician File Priority Order is; Physician File NPI Physician Group NPI in the Physician File Provider NPIN from the Provider File Block 33 Name Overrides the Location or Physician s Name in Block 33 Priority Order is: Physician Name Page 25 of 45

26 Location Name (selected in Defaults File) Provider Block 33 Name Block 33 Provider Number Provider number for this payer (block 33b New HCFA or 33 PIN Old HCFA) Block 33b Group Number Group Number if any (Block 33b New HCFA or 33 GRP Old HCFA) Block 24 J K Number- Provider number for this payer (24j New HCFA or 24k Old HCFA) Block 10d Reserved for local use block on the HCFA form only (not in ANSI 837) Block 17a Overrides the UPIN number from the Referring Physician File (HCFA only not in ANSI 837) Block 19 Special entry for Reserved for Local Use on HCFA form only. Overridden by claim entry Block 19 entry Block 23 Prior Authorization Number Overridden by Authorization if used on the claim from the Authorization file ANSI 837 Group Number Group Number assigned by this payer for ANSI 837 claim format (may be the same as the group number entered above) ANSI 837 Provider Number - Provider Number assigned by this payer for ANSI 837 claim format (may be the same as the Provider number entered above) HIPAA Provider Number Type The Entity type required by CMS for ANSI 837 claims (Note: use Blue Shield Provider Number Type on all Blue Cross claims) Default Modifier 1st modifier to be used in special cases such as QB modifiers for Medicare Last Updated By User that last updated this record Entry Date Date this record was added or last modified Deleted Choose Yes to delete this provider number Adding a Referring or Primary Care Physician Referring Physicians are used in DuxWare to record the outside or in-house physician that referred the patient to your practice. Access to this file is from the menu select Support Physician Referring Physician Add/Edit. Referring physicians are also accessed during the Claim Creation process. Once in the Referring Physician Add/Edit screen you may search for the Referring Physician either by Name or Referring Physician Code. To add a new Referring Physician select Add New. Code Enter the code to represent this referring physician Entity Choose the entity type, Physician for an individual physician or Organization if a group In-House Physician Select Yes if this physician works at your practice Name Last, First, Mid and Suffix of referring physician Address Addresses of referring physician s office Zip Enter the Zip code for the referring physicians address to find the correct city and state Telephones Telephone contact information for this referring physician Web Address Referring Physician s practice web address Referring Physician s address Contact Person main contact at the physician s office Practice Name Group Name of practice License Number Referring Physician s License number (not currently used) DEA Number Referring Physician s DEA number (not currently used) UPIN Referring Physician s UPIN number (appears on block 17a New HCFA and 17a Old HCFA) NPIN - Referring Physician s NPI number (appears on block 17b New HCFA) Taxonomy Referring Physician s Taxonomy Code (not used) Page 26 of 45

27 Notes Notes regarding this referring physician (only seen in this file) Entry Date Date entered or last updated Last Updated By User adding or last updating this record Deleted Select Yes to Delete this Referring Physician from the table Adding a Referring Physician payer Link (Provider numbers) Referring Physicians that require specific provider numbers for specific payers must be added to the Referring Physician payer Link file. This file populates both block 17 and 17a of both old and new HCFA forms. It is payer specific and will override the use of the Referring Physician s UPIN number entered in the Referring Physician file for the payer listed. To access this file select Support from the menu bar, Physicians, Referring Physician payer Link. Searches may be made by payer Name or Referring Physician Name. Select Add New to add a record to this file. Referring Physician Choose the Referring Physician from the available list payer Choose the payer issuing the number Identification Enter the Referring Physician s Number Name Type the name that will override the Referring Physician s Name from the Referring Physician file if needed HIPAA Provider Number Type Select the proper HIPAA classification for this number Last Updated By User adding or last updating this record Deleted Select Yes to Delete this Referring Physician from the table Claims Management Procedures Proper claims management is extremely important to the health of any practice. DuxWare has been designed with specific procedures that makes the management of your claims through and effective. Listed below are the processes and steps necessary to properly manage your claims. NOTE: Some features are optional and do not apply to all practices. Page 27 of 45

28 Anatomy of a claim Important areas Claim Number Unique number assigned to the claim Claim Sequence Number assigned to each filing of the claim beginning with number 1 Claim Filing Status Current Status of the claim and sequence Mark Number Unique batch number this claim was filed with Entry Date Date claim was entered into the computer Batch Date Batch-Date claim was entered into the computer (optional) Sequence Date Date current claim sequence was created Mail Date Date claim was filed with this sequence Claim Information Accessible from the ledger by clicking Claim Information this screen allows you to see the Header information contained on the claim. Changes are also possible to correct claims for re-filing. Claim Filing Information The second page of the Claim Information screen contains the filing history and sequence of the claim. The sequence is where the claim was on file (which payer) and in what order it was filed. The filing history is the actual record of sending the claim to the payer or patient and the dates it was sent. Page 28 of 45

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30 Claim Service/Payments The Claim Information Service/Payments is the listing of all of the charges and the associated payments and adjustments made on the claim. Items in this screen may also be edited to correct claims for re-filing. NOTE: Changes made to completed claims are restricted by user level. Changes do affect previously run reports so it is important to know that when making certain changes to claims, reports may have to be re-run to reflect the changes. Claim Sequence Claim Sequence is used to keep track of who the claim is on file with. Claims, when originally created are assigned sequence number 1 and normally filed with either the patient s primary insurance company or in the event that the patient does not have insurance, directly to patient responsibility. Claims, when filed secondary, transferred to the patient for statement billing, or re-filed with the same payer will be assigned sequence number 2 or greater depending upon the number of times the claim is re-filed. Each sequence has it s own Filing Status and will be dealt with individually based upon the sequence filing status. Understanding a bit more about Filing Status or Sequencing The Filing Status Sequence is the order that a claim is filed to insurance carriers and patients. The first sequence created should ALWAYS be to the Primary Carrier ONLY. Sequence 2 should be created and filed ONLY to the secondary, sequence 3 ONLY to the tertiary and so on. Realistically, there should never be more sequences than the number of active policies on a patient s account and a final sequence for the patient if the claim was not paid fully by the patient s insurance(s). As an example, if a patient has two insurance carriers: sequence 1 is filed to the primary insurance. After payment is received from the primary carrier leaving a balance on the claim, sequence 2 is created and filed to the secondary insurance. Once the payment is received from the secondary filing, if there is still a balance due from the patient, sequence 3 would be created and billed to the patient on a statement. There are some instances where sequences may be created that do not fit the above filing order but can be handled properly to keep the same continuity intact. For example; if a claim is filed to a patient s primary insurance but the patient changes their insurance after you filed it, you should correct the claim instead of just transferring the claim from the wrong insurance to the correct one. To correct the claim you would add the new insurance to the patient s account from the Patient Information Screen under the policy section as normal. You would also change the filing order of the old insurance to D meaning Deprecated which will keep you from using the incorrect insurance in the future for this patient. Next, the Filing Status of the incorrect claim should be changed from the old, now deprecated insurance to the new one. The way this is done is to get into the patient s Ledger, highlight the claim in the ledger and select the Claim Information button at the bottom of the screen. Choose the Filing Information button at the top or the bottom of the screen to reveal the Filing Sequences and Filing History information page for the claim. Click on the claim in the top section of the screen listed as Primary under the Sequence column. This will bring up the Claim Filing Status and Sequencing page for the selected claim. Next, simply change the Primary carrier at the bottom of the page from the incorrect insurance to the correct one by using the drop-down arrow on the right. You must also change the Filed status of the claim to Pending in order for the claim to be transmitted in the next batch. To save the changes click the Save button at the bottom of the page. Another common task is to re-file a claim to the same carrier after correcting a claim. To do this you should either simply re-print the claim if it is being sent paper or follow the above procedure to change the filing status from Filed to Pending if it is to be sent electronically. Remember: only Primary claims are transmitted electronically so if you wish to re-file a corrected claim electronically you MUST follow these procedures keeping the claim on the primary filing status and changing it to Pending. Secondary or higher sequences will not go electronically. Page 30 of 45

31 To help everyone understand sequences better, the terminology used in DuxWare to indicate which filing a claim is on has been changed from sequence numbers to its appropriate filing nomenclature. The change was made to help clarify where the claim is in the filing process. The changed sequence nomenclature is; Sequence 1 Primary Sequence 6 - Senary Sequence 2 Secondary Sequence 7 - Septenary Sequence 3 Tertiary Sequence 8 - Octonary Sequence 4 Quaternary Sequence 9 -Nonary Sequence 5 - Quinary Sequence 10 - Denary If you have more than 10 sequences for a claim, something is drastically wrong with the way that claims are being filed and you should call Medical Practice Software for help with this problem. Claim Filing Status Claim Filing Status indicates where a claim is currently in the billing process. The statuses are; Pending Claim has not been filed and will be sent with the next appropriate batch Sent Claim has been filed Hold Claim is on Hold and will not be filed Manual Claim has been marked manually and will not be sent Pre-Scrubbed (Optional) Claim will be sent to the Claim Scrubber for validation Claims created in DuxWare are automatically set to a Filing Status of Pending unless the optional Claims Scrubber is in use at your practice. If the Claims Scrubber is used, all claims are automatically set to Pre-Scrubbed initially, once scrubbed, the claims are then set to Pending. Generation of subsequent sequences in either case will automatically set the claim to Pending unless the user chooses Marked as Mailed when creating the sequence (explained later). Simply, the Claim Filing Status tells you what action has or will be taking place regarding the filing of the claim and to whom the claim has been or is currently on file with. Claim Filing History Claim Filing History indicates when a claim was actually filed (printed, electronically filed or included on a patient statement). A Claim Filing History may exist for each sequence as each may be filed separately. Simply, every time a claim is filed to someone a Filing History is created. These three areas, Sequence, Filing Status and Filing History keep track of where and when a claim has been filed and to whom it is filed with. Understanding these areas is important to understand what is happening at any given time to a claim. This information is contained within the Claim Information from the patient s ledger as well as from the Claim Menu. Proper management of claims begins with proper entry of the insurance payer that you are filing the claim to. Payer File When an insurance company is added to the payer File there are several important selections that must be made in order to properly file claims to the payer. These questions are found on the second page of the payer Add/Edit screen and may be accessed from the menu by choosing Support General payer or from the patient s Policy Add/Edit at the bottom of the Patient Information Screen. The following fields in the payer file determine how claims to this payer will be filed; Billing form type HCFA-1500, UB92, ADA, Kidmed, Statement Only or Statement & HCFA Submit Claims Electronically- Check Yes if this payer is filed to electronically or No if paper claims are used EMC Submission Method Choose Direct if your practice sends claims directly to this payer (ie Medicare Direct) Choose Clearinghouse if you submit electronically through a clearinghouse Choose Other if claims to this payer are submitted any other way All other fields in the payer Add/Edit screen may have relevance in order for your claims to be paid, however the above three fields are the only ones that determine how claims will be sent for this payer and are therefore contained in this section. NOTE: See billing page two above to Page 31 of 45

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33 How to send claims Batch Claim Filing Claims are filed (printed) either individually at the time of creation or by Batching which allows the practice to send all of the appropriate claims at one time. Batching is the most often used method and the only method by which electronic claims may be sent. There are three processes in the batch procedure and all are very similar in function. Batching procedures are specific to the practice but all fall into the categories below. They are; Paper Claims printed at the practice Electronic Claims Direct to the Payer Electronic Claims through the Clearinghouse How to print and send Paper Claims Paper Claims Batches will gather and print paper HCFA forms to be mailed to the payer from your office. This batch is accessed and created by selecting from the Menu Claims Print Claim Forms. Enter your selections to print the Paper Claims Review by clicking Generate Filter List. The report that runs will batch all un-billed paper claims as chosen in the Payer Add/Edit file when the billing question Submit Claims Electronically? is set to No. From the Paper Claims Review choose; Date to batch claims through (usually today) Physician (default ALL) Location (default ALL) User (default ALL) Sequence Selection To print ONLY Primary Claims choose Primaries Only, to print all other choose Secondaries Form Type HCFA-1500, UB92 or ADA. Pick the correct form Include Electronic payers ONLY if your practice DOES NOT submit electronic claims Generate Filter List will run the report The Batch Report that is created will be a list of all claims that will be printed. You are given an opportunity to review the list and make any corrections if applicable. Corrections can be made to claims right from the report by clicking on the heading bar containing the claim number and patient name. A correction window will open with that claim number available for edits. Make necessary changes and hit Save Claim Information Changes or click the Services button at the top to make changes to procedures or fees for the claim and click Save at the bottom of the screen. NOTE: If corrections are made you must re-run the HCFA Form Filter List to include any changes to claims that you made. Once you have a clean Paper Claims Review List on your screen you should choose the printer Icon at the top of the screen and print a copy of the list for your records. Once printed you will need to load your printer with HCFA forms and choose Generate Forms from the top of the report. Once the forms have completed printing you will choose Mark Claims. It is important that you write the Mark Number on the front page of the Paper Claims Review List that you printed in case you ever have to un-mark the entire batch for re-filing. In summary the steps to file paper claims are; Menu Claims Print Claims Forms Generate Filter List Fix errors and re-run filter Print Filter Report Generate Forms Mark Claims and write batch number on filter Mail Claims to the payers from your office Page 33 of 45

34 How to send Electronic Claims Directly to the payer Electronic Claims Batches will gather and create the proper file to be transmitted directly to the payer from your office. This batch is accessed and created by selecting from the Menu Electronic Send Direct Send. From the Direct Submission Claim Review Date to batch claims through (usually today) Physician (default ALL) Location (default ALL) Group (drop down to select your pre-defined direct send group) Generate Filter List The Direct Submission Claims Review list that is created will be a list of all claims that will be included in your file. You are given an opportunity to review the list and make any corrections if applicable. If corrections are made you must re-run the report to include any changes to claims that you made. Once you have a final Clean Filter List on your screen you should choose the Printer Icon at the top of the screen and print a copy for your records. Next, choose Generate File and save the file to your desktop. The file will be named on the save screen. i.e. Medicare claims will be named medpartb. Next choose Mark Claims. Note: It is important that you write the Mark Number on the front page of the Filter List in the event that you have to un-mark the entire batch for re-filing. Once the file is created and the claims have been marked you will send the file to the payer in the normal fashion using a web transfer or a direct modem connection. In summary the steps to file Direct Electronic Claims are; Menu Claims Electronic Send - Direct Run Direct Submission Claims Review report Fix errors and re-run report Print Report Generate File and save to your desktop (ie. Medpartb, claims.txt) Mark Claims and write batch number on report Send Claims to payer Page 34 of 45

35 How to send Electronic Claims Clearinghouse Electronic Claims Batches will gather and create the proper file to be transmitted directly to the payer from your office. This batch is accessed and created by selecting from the Menu Electronic Send Clearinghouse Send. From the Clearinghouse Claims Review report; Date to batch claims through (usually today) Physician (default ALL) Location (default ALL) Group (Choose Clearinghouse claims if your practice submits through the clearinghouse only to payers listed as Yes to Submit Claims Electronically and the submission method is set to Clearinghouse.) (Choose All Excluding Secondaries if your practice sends all primary sequence 1 claims electronically through the clearinghouse which dis-regards the selection in the payer file) Generate Filter List The Clearinghouse Claims Review report that is created will be a list of all claims that will be included in your file. You are given an opportunity to review the list and make any corrections if applicable. If corrections are made you must re-run the report to include any changes to claims that you made. Once you have a final clean report on your screen you should choose the printer Icon at the top of the screen and print it. Next, choose Generate File and save the file to your desktop. Clearinghouse files are named claims.txt. Next choose Mark Claims. NOTE: It is important that you write the Mark Number on the front page of the Filter List that you printed in case you ever have to un-mark the entire batch for re-filing. Once the file is created and the claims have been marked you must actually send the file to the clearinghouse in the normal fashion. In summary the steps are; Menu Claims Electronic Send Clearinghouse Send Run Clearinghouse Claims Review report Fix errors and re-run report Print report Generate File and save to your desktop (claims.txt) Mark Claims and write batch number on filter report Send Claims to payer Page 35 of 45

36 User Management In order for a user to access DuxWare they will have to be added into the User Table. Users are issued a login code and a password. Per HIPAA requirements the passwords will reset after 30 days at which time the user will enter a new password from the login screen. NOTE: User Level 5 (Management) is required to add or remove users from DuxWare. Add a User to DuxWare To add a new user to DuxWare follow the steps below; Select User Information from the Support Menu Choose User Setup Click Add New Choose and Enter a user code to be used as a login code for the user (usually the user's initials) Enter the users last named and first name Enter the password the user will enter to gain access to DuxWare Re-enter the password Select the user level 0 5 Level examples Level 0 For users who only access the system for informational purposes such as nurses Level 1 Front desk users who add patients but do not enter charges Level 2 Front desk users who add patients and enter patient payments Level 3 - Back office users who add patients, enter charges and payments and run reports Level 4 Back office users who handle all back-end duties and run revenue analysis reports Level 5 Management level user who has unlimited access to all areas of DuxWare. This level is able to create and delete users. If this user will have the ability to delete records when necessary select Yes for the question Allow user to Delete Page 36 of 45

37 Program Access All programs within DuxWare have a pre-configured user level access to allow you to control which users have the ability to do certain functions in the DuxWare. The Program Access lists each program and the minimum user level necessary to perform the function of the program. To access the Program Access follow the steps below; Select Support Select Management Select Program Access Click Search to list All programs and the required level necessary for access or functionality If you wish to change level access across the board on a program, select the program from the list and adjust the level as appropriate. User Program Access Programs that have levels set in the Program Access may be adjusted for individual users. This would be helpful if you wish to grant or deny access to a particular program for an individual user that would normally have access or not have access to the program due to the level assigned the user. This program overrides the Program Access levels. To Allow or Deny access follow the steps below; Select Support Select User Information Select User/Program Access Choose Add New Select the user you wish to set access for Select the program from the drop-down list that you wish to allow or deny. Note: If the program is allowable in the general Program Access for a user with a given user level, checking the Allow Access NO button will deny that user from accessing the program selected. If the program is not allowable in the general Program Access for a user with a given user level, checking the Allow Access Yes button will allow that user access to the program even though their level does not allow access. Page 37 of 45