Workflow and Optimization of Remit Processing Make the system work for you! Learn the nuances of remit processing and utilizing tools to help manage remit rejections and establish workflows to increase efficiency in your RCM department Ashley Smith Senior Application Specialist

Topics General Understanding your Electronic Remittance Advice (ERA/835) File Create Visit Owners to help workflow Setup the Clearinghouse Setting up your Transaction Column Sets (TCS) Researching your reason codes Setup the insurance carrier ERA settings Processing an ERA file Review Questions????

General  Use this as your “Go-To” document for ERA setup  If you have remit posting issues – refer back to this document and review the steps against your setup

o Increases accuracy of data entry vs manual payment entry o Time and cost savings for the practice o Automatically populates required information for secondary filing o Quicker response from insurance companies Benefits of Electronic Remittance

Understanding your ERA (835) File

NON-PARSED FILE ISA*00* *00* *ZZ*12502 *ZZ* *150803*1328*^*00501* *1*P*:~GS*HP*12502* * *1328* *X*005010X221A1~ST*835*00155~BPR*I*98.65*C*CHK*C CP*01* *DA* * **01* *DA* * ~TRN*1* ~REF*EV* ~DTM*405* ~ N1*PR*NOVITAS SOLUTIONS, INC.~N3*PAYER ADDRESS~N4*CITY*ST* ~PER*BL*SERVICE AND SUPPORT~N1*PE*COMPANY PAYEE NAME*XX*NPI~N3*PAYEEADDRESS~N4*CITY*ST* ~REF*TJ*TA XID~LX*1~CLP*001617*2*135*98.65*25.17*MB*PAYERCLAIMCONTROL#/I CN*11*1~NM1*QC*1*TEST*PATIENT*P***MI* A~NM1*82*1*REND ERINGLAST*RENDERINGFIRST*M***XX*RENDERINGNPI~NM1*TT*2*CRO SSOVERCARRIERNAME*****PI*PYRID~MOA***MA01*MA18~DTM*050* ~DTM*232* ~AMT*AU*113.25~SVC*HC:99214*135*98.65***1 ~DTM*472* ~CAS*CO*45*9.17**253*2.01~CAS*PR*2*25.17~REF*6 R*4901~AMT*B6*113.25~SE*27*00155~GE*1* ~IEA*1* ~ Understanding your ERA (835) File

ISA*00* *00* *ZZ*12502 *ZZ* *150803*1328*^*00501* *1*P*: GS*HP*12502 * * *1328* *X*005010X221A1 ST*835*00155 BPR*I*98.65*C*CHK*CCP*01* *DA* * **01* *DA* * TRN*1* REF*EV* DTM*405* N1*PR*NOVITAS SOLUTIONS, INC. N3*PAYER ADDRESS N4*CITY*ST* PER*BL*SERVICE AND SUPPORT N1*PE*COMPANY PAYEE NAME*XX*NPI N3*PAYEE ADDRESS N4*CITY*ST* REF*TJ*TAXID LX*1 CLP*001617*2*135*98.65*25.17*MB*PAYERCLAIMCONTROL#/ICN*11*1 NM1*QC*1*TEST*PATIENT*P***MI* A NM1*82*1*RENDERINGLAST*RENDERINGFIRST*M***XX*RENDERINGNPI NM1*TT*2*CROSSOVERCARRIERNAME*****PI*PYR ID MOA***MA01*MA18 DTM*050* DTM*232* AMT*AU* SVC*HC:99214*135*98.65**1 DTM*472* CAS*CO*45*9.17**253*2.01 CAS*PR*2*25.17 REF*6R*4901 AMT*B6* SE*27*00155 GE*1* IEA*1* Understanding your ERA (835) File

FINANCIAL INFORMATION BPR*I*98.65*C*CHK*CCP*01* *DA* * **01* *DA* * Understanding your ERA (835) File

FINANCIAL INFORMATION TRN*1* Understanding your ERA (835) File

LOOP 1000A PAYER N1*PR*NOVITAS SOLUTIONS, INC. Understanding your ERA (835) File

LOOP 2100 CLAIM PAYMENT INFORMATION CLP*000133*2*135*98.65*25.17*MB*PAYERCLAIM CONTROL#/ICN*11*1 CLP02 = 1 Processed as Primary CLP02 = 2 Processed as Secondary CLP02 = 3 Processed as Tertiary CLP02 = 4 Denied Understanding your ERA (835) File

LOOP 2100 CLAIM PAYMENT INFORMATION CLP*000133*2*135*98.65*25.17*MB*ICN/PAYER CLAIMCONTROL#*11*1 Understanding your ERA (835) File

LOOP 2100 CLAIM PAYMENT INFORMATION CLP*000133*2*135*98.65*25.17*MB*ICN/PAYER CLAIMCONTROL#*11*1 Understanding your ERA (835) File

LOOP 2100 CLAIM PAYMENT INFORMATION CLP*000133*2*135*98.65*25.17*MB*ICN/PAYER CLAIMCONTROL#*11*1 Understanding your ERA (835) File

LOOP 2100 CLAIM PAYMENT INFORMATION CLP*000133*2*135*98.65*25.17*MB*ICN/PAYER CLAIMCONTROL#*11*1 Understanding your ERA (835) File

LOOP 2110 SERVICE LINE PAYMENT INFORMATION SVC*HC:99214*135*98.65**1 Understanding your ERA (835) File

SERVICE LINE ADJUSTMENT(S) CAS*CO*45*9.17**253*2.01 CAS*PR*2*25.17 Understanding your ERA (835) File

LINE ITEM CONTROL # REF*6R*4901 Understanding your ERA (835) File

ACTUAL ALLOWED AMOUNT AMT*B6* Understanding your ERA (835) File

Create Visit Owners to help workflow

Some Examples of Visit Owners that could benefit your workflow: Remittance Review Remittance Review Timely Filing Remittance Review Diagnosis Remittance Review Eligibility Remittance Review Non Covered DO NOT MOVE ANY VISIT OWNERS OTHER THAN UNASSIGNED TO THE TOP; THE TOP VISIT OWNER IS DEFAULTED TO ALL VISITS

Create Visit Owners to help workflow Here are some additional examples of Visit Owners set up by reason code that could benefit your workflow

Create Visit Owners to help workflow You can assign an Visit Owner at the insurance carrier level: If a claim has multiple reason codes, which have different owners assigned to them then the first owner encountered is the one assigned. Only ONE visit owner can be assigned per visit Visit owners field in Task Manager can help with task queues

Clearinghouse Setup

Administration Clearinghouse File Processor Settings

Clearinghouse Setup If you use Vis Processor you have additional settings: Check Automatically Process Remittance Exclude 835 Remittance This will process all response files automatically from the clearinghouse except your 835 files

Transaction Column Set (TCS) Setup

Typical ERA

Transaction Column Set (TCS) Setup Column order changes in Payment Distribution CAN cause display issues. If you need to change the order, GE suggest to make the changes in Administration. This will change for ALL USERS!!!

Transaction Column Set (TCS) Setup Payment The payment column must have a payment type populated. You can select Allow Payment Type Override to change the payment on a needed basis at the visit level.

Transaction Column Set (TCS) Setup Payment If the payment column does NOT have a payment type then ALL the payment amounts will go to unapplied. Everything else including adjustments will post.

Transaction Column Set (TCS) Setup Actual Allowed VERY IMPORTANT to create a column with type of Actual Allowed AMT*B6 amounts post to this column FEE = Actual Allowed + Contractual Adjustment

Transaction Column Set (TCS) Setup Contractual Adjustment If ‘Contractual’ on the Adjustment column is checked off, then Centricity links the Actual Allowed column to the Contractual Adjustment Check off to ‘Allow Adjustment Type Override’ in order to see the Adjustment type in the TCS If you have multiple Adjustment columns – ONLY ONE needs the Contractual box selected Contractual Adjustment = Fee – Actual Allowed

Transaction Column Set (TCS) Setup If you do NOT have ‘Contractual’ checked off then: The Actual Allowed will post The Contractual Adj will not post

Transaction Column Set (TCS) Setup Deductible Plug-ins are hard coded to post a reason code of 1 (e.g. PR1) to the first deductible type column it finds The name field is a free text field therefore cannot be used for posting When posting ERA ALWAYS set the action to None. If you set the action to Transfer, that amount will be moved to the patients responsibility even if there is another insurance to bill.

Transaction Column Set (TCS) Setup Co-Insurance Plug-ins are hard coded to post a reason code of 2 (co-insurance) and 3 (co-pay) to the first Co- Insurance type column it finds The name field is a free text field therefore cannot be used for posting When posting ERA ALWAYS set the action to None. If you set the action to Transfer, that amount will be moved to the patients responsibility even if there is another insurance to bill.

Transaction Column Set (TCS) Setup Residual Once a CLP segment is processed, any remaining balances goes to the residual column The residual column looks for another payer to bill. -Yes, then leave the balance in insurance then move it to the next payer -No, then move the balance to the patient Enter a general note to explain the patient transfer. It should be inclusive of deductible, co-pay, and co-insurance. - This is not required. Check off option to Show notes on statement if you want your note to be shown.

Transaction Column Set (TCS) Setup Residual If Residual is set to NOT Transfer -The payment will post -The balance remains in insurance responsibility -The visit remains in the status it was in prior to the ERA being processed Example of a possible exception: Some Medicaid Carriers do not bill their patients no matter what – you would create a separate TCS just for Medicaid Remittance and set your residual to none. This will prevent any balances being accidentally transferred to the patient.

Transaction Column Set (TCS) Setup Line Information Captures EOB group and reason codes required for billing electronic secondary claims. All elements post automatically from ERA.

Transaction Column Set (TCS) Setup Line Information Min required electronic fields: -*Adjudication date* -Group -Reason -Amount *Minimum when procedure paid in full*

Researching your Reason Codes

-Decide if the reason code and action require a Visit Owner Reject to Review is most common used for corrections or decisions Setup can differ between practices, insurance carriers, and preferences Adjust this code off Reject to Review then make a decision Transfer this to the patient None -Setup quality is dependent on preparation -Use EOB’s to list current payer responses -Make a list of reason codes to setup -Decide on actions for the reason code:

Researching your Reason Codes Make a list of reason codes to setup

Insurance Carrier Setup

Insurance Carrier Payer Literals tell Centricity which plans are in an ERA Review multiple ERA files with the same payer literal. ERA files can be created by LOB: PPO, HMO, Medicare, Medicaid etc… You may file two carriers to two different addresses but get paid on the same ERA Insurance carriers in the ERA WITHOUT a literal WILL NOT post Look at ACTIVE and INACTIVE carriers when researching payer literals **Insurance Carrier Payer Literals are Very Important ** Insurance Carrier Setup

Look at ERA files with the same payer literal N1*PR*NOVITAS SOLUTIONS, INC. Determine which insurance carriers could be in the file ISA*00* *00* *ZZ*12502 *ZZ* *150803*1328* … N1*PR*NOVITAS SOLUTIONS, INC. … CLP*  Medicare Part B … CLP*  Medicare Part B … CLP*  Medicare Secondary The ERA file contains Medicare Part B and Medicare Secondary claims. Both carriers will need to be set up with the same payer literal and TCS Insurance Carrier Setup

All like insurance carriers – Transaction Column Set Every insurance carrier in your ERA needs a TCS that is setup for ERA

Insurance Carrier Setup All like insurance carriers – Payer Literal Each insurance carrier in an ERA file must be setup on the insurance carrier EDI tab Payer Literal section Literal means that it must be exactly as it appears in the ERA file, punctuation included N1*PR*NOVITAS SOLUTIONS, INC.

Insurance Carrier Setup All like insurance carriers – Response Processor EDI Tab -Response Processors -New/Modify -Claims Processor Clearinghouse Settings button

Insurance Carrier Setup Processing Options We recommend you select Process Claim Level Codes All like insurance carriers – Response Processor

Insurance Carrier Setup Post $0 Amounts For We suggest you select Allowed & Payment to post $0. $0 Payment is required for secondary filing. A blank payment representing $0 will cause a file level rejection. Copay & Deductible are mapped from the plug-in but $0 has no impact on them. All like insurance carriers – Response Processor

Insurance Carrier Setup If Actual Allowed Differs from Allowed Used to manage differences in allowed amounts between the payer and your CPS fee schedule setup Recommend to Log in Remittance Report File You can select Reject Visit You can assign a Visit Owner –e.g. Remittance Allowable If you do not have your procedure fee schedules set up with accurate allowed amounts ~ We strongly suggest not selecting this option. It would report every ticket in the remit_ report. All like insurance carriers – Response Processor

Insurance Carrier Setup Post Actual Allowed for Primary Insurance Carrier Only Select Post Actual Allowed for Primary Ins Carrier only Actual Allowed triggers the Contractual Adjustment. Usually we only adjust on a primary payment. All like insurance carriers – Response Processor

Insurance Carrier Setup Ignore B6 Amount and Calculate Actual Allowed Amount Payers do not always include all expected adjustments in the actual allowed. Here is an example where we must ignore the payer’s Actual Allowed Medicare sometimes returns two CO 45s on one procedure, but the actual allowed only includes one Ignoring the B6 and calculate on all 45’s will take the correct adjustment Please note that if you select this option it will ignore ALL actual allowed (B6) All like insurance carriers – Response Processor

Insurance Carrier Setup Override Standard Payer Name If you use this field – you will have to populate the exact name on each carrier that has the same payer literal. All like insurance carriers – Response Processor

Insurance Carrier Setup Override Standard Payer Name In this case, all payments linked to the payer literal NOVITAS SOLUTIONS, INC. would have Medicare B-CMS1500 as the payer Use the override property to enter Medicare All like insurance carriers – Response Processor

Insurance Carrier Setup Procedure Code Bundling/Unbundling CPS can post SOME bundling situations Check Ignore SVC06 Bundling and Post Payment All like insurance carriers – Response Processor

Insurance Carrier Setup All like insurance carriers will need to have which plugin you are using to process your 835 files. You will need to drop down to the appropriate plugin in the Processing 835’s Using box. All like insurance carriers – Response Processor

Insurance Carrier Setup Most Commonly Used 835 Processor by Filing Method Professional (HCFA) - VisClaims File Processing PI Institutional (UB) - VisInstitutional File Processing Institutional (UB) Medicare FQHC - VisMedicare FQHC File Processing All like insurance carriers – Response Processor

Insurance Carrier Setup Non Payment Reason Code - General All Row Reason codes you want to just post with no action other than moving to the next step (includes fully paid claims) Exception Rows Procedure level non payment code you want to trigger an action Rules Limit of 10 codes per line with a like action; no duplicate codes Comma separated with NO spaces Assign an action Assign a Visit Owner when necessary

Insurance Carrier Setup Non Payment Reason Code – Ignore Everything will post; payment, adjustment, line info, etc… The balance remaining after posting will NOT get put into the residual column Reject Visit property will not affect the residual column Sometimes used to process partial payments to the next step for the procedures that adjudicated successfully If you use this option – make sure to look at your visits in any status. If the claim happens to be a crossover – your visit could potentially be in a Sent Secondary status. STRONGYLY SUGGEST USING NONE ACTION TYPE INSTEAD OF IGNORE.

Insurance Carrier Setup Non Payment Reason Code – Ignore Example: Your claim has 3 procedures; 1 denied for CO 96 and the other two paid. If you setup the reason code 96 with Ignore and Reject Visit: Claim will move to a Filed Rejected status; flagged to be worked Procedure with 96 stays in insurance responsibility The other 2 procedures go to residual column and move to the next payer or patient

Insurance Carrier Setup Non Payment Reason Code – None Everything will post; payment, adjustment, line info, etc… The balance remaining after posting WILL get put into the residual column Setting Reject Visit with an action of none will stop all balances in the residual column from transferring Used to stop the claim and allowing an update

Insurance Carrier Setup Non Payment Reason Code – None Example: Your claim has 3 procedures; 1 denied for CO 97 and the other two paid. If you setup the reason code 97 with None and Reject Visit: Claim will move to a Filed Rejected status; flagged to be worked Procedure with 97 moved to residual column Since one of the procedures in the residual column has an action of Filed Rejected, the action of transfer is stopped for the whole claim and the column is grayed out

Insurance Carrier Setup Non Payment Reason Code – Adjust Action of adjust will always take an adjustment Needs an Action Type to be associated with the adjustment Do not use if a judgement call is needed. Instead setup the code with an action of None and Reject Visit so it can be reviewed. CPS will auto create an adjustment column if there isn’t one in the TCS. No adjustment type will display but the DB will capture it e.g. Sequestration for Medicare

Insurance Carrier Setup Non Payment Reason Code – Transfer A code like CO 100, payment made to patient, can be setup to transfer the balance to the patient. Caution: This action will always transfer the balance to the patient, even if they have another insurance. If transfer is not an ALWAYS rule, do not use this action. Do either: Reject Visit with action of None so it can be reviewed Do not set up the code and let the residual column decide to transfer or not. This will not be set to review.

Insurance Carrier Setup Reject Visit When the action is None, this setting will stop the Residual column from completing the action of transfer Visit will be in Filed Rejected status Recommend to assign a visit owner to the visit Different codes can be setup with different visit owners Two different denial codes setup with different visit owners will have the first owner encountered applied to the visit Non Payment Code Properties – Reject Visit

Insurance Carrier Setup Split Visit On a partial payment, use this if you want the paid portion of the claim to move to the next step while the denied portion to be Filed Rejected for review If a decision needs to be made to split, do not use this setting as this will always split The denied procedures will split to a new ticket number ending with a letter; e.g A Paid procedures will remain on the original ticket number Non Payment Code Properties – Split Visit

Insurance Carrier Setup Non Payment Code Properties – Claim Level Claim Level Processing CPS posts payments based on procedure level information. However some functionality exists at the claim level. You can: Stop all payment posting from occurring Log in the Remit_ Report Assign a visit owner The Reject Visit property is automatically selected

Processing an ERA File

Open EDI Response Management Select Clearinghouse Recommend to enter Date Received Use Search Field to Find - Check Number - Check Amount Caution: If using check amount to search for files, do not include ending zeroes: e.g. enter 2300 not or not

Processing an ERA File Viewing an ERA File Locate your remit file in EDI Response Management Right Click and View the remittance Advice Report to verify information in the 835 file

Processing an ERA File Viewing an ERA File When you right click and view - the file will open the generic XML file viewer Select Record Type N1 then select the Next button N102 Value column contains the Payer Literal

Processing an ERA File Viewing an ERA File Select Record Type BPR then select the Next button - BPR02 Value Column contains the Check Amount - BPR16 Value Column contains the Check Date For some clients, if there is a next button after selecting BPR, that means there is more than one check in the ERA file.

Processing an ERA File Place a check next to the file you want to process Select the Process button

Processing an ERA File Remittance Processing Batch Options Automatically create a new batch for each check Use Default Batch Use Specific Batch **Best Practice** –Select a batch name Ask for a batch name for each file can be checked if processing more than one file

Processing an ERA File Viewing the Remit_ Report -Date and file processed -Check number and Insurance used to post the ERA -Detailed Log of posting Once you review the Remit_Report – it will need to be Archived

Processing an ERA File Typical Issues: Bundling Cannot find a match Payer Literal is missing Check Number already posted Ticket does not exist Viewing the Remit_ Report Unapplied Key word Could not post or Could not complete posting

Processing an ERA File Transaction Management Transaction Management will show the transactions for the file and amounts that were posted Use the Remit_ report to help identify the Un-applied funds Double click on the transaction line to open Payment Entry

Processing an ERA File Payment Entry Verify Transactions in the bottom window pane Double click on line items to edit a transaction Compare this to your EOB and reconcile: –Payment –Adjustment –Transfer to insurance or patient

Processing an ERA File Payment Entry Claims that should deny but transferred have a reason code that is not setup. Report these instances to your Billing Manager so that they can update the Non Payment Reason Codes setup

Processing an ERA File SUGGESTION… Once you have gotten a feel for your setup and you think everything is posting as it should and you think its safe to just spot check your transactions –Sort your Transfer column; if you find there were large amounts transferred to the patient - look to see if a reason code was not setup, therefore it transferred that balance to the patient. –Review the reason code and decide if there is an action you would like to take place and set it up –Report these instances to someone in your Practice (Billing Manager) that can update the Non Payment Reason Code setup on the Insurance Carrier

Processing an ERA File Review posted information From Payment Entry you can drill into the Transaction Distribution to make any updates required. You can also see the line information and COB information for secondary filing or researching a denial.

Processing an ERA File Review posted information You can also see the Line Information and COB information for secondary filing or researching a denial.

Processing an ERA File What do you do if you realize you have posted to a wrong DOE or wrong batch? How do you move those transactions?

Processing an ERA File Transaction Management – Move Transactions Select Checkbox next to Batch Click Move

Processing an ERA File Transaction Management – Move Transactions -Create a New Batch with the correct DOE -Or locate the batch you have created already and say OK

Processing an ERA File Transaction Management – Move Transactions

Processing an ERA File Review Remittance Reject Visits Review the visits that had denials you setup to flag for review: Status of: Filed Rejected Owner of: Remittance Review or whatever Owner you have set up for your reason codes; you CAN select more than one All Dates

Processing an ERA File Review Remittance Reject Visits Drill into the visits you need to review to find out the reason for the denial:

Processing an ERA File Review Remittance Reject Visits Go to the Claims tab to see the messages posted by the ERA transaction: Date and File Name give processing information Description contains the Remark Codes and reasons for any action taken on the visit In this case: MA01, MA18 (crossover codes)

Let’s Review

Every carrier that could be in the remit MUST have the Payer Literal; it must be listed exactly how it is in the ERA – including punctuation Assign a Transaction Column Set (TCS) that is for remittance processing to ALL CARRIERS ALL CARRIERS must have the Response Processor Plugin selected if it has the same payer literal; this does include Inactive Carriers If you are using a Payer Override Name – ALL “Like” carriers must have the SAME override name populated If a procedure post in the residual and transfer to the patient; this means this reason code needs to be set up. Notify your Billing Manager or whomever is responsible for the administration setup in your practice ERA processing is not 100% however if your setup is correct it should be pretty close; you still have to spot check and verify the posting

Let’s Review Electronic  Open EDI Response Management (1 click)  Search and locate my check using check # or amount (populate at most 3 fields - select okay) so we will say (4 clicks including OK)  Check box for file you want to process (1 click)  Select process button (1 click)  Click yes I do want to process (1 click)  Select batch option (depending on option selected this could be 1 click - however we will go with the most clicks including OK 5 clicks)  Go into Transaction management (1 click)  Pull up the batch (6 clicks to really narrow down your criteria)  Open the transaction (2 clicks)  Review the payment entry (1 click)  If non-payment reasons not set up - move monies back to the insurance carrier – (1 click)  OK (1 click)  Payment is posted GRAND TOTAL - 25 CLICKS TO PROCESS AND VERIFY AN ERA PAYMENT

Let’s Review Manual  Open Payment entry (1 click)  Select batch you are posting to (4 clicks)  Enter check amount (5 clicks)  Check # (check# has 10 numbers so 10 clicks)  Check date (8 clicks)  Enter the ticket number (6 clicks)  New (1 click)  If an alert note popup (1 click)  Actual allowed on each code - 3 codes - 6 clicks each so (18 clicks total)  Payment on each - 3 codes - 6 clicks each so 18 then 1 code was $0 so 1 click – (total of 19 clicks)  Populate copay on 3 codes - 6 clicks each – (18 clicks)  Populate deductible on 1 code – (6 clicks)  Populate line level information on each code for electronic 2ndary filing and also needed for denial review - 28 clicks for 2 code, 38 clicks for 1 code, 15 clicks on 1 code -the $0 pay (total of 109 clicks) Manual Continued on next slide

Let’s Review Manual – Continued  COB info ( 17 clicks)  ICN # (15 clicks)  File next carrier (1 click)  OK (1 click)  Payment is posted GRAND TOTAL CLICKS TO POST THE SAME PAYMENT MANUALLY WOW!!! 25 to 240 clicks!!!

BONUS** Active Report We have an active report called Copy Response Processor Settings that will copy over your response processor settings from one carrier to another carrier(s). 1.Set up your “Source Carrier” response processor settings in Administration>>Insurance Carriers 2.Open up Reports and run the Copy Response Processor Settings Active Report 3.Select that Source Carrier 4.Select the Destination Carrier(s) you wish to copy settings to

BONUS** Active Report What is a “Source Carrier”?  This will be your original carrier you set up. You will use this carrier to copy to other “LIKE” carriers. For instance, you would set up a Medicare carrier – you would then use this carrier as your “Source Carrier” to copy to other Medicare carriers. Remember when copying – if you have the override name populated – this will populate to all carriers you select as your Destination Carrier(s).  I suggest setting up one Medicare, one Medicaid, and one commercial “Source Carriers” and then copying those settings to other Medicare, Medicaid, and commercial carriers.

Questions

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