Practice Insight Instructional Webinar Series Presented by: Advanced

Practice Insight Instructional Webinar Series Presented by: Advanced

Practice Insight Instructional Webinar Series Presented by: Advanced Claim Shaun McAnulty Product Training Specialist Manager Topics to Cover

Transfer Files Claim Status Use Selection Criteria Right Click Functionality Editing a Claim Transfer Files Upload Files Response Files

View complete file in the format is was sent to PI in. See who uploaded claim file. See claim files original uploaded file name. View error messages if Claim File fails to load. File break down showing claim basic stats. Download file if you need. Repost to SFTP using Right Click if File is missing on PM. (Integrated users) Download file to repost to PM

(Manual) Full EOB View Mark ERA responses as Received once they are pulled into PM (Best tracking) File ID: used in selection criteria to locate this group of claims File Name: the original file name for the upload. File Type: what file was uploaded and what format. Multi Select

Responses Staff Name: who uploaded the file. If the claims have any issue loading there will be a message displayed Mark ERA responses Received (organizational) See when a response was viewed & who by, when mark received & who by. Filter List Responses

Locate responses by File Type, File Name, Date ranges, Description, Status, File ID (File responses came in on), Retrieved ID (What file responses came in on) and Perform a Check Search using the Check Number. Statuses Claim Status Definition Source VALID Claim Valid (Must be set to TESTER /SCRUBBER

READY to SEND to Payer) READY Claim Ready to be Batched Auto Processed /Manual Status and Sent to Payer Override Claim Acknowledged Response ACK ACCEPTE Claim Accepted by the Payer D

PAID-ERA Claim Paid by Payer PAID Claim Paid according to a User Green= Commonly expected Statuses Statuses Payer Response Payer Response (ERA 835) Manual Status Override/ Received paper EOB Red= Error or Workable

Common Working Statuses Claim Definition Status INVALID Claim Invalid by Source TESTER /SCRUBBER Tester or Scrubber REJECTED Claim Rejected by Payer Response

Payer DENIED Claim Denied by a Payer Green= Commonly expected Statuses Statuses Payer Response / Real Time Claim Status (276) Red= Error or Workable Common Working Statuses Additional Statuses

Claim Status Definition APPEALED Claim Appealed by End User COMPLETE Claim considered Complete by User DELETE Claim Marked Deleted by a User PAID-PYR Claim Payment Acknowledged by Payer

PEND-USR Claim Pended by User PENDED Claim Pended by Payer Green= Commonly expected Statuses Statuses Source Manual Status Override Manual Status Override Manual Status Override, will not show on reports. Real Time Claim Status (276) Manual Status Override

Payer Response / Real Time Claim Status (276) Red= Error or Workable Additional Statuses Organizational Statuses TESTER rejections How we get Invalid Claims 1st level of testing Rule-based edits are used to stop claims with missing or invalid data or to flag

claims that meet a particular criteria. Double click on rejection to take you to field in error for easy correction Once the claim is corrected in Practice Insight it will retest as VALID then Ready the claim. EDIFECS rejections 2nd level of testing Runs after claim has batched but before its sent to the payer, further tests claims to assure they are ANSI compliant. Correcting the claim WILL NOT make it VALID, Correct then Ready Claim! How we get Rejected

Claims. Payer/Trading Partner Rejections The same rejection message does not always have the same reason. Look for clues in the rejection message to determine the cause: o Example: Rejection message A7:562:85 is an enrollment rejection. The 85 points to the billing provider. In the ANSI file the billing provider name has a qualifier of 85. See below example of an ANSI file billing provider loop: o EDI ID# 131415021 in Demo Database Loop 2010AA Billing Provider Name NM1*85*2*GROUP MEDICAL*****XX*1234567890 How we get Rejected

Claims. Payer/Trading Partner Rejections View the ANSI file to see which qualifier the rejection message is referring to: Using the Right Click to View Batch File! Example of common qualifiers referenced in rejection messages: o o o o o NM1*85 = billing provider

NM1*82 = rendering provider NM1*IL = subscriber NM1*77 = service facility NM1*DN = referring provider Selection Criteria Vendor/ CBO Level only: specify customer. Give age buckets, or calendar dates. Then select what date should be used for the selection. Specify an uploaded claim file from Transfer Files.

Can narrow selections to specific Providers as well. Narrow claim selections by staff member assigned to. (Hotkey: A on claim) Name or range search, also can use Wildcard Searches. (EX: %%ith) Unique Id for specific claim in EDI Returns all claims based on Responsible Payer.

If Clinical Scrubbing (Extra Service) Edit Id can be entered to locate all claims with error. If Payer or CH sends back their ID number for the claim it is also searchable. Selects claims using PI Payer ID.

The Outbound ID # for a Payer Narrow by Type of Payer. Can group claims with the same Response ID Select claims that contain the same Retrieved ID. RIGHT CLICK OPTIONS Claim Selection View

Standard Functions Status Message View Claim Related Functions Views of Claim Reports Functions for All Claims Claim Related Functions

Editing Claim Have the capability to pass change log back to PM. Eliminating dual work Easy, logical layout to work claims. Change transaction sequence easily moving their order. Hover text displays ANSI coordinates. Assisting you in locating the potential problem the payer or tester may be flagging. Views of Claim Reports

Inbound or Outbound Files? Functions for ALL SELECTED Claims Status Message View Options Additional Functionality Ctrl+C: With a line item (Claim list view, or Status message view) highlighted, the user can copy and paste values. When

CTRL+C is used a clipboard of the data will appear, to copy data simply double click on value desired. Ctrl+B: Displays what the claim would look like on a potential batch. Allowing you to view the potential Ansi data you would send to the payer. Delete Key: If user has permissions, using the delete key can delete highlighted selection (i.e. Claim, Uploaded File).

Space Bar: Clears radio selections when no radio selection is needed. F4: (for use in Selection Criteria fields) Displays search tool or multi select dialogue box for fields. Question and Answer

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