Presentation on theme: "Enrollment Manager Presented By: Shaun McAnulty. ENROLLMENT MANAGER Came about as an Enhancement request, users wanted a single location to track and."— Presentation transcript:
ENROLLMENT MANAGER Came about as an Enhancement request, users wanted a single location to track and monitor Provider record setups. Enrollment Manager is a vendor application used to create EDI enrollment records, download enrollment forms, submit enrollment requests to PI, as well as track submission of enrollment requests sent direct to payers. This tool allows vendor users to have an electronic storage of their enrollment records. Vendors can use this tool to log and track EDI enrollment activity leading up to, and after, the customer’s implementation date.
GOALS FOR UNDERSTANDING Enrollment Manager Access Who When Where Why Types of Enrollment records Requirements for the Enrollment Process Steps to adding a New Enrollment Record Working Enrollments
ENROLLMENT MANAGER ACCESS: WHO Vendors with Access to Admin Tools and Enrollment Manager WHEN Prior to Customer Implementation Admin Tools -> Enrollment WHERE
ENROLLMENT MANAGER: Why Add Enrollment Records for New Customer Setup (part of Implementation process) track progress of enrollment for customer, prior to “Go Live” date. Add Enrollment Records for Existing Customers (for customer who is already active) track progress of customer’s requested enrollment.
TYPES OF ENROLLMENT RECORDS Prof Claim Inst Claim Dental Claim Select appropriate transaction type for your customer to create enrollment records for payers that require EDI enrollment for both Claims and Remit setup, such as government payers, Medicare, Medicaid, Tricare. ERA Select to create enrollment records for payers with option to enroll for ERA setup, such as Aetna, Cigna, UHC, many commercial payers. Note: Most commercial payers do NOT require claims enrollment but all payers do require ERA enrollment. BASIC ELIGIBILITY: Select to create enrollment records for payers that require EDI enrollment to submit 270 eligibility requests and receive 271 responses. ENHANCED ELIGIBILITY: Select to create enhanced eligibility enrollment records for payers that provide option for enhanced eligibility. Note: Enhanced eligibility requires the provider to have access (user login and password) to the payer’s website.
REQUIREMENTS FOR ENROLLMENT Use of Enrollment Manager Assumes the customer and provider records have been added into EDIinsight. You will not be able to add enrollment records into Enrollment Manager until the customer and provider records have been added.
STEPS TO ADD NEW ENROLLMENT 1. Login in to EDIinsight and navigate to Admin Tools 2. Select the Enrollment button. 3. From the Enrollment Manager screen select the customer you’d like to create enrollments for. 4. Once the customer is selected, click on the button to create a new enrollment record. 5. The software will prompt you to select a transaction type for the newly created enrollment record. I. You can only select one transaction type from this prompt. Each transaction type will require its own enrollment record.
STEPS FOR NEW ENROLLMENT: 6. The next screen displays a list of current providers to choose from, based on the Customer, for the selected enrollment record. I. Only Billing providers are shown for Professional, Institutional, Dental claims and ERA enrollments. II. Both Billing and Rending providers are shown for Basic and Enhanced Eligibility enrollments. III. To change the type of provider being shown or only view certain providers based on entity, tax ID, state, or other criteria for any type of enrollment, use the FILTER button. Highlight your desired provider and select the continue button.
STEPS FOR ENROLLMENT: Continued 7. A dialog box will appear asking you to select payers for the new enrollment transaction record. 8. The payer selection screen will show a list of payers that require enrollment for the transaction type selected within the providers state as well as all national payers. To select payers outside of the provider’s geographical region, users can select the filter button to view all payers. Clearing the filter selections will show all payers once saved or the selection can be used to narrow the payer list.
STEPS FOR ENROLLMENT: Continued 9. Once all desired payers have been chosen select the button. 10. When creating claim enrollments, if ERA enrollments are also offered in conjunction with the selected claim format, the software will prompt the user to confirm ERA enrollment record creation. I. From here the user can choose to create ERA enrollments or continue with only the original transaction records.
STEPS FOR ENROLLMENT: Continued 11. A verification page will appear listing all pending enrollment records. I. To create these records the user must select the Create Checked Enrollments buttons located at the top or bottom of the screen. II. The screen will default to selecting all listed enrollments. III. If the user wants to exclude a record from creation, the user must de-select the record to exclude.
STEPS FOR ENROLLMENT: Continued 12. A final confirmation page will appear showing all created enrollments and containing links to the required enrollment forms. I. Users may print this page as confirmation of their newly created enrollment records.
STEPS FOR ENROLLMENT: Continued 13. Once the confirmation page has been closed the user will be taken to the enrollment manager screen and the current date will be set in the “Created Begin” field. I. To see the newly created records the user must press the button located on the right side of the screen. II. If the date is cleared, all enrollments for the selected customer will be shown in the list view.
STEPS FOR ENROLLMENT: Continued 14. New enrollment records default to a status of INCOMPLETE indicating that the vendor must take action to complete the enrollments.
WORKING ENROLLMENTS: The Method column in Enrollment Manager shows how each enrollment should be worked: I. Standard (Most Enrollments) II. Paperless (Remit Enrollments for payers routing through Optum Insight and Cigna) III. Auto-Approve (Enhanced Eligibility Enrollments)
WORKING STANDARD ENROLLMENTS: Most of payer enrollment types are considered standard and require providers to fill out a downloaded enrollment form and submit to either Practice Insight or the insurance payer. To determine where to submit the enrollment, refer to the “Submit to PI” column of the enrollment list view or by viewing the Enrollment Instructions document for each enrollment. 1. To work a Standard enrollment, access the Enrollment Instructions by highlighting the enrollment record and select the button to open the PDF instructions in a browser, or use the shortcut key “d” to download the instructions to your computer for later viewing.
WORKING STANDARD ENROLLMENTS: 2. Complete all the steps listed in the Enrollment Instructions. I. If the enrollment is marked “ YES ” in the “Submit to PI” column, after completing the steps listed in the instructions and using the button to upload any documents required for the enrollment, you will need to submit the enrollment to Practice Insight by highlighting the enrollment record and selecting the button. When the enrollment record has been submitted, the status of the record will be changed to PENDING and the “Assigned To” column will be assigned to the destination receiver for that record. Most enrollments will default to PI Enrollment. Once an enrollment is assigned to PI Enrollment, it can be viewed by non-Practice Insight users, but no longer edited or re-submitted until Practice Insight has finished with the enrollment and assigned it back to the vendor or customer who created it. For vendor users with “DELETE” full privileges in Enrollment Manager, they can always edit an enrollment or add action taken regardless of who created the record or who the record is assigned to. If a vendor with “DELETE” full privileges in Enrollment Manager adds an action to change the enrollment to INCOMPLETE that is currently assigned to PI, it will default to reassigning the record to the vendor user that made the change. This will move the INCOMPLETE record out of PI’s queue and back into the vendor’s queue. II. If the enrollment is marked “ NO ” in the “Submit to PI” column, you will need to submit any enrollment documents from the instructions directly to the payer. These enrollment records do not need to be assigned to Practice Insight, but you can use the button to update the enrollment and show which step you are currently on. If you complete the enrollment instructions and receive notification from the payer that the enrollment was approved, you may wish to add the “APPROVED” action to the enrollment so you know it is finished.
QUESTIONS? Using Enrollment Manager will give Enrollment records created there 1 st Priority over any Emailed Enrollments. ENROLLMENT MANAGER is NOT intended for Support use. Users should still use Issue Manager for Enrollment Questions. Practice Insight is available for Enrollment Manager Questions and support.