Daily Procedures Unit 7

Transcription

1 Daily Procedures Unit 7 The Daily Procedures unit contains the following chapters: Processing Claims and Pre-Authorizations Aging Accounts Processing Statements ebusiness Online Center EagleSoft EveryWare End-of-Day/End-of-Month and Year Patterson EagleSoft Overview Daily Procedures Unit 7 457

2 Processing Claims and Pre- Authorizations Overview The Process Insurance Claims window in EagleSoft offers more ways to work from one centralized place. There are new ways to edit, view and print claims. You can also make payments, re-create claims and change insurance answers all in this window. The following information is in this chapter: Batch printing insurance claims and pre-authorizations Making payments on claims Closing/re-creating claims Reprinting insurance claims and pre-authorizations Submitting electronic claims and pre-authorizations Adding notes about a claim or pre-authorization Closing unpaid claims and pre-authorizations Changing insurance/employer information Changing insurance answers 458 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

3 An Introduction to the Claims Window Accessing the Claims Window To access the Process Insurance Claims window: From the Activities menu, choose Process Insurance Claim. -or- Select Claims from the toolbar or press CTRL + I. -or- From the Account window, right-click in the top and select View Claims for Account or View Claims for Patient. From the Integrated Mode window, click on the Insurance icon. From the Practice Management Insurance icon. Find Name Front Office window, select the Use the Find Name box to find a particular patient with insurance information by typing the last name of the patient and pressing the Tab key. Print Envelopes/Labels If checked, this feature prints your choice of mailing labels or envelopes for each claim that is printed. If multiple claims exist for the same insurance company, it prints an envelope or label for each of those claims. Show What Check one of the following to change ledger view according to claim type. Show Claims and Pre-Auths Show Claims Show Pre-Authorizations Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 459

4 View Click one of the following checkboxes to change the ledger view according to claims status. Unsubmitted Unprinted paper claims Unsubmitted Elec Claims waiting to be submitted electronically O pen Waiting for a payment on the claim In Process Waiting for eclaims reports only Ledger Claim Information Patient Name The patient f or whom the claim has been generated. Date Created The date the walkout was processed. Days Outstanding The number of days since the claim was printed or submitted. Form N ame The form used to print the claim or submit the claim electronically. ADA 1990/ ADA 1994/ADA 2000/ADA 2002/ADA 2006 Lines, teeth, boxes and so on, al ready printed on the paper (pre-printed form) Blank ADA 1990/ADA 1994/ADA 2000/ADA 2002/ADA 2006 Blank piece of paper is used. The printer you are using prints the lines, teeth, boxes and so on CMS 1500 Prints on an AMA form (pre-printed form) Denti-Cal A California dental claim form Elec. Denti-Cal An electronic California dental claim form E lectronic Submit Submits the clai ms electronically to the clearinghouse for distribution to insurance Print Waiting to be printed Open Has been printed or submitted electronically and is awaiting payment from insurance Closed Has been closed by being marked final upon payment from insurance or marked closed from the Process Insurance Claims window Elec. (Electronic Submit) Waiting to be submitted electronically Marking Claims Mark a claim by highlighting the claim, then clicking Mark, or by double-clicking on the individual claim. This places an arrow next to the claim you have marked. To unmark the individual claim, highlight the claim and click Clear. Auto-Mark Select any amount of claims, right-click, and change the form or mark them for submission. To use this function, click on a claim, hold down the Shift key and click another claim to select a group of claims. To mark the claims for submission, rightclick and choose Mark. You can also use the Ctrl key and mouse to select multiple nonsequential claims. 460 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

5 Mark All or Clear All Mark all of the claims by pressing the Mark All button. Use the Clear All button to unmark all marked claims. Again, when claims are marked to be printed, an arrow will appear next to each claim. Changing Forms From the right-click menu, you can select a new form for the highlighted claim(s). Claim Actions Processing Claims Submitting and printing claims is often time-consuming, stressful and inefficient for the entire office. The Claims Processing window in EagleSoft not only speeds up the process but it gives you several options when submitting the claims: entering notes, changing insurance answers and many others. Select a claim or claims. When you have marked a claim, click Process. The claim should then be processed, and the status will change. Viewing or Editing Claims From the View options, choose the category for the claim(s) you want to view details for. Highlight (or click on) the claim to be reviewed. Click View Claim to display the highlighted claim. The services are displayed as they are entered during the walkout. Click Notes to enter notes pertaining to the current claim. These notes will appear in the Account window. To add a note, click Add. After viewing or adding notes, click the Close button. Select the checkbox to add the note to the patient s account statement. Click Chg (Change) Answers to change insurance answers. For more information on this option, refer to the Change Answers section later in this chapter. Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 461

6 Closing an Insurance Claim There are several reasons you might want to close an insurance claim. Claim not closed upon final payment Changing the provider Modifying insurance using the Change Insurance button Deleting incorrect service(s) for a walkout Use the following instructions to close an insurance claim: From the View options, check the box next to the appropriate setting for the claim(s) you want to close. You may need to check the box next to all options in order to locate the claim you are looking for. Select the claim, mark it, and click Close Claim. Claims can be closed one at a time. Click OK to begin the process of closing claims. Verify that you are ready to close the claim(s) by choosing Yes to continue on the Ready to Close Claim message. Choose No if you are not ready to close the claim. The Closing Primary Insurance Claim window for every claim you have marked to be closed appears. In some cases, there is an amount unpaid by insurance. If there is, determine how you would like to handle any remaining balance on the insurance claim. In most cases, you will apply the difference between the estimated and the paid amount back to the patient so that the account will receive a statement for that amount. Alternatively, you may decide that a credit adjustment is necessary for the patient. Click Apply the amount unpaid back to the account to increase the patient balance by the amount unpaid by insurance. Click Credit the account to apply an adjustment to the account. Additional fields will become visible and enabled on the Closing Primary Insurance Claim window (see the preceding image). Use Credit the account for situations such as Delta Dental write-offs. Click Re-create Claim if you want to re-create the claim. Click Apply Unpaid Amount Back To Remaining Benefits to increase the Remaining Benefits of the patient. Note: You may want to leave this unchecked if the claim was submitted in one year and the payment is not received until the next year. 462 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

7 If the patient s deductible differs from what appears on the EOB, check the box to Update Annual Deductible for Patient and key in the appropriate amount. Select the Assign services to current balance at next aging checkbox, if you want the services to go to the current balance. When True Date Aging is processed, the patient s aging balance for this service will remain current and age according to the insurance payment date not the date of service. Click OK to save your choices for closing the claim. If secondary insurance exists, you will be prompted (see the following image). Secondary Claim Choose from the following four options: Print/submit the secondary claim now Begins the processing of the secondary claim. Select OK to complete the transaction. Print/submit the secondary claim later Adds the secondary claim for later submission through the Process Insurance Claims window. The claim appears in the Unsubmitted Claims list in the Process Insurance Claims window. Submit the secondary claim electronically Adds the secondary claim to the system to be submitted electronically. The claim is changed to the Unsubmitted Elec status in the Process Insurance Claims window. In most cases, insurance companies require an EOB from the primary insurance company in order to process the claim. Submit the secondary claim manually The secondary claim is recorded in the system but needs to be manually filled out and submitted by your office. The claim is then placed in the Open list in the Process Insurance Claims window. Close the Secondary Claim Closes the secondary claim without submitting or printing it. When you have made your selection from the choices above, click OK to continue. Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 463

8 Viewing or Modifying Closed Claims From the Account window, right-click on the account name and choose Insurance Info. The Patient Insurance Information window is displayed. From this window, you can view the status of the claims. To view and/or modify the claim, select the claim and click View Claim. Select any claim and click View Claim. From the View Individual Insurance Claim window, you can add notes or change insurance answers. Entering Claim Notes To add notes to the claim, click Claim Notes. You can add the notes in the following Insurance Claim History window or view current notes. Click Add to create a note. Enter the text you want attached to this claim. The text you enter here will be attached to this claim along with the claim activity. Click Close when you are finished. When the claim appears in the patient s account ledger, the note will appear below the claim item along with any claim activity. Making Payments In EagleSoft, you can enter insurance payments from the Process Insurance Claims window. This enables you to enter all insurance payments received in one day from one window. Select the claim and click Make Payment. 464 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

9 The Receive Insurance Payments window appears. If the Receive Insurance Payments window does not come up, make sure you have selected an open claim. Enter the relevant payment information and click OK when you are finished. You are returned to the Process Insurance Claims window. Change Insurance It is now possible to change the employer or insurance companies, while in the Process Insurance Claims window. From the Process Insurance Claims window, click Change Ins (insurance). The following window appears. To change the employer/insurance for this claim, click in the Change To box and use your F2 button to select another employer. The Change Whom section enables you to change how the claim affects certain criteria. To Change Insurance, click in the Change To box and use your F2 button to select another employer. Once you have selected the employer and insurance company, select a Change Whom option. Change Whom Options Change The Employer/Company On This Claim Only If you want to change the employer/insurance company only on this claim, select this option. Change The Employer/Company For This Claim and All Patients With This Policy Holder Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 465

10 Change Answers This changes the employer/insurance company for this claim and all future claims associated with the policyholder, including all other patients with the same policy. To view the patients with this policy, click View Patients. This window will give you information on the patient s ID, name, Social Security number, birth date and primary employer. Click OK when you are finished. You will be returned to the Process Insurance Claims window. In EagleSoft, you are able to change answers on walkouts after they are processed. You can enter or change this information in the Process Insurance Claims window. Select the claim and click Chg Answers (change answers) to change information on the insurance form. The Modify Claim Answers window appears. Simply add, edit or delete any answers. Select the AutoNote button to include any pre-recorded narratives to your claim. Click OK when you are finished. Your information is saved to the claim. This claim will then need to be closed and re-created if you wish to resend the claim. Viewing and Printing Rejections Click Rejections to obtain a printable list of all known eclaim rejections and solutions. If you are encountering problems submitting eclaims, consult this list for answers before calling the EagleSoft ebusiness Department. 466 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

11 Past Reports Click Past Reports to view the last five eclaim reports. Reprint these reports by highlighting the correct date and clicking Print. Reports are only accessible on the computer where claims are processed. Printing and Reprinting Insurance Claims From the Process Insurance Claims window, you can print a single claim, a selected number of claims or all unprinted claims. Up until the claim has been closed, you can reprint the claim(s) from the same window. Mark the claim or claims to be printed. be displayed by by typing the If necessary, change the Primary Form Name. To do this, click the form name of the claim. This accesses the dropdown list box of form choices. Make your new selection by clicking the name of the form you like. Choose View Claim to review details about the selected (highlighted) claim. Choose Process to print the claims you have marked. Show Tax on Insurance Claim Note: All unprinted insurance claims and pre-authorizations will default. Use Find Name to find a particular patient with insurance information last name of the patient and pressing the Tab key. Click Setup to direct the printing of claims to a different printer, if applicable. Answer the prompts regarding loading the appropriate insurance forms. If more than one type of form will be used, the claims will be batched according to the different form types. Determine if the first form has been aligned properly. If so, answer Yes to the question about properly aligning the form. If the form is not properly aligned, make the appropriate adjustments to the printer and answer No to reprint the first form. Choose Cancel to exit the printing of the insurance claims. To show reimbursable tax on the ADA 2002 insurance claim form, select the checkbox Show Tax on Insurance Claim under Employer Preference. Insert the amount of tax in the Accounting Preferences tab. Using this preference will include the calculated amount of tax on box 32 of the ADA 2002 form. This will set that preference for all new Employers entered after selecting this preference. Use the Mass Updates Utility to add the tax preference to all employers. Under Utilities Mass Updates Global Employer Preferences, select the checkbox Show Tax on Insurance Claim. Otherwise, edit individual Employers in the Edit Employer window. See the Service Code section for more information on setting up Service Code to be submitted on Insurance Claims. Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 467

12 NPI CMS 1500 Form To accommodate the NPI changes, EagleSoft has added the CMS 1500 form for medical insurance billing. The Practice or Site window has an Identification tab for entering the following identification numbers. The CMS-1500 form will use these group numbers to populate boxes 32a and 32b. 32a is NPI only. 32b can be any of the other group numbers. NPI (type 2) State License Number Blue Cross Provider Number Medicaid Provider Number Provider UPIN Number Location Number Clinical Laboratory Improvement Amendment Number Medicare Provider Number CHAMPUS Identification Number Provider Plan Network Identification Number State Industrial Accident Provider Number Blue Shield Provider Number Provider Commercial Number Federal Taxpayer s Identification Number Provider Taxonomy Single Site Offices Select the checkbox Use Practice NPI (Type 2) on Insurance Claim to cause the NPI on the Practice Identification tab to be used on all ADA Insurance claims when ID Dentist By is set to NPI on the Employer Preference screen. Use Practice (Site) NPI on Insurance claim. The Provider Identification window will be altered to include the qualifiers for additional NPI required identification. 468 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

13 To access the Provider Identification window, select Lists Provider/Staff. User may select a qualifier for each label. (Populates Box 33b.) Under List General Setup Provider Label, you can add a Qualifier as well as a Description. The Qualifier is a prefix for the Provider Identification. Box 33b will not be populated if a Qualifier is not selected for the customizable label. The Employer Preferences has an ID Facility By dropdown list. Access the Employer Preferences window at Lists Employers. Select the desired employer. In the Employer window, select the Preferences button. This refers to box 32b. Enter this number in Practice Identification, to automatically populate box 32b. This ID Facility By dropdown list has also been added to the Employer Preferences window under File Preferences Employer. The ID Facility By allows users to select a practice identification number for claims (CMS form 32b) If this option is selected on an ADA form, the Practice ID will appear in the Billing Dentist or Dental Entity area. Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 469

14 The Global Employer Preferences includes ID Facility By column. In the Insurance questions window the Champus radio button becomes Tricare Champus and Referring ID (Box 17) changes for the CMS-1500 form only. Diagnosis codes and pointers that are entered in the Service Code will be defaulted onto the form in Box Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

15 Service area of insurance questions screen will have the following added input area. This matches the service area on the CMS-1500 form. Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 471

16 NPI Breakdown Setting Up NPI Once your insurance companies begin accepting the NPI number, you will need to enter these new numbers for your insurance claims. Review the NPI Changes section of this document for information on entering your NPI numbers. To determine your NPI Type, visit Paper Claims for Type 1 NPI ADA 2002 or Older NPI numbers are entered in Provider Identification screen. Go to Lists Provider Identification input Type 1 NPI into the National Provider ID field. 472 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

17 Go to Lists Employers Preferences change ID Dentist By and/or ID Treating Dentist By to National Provider ID depending on where you would like the number to appear on the claim form. **If you wish only to submit the NPI and not the additional provider ID (boxes 52A and 58), set ID Dentist By and/or ID Treating Dentist By to None. Paper Claims for Type 1 NPI ADA 2006 NPI numbers are entered in Provider Identification screen. Go to Lists Provider Identification input Type 1 NPI into the National Provider ID field. No need to edit the employer as this form has a place for both NPI and additional provider ID. Paper Claims for Type 2 NPI ADA 2002 or Older If you are submitting a Type 2 NPI, you will also need to submit a Type 1 NPI. If you are submitting a Type 2 NPI on your insurance claim, use the following steps: Go to List Practice Information Identification. Enter the NPI Type 2 number in the National Provider ID box. Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 473

18 Select the checkbox Use Practice NPI (Type 2) on Paper Insurance Claim. Go to Lists Provider Identification input. Type 1 NPI into the National Provider ID field. Go to Lists Employers Preferences set ID Dentist By and/or ID Treating Dentist By to National Provider ID depending on where you want the number to display on the claim form. If Use Practice NPI on Insurance Claim is checked, the Type 2 NPI number will appear in box 49 of the 2002 ADA form instead of the Type 1. Paper Claims for Type 2 NPI ADA 2006 Use the following steps: Go to List Practice Information Identification. Enter the NPI Type 2 number in the National Provider ID box. Select the checkbox Use Practice NPI (Type 2) on Paper Insurance Claim. Go to Lists Provider Identification input Type 1 NPI into the National Provider ID field. Electronic Claims for Type 1 NPI Electronic claims will submit both NPI and additional provider ID. Go to Lists Provider Identification input Type 1 NPI into the National Provider ID field. 474 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

19 Electronic Claims for Type 2 NPI This checkbox does not need to be selected. Electronic claims will submit both NPI and additional provider ID. Go to Lists Provider Identification inp ut Type 1 NPI into the National Provider ID field. Go to List Practice Information Identification Enter the NPI Type 2 number in the National Provider ID box Both Type 1 and Type 2 NPI numbers wil l appear on an electronic claim as long as: Type 1 is entered under List Provider/Staff Identification National Provider ID Type 2 is entered under List Practice Information Identification National Provider ID (Type 2) Frequently Asked Questions About Claims Q: How do I reprint a claim? A: From the Process Insurance Claims w indow, you can reprint any claim up until the claim has been closed. Note: All unprinted insurance claims and pre-authorizations will be displayed by default. Use Find Name to find a particular patient with insurance information by typing the last name of the patient and pressing the Tab key. Mark the claim or claims to be printed. Choose Process to print the claims you have marked. Answer the prompts regarding loading the appropriate insurance forms. If more than one type of form will be used, the claims will be batched according to the different form types. Determine if the first form has been aligned properly. If so, answer Yes to the question about properly aligning the form. If the form is not properly aligned, make Patterson EagleSoft Overview Processing Claims and Pre-Authorizations 475

20 the appropriate adjustments to the printer and answer No to reprint the first form. Choose Cancel to exit the printing of the insurance claims. Q: There are no lines on my claim form. Why is that? A: Double-check the claim form that you have chosen to print. Ensure that it says Blank <<number>> ADA form. 476 Processing Claims and Pre-Authorizations Patterson EagleSoft Overview 15.00

21 Aging Accounts Overview The Age Accounts function is helpful in keeping track of the length of time that an account is overdue. EagleSoft provides four separate categories of the account balance: Current, 30 Days Overdue, 60 Days Overdue and 90 Days Overdue. Amounts in these categories determine whether an account should receive a finance charge on the billing statement, a phone call to induce quick payment on the account or perhaps a phone call to the collection agency. Practice Management provides two different methods of aging: Category Aging and True Date Aging. Aging Balances with Category Aging When using Category Aging, all balances are moved to the next category upon aging. For example: The Current Balance is placed into the 30 days overdue category, with the exception of Estimated Insurance amounts All balances in the 30 days category overdue category are transferred to the 60 days overdue All balances in the 60 days overdue category are transferred to the 90 days overdue category Before starting this process, we recommend that you make a backup of your data and print the Accounts Receivable by Responsible Party report. It is also recommended that this procedure be performed once every month. Most offices have found i t beneficial to perform it in sequence with their End-of-Month procedure. Here is a reminder list: Make a backup of the system Print the Accounts Receivable by Responsible Party report Process statements Perform Category Aging Patterson EagleSoft Overview Aging Accounts 477

22 To Age Accounts with Category Aging 1. Go to Activities and choose Age Accounts. The Age Accounts window is displayed. The number of days since the last account aging was performed, the date and the user who performed the last aging will be displayed. 2. Choose Category Aging as t he method to age the accounts. Click OK to begin the process of aging the accounts. All the accounts with outstanding balances will be aged to the appropriate categories. This process will go quickly. When aging is finished, click Cancel to exit the window and return to the virtual screen. Aging Balances W ith True Date Aging When using True Date Aging, the process looks at the transaction date of outstanding services and determines the aging category in which it belongs. If the transaction is 0 to 29 days old, it remains in the Current column. If the transaction is 30 to 59 days old, it is added to the 30-D ay column. The same process follows for accounts older than 60 days. Note: Account aging can take an extended period to complete. The time varies based on the size of your database, the number of outstanding transactions and the speed of your computer. If you are aging accounts during your EOD process, expect the time to complete the EOD to increase. To Age Accounts With True Date Aging Go to Activities and choose Age Accounts. The Age Accounts window is displayed. The number of days since the last account aging was performed, the date and the user who performed the last aging is displayed. Choose True Date Aging as the method t o age the accounts. Click OK to begin the process of aging the accounts. All of the accounts with outstanding balances are aged to the appropriate categories. Click Cancel to exit the window and return to the virtual screen window. 478 Aging Accounts Patterson EagleSoft Overview 15.00

23 Processing Statements Overview The Statement Wizard is used to generate billing statements for all accounts that have outstanding account balances. Statements for all accounts, individual accounts or for a section of the accounts may be generated. There are several options to choose from while processing statements: Customized messages for accounts with 30, 60, and 90 day balances Applying finance charges and/or billing charges Excluding accounts with a small balance Including or excluding the details of the transactions Note: If you utilize True Date Aging, you should age accounts before processing statements. If you utilize Category Aging, you should age accounts after processing statements. The following information is included in this chapter: Setting up statement preferences Processing statement p references Adding messages to the statements Viewing the Account window while processing statements Statement Preferences Statement Preferences can be set up in File Preferences Statements. Specify your choice for the default setting for: Show Estimated Insurance on Statements Create Account Note for Statements Add Statement Message to Account Note Return Address on Statements Wizard Preferences Patterson EagleSoft Overview Processing Statements 479

24 How to Process Statements It is recommended that you set up your preferences before processing statements for the first time. For more information about Preferences, go to the Statement Preferences section in the Preferences chapter located in the Setting up Your Software unit. G o to Activities and choose Statement Wizard. The first Statement Wizard window displays a summary of information from the last batch of statements processed. To review a detailed summary for the last batch of statements that were processed, click View Last Batch Detail. Click Next when you are ready to continue. If the last batch of statements processed correctly, make sure that the Yes button is marked and click Next. If the last batch did not process correctly, click the No radio button, and enter the Responsible Party or ID of the last stateme nt that was processed successfully. When the information needed to restart printing with is entered, click the Next button. Make your selection for the account(s) to Create Statements For (see the following image). 480 Processing Statements Patterson EagleSoft Overview 15.00

25 Use: All Accounts To: Print statements for all accounts with balance due. Accounts A - L Print statements for accounts with last names beginning with the letter A through the letter L. Accounts M - Z Range of Accounts Print statements for accounts with last names beginning with the letter M through the letter Z. Print statements for accounts that fall in the range that you specify. This will be based on the beginning letter of the last name of the responsible party. Individual Account Print statement for specified account. Accounts that have not had a statement in the last _ days. Enter a number in the days box to print statements that meet this criterion. Enter the criteria you wish to use from the following to specify What Accounts Should Receive Statements. Accounts with balance greater than or equal to: $ (blank) Enter the least amount an account can have in order for a statement to process. Accounts with 100% estimated insu rance Select this checkbox if you want to print statements for accounts that have their entire balance in estimated insurance. If the estimated insurance is expected to cover all of the balance, but the office has not received payment, this feature enables you to send a statement to the patient, even though the patient s portion is zero. Accounts with estimated insurance Uncheck this box if you would prefer to not generate statements for accounts with outstanding estimated insurance. Accounts with outstanding claims Uncheck this box if you prefer not to generate statements for any account that h as an outstanding claim, even if insurance was not estimated. Specify your choices for How do I want the statements to look? Patterson EagleSoft Overview Processing Statements 481

26 Include Item Detail If this box is checked, the statement contains detailed information about the services that were rendered and payments received. Include All Items Since Choosing Account Last Statement includes all new activity on the account since the last statement was processed for the account. If you would like to choose the date range for activities, click on the radio button next to I Will Choose A Date, and enter the date from which you would like to begin. Due Date This is the date to appear on the statement by which you will require payment. Sort Transactions This is how the transactions for each account will be sorted on the statement. Choose either By Patient or By Date. What Message do y ou want to print at the Bottom of the Statement? Choose a message from each of the dropd own boxes, or press the F2 key to create a n ew message. If you have set up a Message for Statements in the Account Preferences window, it will override any of these messages. See the Account Activities chapter in the Account Management unit for information about Messages for Statements. Click Next when you are ready to continue. Check the box next to I want to apply a billing charge if you charge your patients a fee for sending a statement. If you do not want to apply a billing charge, skip to step 14. Enter the amount to apply as a billing charge. To increase or decrease the number a dollar at a time, click on the up and down arrows next to the entry box. Click on the dropdown box to choose the number of days that an account has to be overdue in order to be charged a billing fee. Select the checkbox I want to apply a fin ance charge checkbox to apply an a dditional charge to overdue accounts. If you do not want to apply a finance charge, skip to step 18. Enter the Finance Rate Percentage that y ou would like to apply. C lick on the dropdown box to choose the number of days that an account has to be overdue in order to be charged a finance charge. Enter a minimum finance charge amount. 482 Processing Statements Patterson EagleSoft Overview 15.00

27 If you would like to print an Audit Trail for this process, check the box next to this option (see the preceding image). The audit trail lists accounts that had a statement processed with their amount due. Click Cancel to exit from the Statement Wizard without processing or printing statements. Click Back to go back to previous Statement Wizard choices. Click Finish to continue. The Statement Queue appears. The Statement Queue When using the estatement option, the notes area allows for only 150 characters. From the Statement Queue, choose from the following functions: Print to Paper Select the radio button t o print your statements to paper. Use the dropdown list to select the format and printer. Enhanced Statement (Plain Paper) Select this option to use plain paper to print our enhanced stat ement layout without a border. Classic Statement (Plain Paper) Select this option to use plain paper to print our original statement layout. Pre-Printed Classic Statement Sele ct this option to use pre-printed forms in the original statement layout. Pre-Printed Enhanced Statement Select this option to use the enhanced statement forms that contain borders. Pre-Printed Enhanced Statement w/border Select this option to use pre- forms in the enhanced layout. printed Send Electronically Select this radio button to send statements using estatements. Mark All Marks all statements for processing (default choice). Clear All Unmarks all statements for processing. Note Enter personalized notes on individual statements. This message overrides any message entered in the following areas: Message for Statements textbox from Preferences in the Accounting window. The messages selected in the Statement Wizard. Patterson EagleSoft Overview Processing Statements 483

28 View Acct (account) Click View Acct to view the account information in the Account window. You are able to view the entire ledger for each patient, but the functions are unavailable. Use the Unapply Chgs button to remove p reviously applied finance charges from statements in the Queue. Use the Remove button to remove a statement from the list. Select the Remove All button to clear the entire list. Select the Hide Detail button to display the basic information about each statement in the queue. Select the Expand Detail button to display the full detail on each statement in the queue. Select the Audit Trail button to print a report of everything currently in the Queue. Click OK when you are ready to process statements. Click Cancel to cancel statement processing. At the top, select the Filter tab. From here, you can filter the Statement Queue by Provider, Processed, Not Processed and Last Batch Only. Note: Amount due now does not reflect current billing or finance charges that may be applied. 484 Processing Statements Patterson EagleSoft Overview 15.00

29 ebusiness Introduction How Do I Create ebusiness is the ter m used when discussing the combination of business, Internet, and current communication technologies. E aglesoft has three forms of ebusiness: Electronic Claims, Electronic Statements and Online Center. ( Clinical must be installed). These technologies will allow you to expedite and track your statements and insurance claims efficiently and economically. Using EagleSoft ebusiness solutions reduces the hours spent printing statements or claims while eliminating the extra days waiting for payments by insurance carriers. By submitting your statements and claims electronically, you have taken another great leap in the automation of your office. Th is chapter will give you information on setting up and using three of these features. Following is an outline of what is included in EagleSoft s ebusiness features: Setting up and using eclaims Setting up and using estatements Using Online Center and the Online Update Center. an eclaim? Creating an eclaim is not much different from creating a regular insurance claim. Anytime you walk out a patient or create a pre-authorization, you will be prompted to create an insurance claim. Instead of using one of the paper forms, you will be submitting electronically. Creating Electronic Claims There are four areas in EagleSoft where insurance claims are generated. Those areas are: The Walkout Statement window Walkout Statement Utilities Receive Insurance Payments window (creates secondary claims) Process Insurance Claims window Patterson EagleSoft Overview ebusiness 485

30 All primary insurance claims are created during the walkout process, and all secondary claims are created through the Receive Payments window. In each of the cases, all claims are prepared for batch electronic submission. This means that an entire group of claims is sent at once instead of sending a claim with each walkout entry. To prepare the insurance claim for electronic submission, do the following: After you have finished entering services in the Walkout Statement window, click Process Enter any payment, adjustment or recall information in the Walkout Processing window and click OK For information on the Walkout Processing window, see the Walkout Processing chapter in the Account Management unit The Insurance Questions window is displayed if the current patient has insurance If you wish to prepare this claim for electronic submission, choose Submit Electronically for the Print Claim status. Respond to any questions in the insurance questions section Click OK to prepare the claim for electronic submission This claim will be added to the Insurance Claim batch as Unsubmitted Creating Pre-Authorizations Pre-authorizations are created in the Treatment Plan window. From the Treatment Plan window, click Process. From the Treatment Plan Processing window, highlight the plan you wish to create the pre-authorization for, specify any other necessary settings and click OK. The Insurance Questions window is displayed. If you wish to prepare this pre-authorization for electronic submission, choose Submit Electronically for the Print Claim status. Respond to any questions in the insurance questions section. Click OK to prepare the pre-authorization for electronic submission. T his claim will be added to the Insurance Claim batch as Unsubmitted. See the section on Patient Preferences for more information on Orthodontic settings. Creating Pre-Authorizations for Orthodontic Patients Pre-authorizations are created in the Treatment Plan window. To submit an orthodontic claim for a previously designated ortho patient, enter the scheduled treatment into a treatment plan. Process a Pre-Authorization of orthodontic services and select the Submit as Statement of Actual Services checkbox. 486 ebusiness Patterson EagleSoft Overview 15.00

31 NEA integration FastAttach TM enables healthcare providers to transmit attachments in support of electronic claims, to payers via the Internet. Attachments include X-rays, perio charts, intraoral pictures, EOBs, Lab Reports, EKGs, etc This feature is designed to bridge between NEA Fast Attach and EagleSoft eclaims. Contact your ebusiness representative for more information on setting up eclaims with NEA Fast Attach at Setting up NEA Payer IDs To setup your Insurance Companies to use Fast Attach, select List Insurance Companies. Enter the NEA Payer ID or select the blue hyperlink to open the NEA Payer ID list and search for the correct Payer ID. Highlight the desired Payer Name and select the Use button. Select OK to save. Patterson EagleSoft Overview ebusiness 487

32 NEA Attachments on Claims After creating an eclaim, open the Claims window. Highlight and Mark the desired claim(s). Select the Attachment button on the right to launch the FastAttach software. Attachments and the Claim Screen The Process Insurance Claims screen has an additional column for Attachments. When a claim has attachments, the column will display the status of the claim. NEA Attachment Claim Statuses The following statuses display on the Process Insurance Claim screen in the Attachments column: 488 ebusiness Patterson EagleSoft Overview 15.00

33 Blank Indicates no NEA attachment. Incomplete Indicates attachment has been sent to FastAttach but not processed completely. Complete Indicates attachment successfully received by NEA. Payer Ref # Indicates Payer Reference Number has been entered into EagleSoft for this claim, and the claim is waiting to be sent to Fast Attach. Rejected Indicates the attachment file was sent to NEA but was rejected by NEA for some reason. Rejected-E Indicates something was invalid or corrupt with the information EagleSoft tried to send to FastAttach. NEA Payer Reference Numbers Selecting the Attachment button when there are either no marked claims or no claims with an Incomplete status will block entry to Fast Attach. To attach a Payer Reference number to a claim, open the claim and select View Claim. The Payer Ref. # appears only on claims with an Open status. In the NEA Payer R eference No. field, enter the number supplied by the insurance company. Select OK. In the Process Insurance Claims screen, mark the claim and send it to Fast Attach. Electronic Remittance Advice To Enroll for ERAs, call ebusiness Sales at Electronic Re mittance Advice (ERA) is an electronic Explanation of Benefit (EOB) information. One ERA can contain one or multiple EOBs. These ERAs will replace or be in addition to the current EOBs your practice is currently receiving. Payment of claims will still be received in the same manner in which they are received today. Receiving ERAs ERAs are obtained when downloading eclaim reports from our preferred clearinghouse. If there are ERAs received during a report download, a message box will appear prompting the user to review the ERAs at that time. Patterson EagleSoft Overview ebusiness 489

34 Viewing ERAs Once received, ERAs are held in a queue waiting further processing when the payment is received in the office. Select Electronic Remittance Advice from the Activities menu o r select the ERAs button from the claims window to view a list of received ERAs. The Legend button explains the visual aspects of the window. Processing ERAs Once payment is received by the office: Go to Activities ERA Highlight the ERA and then click the Bulk Pmt button to open the Bulk Insurance Payment window. Attempting to make an insurance payment via the Bulk Payment 490 ebusiness Patterson EagleSoft Overview 15.00

35 window or the Insurance Payment window, will trigger an alert to the existence of unprocessed ERAs. Select Yes to open the ERA screen and process outstanding ERAs. Select No continue making payments. All open claims for the insurance company or payment group will appear, and those claims included in the chosen ERA will have the payment amounts automatically distributed based on information received in the ERA. Payment type and check number will also be completed. to The service distribution amounts will also default based on the ERA information. This eliminates having to select the Distribute button and manually enter the amounts based on the EOB. After a quick review of the payment amounts, the user can click OK on the Bulk Insurance Payment window to post the payments. This will then complete the ERA. Patterson EagleSoft Overview ebusiness 491

36 Provider Level Adjustments Occasionally, ERAs will contain adjustments that need to be made at a provider level rather than a claim level. ERAs with provider adjustments are identified with an icon in the Electronic Remittance Advice window. When these ERAs are sent to the Bulk Insurance Payment window, a message box will also appear warning the user that a provider level adjustment exists. Users will need to manually adjust the total payment amount in the Bulk Insurance Payment window to compensate for the provider level adjustment. Processing Non-payment ERAs Highlight the ERA that has the zero dollar amounts and check the Completed box for that ERA before selecting OK. ERA on Bulk Payments When attempting to make an insurance payment via the Bulk Payment window or the Insurance Payment window, EagleSoft issues an alert to the existence of unprocessed ERAs. 492 ebusiness Patterson EagleSoft Overview 15.00

37 Select Yes to open the ERA screen and process outstanding ERAs. Select No to continue making payments. How Do I Create estatements? Like eclaims, creating estatements is very similar to creating regular statements. After the statements are set up through Statement Wizard, you have two options: to print or to send electronically. When you have finished preparing your statements in the Statement Wizard, click Finish. The Statements to Process window appears. If you are ready to process statements, click Process. The following window appears. This displays the status of your statement transmittal. When the Electronic Statements window appears, click OK. Patterson EagleSoft Overview ebusiness 493

38 Preferences Setting Up Preferences Before submitting estatements or eclaims, you need to set up preferences. The preferences need to be set up for the insurance forms, provider identification and modem setup. Once these preferences are entered, they are for your entire system and will probably not need to be changed again. For assistance with setup, please contact the EagleSoft Technical Support Department. Default Insurance Form To set up electronic submission for all new employers, follow these instructions: From the File menu, choose Preferences. Click the Insurance tab. In the Default Insurance Form field, choose Electronic Submit from the dropdown list box. In the Print Default Ins Form for eclaims, choose an insurance form from the dropdown list box. Click OK to save your changes. By setting the default insurance form to Electronic Submit, when a new employer is set up, Electronic Submit is automatically assigned as the means for submitting insurance claims. 494 ebusiness Patterson EagleSoft Overview 15.00

39 However, you can overwrite this default for individual employers as necessary. To change the current insurance form for all employers, go to Utilities Mass Updates Global Employer Preferences. Select the Default Insurance Form checkbox and choose another insurance form from the Form dropdown list box. Changing the Default for an Employer Insurance Form These instructions show how to change an employer s default insurance form from paper claims to electronic subm ission. If you need to change the default insurance form for several employers, you need to perform a mass update of all employer preferences. Go to Lists and choose Employer/Coverage List. Highlight the employer and click the Edit button. The Edit Employer window is displayed (see the following image). In the Ins. Form field, choose Electronic Submit from the dropdown list box. Select the Default insurance claim. Click OK to save your changes. form to be used when opting to print your electronic By changing the default insurance form to Electronic Submit, claims prepared for this employer will be set up to be submitted electronically. P rovider Identification As with all insura nce claims, it is important to make sure that the correct license, tax numbers, and so on, are set up for the provider. Before submitting electronic claims, it is a good idea to review this information. To do this, follow these instructions: Go to Lists Practice Management Lists and choose Provider/Staff. Highlight the provider and click Edit. The Edit Provider window is displayed. Patterson EagleSoft Overview ebusiness 495

40 From the Edit Provider windo w, click Identification. The Provider Identification window is displayed (see the following image). Submitting eclaims Verify the identification number and make changes as necessary. The most important information to verify is the Federal Tax ID, Site ID and License numbers. The Site ID is used for electronic claims enrollment and defaults to the ID already set up for that provid er. Enter any of the relevant Other IDs. Some insurance companies may require an identification number other than the TIN or Social Security number. The Other ID field is used for this purpose. It appears only on the ADA 1994 form or electronically. Click OK to save any c hanges, or click Cancel to exit without saving any changes. Click OK again from the Edit Provider window to save your changes. eclaims Preferences Setup If you are a new user, please call the Patterson EagleSoft ebusiness Department at , for information on enrollment. Before submitting electronic claims or pre-authorizations, electronic claims preferences need to be set up properly. From the File menu, choose Preferences Click the ebusiness tab Choose Electronic Claims from the Service dropdown list box and select eclaims from the Provider dropdown list box Login and Password (assigned by Patterson) You should have received this information from Patterson Number to Call If you are using a phone number from the Phone # list, select the Use Number from list radio button If you are using a number from the list, click Number to Call. It is recommended that you use the primary default phone number. Click OK. Number Used to Dial numbers. Click the Use Area Code checkbox if the area code needs to be dialed. Out Enter a 9 here if you dial a 9 when calling outside 496 ebusiness Patterson EagleSoft Overview 15.00