Presentation on theme: "Presented By: Shaun McAnulty Product Training Specialist ERA & Denial Management Training."— Presentation transcript:
Presented By: Shaun McAnulty Product Training Specialist ERA & Denial Management Training
Goals Manage Tables Manage Expects Manage Codes Manage Expects Add, edit and lock fee schedule. Group Reason codes Flag as expected or not Assign corrective action Assign to specific staff member Know how to assign work to staff members Transaction level with Follow Up Status Group/Reason Code level with Manage Codes ERA Analytics
Clinical Claim Scrubber! 100% EOB to ERA(835) ERA & Denial Manager!
PM Claim created and sent to Practice Insight. PI Practice Insight receives claim (837). Send Claims (837) to Payer. PAYER Payer receives Claims (837). Payer sends ERA (835) Response to PI. PI Practice Insight receives ERA (835). ERA MGR ERA & Denial Manager uses ERA (835) data to populate transaction lines.
ERA & Denial Manager ERA & Denial Manager: Itemizes the ERA response(835) from the PAYER to populate individual workable transactions. Allowing users to select, group, and work specific claim transactions individually. Allows users to organize and manage remittance data. o Selection criteria o Line level workability Grants users the ability to prioritize, monitor, and work transactions efficiently. o $0.00 payments o Over/ Under payments Allows for routing work to specific users. o Manage Tables o Tasks
ERA Manager Selection Criteria TRANSACTION View This is the individual transaction line Status Message History for the CLAIM!
Statuses Denied: Transaction was labeled as DENIED by the payer. Paid: Transaction was labeled as PAID by the payer. Pended: Payer has pended this transaction in their system. Reversal: Allowed amount on the transaction is negative, meaning the payer is taking money back. *This Status NEVER CHANGES! ERA Status Appealed: Appealed by user Complete: Complete by user New: Transaction to be reviewed NoAppeal: No appeal allowed Paid: Payer making payment Pend-USR: Pended by user Transfer: Transferred by user Follow Up Status
View/ Edit Transaction
ERA Summary If Claim found in EDI then Claim data displayed here. ERA Information from Payer. ERA records show transaction data for chosen transaction(highlighted) and for other transactions on claim.
ERA Summary Cont. Codes can be designated as Expected or Unexpected. Specific codes can also be assigned to individual staff members. Any Note built for the specific code would display here along with the codes description
Using the ERA Summary you: Get a snap shot of the transaction and any transactions for that claim. Allowing you to make initial decisions on how to proceed with the transaction. Then back at the Update Transaction screen you: Can then mark the transaction or all associated transactions with the same Follow Up status. May also Assign the Transaction to a Staff member
Updating Transaction *Once Saved, if there are multiple transactions associated with the claim. Follow up Status Complete Follow Up Action added No further action needed. You will be prompted to update the other transactions associated to the EDI Claim ID. Yes = Will change all associated transactions No = will only change the individual transaction worked.
TASKS ERA & Denial Management was purposefully built to be mostly worked by building Tasks
Manage Tables From here you can access the expects(fee schedule) table using the Manage Expected Amounts. o From this table you can: View Fees Add Fees Edit Fees Lock Fee rates Manage Codes displays all the Group/Reason codes received on ERA’s. o From this table you can: Flag codes as expected or unexpected Assign codes to specific staff id
Expect List / Fee Schedule Manually add fees Creates a report view of fees
This data is used & maintained to compare to ERA(835) data as it is received from the Payer! The Edited column displays if the rate is “Locked” or not. If an N is displayed the rates will be overwritten if higher values are present on incoming ERA’s(835). *For the best analytical data you want to lock your rates! Simply edit the Expect.
Editing Expects Here you can build a new expect/fee or edit(to lock) an existing fee.
Manage Codes Allows the you to monitor and flag specific codes to be expected or unexpected. From here you can also assign a code to a staff member and lastly assign courses of action for each code. Take note that the list is not uploaded or manually added, it is only populated by received ERA(835) data!
Editing Codes The full code and description are non- editable. Assign a Staff member to this code. Flag the Code as Expected, or Unexpected. In the Note area you can be as detailed or general as you’d like, this will appear on the View Summary as the next step to take!
Transaction Level: ERA Transaction: Update Transaction Methods to Assign Work Group\Reason Code Level: Manage Codes Table: Edit Code General Level: Task Manager: Staff ID
Tasking New Zero$ Paid ERAs Description: New 0$ Paid ERAs Follow up status: New Min/Max Amount: 0 (for both) Amount Of: Payment Save Denials by Type Description: CO-16 Denials ERA Status: Denied Group
Dashboards o Adjudication Summary Graph o Aged Cash Graph o Days Sales Outstanding by Procedure o Denial Rates by Procedure o Top 5 Denial Codes Web Browser o Analysis by Procedure and Reason o Analysis by Reason Data-Miners o ERA Denial Analysis o ERA Reimbursement Analysis Analytics
Points to Remember ERA Manager provides detailed view of all ERA Transactions in an ERA file. Detailed view includes: charge amount, amount paid, allowed amount, Claim Group and Adjustment codes. ERA Manager provides customers with the ability to sort ERA transactions by CPT code, Check number, Payer, Claims Adjustment Group and Claim Adjustment Reason Code and Status. ERA Manager allows customers to view ERA transactions by status, including Denied ERA Transactions. The Denial Screen allows staff members to add notes while working denials that will be attached to the era transaction. Staff Members can also add a follow-up status to the ERA transaction such as Paid, Appealed, Transfer, etc. Main Training Points:
Points to Remember Analysis reports provide data such as break down of CPT codes that were denied for a Claim Adjustment Group Codes and Reason Code. All ERA data is stored in Manage Tables. The Expects table stores CPT code with modifier, charge amount, allowed amount, and expected paid amount. Customers can use this table to see if they are over/under billing an insurance company and compare allowed amounts. The Codes Table stores all received Group/Reason codes and allows for assignment and prescription of action. The Payer table stores all inbound payer names and allows for matching of unmatched payers. Main Training Points: