Practice Insight Customer On-Boarding Presented by: Shaun McAnulty
General Process 1)Become PI Reseller. 2)Setup Default Customer Record and Required Fields. 3)Partner with Providers office. 4)Once contracts signed Build New Customer in EDIinsight. a)Build Provider Records & Start Enrollment Process. Make sure to enroll for ERA’s if allowed. **Process can take up to 30 days!** b)Uploading a claim file with providers will assist in building Provider Records. 5)Create Staff under the customer (if needed) adding Default Tasks to staff. 6)Customer uploads live claims
Default Customer/ Required Fields A default customer can be setup to make customer entry quicker and easier. IMPORTANT NOTES There is only 1 default customer per vendor record. Users (with permissions) may also change what is defaulted into the customer record upon building the record. Defaults will differ vendor to vendor depending on what kind of providers and software they're reselling and supporting. Some vendors may have few defaults but several required fields because they resell multiple PMs with varying capabilities. Some will have more defaults because they resell one PM with the same capability all the time.
Customer Information Tab Fields in Yellow should be added on ALL Customer Records. Fields in Green are dependent on the situational setup Fields in Red are NOT ADDED BY VENDORS. For general setups the Yellow fields are Required. Fields in Green MAY BE needed based on the customer your setting up, the PM they use, and Clearinghouse they used to go through. *Rule Of Thumb – If you have the information available or can get it, insert it.
Setup Specifications Tab General Setup will refer to any Staff setup under this Customer. If SFTP or HTTPS integration is to be used create and insert a unique login, once you hit the TAB key or move away from the field you will be prompted to enter a WORK Email. Insert where you want the SFTP password to be sent at that time. ERA Responses is what format the Response should be delivered in, if blank the system will pass through whatever format it received the response in. Claim Responses will work in the same fashion, keep in mind if using Integration we normally expect File to be chosen
Claim Services Tab The Claim Format can be used to tell Claim Manager what format the claims are in, the system will attempt to read whatever is uploaded even if format is left blank. Loaders are generally added by PI employees and only need to be selected if you are aware of what loader to use. Auto Ready Claims will auto Ready claims after they are uploaded via sftp https. Fields in Yellow should be added on ALL Customer Records. Fields in Green are dependent on the situational setup Fields in Red are NOT ADDED BY VENDORS.
Clinical Scrubbing Tab This tab will only be required if Clinical Scrubbing is used. If so then the CS Submitter ID and Status are REQUIRED. Enter a Unique Submitter ID into the field and select customer Status, adding a Prv Count, Specialty, and Contact Name (Someone at providers office) is also Highly Recommended. Next choose a Scrub Response delivery method, and add any addition filters if you’d like. Once set YOU MUST HIT THE REGISTER CLINICAL SCRUBBING BUTTON and it will populate the Registration field with a date.
Additional Services Tab Additional Services is to setup the Customer with Statements or to verify or view the EOB to ERA setup information. If none of these services are used this tab can be skipped.
Provider Records The Group and/or Doctors for the Customer all need to have their own provider records built. Simply hit the NEW button to create the a Doctor Record.
Doctor ID Purple Fields = Fields that will auto fill on the record if they are filled out on the Customer Information Tab!
DOCTOR ID It is critical to have a Billing Provider record setup or else claim uploads will fail. Rendering Provider records require providers Specialty. Any provider should have their own Record setup under the customer. Use Doctor IDs to designate specific settings for specific Payers. Make sure the Record is setup exactly as the Payer will recognize the Provider.
DOCTOR ID Records Inside a Doctor ID you have Doctor ID Records. These are used as identifiers for this specific provider. If you have the Providers PTAN # it is a good idea to inter it here.
DOCTOR ID Records The ID Type identifies what this record contains, it may be the State License ID, Specific Payer Type ID’s, etc… Practice Type denotes if this is a Group or Solo which affects how the Claim is sent to the Payer. So understanding how the provider is recognized by the Payer is paramount. The other options can affect the claim as well by overriding pre-sets of data sent to the Payer.