ec billing procedure 12-2016.pages

Electronic Claims Biller Procedure

1. Move daily lab reports2. Work ‘Pending with Errors’ claims3. Print HCFA claims4. Send OCC claims (FIRST OF EVERY MONTH)5. Send Batch Reports / Log Receipts6. Send patient statements (EVERY TUESDAY)7. Work ‘Clearinghouse Rejected’ and ‘Insurance Rejected’ claims

MOVE DAILY LAB REPORTS (1)

1. eCW > Reports > eBO Reports2. Browser will open > enter username and password > OK3. eCW-eBO home > Classic View4. Saltzer Custom Reports > Lab 5. If today is a Monday, you will move ALL Lab Reports for Friday, Saturday, and

Sunday a. If today is after a long weekend, remember to include reports from the

last day before all days off (i.e. BO closed Thursday & Friday, you will need to move Weds-Sun).

6. Lab_daily_reports > More …a. View run historyb. Verify top item is for PREVIOUS DAY

i. If report has not been run, notify Help Desk & wait for reportc. Actions > click on blue icon (View run history details) for yesterday’s

date (or Friday/Saturday/Sunday)

d. Actions > click papers icon (View outputs)e. Versions > Select desired date, but do not check the box next to the date

Revised 12/29/2016 of 15

f. Actions > click Download icon g. Pop-up window (bottom of browser window) > Do you want to open or

save?> Click next to Save > Save as

h. Save dialogue > verify directory is Lab Reports \\wolverine\Business\Lab_reports\

i. Add [DATE OF REPORT] to end of file name > Lab_Visit_Exception_Report_CurrentDay033116

i. Savej. Close > Close

i. If running reports on a Monday, click on blue icon for next day’s report

k. Repeat from c. until ALL Daily Lab Reports have been downloadedl. Close

7. Lab_Govt_Registration > More …a. View run historyb. Verify top item is for PREVIOUS DAY

i. If report has not been run, notify Help Desk & wait for reportc. Actions > click on blue icon (View run history details) for yesterday’s

date (or Friday/Saturday/Sunday)

d. Actions > click on papers icon (View outputs)e. Versions > Select desired date, but do not check the box next to the datef. Actions > click on Download icon g. Pop-up window (bottom of browser window) > Do you want to open or

save? > Click next to Save > Save as

h. Save dialogue > Verify directory is Lab Reports \\wolverine\Business\Lab_reports\

i. Add [DATE OF REPORT] to end of file name > Registration_Form_Govt_visits_Current-Date033116

i. Savej. Close > Close

i. If running reports on a Monday, click on blue icon for next day’s report

k. Repeat from c. until ALL Lab Govt Registration Reports have been downloaded

8. Close browser9. Move all reports

Revised 12/29/2016 of 15

a. FileZillab. Local site: (left window pane) = \\wolverine\Business\Lab_reports\c. Click next to server icon in upper left corner of window (Open the Site

Manager)

> select SLHS_Labs d. Remote site should open in right window pane

e. Select all Lab and Registration reports in left window pane (Local site) and drag to right window pane (Remote site) to copy

f. Confirm all files have successfully transferred10.Delete labs from Local Site

a. Select all reports in left window (Local site) > Right click on files > Delete > Yes

b. Close FileZilla11.Outlook > New Email

a. To: [email protected] (Cheryl Hanson) > Subject: Daily Lab Reports [DATE OF REPORT(S)]

b. “All lab reports have been moved for [DATE OF REPORT(S)].”c. Send

Revised 12/29/2016 of 15

WORK PENDING WITH ERRORS CLAIMS (2)

1. Billing > Claims2. Service Dt(s) = 07/01/2015 to [YESTERDAY’S DATE] 3. Claim Status = Pending With Errors4. Assigned to = All5. Lookup

ALL Claims1. Open Claim2. Errors tab > check errors > can I fix it?3. If no errors found

a. Options > View Logs > View Claim Status Log (277 Unsoclicited)

4. If I can fix problema. Notes > describe changes madeb. Claim Status = Review Completed > OK

Revised 12/29/2016 of 15

5. If Coding/CSR errora. Follow Up > Notes > copy and paste errorb. Claim Status = [Biller Review/CSR Team to Correct] > OK

6. If I don’t know how to fixa. Notes > copy and paste errorb. Claim Status = Failed Validation > OK

PRINT HCFA CLAIMS (3)1. Billing > Claims2. Service Dt(s) = 07/01/2015 to [YESTERDAY’S DATE] 3. Claim Status = Print HCFA4. Assigned to = All5. Lookup6. Open claim7. If OCC claim > Claim Status = Submitted

a. Do not count toward paper ## and $$ total for the dayb. OCC claims sent on 1st of the month

8. If Work Comp/Motor Vehicle Accident/3rd Party Insurance > send HCFA with Chart Notes

9. If Secondary > Send EOB with HCFAa. Insurance & Payments > Double-click payment > Double-click itemb. Post CPT > View ERA or open EOB pdf > Print (1 page only for EOB)

10.If Tertiary > Send both prime and secondary EOBs with HCFA11.On a scratch paper, note total ## of claims, and total $$ amount of claims for

Daily Sends Report

12.Double-click claim a. If this is a Secondary needing a HCFA

i. Print EOB and include with HCFAb. If Insurance is WPS VACAA

i. Claim Status = Ins Team to Correctii. Assigned to (per patient last name) > …

1. A-M > Gina2. N-Z > Noelia

Revised 12/29/2016 of 15

3. Priority = High4. Notes > “Claim ready to process”5. OK

c. All other paper claimsi. Prog. Notes > Print > Print > Close > Examine progress note for:

1. Simple Office Visits do not need additional notes with claimi. 92012, 92014-15, 99201-205, 99211-215

b. Labs (8xxxx) do not need additional notes with claim IF results are outlined in the Progress Note > If not, print lab report

c. X-Rays (7xxxx) need to be printed and included with claim

2. Print HCFA (02-12) > opens in Word > File > Print > Printer > HCFA > Print > margins outside printable area > Yes > close document > Don’t Save

3. eCW > Follow Up tab > Notes > “Paper claim sent to [Insurance] with chart notes” > OK

ii. Repeat b. for all Print HCFA claimsb. Match HCFAs with Progress Notes/etc. > put in envelope > outgoing mail

i. State Insurance Fund claims CANNOT be stapledii. All other claims are staplediii. Multiple claims to same mailing address can be put in one

envelope

For RAILROAD MEDICARE13.Unapproved RR Mcare providers must submit their first claim as a PAPER claim14.Prog. Notes > Print > Close > Examine progress note for:

a. Simple Office Visits do not need additional notes with claim

i. 92012, 92014-15, 99201-205, 99211-215

b. Labs (8xxxx) do not need additional notes with claim IF results are outlined in the Progress Note > If not, print lab report

i. X-Rays (7xxxx) need to be printed and included with claim

15.Print HCFA (02-12) > opens in Word > File > Print > Printer > HCFA > Print > margins outside printable area > Yes > close document > Don’t Save

Revised 12/29/2016 of 15

16.eCW > Notes > “First paper claim sent to RR Medicare with chart notes”

SEND OCC CLAIMS – FIRST OF EVERY MONTH (4)

1. Note current OCC Claimsa. Billing > Claimsb. Service Dt(s) = 07/01/2015 to [YESTERDAY’S DATE]

c. Claim Status = Submittedd. Ins Grp = Occupational Medicinee. Lookupf. Note claims to compare with Account Lookup results

2. Billing > Account Lookupa. Service Dt(s) = 07/01/2015 to [YESTERDAY’S DATE]b. Facl. Grp = SIHP TINc. Patient Stmt Cycle = Ignored. Sort Order = Insurance, Patiente. Insurance Group = Occupational Medicine

f. Include Unposted Payments = checkg. Acct (Claim) Balance = > 0.00h. ‘Don’t Send Statements’ Patients = checki. Lookup

Revised 12/29/2016 of 15

3. Uncheck any claims that don’t match Claims results

4. Patient statements > Green arrow > PayorInvoice > Browser will launch

5. Enter Login and Password

6. eCWEBO > Statements > Payer Invoice Report

7. Report By: > Billing Facility

8. Select Claims: > Select all > OK

9. Payer Invoice Report > Ctrl P (print) > Print 2 copies > Close browser

10.eCW > “Are you sure you are completely done with the generated Payer Invoice” > Yes

11.“Do you want to add ‘Patient Statement Printed’ log for all the claims in the report?” > Yes > OK

12.Add ## and total $$ to Paper Claims Totals count for the day

13.Mail one copy of each invoice to appropriate OCC

a. Duplicates go in top drawer with other OCC invoices

SEND BATCH REPORTS / LOG RECEIPTS (5)

1. eCW > Billing > Batches2. Date(s) = [yesterday’s date]

a. If today is a Monday, select date range for Friday, Saturday, and Sunday 3. Confirm batch deliveries on Trizetto

a. Web Browser > https://mytools.gatewayedi.com/LogOnb. User = 3A08 > Password = eCWS3A08 > Log inc. Daily Tasks tab > Confirm File Deliveryd. Select Range = -- Choose -- > From: = [Yesterday’s Date] > To: =

[Yesterday’s Date]a. If today is a Monday, select date range for Friday, Saturday, and

Sunday e. Create Report

Revised 12/29/2016 of 15

f. Confirm all batch claim ##s and $$ listed in Trizetto report match eCW batch report

a. Confirm Status = Processedb. Missing batches will need to be resent

g. Close browser4. Log receipts (use the batch report from eCW)

a. \\wolverine\business\EC Claims\EC Logs\ > open [Month] [Year] Receipts file (Mar 2016 Receipts)

b. Enter initials and [TODAY’s DATE]c. Enter claim ##s and $$d. SAVE > Quit

5. Create Batch Report a. eCW > Batch Report > Copyb. Excel will automatically create a new spreadsheet with the report

6. Select from cells 1A to I6 > right-click inside selection > ...Insert > Shift cell down > OK

7. Column A > select column > right-click > Delete8. Column E > select column > right-click > $ to define as currency9. Column E > select column > right-click > Insert > E will become blank10.Column G > select column > right-click > Insert > G will become blank11.Expand all columns12.Reduce size of columns E and G13.Delete TrackingNo in column J

14.Select cell 5B > Bold > “SIHP SENDS [TODAY’S DATE]”

15.Select from cells 8A to column IA and then down to include all your dataa. Right-click inside selection > Sort > Custom Sort…b. Sort by = Column H > OK

16.Go to bottom row of report > skip 1 line > select cell in column Ba. Bold > enter “SIHP ELECTRONIC”b. Down 1 cell > Bold > enter “SIHP PAPER”

Revised 12/29/2016 of 15

c. Down 1 cell > Bold > enter “SIHP TOTAL”

17.Select all Claims cells from D8 down to bottom of data + 2 more rows down (will line up with SIHP ELECTRONIC)

a. Home toolbar > Autosum

18.Select all Amount cells from F8 down to bottom of data + 2 more rows down (will line up with SIHP ELECTRONIC)


19.Enter # of SIHP Paper Claims in column D (from scratch paper)

20.Enter $$ amount of SIHP Paper Claims in column F (from scratch paper)

21.Select Electronic & Paper Claims totals in column D + 1 more row down (will line up with SIHP TOTALS)


22.Select Electronic & Paper Amount totals in column F + 1 more row down (will line up with SIHP TOTALS)


23.Page Layout toolbar > Orientation > Landscape24.File > Save As > \\wolverine\EC Claims\EC Logs\Daily send report\[Month]

[Year] SIHP\ folder (...\Daily send report\March 2016 SIHP\)25.File name = SIHP Sends [TODAY’S DATE] (SIHP Sends 033116)26.Save as type = Excel 97-2003 Workbook27.Save28.Outlook > New Email

Revised 12/29/2016 of 15

e. To: Supervisors group > Subject: SIHP Daily Sends [TODAY’S DATE]f. “Please see attached.”g. Attach Sends Report > \\wolverine\business\EC Claims\EC Logs\Daily

send report\[Month] [Year] SIHP\SIHP Sends [TODAY’S DATE]h. Send

SEND SIHP PATIENT STATEMENTS – EVERY TUESDAY (6)

1. Ask Keyers if they are done ePosting [Carrie Parker/Hailey Poncia]

a. You CANNOT continue until Keyers give the OK

2. eCW > Billing > Accounts LookUp3. Lookup Statement Range

a. Appt Provider = All should be checkedb. Service Dt(s) = 07/01/2015 to [yesterday’s date]c. Facility > Facil. Grp = SIHP TIN (Southern Idaho Health Partners)d. Collection Status = Not given to Collectione. Patient Stmt Cycle = Apply - Guarantor based f. Sort Order = Guarantor Name, Patientg. Include Claims Assigned to Patient only = [checked]h. Dunning Messages = [checked]i. Include Unposted Payments = [unchecked]j. Acct(Claim) Balance = > = 9.99k. Deceased = [checked]l. Batch range = 500 (bottom left corner of window pane)m. Lookup

4. If there are less than 500 patients do not send statements5. If there are 500+ patients > Click 1-500 drop-down > Note total ## of

statements for email6. Check top left checkbox > First 500 statements will be selected

Revised 12/29/2016 of 15

7. Patient Statements > eGuarantor Statements8. If an ERROR message pops up:

a. Write down account ## and error reasonb. Patient’s Responsible Party error > if any 18+ patients are found

a. Write down account numbers > Close > No b. Patient > Lookup > Patient Infoc. Responsible Party > Select > Self > OK > OK > Closed. Lookup to refresh info

c. Missing Address Information errorsa. Write down account numbers > Close > No b. Patient > Lookup > pull up accountc. [Work Error]

d. Less than $0 Balance alerts > Statements are not sent to these patients9. Save As > Make sure you are in \\wolverine\Business\Statement_Files\SIHP

[Month+Year]\a. File Name = “SIHPSTMT[TODAYS DATE]” (SIHPSTMT070516)

a. Add “_2” etc. to name for multiple filesb. Save as type = [Blank] > Savec. Upload to GatewayEDI? > Yesd. “…Do you want to add logs for these eStatements?” > Yes

10.If there is a list of patients who are due refunds, ignore > Close11.Lookup to refresh list > repeat 6.-11. until all statements are sent12.Outlook > New Email

Revised 12/29/2016 of 15

a. To: Kathleen DeLaCruz, Jamie Busch > Subject: SIHP Statement Sent [TODAY’S DATE]

b. “Sent ## SIHP patient statements today.”c. Send

WORK REJECTED CLAIMS (7)

1. Service Dt(s) = 01/01/2013 to [TODAY’S DATE] 2. Claim Status = Clearinghouse Rejected3. Assigned to = All4. Lookup

ALL Claims1. Open Claim2. On a scratch sheet write down the count of each Rejected claim you work

a. Note total ## of claims for the date of the most recent submission (not $$)

3. Errors tab > check errors > can I fix it?a. If I can fix problemb. Note claim submission date on scratch sheetc. Notes > describe changes maded. Claim Status = Review Completed > OK

4. If no errors in Errors tab

a. Options > View Logs > View Claim Status Log (277 Unsoclicited)

Revised 12/29/2016 of 15

b. Note claim submission date on scratch sheet5. If subscriber number issue

a. Insurances & Payments tab > Move claim window to left of screenb. Info > Scan > Compare subscriber number > Close

i. If incorrect > Double click on insurance in Insurances field1. Subscriber No > correct > OK

ii. If correct > Insurances & Payments tab > check Bill to Patientiii. Notes > note action taken iv. Set Claim Status > OK

6. If Coding errora. Follow Up > Notes > “Please review for errors.”b. Claim Status = Biller Review > OK

7. If I don’t know how to fixa. Notes > describe problemb. Claim Status = Failed Validation > OK

8. Repeat 1-7 for all Clearinghouse Rejected claims9. When Clearinghouse Rejected are complete > Claim Status = Insurance Rejected

a. Lookupb. Repeat 1-7 for all Insurance Rejected claims

When ALL Rejected Claims are completed2. Add totals to the [Month] 2016 Receipts spreadsheet

Revised 12/29/2016 of 15

a. Windows Explorer > U:\EC Claims\EC Logs > [Month][Year]Receipts > March 2016 Receipts

b. Record # of worked claims for corresponding date of previous submissions and insurance > Save

Revised 12/29/2016 of 15

ec billing procedure 12-2016.pages

Documents