Integrating Allscripts Payerpath with Office Manager · between Allscripts Payerpath and Allscripts...

Integrating Allscripts Payerpath with

Office Manager

AUGUST 9 – 11, 2016

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Introduction and Agenda

AUGUST 9, 2016


OverviewGoals: This session will show Payerpath user workflows and tools to effectively reconcile

and track their Claim, Eligibility and Appointment reminder statuses using Office

Manager.

Topics include:

• Eligibility, Appointment reminder and 277 Claim Notes Integration with Allscripts PM.

This advanced session is for clients that want to leverage Office Manager for integration

between Allscripts Payerpath and Allscripts PM. This session will demonstrate how clients

can use Office Manager to drive workflows based off various Allscripts Payerpath status.


Agenda• Understanding Eligibility Verification

• Integrating Eligibility Verification Reponses with Office Manager

• Understanding Payerpath Call

• Integrating Appointment Reminder Responses with Office Manager

• Understanding 277 messages

• Configuring 277 messages

• Integrating 277 messages with Office Manager

Understanding Eligibility Verification


Eligibility Verification• Batch Eligibility

Appointments are gathered and forwarded in a report format for bulk eligibility verification

Batch Eligibility allows a client to pull results based on account types, appointment types,

payers, locations, providers, etc.

The system is configured to automatically process appointments

Batch eligibility requests can be scheduled from 1 day prior to several weeks in advance of

the patients appointment.

Responses are returned to the Appointment Scheduler

Batch results can also be viewed within Payerpath

• Real Time Eligibility (Can be done in PM and Payerpath)

Process a demand request at anytime

Receive responses within 30 seconds or less


Appointment Management

• The coverage status of an

appointment can be seen in

Appointment Scheduling and

in Office Manager.

• The coverage status

appears in column “C” and is

color coded

• The user must highlight the

appointment and right-click

to view the eligibility

response details.


Eligibility Responses

Indicates PENDING eligibility response (Automatic)

Indicates RECEIVED with active coverage (Automatic)

Reflects report has been read with active coverage (Manual)

X

Reflects report has been read with inactive coverage (Manual)

Indicates EXCEPTION eligibility response (Automatic)

Indicates INACTIVE coverage (Automatic)


Eligibility Response View• Select your

appointment and

right click

• Click on View

Eligibility

Response

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Eligibility Response Report

Enhanced to include ALL data returned in the eligibility response files from the payers. Simply click on the applicable Service Type category to view the detailed benefit coverage. Appointments get pulled for the verification report.


Detailed Example of Service Type (30) –Health Benefit Plan Coverage

Integrating Eligibility Verification

Reponses with Office Manager


How to Configure Office Manager

• Select the filters

that better fit the

needs of your

organization

• Analyze your

appointments

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Work Group Maintenance Appointment

Assign

operators to

the queues


Using Office Manager

• Click in Office Manager and the Queue

• Right click on the appointment

• Review eligibility response

• Update the coverage field as needed in

the appointment detail screen

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Using Office Manager vs. Appointment Management

• Centralized vs. decentralized operations

• Dedicated hours vs. as time permits

Understanding Appointment

Reminders


Appointment Reminders• Payerpath Call is a service that helps Clients automate the time-consuming

task of calling patients to remind them of an appointment.

• Clients transmit a list of patients appointments from Allscripts PM to Payerpath

for Call fulfillment.

• Patients receive a professionally-recorded, custom message reminding them of

the day, date and time of their appointment.

• Text Messaging is also available for patients that prefer to receive a text

message.


The iRemind Appointment Export is used to extract appointment detail from Allscripts PM™ and to generate a file that is transmitted to Payerpath using the EDI Transport Utility (EDI Send and Receive Process).

This is exported file is transmitted by Payerpath where appointment reminder calls are generated.

A result file is returned by Payerpath. From this file, Payerpath generates a confirmation report that is sent to you and placed in a folder under the database's Ntierfilesdirectory.

How Does It Work?


Integration – Appointment Export (IRE)

Items designated in the

IRE will determine which

appointments get pulled.


Integration

A patient’s Contact

Preference of “Do Not

Contact” on the

Additional Info tab in

Registration (REG) will

always be excluded

from any Call export

file. Patients without a

Contact Preference are

included in the export.


Integration

When right-clicking on

an appointment in

Appointment Detail or

Confirm Appointment

windows, a Confirmation

Result drop-down list is

available. The

Appointment Reminder

confirmation result

automatically populates

this field with a short

description.


Integration

Preloaded Confirmation

Result Codes will populate

once a call has been made.

From the appointment

activity it can be seen at a

glance whether calls were

made and the result.

Codes returned are

preloaded in Appt.

Confirmation Result Code

Maintenance.


Code Short Description Long Description

F Answered- Called Receptionist A person pressed the touch tone key to speak to the receptionist

] Answered- Confirmed Left Message Identification confirmed and then pressed the touch tone key to

leave a message

__ Answered- Confirmed No Identification confirmed and then pressed the touch tone key to

indicate “no” as the response

L Answered- Confirmed Repeated Identification confirmed and then pressed the touch tone key to

replay the message

K Answered- Confirmed Rotary Message Identification confirmed and then rotary response accepted

G Answered- Confirmed Yes Identification confirmed and then pressed the touch tone key to

indicate “yes” as the response

N Answered- Entire Message A person answered and listened to the entire message

H Answered- Hung Up A person answered but did not listen to the entire message

M Answered- Left Message A person answered and pressed the touch tone key to leave a

message

^ Answered- No A person answered and pressed the touch tone key to indicate “No”

as the response

T Answered- Repeated Message A person answered and pressed the touch tone key to repeat the

message

E Answered- Rotary Message The call was completed and a rotary response was accepted

Reports – Integrated Return Codes

Over 30 Recordable

Responses:

• Confirmed

• No Answer

• Answering Machine

• Out-of-Order

• Busy

• Not Called

• Answered: No Response

• Rotary Message

• Repeated Message

• Never Call Patient

…And More!


Reports – Quick ViewAppointment Reminder

Notification Report

Clients will receive a separate


Notification Report (AN) for each

file transmitted.

Each AN report will list the

number of Accepted reminders,

the number of Rejected reminders

(if any) and the Total reminders in

the file.


Reports - LocationAppointment Reminder

Processing Summary Report


Appointment Reminder Processing

Summary Report (AP) for each

file transmitted.

Each AP report will list the

actual call/text results.


Reports - Patient

Each AP report will list the

actual call/text results.


Processing Summary Report


Appointment Reminder Processing

Summary Report (AP) for each

file transmitted.

Integrating Appointment Reminder

Responses with Office Manager



• Select the filters that

better fit the needs of

your organization

• Analyze your

appointments

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Work Group Maintenance Appointment

Assign

operators to

the queues



• Click in Office Manager and the Queue

• Right click on the appointment

• Update the confirmation result field as

needed in the appointment detail screen

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Understanding 277 Messages


What are 277 Claim Status Messages• 277 Transactions are the EDI response to the inquiry about the current status of a

specific claim or claims.

• These transactions utilize claim status categories to communicate if the claim has been

acknowledged, pended, finalized or if additional information is being requested.

• These transactions utilize claim status codes to further explain the status of the claim.

• Payerpath has created custom transactions to communicate the status of the claims.

• 277 Transactions are the EDI response to the inquiry about the current status of a

specific claim or claims.

• Professional and Institutional claims are supported (where data is available).

• 3 Message Types are generated (277U, 277A, & 277P).


Types of Claim Status MessagesPAYERPATH (277 MESSAGES) CARRIER (277 MESSAGES)

• Utilize custom claim status categories and codes to

communicate the status of the claim.

• 277U - Upload detail report

• Utilize HIPPA compliant claim status categories and

codes to communicate the status of the claim.

• 277A - Carrier Acknowledgement (usually within 24

to 48 hours after transmission).

• 277P - Payer Reports (usually within one to three

days, depending on the payer’s processing

capabilities).

CODES

ACC_STATE

ADMIT_DATE

BILLING_SPECIALTY

CLIA

DIAG_CODE1

CATEGORIES

CODE

FAC

INFO

INS1

PAY1

CODE DESCRIPTION

27 Policy canceled.

28 Claim submitted to wrong payer.

29 Subscriber and policy number/contract number mismatched.

30 Subscriber and subscriber id mismatched.

31 Subscriber and policyholder name mismatched.


Where Can I Find Claim Status Messages

1. Under Financial Inquiry (FIN) &

Account Ledger right click on the

voucher

2. Select View Claim Status2

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Where Can I Find Claim Status Messages

1. Under Claims Review (CRE) &

Office Manager right click on the

voucher

2. Select View Claim Status2

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277 Claim Notes Examples

1. Source - Payer

2. Action Code - Status

3. Claim Category

4. Claim Status

5. Description

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1. Source - Payer

2. Action Code - Status

3. Claim Category

4. Claim Status

5. Description

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277 Messages document

in the Practice

Management what

appears under Payerpath

Configuring 277 Messages


Allscripts Interface Configuration (AIE)

Three different AIE Format

Class Maintenance records

and the corresponding Broker

Format Maintenances are

required for ANSI 277 Claim

Status Notes setup to have the

three types of files return

correctly.

• 277U

• 277A

• 277P


Claim Status Category Maintenance

• Claim Status

Categories auto-

populate under the

Claims Status Category

Maintenance Table.

• Descriptions have to be

updated according to

Washington Publishing

Company (WPC)


Claim Status Code Maintenance

• Claim Status Codes

auto-populate under

the Claims Status

Code Maintenance

Table.

• Descriptions have to

be updated

according to

Washington Publishing

Company (WPC)

Integrating 277 Messages with Office

Manager



• Select the filters

that better fit the

needs of your

organization

• Analyze your

claims

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WQM Configuration Tips• Map all queues

• Create multiple queues to track trends

– Payerpath failed claims 277U

• Custom Codes

• Billing Dates*

– Payor rejections 277P

• HIPPA Compliant Codes

• C/S Import Dates*

• Avoid overlapping

• Balance queue volumes (Weekly/Monthly Queues)

• Appropriate timing (0 Days)

• Validate your queues against Payerpath*Not recommended for workflow organizational basis


Work Group Maintenance Unpaid Claims

Assign

operators to

the queues


WGM Configuration Tips

• Map all groups

• Add managers to all queues

• Prioritize the queues


Step 1: Accessing Unpaid Claims Mgmt.

1. Click on Office

Manager

2. Click on the

Unpaid Claims

Management

folder

3. Click on the

desired folder

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Step 2: Dragging & SortingSort using any column header

Left click on any column header

Drag to sort by that column

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• Sort using any column header or multiple column headers

Step 2: Dragging & Sorting


Step3: Reviewing the Claim

1. Right click on

your claim

2. Select View

Claim Status

3. Review the

report

4. Make

appropriate

changes

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Step 4: Adding Claims Notes

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1. Right click on your claim

2. Select Claim Notes

3. Click the magic wand

4. Type your note and

save

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Step 5: Rebilling Your Claims

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1. Right click on your claim

2. Select Edits

3. Check Rebill

4. Click Save

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Let’s talk about Auto ReplaceWhat is it?:

• When the Auto Replace setting is turned any claim that is in a Failed or

Warned status (and ONLY in those two statuses) will be deleted when a

replacement/new claim with the same claim number and payer are

uploaded to Payerpath.

Workflow Benefits:

• Users don’t have to go back into Payerpath and manually delete claims

that have been corrected and resent from their PM system. This allows

tighter integration between PM and Payerpath. A user can fix all of their

issues in the PM system and have minimal need to spend more time in

Payerpath doing additional manual steps.


Office Manager Workflow Tips

• Drag and sort claims

– Billing date

– Follow up date

– Payor

– Provider

• Add claim notes before rebilling the claim

• Reconcile your claims


Top 4 FAQ• Does Office Manager work with other Payerpath solutions?

– Yes: Electronic Remittances.

• Is Office Manager updated real-time?

– Yes: Office Manager is updated/refreshed as soon as the messages are received.

• Does the APM reconcile failed claims with Payerpath?

– Yes: Payerpath has a setting that allows you to automatically reconcile your claims*.

• Is there an additional charge for 277 Messages?

– No: 277 integration is included with the Payerpath services.

* Client’s Payerpath ID, Claim number, & PP Payor ID have to be the same

Integrating Allscripts Payerpath with Office Manager · between Allscripts Payerpath and Allscripts...

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