EDI Insight Manual. Training Manual. Presented By

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1 EDI Insight Manual Training Manual Presented By

2 EDI Insight Manual 2 Step 1 Upload File: Select the file to transmit on the eceno claims transmission screen and click connect. Login to EDI Insight, when prompted. Step 2 Click on TRANSFER Files option to begin upload process. Click on UPLOAD File option to select the claim file to upload. The file will be processes and will display on the TRANSFER Claim Files screen with the Status, Claims Valid and Invalid, Total, and Claim Amount among other information. Step 3 Verify Claim Count: Verify the total number of claims against your Insurance Filing report in eceno to confirm that the correct amount of claims have been uploaded to EDI Insight. Step 4 If there are invalid claims, double click on the claim file to open and view all claims. Step 5 Click on LIST Invalid to view any claims which did not meet the minimum requirements to be sent to the carrier. **Depending on the number of invalid claims to work, you may want to ready the file before working invalid claims, however, if you only have a couple invalids, it may be easier to correct, then ready the file. It is completely your preference!

3 EDI Insight Manual 3 Step 6 To correct the invalid claims, highlight a claim and double click on the error in red noted at the bottom of the screen. Take the necessary steps to correct. Upon saving the changes to the claim, the claim should change to valid. Step 7 If there are claims that were posted incorrectly, or changes need to be made to the claim that cannot be done in EDI Insight, highlight the claim, and press the delete key on your keyboard. This will change the status of the claim to delete, so the claim will not be sent to the carrier. It is then your responsibility to correct the claim in MedEvolve eceno and refile it, so it will be picked up in a future daily process and sent again to EDI Insight. Step 8 When finished working the invalids, go back to the TRANSFER Claim Files screen, highlight the file, and click READY File. This marks all VALID claims as ready, so EDI Insight knows the claims are ready for submission to each carrier. EDI Insight will begin updating claim status after sending claims and receiving responses from the carrier. Step 9 Check for Invalid and Rejected claims from previously uploaded files. From the Claim Manager screen, click Invalids & Rejects. A list of claims will display that have a status of either Invalid or Rejected. These are claims that have either not made it to the carrier (invalids) or have been rejected by the carrier (rejects) and need attention. Work these claims individually by reading the message and researching what needs to be corrected. Upon modifying the claim information, it may be necessary to RETEST and/or READY the claim, so it can be made available to EDI Insight for submission to the carrier.

4 EDI Insight Manual 4 Step 10 Once all claims have been worked, today s file status is Ready, and invalids and rejected claims have been addressed, check the Response Files area at the bottom of the screen for ERA files to download. ERA files are noted as ERA under column header, File Type. Highlight an ERA file and click DOWNLOAD File. The file will be saved to the correct directory for processing upon logging out of EDI Insight and checks displayed in the Electronic Remittance tab in Posting. Step 11 Exit EDI Insight by clicking on the top right X to close. Answer YES to the prompt asking if you wish to terminate all active sessions. The file on the claims transmission screen should drop to the transmitted folder, and the ERA files will process in Posting. NOTE: You can run EDI Insight independent of MedEvolve eceno, however, for successful claims transmission and ERA processing, you must be logged into EDI Insight from the transmission screen!

5 EDI Insight Manual 5 Transmitting Electronic Claim Files Downloading Electronic Remittance Advice via EDI Insight Select the claim file to upload by placing a checkmark next to the file. If there is no file to send, but remittances are available to download, place the check mark next to Practice Insight. Click Connect. Enter User Name and Password assigned and click Connect. Standard Key Functions in EDI Insight The following keystrokes can be used throughout the application: F1 Online Help Right Click More Options F2 Edit Record Edit Record F3 Add New Record Add New Record F4 Choice List/Search Files Space Bar Clears Radio Control Buttons ESC Cancel/Exit Without Saving Close Program End Save and Exit Save and Exit **Display can be re-sorted by clicking on the column headings.

6 EDI Insight Manual 6 Claim Manager Screen B A C * D The Claim Manager screen is the first screen the user sees upon logging into EDI Insight. A. Task Bar: Lists each open application and indicates the active process in red. B. Left Side Menu Bar: Includes buttons for each application. C. Top Section: Uploads claims from MedEvolve eceno to the claims management server and allows user to select claims to view. 1. TRANSFER Files: Allows for upload of claim file from MedEvolve eceno. 2. PRINT Reports: Launches Report Manager where user can run data mining and web reports based on claims entered in EDI Insight (see options below). 3. SELECT Claims: Searches for claims based on search criteria entered in Claim Selection area. 4. CLEAR Selections: Clears claim selection criteria to begin search again. 5. SELECT Invalids & Rejects: Finds all claims that have INVALID or REJECT status. 6. Print Claim List: Allows user to print claim list. D. Bottom Section: Shows response reports from EDI Insight and the payers and allows the user to download reports and electronic remittance advice from payers. *To begin the upload process to transmit a claim file to Practice Insight, click the Transfer Files option at the top of the screen.

7 EDI Insight Manual 7 Steps to Upload a Claim File 1. Click on the Upload Files button. 2. When prompted with the box below, select the claim file to upload. When the claim file is displayed in the File name field, click the OK button. C:\EDI Insight Files NOTE: The first time a file is uploaded, it will be necessary to browse to the following directory on the PC: C:\EDI Insight Files. To do this, use the drop down arrow in the Look in field to find Local Disk C: and the folder named EDI Insight Files. After the first upload, the location will be stored to the PC for future uploads.

8 EDI Insight Manual 8 3. The file will be securely transferred from your PC to the Claims Server using SSL technology. You will see the box below indicating the status of the file upload. 4. The claims will then be loaded into the claims management database. The payers and providers will be matched to valid payers and providers in the EDI Insight data base. You will see the following box as claims are being loaded: 5. If the file was loaded without any errors, the claims tester (pre-scrubber) will test each claim. A claim will either be VALID or INVALID. If the claim is set to INVALID, it will have a status message attached to the claim showing the reason the claim is invalid. 6. A new file will appear in the uploaded files list. Check the status, claim count, and total claim amount of your uploaded file. The totals should match back to your Insurance Filing report in eceno. If the file loaded correctly, the status will be TESTED; if not, please contact MedEvolve support. Double click the highlighted file to view the claim list. Invalid claims can be fixed in the claim list view by double clicking the highlighted claim. 7. A new response file will appear in the Downloaded Files list on the bottom half of the screen. Double click the file to view. The file can be printed while viewing by right clicking and choosing Print. The file can also be downloaded to your PC by pressing the Download button. 8. To make all VALID claims in the uploaded file READY, highlight the file and press the READY button. This will make all of the VALID claims READY to be processed. Any invalid claims in the file will remain invalid until fixed. NOTE: the invalid claims will NOT be sent on to the payer!!!

9 EDI Insight Manual 9 Claims Testing & Working Uploaded Claims Upon receiving batch claim files, EDI Insight runs edits on each claim for validity including: CPT/HCPCS/ICD-9 Codes: validation based on the date of service of the claims. ANSI Code Sets: validation includes modifiers, place of service, and type of service. City, State, Zip: validation compares zip code to correct state. Required Group and Provider ID: validation based on requirements by the payer. Table-Based Rules: testing for required ANSI fields and payer specific data elements. TESTED 55 Once claims are uploaded into EDI Insight and marked with a status on the Transfer Claim Files screen, it is imperative that the claims be worked to ready them for transmission to the carrier. The claims will be listed in the top section with the status of either VALID or INVALID, based on the initial testing during upload. Double click on the claim file to view the individual claims and find INVALID claims. VALID VALID VALID VALID VALID VALID To list only INVALID claims, click on LIST Invalid, and the list will only return those claims that have an invalid status and must be worked.

10 EDI Insight Manual 10 How to Fix Invalid Claims Invalid claims listed below Insured names will be shown here. Billing provider or group name will be shown here. Rendering provider names will be shown here. Status messages listed below Fix Invalid Claims 1. Press the INVALID button on the list view to list ONLY INVALID claims. 2. Click on claim and look at the Status Message List to view the rejections. The rejections will be highlighted in RED. 3. Highlight the red status message; scroll to the right of view more information about the rejection. 4. Double click the red rejection message to fix the claim. If the system knows which field is the problem, the edit screen will appear with the cursor on the field that needs to be fixed. If the system does not know the field to fix, you will be prompted to fix the claim by pressing F2 or Edit while highlighting the claim in the list. 5. Fix the field with the error and press the Save icon or the END key to save your changes and exit. If the claim was successfully fixed, the error message will disappear, and the claim status will change to VALID if all rejections are corrected. Edit Valid Claims 1. Highlight claim and double click, F2, or press Enter to edit the claim. 2. Enter any additional, missing, or corrected information. 3. Press the save icon or the end key to save your changes and exit. Press the ESC key or the cancel icon to exit without saving. See next page for the Claim Screen

11 EDI Insight Manual 11 Claim Screen A B D Patient Information is listed here. C A. Payer Information: if the payer ID is missing, click on the yellow file folder to add payer. Search by payer to determine Payer ID or wait for entire Payer ID List to populate at the bottom. B. Claim Visit Information: Correct visit information here based on what is incorrect. REMEMBER: if changes are made in EDI Insight, the changes must also be made in eceno for accurate reporting!!! C. Claim Transaction Information: Individual procedures will be listed here. If procedures are invalid, the claim will need to be deleted from EDI Insight and reversed/reposted inside eceno for correction. D. Save Changes: When the changes to the claim are complete, click on the save icon. The claim is re-tested upon saving, and if it passes all edits, the claim status will change to VALID. ***Note: All edits made to claims are tracked. Press the View Changes button on the bottom section of the Claims Manager screen to display changes made to claims. The log can be printed and used to update changes inside eceno.

12 How to View an Individual Claim Claim Options EDI Insight Manual 12 From the Uploaded CLAIMS screen, the user can click on an individual claim to view the responses listed. The list of options will change to: LIST Invalid: Displays only the invalid claims. These claims will not be sent to the payer until they are corrected and pass the tester as valid. LIST All: Displays ALL claims in the uploaded file. VIEW Claim: Displays a CMS-1500 (HCFA) image of the selected claim. RETEST Claim: Retests the individual claim record. READY Claim: Sets the individual claim to READY. Claims listed below Insured names will be shown here. Billing provider or group name will be shown here. Rendering provider names will be shown here. Status messages listed below Transfer Claim Files Screen UPLOAD File: Finds and uploads the file from MedEvolve eceno. SCRUB File: (If applicable) sends a loaded claim batch to Practice Insight s trading partner s system to be scrubbed for clinical edits. RETEST File: Retests every claim in the selected (highlighted) file. VIEW File: Allows user to view the contents of the uploaded file. ***READY File: Changes all VALID claims in the selected (highlighted) file to READY. If any of the claims are invalid, the claims will remain INVALID and can easily be retrieved in Claim Manager by clicking the SELECT Invalid & Rejects button. Claims that are ready will be picked up by Practice Insight for processing to the carrier. LIST New: Displays new files which have not been set to READY. LIST All: Lists all uploaded files.

13 Options from Uploaded Claims Screen EDI Insight Manual 13 RIGHT CLICK OPTIONS on Uploaded Claims Help F1 Submit/End End Cancel Esc List Valid Claims Only Alt+F8 List All Claims Alt+F9 View Claim Information on CMS Form F9 Clinically Scrub Selected Claim Alt+F7 Test Claim F5 Set Claim to Ready to Send Claim Alt+F6 Get Support on Selected Claim F8 Secondary COB Summary c View Claim on HCFA1500/UB92 Form v Type memo here! Claims Options from Uploaded CLAIMS Screen VIEW Change Log: Shows a list of changes that have been made to a claim such as adding referring physicians, changing diagnosis pointers, etc. PRINT Timely Filing: Shows filing history of a claim including when the claim was filed to the payer and responses back from the payer, if applicable. ADD Memo: Add memo to store on the claim. EDIT Memo: Edit memo already stored on the claim. Doctor s Name Address Telephone Patient Name Here Patient ID Patient Name Here Physician s Name Prints Here

14 Searching for Claims EDI Insight Manual 14 Start on Claim Manager screen and click CLEAR Selections. When searching for particular claims, claims for a particular carrier, claims by date range, etc, go to the Claim Manager screen. It is best to click CLEAR Selections first to be sure the search will start from scratch. From here, select the criteria to search for claims. At least one claim status must be selected to produce results.** **Claim Status: Click on drop down arrow to select one status or multiple. Click on the save button when exiting. Beginning/Ending: Date range for claims. Date Range: Select by Date Range Uploaded for claims by upload date, or by Date Filed for claims by file date. Uploaded File: Drop list down to see ALL uploaded batch claim files. Billing Prv: Allows selection of a billing provider (group name), if you have more than one. Otherwise, the search will, by default, pick up ALL claims for your group. Rending Prv: Select rendering provider (insurance provider) to search for claims. Insured Last: Searches for claims by insured last name. Patient Last: Searches for claims by patient last name. Insured ID #/Insured Group #: Searches for claims by patient insurance and/or group ID. Pt Account #: Search for claims by patient account number. NOTE: the account numbers in EDI Insight will always appear with a - followed by another set of numbers. It is not necessary to search by the entire number. Use ONLY the account number you have assigned to the patient in eceno, and the search will find ALL claims uploaded for the account number! EDI Claim ID: Search for claims based on EDI Claim # EDI Insight assigned. EDI Scrub ID/EDI Batch ID: Please contact MedEvolve about these search options. Payer #: Search for claims by Payer # assigned to payers by EDI Insight. Payer ID: Search for claims by actual Payer ID. Payer Name: Search for claims by payer name. Payer Type: Search for claims by various payer types. Use drop down to access the list from which to choose. Payer Claim #: Search for claims by payer assigned claim number. Resp Payer: Select responses from Primary and/or Secondary carrier(s). Claim Format: Select professional claims or institutional (facility) claims. Leaving options blank will search all. Connection ID: Unknown. Payer/CH Ref #: Unknown. Response Msg ID: Unknown. Retrieved ID: Select claims based on Retrieved ID that EDI Insight assigns files received from carriers. You can find this number by clicking on the TRANSFER Claim Files screen, highlighting a response file, and scrolling all they way to the right to find the Received ID column.

15 Downloading ERA Files EDI Insight Manual 15 Files are available for download on the Transfer Files screen. Files marked ERA can be saved and processed in eceno for automated posting. Highlight (click) on file to be saved and press DOWNLOAD File. C:/EDI Insight Files/ Select the appropriate directory-usually C:/EDI Insight Files. Click Save. When you are finished downloading all ERA files, close out of EDI Insight, and the ERA checks will be processed by eceno and viewable in the Electronic Remittance tab in Posting. ***NOTE: In order for ERA checks to properly download and be viewable in Posting, you must be logged into EDI Insight from the Transmission Screen in eceno!!! If you are not logged in through the Transmission Screen, the checks will NOT process correctly!!!

16 EDI Insight Manual 16 When claims have been worked and ERA files downloaded, EXIT EDI Insight by clicking on the top, right X to close. The claim file will drop to the Transmitted folder, and the ERA files will process into checks in the Electronic Remittance tab in Posting. Report Manager Options Contact MedEvolve to find out other great features including but not limited to EDI Insight s tool, Data Miner, which generates reports based on claim input, the Claim Scrubber module, and Eligibility!