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

41 Print Reports After Submission Choose from the list of reports to print after claims have been submitted. The information on these reports is from the previous eclaims submission. For exam ple, if you submitted some claims on the previous day, the reports for that submission are printed the next time you submit claims. Save Click Save when you are finished setting up the eclaims preferences. Modem This button is used primarily for troubleshooting by the EagleSoft ebusiness Team. IDs Click this button to view all registered providers and their IDs. Before adding or changing any IDs, please call EagleSoft to enroll or verify these ID numbers. Assigning Payer IDs Before submitting electronic claims to eclaims, each insurance company in your system must be assigned a Payer ID and a payment source. Use the Assign Payer ID Utility to assign IDs to multiple payers. Under Utilities, select Assign Payer ID. The Search field allows for searching on whichever column the list is sorted by. Select the Tab key to begin searching. The matching record will be highlighted. Sort by columns by selecting a column heading. Each insurance company record lists the Payment Source, eclaim ID (for electronic claim submission) and NEA ID (for medical insurance claim attachments) is manually editable within that record s row. Use the Shift or Ctrl key to select multiple rows. When more than one row is selected, fields for entering identifiers to apply to each row become visible along with their corresponding application buttons. Patterson EagleSoft Overview ebusiness 497

42 To enroll, call ebusiness Sales at Select the hyperlinks or use the F2 key to open the Claim Payer ID, NEA Payer ID or Pymnt Source. Select Use to save any changes made in the ebusiness Identifiers Setup window and return the chosen record s values to the insurance company window. Cancel button will exit without saving. This same logic will be applied at the time of processing eclaims when a claim associated with an insurance company that has no eclaim ID assigned is encountered. At that time, the user has the option of opening the ebusiness Identifiers Setup window to assign an eclaim ID. Editing Insurance Companies for Payer IDs You can manually assign Payer IDs to an insurance company from the Edit Insurance Company window. Go to Lists Practice Management Lists and choose Insurance Companies. Then, select the insurance company you want to edit. 498 ebusiness Patterson EagleSoft Overview 15.00

43 Enter the correct eclaims ID from the Payer List. Submitting Electronic Claims/Pre-Authorizations using eclaims If a Payer ID is not listed for an insurance company during this process, you will be prompted to give that insurance company a Payer ID at that time. To submit claims, go to Online Elect Claims. The Unsubmitted Elec checkbox is selected by default. Mark the claims you wish to submit. Click Process. The following window is displayed. Mark the claims you want to print in addition to electronic submission. Click Start to send the claims. EagleSoft automatically runs a series of tests that check for incomplete information in the following areas of your eclaims: no Tax ID, incomplete or no insurance company address lines, no city for an insurance company, no state for an insurance company, incomplete or no patient address lines, no city for a patient and no state for a patient. Patterson EagleSoft Overview ebusiness 499

44 Preverifications Your eclaims software now performs a series of tests to ensure that your eclaims have the necessary information. The software checks for the following types of errors: No tax ID Incomplete or no insurance company address lines No city for insurance company No state for insurance company Incomplete or no patient address lines No city for patient No state for patient No ZIP code for patient If there are any claims with incomplete information, the following message appears. Click Report to print a listing of the errors found in the incomplete claims. Click Continue to submit the complete claims. The incomplete claims will not be submitted until the information is updated. Click Cancel to return to the eclaims Submission window. After EagleSoft establishes a connection with the clearinghouse, the transmittal window appears. To enable easier claim submissions, the claims are submitted to a bulletin board system via an 800 number dedicated only to EagleSoft customers. If a connection is not established the first time, EagleSoft continues to dial the number up to three times. When the connection is established, a status message appears in the upper middle of the window to inform you of transmission progress. Claims Status Pre-authorizations are listed in green on the claims window. Pre-authorizations can be submitted; however, the status of the claim is not updated. As claims are electronically submitted, their status will change based on information provided by the clearinghouse. Use the following to determine the status of a claim: Status Unsubmitted Claims will appear in this view when Print Later is selected from the Insurance Questions screen during the walkout or when selecting Print/Submit Secondary Claim Later when prompted to submit the secondary claim. Unsubmitted Electronic Claims will appear in this view when Electronic Submit is selected from the Insurance Questions screen during the walkout or when selecting Submit Secondary Claim Electronically when prompted to submit the secondary claim. 500 ebusiness Patterson EagleSoft Overview 15.00

45 In Process Claims will appear in this view after you have successfully submitted claims to the clearinghouse. The claim will remain in this view until the proper reports have been downloaded from the clearinghouse at the time of submission. Reports are not available until the next business day following claim submission. Open Claims will appear in this view when Print Now or Submit Manually is selected from the Insurance Questions screen during the walkout or when selecting the Print/Submit Secondary Claim Manually when prompted to submit the secondary claim. Closed Claims has been closed. Receiving Claim Information Normally, when you submit claims, EagleSoft checks for any reports regarding previously submitted claims and downloads the reports, if available. There may be instances where you want to connect to the clearinghouse without actually submitting new claims in the event that you need only to check for or download reports on previously submitted claims. You may do this by following these steps: Go to Online Electronic Claims. Unmark any claims that you do not wish to send. Click Process to receive the following prompt: Click Yes. The same windows displayed when actually submitting claims will be displayed at this time as well. EagleSoft downloads any reports regarding previously submitted claims if they are available and updates your data appropriately. Reprinting Reports If you need to reprint reports, EagleSoft stores the last five reports downloads. To access these reports, click on the Past Reports button in the Process Insurance Claims window and select the correct date from the list. estatements Like regular statements, estatements are prepared in the Statement Wizard. When the statements are prepared, they are then submitted to the clearinghouse. The clearinghouse then prints and mails the statements to your patients within one business day. Before beginning estatement submission, you will need to set up your preferences. Setting up Preferences If you have already set up your modem, you can begin setting up your preferences. Follow the directions below: Go to File Preferences and select the ebusiness tab. Patterson EagleSoft Overview ebusiness 501

46 Select Electronic Statements from the Service dropdown list box. Select the Provider dro pdown list box. Be sure to enter the following information in the specific boxes. Account Number Enter your office account number supplied by Patterson. First Name Enter EAGLE (all caps); this box always has the word EAGLE. Last Name Enter the information supplied by Patterson. Password Enter the word INC. Number to Call There are three possible numbers to call. Read the instructions below for the number to call. If using Wildcat 5.0, use If using Wildcat 3.0, use one of the following numbers: or Number Used to Dial Out If you use a 9 or another number to dial out, enter that number here. Save Click here to save your settings. Modem This button is used to troubleshoot by the EagleSoft ebusiness Team. When you are finished, click Save and then OK. Sending estatements Go to Activities Practice Management Activities, and select Statement Wizard. Click Next to go to the next window. Follow the on-screen instructions to customize this batch of statements. For a stepby-step walk-through on statement processing, go to the How to Process section of the Statements chapter. When you have reached the final statement window, click OK to process the selected statements. Click OK to send the statements. You should hear the modem dialing. A small box displays your statements being sent. When you are finished, click OK. 502 ebusiness Patterson EagleSoft Overview 15.00

47 Online Center Introduction The Online Center gives you the ability to submit eclaims and estatements, track and recalculate billing and even surf the Web from one location. Designed like a Web page, the Online Center offers a smooth and efficient way for you to view and process all of your electronic business. You must have Microsoft Internet Explorer 5.0 or higher to use this function. If you have Internet access, you can access some of these Web site links. Getting Started in the Online Center Accessing Online Center You can access the Online Center three ways: From the Online menu, choose Online Center. -or- Click the Online Center icon on the Integrated Mode window. -or- From the Practice Management Front Office window, click the Online Center icon. Online Menu Options Click Electronic Claims to access the Claims window. All unsubmitted electronic eclaims are displayed. Click Electronic Statements to process your estatements. If you have Internet access, click World Wide Web Links to use one of the following options: EagleSoft Home Page Access technical support, training information, certified hardware providers and much more. Patterson EagleSoft Overview Online Center 503

48 Using the Online Center Window Send to EagleSoft Support Select this to send a question to EagleSoft Support. Patterson Dental Company Select this to access the Patterson Dental Company Web site. Order Patterson Products (Remo-Net) Access Patterson s online ordering center. Patterson Office Supplies Home Page Access Patterson Office Supplies Web site to order dental management products. The design of the Online Center window is the same as an Internet Web page. Each word, Process and Details, is linked to its appropriate window or report. If you have any previous Internet experience, you will find this format familiar. Toolbar The Menu is designed similarly to Microsoft Internet Explorer toolbar. Arrows The left and right arrows advance the page forward or backward. These arrows are used mainly when browsing the Web. Stop This button will stop the loading of any Web page. Home Click this button to return to the Online Center. Internet Browser Click this button to connect to the Internet. You must have a dial-up connection set up before this function will work. Print Click this button to print the Online Center page. Recalculation Online Center gives you the option of recalculating your ebusiness figures in the same window. If you have processed your eclaims through the Online Center and want to see how this has changed the batches total, just click Re-Calc. Enter a date range in the Re-Calculate Totals box and click OK. The totals should be recalculated. ebusiness Toolbar Buttons The side buttons enable you to view ebusiness summaries. You can also synchronize your EveryWare Web information, change your password and upload from EagleSoft Direct. 504 Online Center Patterson EagleSoft Overview 15.00

49 Just click one of the summary buttons to view a printable total of ebusiness activity. To print this report, click the printer icon. EagleSoft EveryWare Click the EagleSoft EveryWare icon to access the program that enables you to view and export data to a handheld computer or the Web. From the EagleSoft EveryWare window, you can view EveryWare information, ereferrals, infoport information and more. FAQ Click the FAQ icon to access EagleSoft s Technical Support Department page. Receive quick 24-hour software assistance by using the Frequently Asked Questions, the Solution Database or Personal Assistance ( ). Click on Search the Solution Database by entering keywords or phrases that are related to your concern. If you have any more questions, or you prefer the personal touch, click on Ask Us under Personal Assistance. Your query will be ed to EagleSoft Technical Support and responded to within 24 business hours. enewsletter Click the enewsletter icon to subscribe to the EagleSoft Newsletter and receive an with tips and tricks for using EagleSoft software, as well as dates for Continuing Training Courses. eclaims/estatements Process eclaims and estatements from the Online Center. You can also view details, transmission logs and solutions for any eclaims rejections. For more information, see the Submitting Electronic Claims and Submitting Electronic Statements sections that follow. Electronic Submission Totals View submission totals for estatements and eclaims. Click Details to view and/or print the Electronic Submission Summary report. Quick Links If you have access to the Internet, click on one of these links to access that particular site. You can access different dental Web sites by clicking on any of the preceding links. Patterson EagleSoft Overview Online Center 505

50 Submitting Electronic Claims The claims section of Online Center is devoted to providing you with an easy way of processing your eclaims. You can view and print eclaim totals from the main page. The following image displays information based on eclaim submissions. 11 batches were submitted and a total of 1236 claims/pre-authorizations were submitted. If you click on Process, then the Claims window appears. The only claims that appear are unsubmitted electronic claims, and they are marked by default. Note: The Claims section only tracks eclaims. Submitting Electronic Statements The Online Center also provides a way for you to submit and keep track of estatements. This report features the Date/Time the statements were processed, the number of statements submitted, descriptions of each statement, the User ID of the person who processed the statements and the computer they were submitted on. When you are finished submitting your estatements, return to the Online Center. The number of Total Statements and Total Forms should be updated. If it isn t, click the Re-Calc button on the top right of the window. This should recalculate the figures in between selected specific dates. Click Process to send your statements. For information on sending statements, see the Statements chapter located in this unit. Click Details to view report details. Electronic Submission Totals You can view totals for both forms of ebusiness on the same window. Online Menu Use the Online menu on the EagleSoft toolbar to access additional support tools. Remote Support From Patterson Technology Center Select this option under the direction of a Patterson Support Specialist to allow the specialist to access your computer remotely. 506 Online Center Patterson EagleSoft Overview 15.00

51 Live Help Select the Live Help option to send a message directly to a Patterson Support Specialist for assistance. A real-time chat session will begin, allowing the specialist and your office to communicate directly online. FAQ Click the FAQ icon to access EagleSoft s Technical Support Department page. Receive quick 24-hour software assistance by using the Frequently Asked Questions, the Solution Database or Personal Assistance ( ). Click on Search the Solution Database by entering keywords or phrases that are related to your concern. If you have any more questions, or you prefer the personal touch, click on Ask Us under Personal Assistance. Your query will be ed to EagleSoft Technical Support and responded to within 24 business hours. Support Select this option to send an directly to a Patterson Support Specialist. Patterson EagleSoft Overview Online Center 507

52 EagleSoft EveryWare Introduction EagleSoft EveryWare provides a way of accessing important EagleSoft data from virtually anywhere. With Palm OS integration and Web access, EagleSoft enables you to manage and view practice information from your handheld computer or Internet browser. Using the EveryWare Export Wizard The EveryWare Wizard gives you a step-by-step walk-through for exporting practice management information to the Web or your handheld. From the Online menu, select EveryWare Sync. Preferences. The Sync. Preferences window appears. EagleSoft Before you can continue, you need to create a password. This password is used each time you log on to EagleSoft EveryWare preferences. It is recommended that you make your password a combination of alphanumeric characters (for to ensure the integrity of your data. Enter a password and click Next. A window appears asking you to verify the password. Click Yes to continue. The next window gives you the opportunity to choose five different areas of data for exporting: Schedule, Phonebook, Prescriptions, Post Ops and Tasks. Select the modules you want to export to your handheld or the Web. If you want th e Wizard to appear each time you Hot Sync your palm, click Yes. Choose from one of the following sync methods: Prompt for overwrite Desktop overwrites Web Web overwrites Desktop Click Next to continue to the final EveryWare Export Wizard window. The final window gives you a summary of information that is going to be sent to the handheld and/or the Web. 508 EagleSoft EveryWare Patterson EagleSoft Overview 15.00

53 Click Web Sync to send the information now. Using EveryWare Scheduler Click Finish to save the information and transmit later. Web Sync There are two methods for transmitting information to your EagleSoft EveryWare Web page: manually or scheduled. Manually If you choose to send the information manually, make sure you ve set up the preferences before proceeding. Then, click the Online menu and choose EveryWare Web Sync. Alternatively, from the Online Center window, click on the EveryWare Web Sync button located on the left of the window. The informat ion is then uploaded to the EveryWare Web page The EveryWare Scheduler enables your office to schedule times EveryWare information c an be imported to the Web from the workstation with the modem. To access the EveryWare Scheduler, click on Start Programs EagleSoft and choose EveryWare Scheduler. To schedule a time to run an update, click Add. Enter a time to run an update. In order to avoid any office activity disruptions, we recommend not running the updates during business hours. Choose whether or not you want the update to run everyday or just on the weekdays. Choose a Synchronization Method: Desktop Overwrites Web The information in EagleSoft overwrites the information stored on the Web. Click OK. Web Overwrites Desktop Information stored on the Web overwrites information in EagleSoft. If you want the EveryWare Scheduler to start when you start your computer, click in the Start the EveryWare Scheduler every time I start this computer checkbox. When you are finished entering scheduled times, click on the top-right corner to exit out of the EveryWare Scheduler. The Scheduler will not run if it is shut down. If you want the EveryWare Scheduler to keep running, minimize the window by clicking the minus sign in the top-right corner of the EveryWare Scheduler window. If it s minimized, the Scheduler will still run and perform any synchronizations. To verify that the Scheduler is running, check the Task Bar area in the bottom right of your computer screen. Using EagleSoft EveryWare for the Web To use EveryWare for the Web, go to the Online Center or open your browser and type in Patterson EagleSoft Overview EagleSoft EveryWare 509

54 From the EveryWare Web page, click Web Based on the EveryWare menu. Enter your EveryWare (EagleSoft) Client ID and Password that was set up in the Wizard, and then click Login. Click one of the following to view information for that exported area: phone book, postop calls, prescriptions, schedule and tasks. phone book From the phone book page, you can filter the view by selecting different criteria from the phone number dropdown list box. Click on the underlined column headings to change the list order. Click the underlined word View to view more information. post op calls When you click post op calls, a list of current post op calls appears on the window. Select a provider or all providers from the first dropdown list box to view only post ops for that particular provider. To search for a particular patient s post op calls, enter some or all of the patient s first or last name. You can also view more information by clic king the underlined word View. prescriptions The prescriptions page enables you to sort prescriptions according to provider and the type of drug. Choose the provider dropdown list box to view prescriptions for particular providers. Click the under lined word View to look at detailed information about the drug. To search for a patient s prescription(s), enter some or all of the patient s first or last name and click Find. schedule From the schedule page, view appointments by chair for a day. Click Next Day to view up to seven days of appointments. Select an appointment block to view more details about that appointment. Search for appointments by entering some or all of the patient s first or last name in the Find field box at the top of the window. Double-click on the appointment to view more information about the appointment. tasks Click tasks to access the tasks page. From the tasks page, re-sort the order of tasks by clicking on the Status, Priority and Subject headings. View tasks for a particular provider by clicking the Show Tasks dropdown list box and selecting a provider. Search for tasks by entering the first part of a task name, and click Find. To add a new task, click Add Task. Click the underlined word Edit in the far-right column to modify a task. The next time you Web sync, the new tasks are downloaded into your database. The synchronization method for the Web determines if modified tasks are downloaded to your database. 510 EagleSoft EveryWare Patterson EagleSoft Overview 15.00

55 End-of-Day/End-of-Month Overview The End-of-Day (EOD) option is used to group together all of the transactions since the last time an End-Of-Day was processed and generate reports based on that time period. Regardless of when EOD is processed, it will only process those transactions that have taken place since you last processed EOD. Processing End-of-Day From the Activities menu, choose Practice Management Activities and then Process End-Of-Day. The Process End-of-Day window is displayed. Review the default Description, the current date. If you would like to modify it, type a new Description. The number of Transactions Since Last End-of-Day and the date End-of-Day was Last Processed On is displayed. When processing EOD while transactions are still being entered or modified in EagleSoft, you need to choose a final transaction to include on the current EOD. To do this, click the Choose the last transaction to include dropdown list box and select the final transaction to include on the EOD. If any of the following tasks are being performed, you are unable to process EOD unless you have exclusive use (all others need to be logged off EagleSoft): Aging all accounts using True Date aging. Adjust accounts with offsetting debits and credits. Update late payment plans. If none of these tasks are being performed, select a transaction and continue processing EOD. Select the Age all accounts using the True Date Aging checkbox if you would like to age all accounts using this method. True Date aging ages accounts by service date and can be done daily. Note: Using this method may significantly increase the length of time required to process the EOD. Patterson EagleSoft Overview End-of-Day/End-of-Month 511

56 Select the Save Indicators to File checkbox to use Infoport to export your indicators to a spreadsheet program. The At EOD, Export Indicators to File checkbox on the Accounting Preferences tab must be selected for this option to be available. Select Adj. accts. seen today with offsetting debits & credits if you want the endof-day process to adjust the accounts. Check Update Late Payment Plans if you wish to apply overdue payment plan accounts to the current balance. Also, key in the number of days overdue. Select the reports you d like to print for this day. The reports that may be printed when processing the End-of-Day are: Deposit Slip Post Op Calls Audit Trail Secondary Deposit Slip Collections Reconciliation Deposit w/ Itemized Cash Production Reconciliation Provider Productivity Adjustment Reconciliation Day Sheet Deleted Transactions Scheduler Audit Trail Appts Without Walkouts Prescriptions End-of-Day Reports For more information on printing EOD reports, see End-of-Day Reports. Click Setup to direct the reports to a different printer than the current default. Click OK to process the EOD. You are then prompted to make sure that you want to proceed. If you do, click Yes. If you do not want to proceed, click No. If you choose No, click Cancel to exit this option and return to the EagleSoft Main menu. Once all of the no productivity reports have been printed, EagleSoft prompts you to review these reports. If you want to continue with EOD processing, click Yes. If you do not want to proceed with EOD processing, click No. If you choose No, your day has not been processed completely, even though some of the reports have printed. You need to start the End-of-Day process again before entering new transactions into your system. Otherwise, new transactions are entered for the current day. Printing Daily Reports from the Reports Menu In addition to printing the reports through the End-of-Day process, you may utilize the Reports menu for the following situations: Print a daily report for a previous EOD (Other Range of EODs). This may be used to reprint a day s report(s) if they printed incorrectly. Reprint reports from the previous day if they did not print successfully. Print the day s activity prior to processing the EOD (Today). From the Reports menu, select the appropriate End-of-Day report. For example, select the Daily Audit Trail report from the Financial Report Grouping. 512 End-of-Day/End-of-Month Patterson EagleSoft Overview 15.00

57 Processing End-of-Month For the most recent processed day s totals, choose the Other Range of End Of Days report. This automatically uses the last End-of-Day you processed for its totals. Click Preview Report to generate the report on window. Click Print to print the report. Deposit Slip/Secondary Deposit Slip Because most banks do not need to see your credit card deposits, and so on, EagleSoft offers the Secondary Deposit report. This report is specifically designed to display the Payment Types set up in EagleSoft to be included on this report. These payment types, however, are excluded from the main Deposit Slip report. Note: If you want payment types to be on the Secondary Deposit Slip report, you must select the Include on Secondary Deposit checkbox. For more information on setting payment types up, see the section on Payment Types in the General Setup chapter located in the Setting up Your Software unit. If you have multiple providers, and you want all provider payments to be shown on one deposit report, make sure all providers have the same Bank Account Number in Lists Practice Management Lists Providers/Staff Identification. Process End-of-Day You must first process the EOD for the current day before processing EOM. First time users: One End-of-Month must be processed without selecting the end transaction. After the first time, you will be allowed to select the transaction from the dropdown list where you wish to end the month. Print Statements We recommend you print/process statements before processing EOM. Even though statements can be processed at any time, most clients find printing statements before running EOM to be more efficient overall. Statements can be processed at any time. They do not necessarily need to be printed before processing EOM. Perform Monthly Backup Using the same procedures you use to make your daily backup, we recommend you make a separate monthly backup. When the backup is complete, it should be kept in a safe, dry location outside your practice, such as a safe deposit box. For more information on making backups, see the Making Backups chapter located in the System Maintenance and Backups unit. Patterson EagleSoft Overview End-of-Day/End-of-Month 513

58 Age Accounts Processing End-of-Month EagleSoft provides you with two different methods to age accounts: Category Aging and True Date Aging. For more information about aging accounts, see the Aging Accounts chapter. Go to Activities and choose Process End-of-Month. The Process End-of-Month window is displayed. Review the default Description, the current month and year. If the description does not reflect the month being processed or if you would like to modify it, type a new description. Choose the EOD to be included. Select the End-of-Day to be the ending point for the End-of-Month that you are processing. The number of Transactions Since Last EOM and the Last EOM information will be displayed. The Reset Insurance Balances option is used to reset the remaining benefits and remaining deductible for all patients with insurance plans that renew in a particular month. For example, if you wish to reset the maximum benefits or remaining deductible for all insurance plans with an anniversary date of January 1, key in 1 and 1 in the With an Anniversary Month Between fields. This would apply when processing End-of- Month for December. Check Run End-of-Year with EOM if you wish to reset yearly totals. For more information about processing EOY, see the following Processing End-of-Year section. Check the box next to the reports you want to print. The reports to choose from are: Accounts Receivable Referral Production Coverage Productivity Provider Productivity Day Sheet Check the box next to the End-of-Month Clean Up tasks you want to perform. The tasks are: Delete Past Appointments Delete OnSchedule Audit Trail Files Delete Electronic Submission History The next window that appears asks if you want to search for appointments for deletion. Select the Appointment Search for Deletion options and click OK. Select an audit trail and click Preview to view the report, or click Delete to delete the report. Click Close to continue with the EOM processing. Enter a date and click OK to delete the electronic submissions on or before the date. A progress meter appears displaying the percentage of the process completed. 514 End-of-Day/End-of-Month Patterson EagleSoft Overview 15.00

59 Processing End-of-Year There are two methods of processing EOY: during the End-of-Month process from the End-of-Month window or from the End-of-Year window. If you are processing an end-of-month for the last month of your fiscal year, you can choose the option of processing the end-of-year as well. If processing EOY right after EOM is not convenient for you, choose the EOY option. Before Processing End-of-Year Before you process EOY, it is very important that you: Perform your monthly backup Perform your yearly backup Access End-of-Year documentation End-of-Year documentation Access the End of Year instructional documents by going to Start Programs EagleSoft End of Year Documentation. Use these files to assist you when processing the End of Year. For more information on making backups, see the Making Backups chapter in the System Maintenance and Backups unit. When Processing End-of-Year with End-of-Month Check the box next to Run End-of-Year with EOM. The Transactions Since Last End-of-Year is displayed. Also, the Last EOY information (date, time and user) is displayed. When you are ready to proceed, click OK to process the EOM and EOY. Select the EOY reports you want to print and click OK. A progress meter appears displaying the percentage of the process completed. Patterson EagleSoft Overview End-of-Day/End-of-Month 515

60 Note: Once this process has taken place, it cannot be reversed without restoring a backup prior to processing End-of-Month/End-of-Year. Choose Cancel to exit the window and return to the Front Office window. When Processing End-of-Year Separately Go to Activities Practice Management Activities and choose Process End-of- Year. Provider Productivity The Process End-of-Year window displays the number of transactions since the EOY and the date and time for the EOY. If applicable, click the Reset Insurance Balances for Insurance Plans checkbox and enter the anniversary months to reset the insurance plan balances. Choose the EOY reports you want to print. Click OK to process EOY. Reviewing Provider Productivity All month-to-date (MTD) accumulators are reset during the process of EOM. All year-to-date (YTD) accumulators are reset during EOY processing. To help you track the performance of your office and the trends that are taking place in your office, EagleSoft calculates several monthly and yearly totals. These productivity totals are calculated for each month and are reset at the time that the end-of-month is processed. Monitoring provider productivity is a very important component of any practice management system. For offices with multiple doctors, provider productivity is a critical component. This section shows you where to review these totals, and provides a more detailed definition as to what the totals actually reflect. The following are areas within EagleSoft where provider productivity can be reviewed: The Provide r Productivity report reveals patients seen as well as adjustment, production, and collection for the time period indicated. The Month-to-Date and Year-To-Date totals are also reflected on this report. Print this report during the Process End -of-day or through the Reports menu. 516 End-of-Day/End-of-Month Patterson EagleSoft Overview 15.00

61 The Practice Management features SnapShot and Trends give productivity, goals and other information for the entire practice. The Productivity button in the Edit Provider window reveals the same information as the monthly and yearly provider totals as well as the Accounts Receivable report for the current provider. Adjustments, Production and Collections The following transactions can be marked to impact Adjustments, Production and Collections: Debit Adjustment Returned Check Billing Charge Credit Adjustment Write-off Account Finance Charge According to what they are marked to impact, the preceding transactions will be included in the total of one of the following columns: Adjustments, Production and Collections. The Day Sheet and Provider Productivity reports reflect these totals. Adjustments A transaction that is figured into the adjustments totals on the Provider Productivity report. The Adjustments Reconciliation reports reflect all transactions that calculate the adjustment totals. Production A transaction that is figured into the production totals on the Provider Productivity report. The Production Reconciliation reports reflect all transactions that calculate the production total, including adjustments marked to impact production. If the adjustment is a debit transaction marked to impact production, the amount is added to the production totals If the adjustment is a credit transaction marked to impact production, the amount is subtracted from the production totals Collections A transaction that is figured into the collection totals on the Provider Productivity report. The Collection Reconciliation reports reflect all transactions that calculate the collections totals, including adjustments marked to impact collections. If the adjustment is a debit transaction marked to impact collections, the amount will be subtracted from the collections totals If the adjustment is a credit transaction marked to impact collections, the amount will be added to the collections totals Patterson EagleSoft Overview End-of-Day/End-of-Month 517

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