Batch Submission (Professional or Institutional Claims)

Transcription

1 Streamlining the flow of information among health plans, hospitals, physicians, and other providers. Electronic Claims Management Batch Submission (Professional or Institutional Claims) Sponsored by: 1

2 Electronic Claims Management DDE HealthXnet has partnered with ZirMed, Inc. to provide Electronic Claims Management (ECM) services to HealthXnet customers. HealthXnet s ECM service is electronically connected to over 1900 payers as well as having a direct connection with most government and large commercial payers. Additionally, if a payer is unable to accept electronic claims the ECM service will drop these to paper and forward via mail. The following slides provide a screenshot walk-thru our Batch Submission ECM service. The screens included show Professional claims screens. The Institutional claims screens are identical in appearance, although the modules differ on the back end (invisible to the user) and the services are offered independently of one another. If you would like information about the Direct Data Entry ECM option (Professional Claims only), please contact HealthXnet. 2

3 Account Welcome The Account Welcome screen displays when a user logs in to the system. The screen will show only those applications to which the customer has subscribed. Action Items display only if applicable and can include claims currently rejected, claims needing name matching, Rejected Claims Dashboard, and Enrollment action items. Alerts include General Alerts, Payer Updates, and Enrollment Activations. 3

4 Providers The Providers screen allows users to establish overrides for data generated by the Practice Management System. Provider types supported by this function are: Billing Pay-To Rendering Facilities Referring Supervising Ordering Primary Care Purchasing. Normally, Provider records are only set up one time, unless the provider s information changes after the record is created. Use provider overrides if: The Practice Management System or Hospital System cannot provide the data elements required to produce a valid claim (e.g., older systems stems that cannot produce a HIPAA-compliant 837 electronic file). The Provider s name needs to be in a different format for a given Payer or Intermediary. 4

5 Name Matching The Name Matching screens allow a user to associate the names generated by the user s Practice Management or Hospital System with the information contained within the ECM system. Normally the names are matched only one time, unless the spelling of a name generated by the users Practice Management System changes. The following items can be matched: Payer Billing Pay To Rendering Facility Referring Supervising Ordering Primary Care Purchased Service 5

6 Batches The Batches screen allows ECM users to: Upload batches (groups of claims) )generated by the billing function in your Practice Management System or Hospital System to the Claims Processing queue Search for a particular batch and review its status Resubmit batches previously not accepted Change a Batch ID 6

7 Claims Submitted claims are listed by default in chronological order, newest to oldest. The search box allows you to locate any claims matching your search criteria easily. Claims Tracking allows you to follow the progress of the claim every step of the way. At-a-glance information includes the claim number, transaction date, patient name, rendering provider, date of service, primary insurance, claim charge amount, and status or your submitted claim. The status of each claim s submission is updated automatically! 7

8 Submitted Claim Status Clicking on a claim s hyperlinked status will open a new window with details about the claim s submission history. If the claim is rejected, this window will include a detailed rejection reason. 8

9 Submitted Edit a Claim Rejected claims may be edited online and immediately resubmitted. The claims editor displays all of the information in the electronic claims file in an easy-to-read format. Changes can be made right to the screen. Changes made in this screen affect only the claim being edited d and do not affect the provider, facility, policyholder or patient records that were used in the claims entry process. 9

10 Rejected Claims Dashboard The Rejected Claims Dashboard is designed to facilitate the management and resolution of claims that have been rejected by either the payer or by the ZirMed system. The HealthXnet ECM system ensures that each claim meets many requirements before sending the claim to the payer. This validation results in quick notification of errors and ability to resubmit claims faster resulting in faster payments. Rejected claims display can be grouped by: Billing provider Facility Payer Rejection date Rejection message (default) Rejection source Rendering provider 10

11 Reports A variety of real-time reports are available online. Reports include rejection grouping, cumulative rejection analysis, as well as batch detail and customized reports specific to your needs. 11

12 Electronic Claims Management Questions? For more information about HealthXnet s Electronic Claims Management service, please contact: t HealthXnet Support (505) healthxnet@nmhsc.comcom 12