Second Quarter Release Notes

Second Quarter Release Notes

·  In all applications we relabeled fields with the label of Payor to Payer.

·  Updated the right-click claim menu. Features in the right-click menu will be sorted by function and then sorted alphabetically.

Claim Manager

·  Changed the order of the Selected Claim List buttons. This change was a result of the change in the right-click menu.

·  Permission for viewing and adding electronic attachments has been modified slightly.

o  To Press F12 (Add/View Attachment) on Claim List user is required to have Claim Edit Permission set to VIEW or higher. (previously ADD)

·  Assign Claim feature now only requires Claim Edit-VIEW Level permission.

·  Assign Claim feature has been enhanced to include an option to unassign a claim from a user. If a user has been assigned to a claim select the option Assign/Unassign a claim to remove user assignment to claim.

·  You can now send electronic attachments to Auto Medical payers on our Payer List. Auto Medical claim payers will have a payer type of AM. These payers have been added as part of our new Work Comp payers. (Please note that not all Auto Medical claims require an attachment)

·  When you click the Clear Selections button “Last Search Days” will be set to All.

·  When a claim file was being deleted from Transfer Files the delete_date was not being set.

·  MREP view will now display the Date of Service if the payer reports the date of service as Statement Beginning/Ending Date (DTP*472). Previously if the date of service was sent on an ERA with the Statement Date indicator it was not displayed on the EOB. This is applicable for Institutional Claims only.

·  Customers that have only Claim Edit-VIEW permissions will no longer be able to change a provider’s NPI using the NPI search.

·  Added Payer Estimated Amount Due and Patient Estimated Amount Due fields to the Misc Data button on the Claim Edit screen for Institutional Claims.

·  Added Prior Authorization field to Insurance 2 window for Primary and Institutional Claims.

·  Removed the option to View HCFA/UB92 from the right-click menu.

·  The View CMS (UB04/Institutional) feature has been updated. The logic for FL43 (Description) has been updated to show the Revenue Code description. This is in compliance with UB04 Billing Guide.

·  Secondary COB Balancing Summary report was showing deleted Line items. Deleted Line items will no longer show on report.

·  In order to set claims in the SENT status to READY you must have Process Manager-ADD level permission.

·  Corrected the field property for the ID Code field when editing a PWK Attachment. Previously it was a numeric field only, now it accepts alphanumeric characters.

·  On the DMERC forms when a user clicks the Save Changes button the button will change from red to green so that the user understands that something has happened. Then they can close the form and return to the Claim Manager screen.

·  If a user tries to click on the Timely Filing Letter for a claim that has not been sent yet, they will receive a warning “Claim has not been sent to Insurance Company. Continue?”.

Claim Loaders

·  New logic has been added for zip files being loaded. This will prevent zips that include multiple files from possibly loading multiple times. This was resulting from a rare archiving issue.

HCFA

·  Added logic that allows you to send drug/prescription information in the line note on Box 24 of CMS-1500 form. The drug information will then be parsed to the Drug Identification Loop (Loop 2410) in ANSI. The new logic is as follows:

o  To send the Drug ID field (Loop 2410 LIN segment) enter a note that contains the value NDC or N4 followed by the Drug ID.

§  Example Note:N41234567899

§  ANSI Data: LIN**N4*1234567899

o  To send the Prescription Number (Loop 2410 REF segment) send a note that contains the value Q followed by the prescription number.

§  Example Note:NDC12345678911 Q87654321

§  ANSI Data: LIN**N4*12345678911~REF*ZX*87654321

o  To populate the Drug Price segment (Loop 2410 CTP segment) the note must contain a value (after the NDC or N4) starting with CTP followed by the drug price information. The note must contain the drug price information in this order: unit price, quantity, and unit of measure.

§  Example Note: N41234567899 Q999999999 DRUGNAME 4ML CTP 20 3 GR

§  ANSI DATA: LIN**N4*12345678911~CTP***20*3*GR~REF*ZX*999999999

o  The data in the note must be sent in the following order (including spaces).

§  Example Note: N4DrugID QPrescription# CTPUnitprice quantity unitofmeasure

NSF

·  Drug/Prescription information can be sent on NSF claims in the HA0 record. The logic for NSF and HCFA is the same. (Please see the above information for logic. This is logic that existed previously.)

·  The HA0 field can load the CTP data (Loop 2410 Pricing Info segment). If the price = 0, then the price field will not load and the 0 will be removed.

o  Example Note: N41234567899 Q999999999 DRUGNAME 4ML CTP 0 3 GR

o  ANSI DATA: LIN**N4*12345678911~CTP****3*GR~REF*ZX*999999999

Professional Claims

·  If a CAS segment (Claim/Line Adjustment) is sent and the monetary amount data element (this is the dollar amount that is associated with the Adjustment code) is blank then a $0.00 dollar amount will load in the field.

·  If a CAS segment (Claim/Line Adjustment) is sent and the Adjustment Reason Code is blank then an XX will load in the field. Practice Insight will create a rule to then make these claims INVALID.

Institutional Claims

·  If a CAS segment (Claim/Line Adjustment) is sent and the monetary amount data element (this is the dollar amount that is associated with the Adjustment code) is blank then a $0.00 dollar amount will load in the field.

·  If a CAS segment (Claim/Line Adjustment) is sent and the Adjustment Reason Code is blank then an XX will load in the field. Practice Insight will create a rule to then make these claims INVALID.

Claim Builders

Institutional Claims

·  Fixed Institutional Claims so that legacy id is no longer being sent for operating provider (Loop 2310B) if the Payer Record Secondary Providers is set to NPI Only/Strip Legacy.

·  If the Taxonomy Code is present in the inbound file or has been added to the claim, we will send that taxonomy code on the outbound file. (This is for gateway customers)

·  For standard non gateway databases, claims that are loaded without matching to a billing provider and get set READY by the vendor will be set back to INVALID when the batch maker builds the batches. This will prevent claims with missing billing providers from getting sent out and causing batch rejections.

·  If a user sets a claim READY and overrides the tester which causes a CAS segment to be sent out with XX as the code or blank, or the amount is blank then the builder will not build the incomplete CAS segment.

·  If the address includes a state that is in lower case (ex: ga) we will outbound the state in all upper case (ex: GA). This was done to prevent 997 rejections.

Professional Claims

·  If the Taxonomy Code is present in the inbound file or has been added to the claim, we will send that taxonomy code on the outbound file. (This is for gateway customers)

·  For standard non gateway databases, claims that are loaded without matching to billing provider and get set READY by the vendor will be set back to INVALID when the batch maker builds the batches. This will prevent claims with missing billing providers from getting sent out and causing batch rejections.

·  If a user sets a claim READY and overrides the tester which causes a CAS segment to be sent out with XX as the code or blank, or the amount is blank then the builder will not build the incomplete CAS segment.

·  If the address includes a state that is in lower case (ex: ga) we will outbound the state in all upper case (ex: GA). This was done to prevent 997 rejections.

Eligibility Manager

·  Added a Payer Setting that allows Practice Insight to force the patient to be the subscriber on the 270 eligibility request.

·  Medicaid of Ohio 270 requests will use the DocID record pin number and place that in the NM109.

·  Added Primary Care Provider Column to the Eligibility Print List. The Primary Care Provider is being pulled from Loop 2120C NM1*P3 (Primary Care Provider) segment on the Eligibility Response (ANSI 271).

·  The Note field in Eligibility Search Criteria is no longer case sensitive.

·  Added Staff Name to the Message when an eligibility request is deleted.

Report Manager

·  Vendor Productivity Report is the vendor version of the staff productivity report. This will allow vendors to run a report on another vendor user, and see what claim activities they have done across all their customers.

·  Claim Rejection Analysis Patient Name blade was corrected to show the Subscriber’s Name if the Patient Relationship was self.

·  Claim Rejection Analysis Support Message blade has been corrected to show Message from Support (2nd message column on the claim status lines).

Change Log

·  Staff Change Log will now display when a user’s password was set to reset at the next login.

·  Staff Change Log will now display the Permission and new Permission Level when changes are made to Staff Permissions.

·  The Claim Change, Claim Activity section will display the name of the Staff Member who sent the claim for Clinical Claim Scrubbing. If the claim was scrubbed during the upload process the name of the staff record will still display as Loader.

Admin Tools

Customer Setup

·  Added ID (Fee ID) column to Fee Manager.

Custom Rules

·  Custom Rules can now be created that will test for dates “on or before” and “on or after” a certain date. Your date format must be mmddyyyy to work.

·  Corrected a problem with the double click to edit feature not recording changes when the CS Form CL_OICOB2 was in use on the rule. Changes made when users double click rules using this form will now be recorded in the change log.

Logins

·  / is no longer a valid character for user’s password. Users with a / in their password were running into problems when running reports. If a user is currently having problems printing reports and has a / in their password use the “Reset Password at next login” feature to have the user update their password.

·  Fixed an issue that was occurring with the SFTP login not saving if the user clicked the X instead of Save when exiting the customer record. New logic has been added to save SFTP user to the Staff Record window. The new logic is:

o  When creating an SFTP user, if the user cancels from email it will clear the login_name and remove the sftp staff record it had created.

o  Login_name is recorded in the customer record even if the user presses cancel out of the customer record.

·  When an SFTP user is inactivated it will now make the staff inactive and change the password to keep the SFTP user from sending or receiving any files.

·  When a Customer Record is set Inactive the SFTP login name will be removed and the SFTP staff record will be set Inactive and the password will be changed.

Task Manager

·  The Note column is now sortable.

·  Fixed the EOB View button for Worklist Tasks.

Dashboard Reports

·  Changes were made to the Dashboard Reports so that they will render faster.

Statement Manager

·  Will now strip single and double quotes from message fields when building the statement file to go to the print vendor. This was causing them to error out the file.

·  Added a new statement format for customers. This new statement includes fields for insurance amount due and patient amount due at the line level. New statement is Statement Loader 7.

·  In Statement Transfer Files, the last column in the Response File section was entitled Messages. We changed it to File Name.

Process Manager

·  Filter List now includes a batch status filter in Process claims in the middle pane where the batches are listed.

2nd Quarter Release Notes (07/26/2010) Page | 1