integrating allscripts payerpath with office manager · between allscripts payerpath and allscripts...
Post on 19-Jun-2020
14 Views
Preview:
TRANSCRIPT
Integrating Allscripts Payerpath with
Office Manager
AUGUST 9 – 11, 2016
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2
Healthy Core• Allscripts provides solutions that streamline workflows across clinical, financial
and operational processes
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 3
Payerpath Knowledge Resources
1. News, Featured Videos,
Knowledge Resources
Client Connect
1. Payerpath Knowledge
Center
1
1
2
3
3
2
Introduction and Agenda
AUGUST 9, 2016
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 5
OverviewGoals: This session will show Payerpath user workflows and tools to effectively reconcile
and track their Claim, Eligibility and Appointment reminder statuses using Office
Manager.
Topics include:
• Eligibility, Appointment reminder and 277 Claim Notes Integration with Allscripts PM.
This advanced session is for clients that want to leverage Office Manager for integration
between Allscripts Payerpath and Allscripts PM. This session will demonstrate how clients
can use Office Manager to drive workflows based off various Allscripts Payerpath status.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 6
Agenda• Understanding Eligibility Verification
• Integrating Eligibility Verification Reponses with Office Manager
• Understanding Payerpath Call
• Integrating Appointment Reminder Responses with Office Manager
• Understanding 277 messages
• Configuring 277 messages
• Integrating 277 messages with Office Manager
Understanding Eligibility Verification
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 8
Eligibility Verification• Batch Eligibility
Appointments are gathered and forwarded in a report format for bulk eligibility verification
Batch Eligibility allows a client to pull results based on account types, appointment types,
payers, locations, providers, etc.
The system is configured to automatically process appointments
Batch eligibility requests can be scheduled from 1 day prior to several weeks in advance of
the patients appointment.
Responses are returned to the Appointment Scheduler
Batch results can also be viewed within Payerpath
• Real Time Eligibility (Can be done in PM and Payerpath)
Process a demand request at anytime
Receive responses within 30 seconds or less
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 9
Appointment Management
• The coverage status of an
appointment can be seen in
Appointment Scheduling and
in Office Manager.
• The coverage status
appears in column “C” and is
color coded
• The user must highlight the
appointment and right-click
to view the eligibility
response details.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 10
Eligibility Responses
Indicates PENDING eligibility response (Automatic)
Indicates RECEIVED with active coverage (Automatic)
Reflects report has been read with active coverage (Manual)
X
Reflects report has been read with inactive coverage (Manual)
Indicates EXCEPTION eligibility response (Automatic)
Indicates INACTIVE coverage (Automatic)
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 11
Eligibility Response View• Select your
appointment and
right click
• Click on View
Eligibility
Response
2
1
1
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 12
Eligibility Response Report
Enhanced to include ALL data returned in the eligibility response files from the payers. Simply click on the applicable Service Type category to view the detailed benefit coverage. Appointments get pulled for the verification report.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 13
Detailed Example of Service Type (30) –Health Benefit Plan Coverage
Integrating Eligibility Verification
Reponses with Office Manager
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 15
How to Configure Office Manager
• Select the filters
that better fit the
needs of your
organization
• Analyze your
appointments
2
1
1
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 16
Work Group Maintenance Appointment
Assign
operators to
the queues
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 17
Using Office Manager
• Click in Office Manager and the Queue
• Right click on the appointment
• Review eligibility response
• Update the coverage field as needed in
the appointment detail screen
2
1
1
2
3
4
3
4
4
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 18
Using Office Manager vs. Appointment Management
• Centralized vs. decentralized operations
• Dedicated hours vs. as time permits
Understanding Appointment
Reminders
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 20
Appointment Reminders• Payerpath Call is a service that helps Clients automate the time-consuming
task of calling patients to remind them of an appointment.
• Clients transmit a list of patients appointments from Allscripts PM to Payerpath
for Call fulfillment.
• Patients receive a professionally-recorded, custom message reminding them of
the day, date and time of their appointment.
• Text Messaging is also available for patients that prefer to receive a text
message.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 21
The iRemind Appointment Export is used to extract appointment detail from Allscripts PM™ and to generate a file that is transmitted to Payerpath using the EDI Transport Utility (EDI Send and Receive Process).
This is exported file is transmitted by Payerpath where appointment reminder calls are generated.
A result file is returned by Payerpath. From this file, Payerpath generates a confirmation report that is sent to you and placed in a folder under the database's Ntierfilesdirectory.
How Does It Work?
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 22
Integration – Appointment Export (IRE)
Items designated in the
IRE will determine which
appointments get pulled.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 23
Integration
A patient’s Contact
Preference of “Do Not
Contact” on the
Additional Info tab in
Registration (REG) will
always be excluded
from any Call export
file. Patients without a
Contact Preference are
included in the export.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 24
Integration
When right-clicking on
an appointment in
Appointment Detail or
Confirm Appointment
windows, a Confirmation
Result drop-down list is
available. The
Appointment Reminder
confirmation result
automatically populates
this field with a short
description.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 25
Integration
Preloaded Confirmation
Result Codes will populate
once a call has been made.
From the appointment
activity it can be seen at a
glance whether calls were
made and the result.
Codes returned are
preloaded in Appt.
Confirmation Result Code
Maintenance.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 26
Code Short Description Long Description
F Answered- Called Receptionist A person pressed the touch tone key to speak to the receptionist
] Answered- Confirmed Left Message Identification confirmed and then pressed the touch tone key to
leave a message
__ Answered- Confirmed No Identification confirmed and then pressed the touch tone key to
indicate “no” as the response
L Answered- Confirmed Repeated Identification confirmed and then pressed the touch tone key to
replay the message
K Answered- Confirmed Rotary Message Identification confirmed and then rotary response accepted
G Answered- Confirmed Yes Identification confirmed and then pressed the touch tone key to
indicate “yes” as the response
N Answered- Entire Message A person answered and listened to the entire message
H Answered- Hung Up A person answered but did not listen to the entire message
M Answered- Left Message A person answered and pressed the touch tone key to leave a
message
^ Answered- No A person answered and pressed the touch tone key to indicate “No”
as the response
T Answered- Repeated Message A person answered and pressed the touch tone key to repeat the
message
E Answered- Rotary Message The call was completed and a rotary response was accepted
Reports – Integrated Return Codes
Over 30 Recordable
Responses:
• Confirmed
• No Answer
• Answering Machine
• Out-of-Order
• Busy
• Not Called
• Answered: No Response
• Rotary Message
• Repeated Message
• Never Call Patient
…And More!
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 27
Reports – Quick ViewAppointment Reminder
Notification Report
Clients will receive a separate
Appointment Reminder
Notification Report (AN) for each
file transmitted.
Each AN report will list the
number of Accepted reminders,
the number of Rejected reminders
(if any) and the Total reminders in
the file.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 28
Reports - LocationAppointment Reminder
Processing Summary Report
Clients will receive a separate
Appointment Reminder Processing
Summary Report (AP) for each
file transmitted.
Each AP report will list the
actual call/text results.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 29
Reports - Patient
Each AP report will list the
actual call/text results.
Appointment Reminder
Processing Summary Report
Clients will receive a separate
Appointment Reminder Processing
Summary Report (AP) for each
file transmitted.
Integrating Appointment Reminder
Responses with Office Manager
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 31
How to Configure Office Manager
• Select the filters that
better fit the needs of
your organization
• Analyze your
appointments
2
1
1
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 32
Work Group Maintenance Appointment
Assign
operators to
the queues
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 33
Using Office Manager
• Click in Office Manager and the Queue
• Right click on the appointment
• Update the confirmation result field as
needed in the appointment detail screen
2
1
1
2
33
3
Understanding 277 Messages
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 35
What are 277 Claim Status Messages• 277 Transactions are the EDI response to the inquiry about the current status of a
specific claim or claims.
• These transactions utilize claim status categories to communicate if the claim has been
acknowledged, pended, finalized or if additional information is being requested.
• These transactions utilize claim status codes to further explain the status of the claim.
• Payerpath has created custom transactions to communicate the status of the claims.
• 277 Transactions are the EDI response to the inquiry about the current status of a
specific claim or claims.
• Professional and Institutional claims are supported (where data is available).
• 3 Message Types are generated (277U, 277A, & 277P).
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 36
Types of Claim Status MessagesPAYERPATH (277 MESSAGES) CARRIER (277 MESSAGES)
• Utilize custom claim status categories and codes to
communicate the status of the claim.
• 277U - Upload detail report
• Utilize HIPPA compliant claim status categories and
codes to communicate the status of the claim.
• 277A - Carrier Acknowledgement (usually within 24
to 48 hours after transmission).
• 277P - Payer Reports (usually within one to three
days, depending on the payer’s processing
capabilities).
CODES
ACC_STATE
ADMIT_DATE
BILLING_SPECIALTY
CLIA
DIAG_CODE1
CATEGORIES
CODE
FAC
INFO
INS1
PAY1
CODE DESCRIPTION
27 Policy canceled.
28 Claim submitted to wrong payer.
29 Subscriber and policy number/contract number mismatched.
30 Subscriber and subscriber id mismatched.
31 Subscriber and policyholder name mismatched.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 37
Where Can I Find Claim Status Messages
1. Under Financial Inquiry (FIN) &
Account Ledger right click on the
voucher
2. Select View Claim Status2
1
1
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 38
Where Can I Find Claim Status Messages
1. Under Claims Review (CRE) &
Office Manager right click on the
voucher
2. Select View Claim Status2
1
1
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 39
277 Claim Notes Examples
1. Source - Payer
2. Action Code - Status
3. Claim Category
4. Claim Status
5. Description
2
1
3
4
5
1 2
3
4
5
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 40
277 Claim Notes Examples
1. Source - Payer
2. Action Code - Status
3. Claim Category
4. Claim Status
5. Description
2
1
3
4
5
1 2
3
4
5
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 41
277 Claim Notes Examples
277 Messages document
in the Practice
Management what
appears under Payerpath
Configuring 277 Messages
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 43
Allscripts Interface Configuration (AIE)
Three different AIE Format
Class Maintenance records
and the corresponding Broker
Format Maintenances are
required for ANSI 277 Claim
Status Notes setup to have the
three types of files return
correctly.
• 277U
• 277A
• 277P
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 44
Claim Status Category Maintenance
• Claim Status
Categories auto-
populate under the
Claims Status Category
Maintenance Table.
• Descriptions have to be
updated according to
Washington Publishing
Company (WPC)
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 45
Claim Status Code Maintenance
• Claim Status Codes
auto-populate under
the Claims Status
Code Maintenance
Table.
• Descriptions have to
be updated
according to
Washington Publishing
Company (WPC)
Integrating 277 Messages with Office
Manager
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 47
How to Configure Office Manager
• Select the filters
that better fit the
needs of your
organization
• Analyze your
claims
2
11
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 48
WQM Configuration Tips• Map all queues
• Create multiple queues to track trends
– Payerpath failed claims 277U
• Custom Codes
• Billing Dates*
– Payor rejections 277P
• HIPPA Compliant Codes
• C/S Import Dates*
• Avoid overlapping
• Balance queue volumes (Weekly/Monthly Queues)
• Appropriate timing (0 Days)
• Validate your queues against Payerpath*Not recommended for workflow organizational basis
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 49
Work Group Maintenance Unpaid Claims
Assign
operators to
the queues
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 50
WGM Configuration Tips
• Map all groups
• Add managers to all queues
• Prioritize the queues
Using Office Manager
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 52
Step 1: Accessing Unpaid Claims Mgmt.
1. Click on Office
Manager
2. Click on the
Unpaid Claims
Management
folder
3. Click on the
desired folder
2
1
3
3
1
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 53
Step 2: Dragging & SortingSort using any column header
Left click on any column header
Drag to sort by that column
1
1
2
2
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 54
• Sort using any column header or multiple column headers
Step 2: Dragging & Sorting
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 55
Step3: Reviewing the Claim
1. Right click on
your claim
2. Select View
Claim Status
3. Review the
report
4. Make
appropriate
changes
2
1
3
2
4
1
3 4
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 56
Step 4: Adding Claims Notes
2
3
1
2
4
1. Right click on your claim
2. Select Claim Notes
3. Click the magic wand
4. Type your note and
save
1
2
3
4
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 57
Step 5: Rebilling Your Claims
1
2
4
1. Right click on your claim
2. Select Edits
3. Check Rebill
4. Click Save
1
2
3
4
1
3
4
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 58
Let’s talk about Auto ReplaceWhat is it?:
• When the Auto Replace setting is turned any claim that is in a Failed or
Warned status (and ONLY in those two statuses) will be deleted when a
replacement/new claim with the same claim number and payer are
uploaded to Payerpath.
Workflow Benefits:
• Users don’t have to go back into Payerpath and manually delete claims
that have been corrected and resent from their PM system. This allows
tighter integration between PM and Payerpath. A user can fix all of their
issues in the PM system and have minimal need to spend more time in
Payerpath doing additional manual steps.
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 59
Office Manager Workflow Tips
• Drag and sort claims
– Billing date
– Follow up date
– Payor
– Provider
• Add claim notes before rebilling the claim
• Reconcile your claims
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 60
Top 4 FAQ• Does Office Manager work with other Payerpath solutions?
– Yes: Electronic Remittances.
• Is Office Manager updated real-time?
– Yes: Office Manager is updated/refreshed as soon as the messages are received.
• Does the APM reconcile failed claims with Payerpath?
– Yes: Payerpath has a setting that allows you to automatically reconcile your claims*.
• Is there an additional charge for 277 Messages?
– No: 277 integration is included with the Payerpath services.
* Client’s Payerpath ID, Claim number, & PP Payor ID have to be the same
top related