Payerpath 101- Tools & Techniques for
Effectively Reconciling and Tracking Claims
August 11, 2016 Presented by: Carrie Murphy
Copyright © 2016 Allscripts Healthcare Solutions, Inc. 2
Healthy Financial Core• Allscripts provides solutions that streamline workflows across clinical, financial
and operational processes
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Payerpath Knowledge Resources
1. News, Featured Videos,
Knowledge Resources
• Client Connect
1. Payerpath Knowledge
Center
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Payerpath Education TrackTIME TOPIC PRESENTER
Tuesday August 9th
1:30 – 2:30 Keep your finger on the pulse using Practice PerformanceAmber Civitarese,
RemitData
Wednesday August 10th
8:30 – 9:30 Patient Responsibility Solutions - Maximize Patient Payment Revenue Opportunities Lisa Temporale
9:45 – 10:45 Allscripts Payerpath: Roadmap to a Healthy Financial Core Steve Mueller
1:30 – 2:30 Optimize Electronic Remittance Posting Anne Havlina
Nicole Beulah
2:45 – 3:45 Integrating Allscripts Payerpath using Office Manager Paola Turchi
4:00 – 5:00 Payerpath Pre-visit solutions: A Healthy Revenue Cycle before Patient Visits Anne Havlina
Thursday August 11th
1:30 – 2:30 Payerpath 101 - Tools and Techniques for Effectively Reconciling and Tracking Claims Carrie Murphy
2:45 – 3:45 The 15 Most Common Allscripts EDI Support Questions Nicole Beulah
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Introductions & BackgroundGoal: Provide knowledge necessary to correctly work, track, and manage claims
within Payerpath for a healthy financial core!
Agenda for Today’s Session:
• Walkthrough Payerpath Claims Editing
• Full Reconciliation Workflow and Functionality
• Understand Claim List and Fixing Claims
• Review Payer Reports and Remittances
• Discuss 277 Claim Notes Integration
• Additional Tools/Tricks
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Claims Management Workflow
August 11, 2016
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Claims Workflow - Upload Detail Report • Upload Detail Report is a “snapshot” of how claims were
initially received from PM system by Payerpath.
• Indicates the claims that were processed by Payerpath and their
performance against the Payerpath claims and coding scrubber.
• Provides detailed information for passed, failed, and warned
claims broken down by payer.
• Can be utilized as a tool to start reconciliation process.
• Information is integrated in Claims Notes for clients on Allscripts
PM.
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Upload Detail Report – View results of claim file Select Reports > Upload Detail
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• Upload Detail List
• Summary Information
• Payer Breakdown
Upload Detail Report – View results of claim file
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• Parsed By Payer
• Claim Level Information
• Description of Edits
Upload Detail Report
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Full Reconciliation• Comprehensive reconciliation functionality embedded into Payerpath
Claims Management allowing clients to reconcile batches of claims or
individual claims.
• Matches claims to individual payer responses, payer reports, and
remittances.
• Should be primary workflow for clients related to claims submission,
follow up, and reconciliation.
• Provides transparency into the claims submission and adjudication
process.
• Allows clients to easily identify claims that have been rejected or
denied by the payers.
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• Reconcile By Batch
• Reconciliation Filter
Full Reconciliation - Workflow
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Full Reconciliation – Batch Reconciliation
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• Batch Level Reconciliation
• Payer Breakdown
• Totals
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Full Reconciliation – Batch Reconciliation
Each unique Batch ID
represents a
corresponding UDR
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Full Reconciliation - Reconcile by Batch, cont.
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Reconcile by Batch allows a user to review all information pertinent to the
individual claim from the Transmitted Claims List.
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V – View Claim Form
H – View Claim History
R – Access Payer Report
$ – Access Patient EOB4
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Dashboard – Claim Status Summary
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• Quick Links
• Claim Status
• My Filters
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Claim Status-ReconciliationUntransmitted - Claims within Payerpath Product
• Passed
• Failed
• In Process
Transmitted - Claims outbound to the Payer from Payerpath
• In Transit
• Acknowledged
• Accepted
• Rejected
• Remit
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• Sort by Payer
• Sort by claim type
• Select Timeframe
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Untransmitted Claims - Failed
Untransmitted Claims will
be deleted after 90 days!
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1. Select Date Range (Today, This Week, last 30 days)
2. Click on Rejected Claims Status
3. Review/Work Rejected claims
Transmitted Claims - Rejected
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Payerpath Claim Form
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• Form Views
• Toolbar
• Functions
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Electronic Fields View
• Electronic Fields
• Categories
• Details
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Secondary COB/EOB View1
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• Secondary Fields
• Adjustment Details
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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.
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• Field Description
• Payer Edits
• Application Reference
Application Field MappingWhile working claims in Payerpath users can click on blue field names to gather
valuable information that can be used in working claim rejections. The Application Field
Mapping provides guidance on correcting information in the practice management
system.
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Full Reconciliation – Claim History
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• Claim Statuses
• Payer Reports/Remittance Access
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Claims Scrubbing, Coding, and Compliance• Proprietary multi-level editing Claims and Coding Scrubber is
embedded into Payerpath Claims Management
• Payer Services team makes weekly updates to codes, edits, and
logic. Also include custom edits and maps that have been
requested by clients.
• Claim Scrubber also includes Coding and Compliance Tools
– Coding Tool-
• Scrubs Medicare Claims for CCI, LCD/NCD, Medical
Necessity, Modifier Usage
• Scrubs All-payers for CCI
– Coding/Compliance Tool – comprehensive and robust online
coding reference tool
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Coding and Compliance Tools
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• CodeCheck Edit – Verify Modifier used for accuracy
• “I” for Information
• Knowledge Source Pro - Library
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Coding Defaults
Payerpath Knowledge Source users can setup CCI Edits for
commercial payers. CCI/LCD/NCD Edits are applied for
Medicare Payers.
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Coding Defaults
Informational: Claim Edit Message shows up in green in Payerpath and no action is required. Claim
will pass without manual intervention
Warning: Claim Edit Message appears in Payerpath in Yellow and requires the user to correct the
information or acknowledge the warning
Error: Claim Edit Message will Fail the claim in Payerpath and will not allow correction from within
Payerpath. The claim would need to be corrected in your practice management system and re -filed
to Payerpath.
Payer Reports
AUGUST 11, 2016
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Payer Reports • Payer reports are responses sent (typically 24-72 hours) by a payer’s EDI
department indicating how they are handling claims sent by Payerpath
• No standard across payers regarding reports and responses leads to:
• Inconsistencies across payers
• Perceived missing information from payers
• Large Quantities of Reports
• 277CA and 277B Payer Report Types
• 277 Claim Acknowledgement – Individual Claim Acknowledgements, there
may be various statuses within one report
• 277 Batch – “277 Reject Report” Batch Level Rejection, all claims in batch
are rejected, typically file related issue such as NPI, Tax ID, Enrollment
• The first step of managing your payer reports is to… Let the Full Reconciliation
Features in Payerpath help you!
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Reports That Reconcile
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• Payer Report List
• Payer Reports
• Matched Column3
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Insurance Follow-up Process/Timely Filing
• If the claim was submitted to a payer that
Payerpath does not reconcile then review
Payer Reports under Reports Payer report
Filter• Payer
• Exclude RCM – Matched Rpts
• Apply Filter
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Payer Reports
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• Payer Report
• Claim Level Examples
• Example Denial
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Payer Rejects Report• Provides same claims that show up in Reconciliation features
• Can be used as a secondary or supporting reconciliation workflow
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Remittance Detail Reports • Electronic Remittance Advice (ERA) received from payers provides an
electronic version of the EOB
• Standardized into template across all payers
• Payerpath provides online presentation with reporting functionality
• Raw Files are sent back to the PM applications for automatic payment posting
• Make sure to work with implementations/support to ensure that PM system is
setup correctly for auto-posting features
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Remittance Detail Reports
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• Payment Information
• Provider Information
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Remittance Detail Report
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• Patient Information
• Service Information
• Payment Information
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Full Reconciliation – Single Patient EOB
• Patient Information
• Reports (R) / Remittances ($)
• Single Patient EOB3
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277 Claim Notes
AUGUST 11, 2016
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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.
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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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Additional Features/Tips
AUGUST 11, 2016
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New Eligibility in Payerpath
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New Eligibility Demo
• Demo
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Payerpath Call results now in Payerpath!!
1. Appointment Reminder
Report (AN)
1. Appoint Reminder
Processing Report (AP)
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Patient Payment Solution Reports
Payerpath Statements - SP/SN reports
Epay/Estatement Reports
Payerpath Receipt Reports
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Preferences
Set the amount of time you want
Payerpath to keep you logged in
(5min- 60 mins).
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Preferences – How can I change my password without calling support?
Having the correct email address on file will allow you to reset
your password yourself without having to call support.
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Email Campaign – Password Reset• Enter Valid Email Address
• Submit and Verify
• Check Email box to complete verification
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Search for Payers
Download Claim/Remit Forms
ICD-10 Readiness dates
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Coming Soon
AUGUST 9, 2016
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New ‘Done’ Feature
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New ‘Done’ Feature
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This presentation has been sponsored by our partners at
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