for Practice Insight Authorized Resellers Martha Johnson Dir Of Payer Development Donna Anderson Supervisor of EDI Enrollment Jes Wettstein EDI Enrollment Specialist Jessica Moran EDI Enrollment Specialist ID: 386222
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Slide1
EDI Enrollment Webinarfor Practice Insight Authorized Resellers
Martha Johnson, Dir. Of Payer Development
Donna Anderson, Supervisor of
EDI Enrollment
Jes Wettstein, EDI Enrollment Specialist
Jessica Moran, EDI Enrollment SpecialistSlide2
Topics we will cover…
EDI Enrollment- What IT IS, What IT IS NOT
Profiling your Customer
Managing the EDI Enrollment Forms (Claims/ERAs)
Tracking EDI Enrollment Requests
Avoiding EDI Enrollment Problems (Delays!)
Enrolling your customer for Real-Time Eligibility
Slide3
EDI Enrollment:What IT IS, What it IS NOT.
EDI Enrollment IS:
a request by the provider made to a payer to allow the exchange of specific EDI transactions with that payer. The provider is already known to the payer.
EDI Enrollment IS NOT:
credentialing or registering the provider’s NPI# or Tax ID # with the payer.Slide4
837 – Claims
835 – Remittance Advice (ERA)
270 - Eligibility Request
276 – Claim Status Inquiry
275 – Attachments (paperwork)
5 Types of ANSI TransactionsSlide5
Profiling Your New Customer
Good questions to ask:
Single office or CBO?
Sharing Tax ID# with hospital or other office?
How many billing NPI#s tied to the Tax ID#?
For each payer, does the provider bill as a group or are the individual providers billing “solo”?Professional claims and/or Institutional claims? Slide6
First things first!
Login to EDIinsight
Add the NEW CUSTOMER ACCOUNT
Get the basics input to the account:
Name, Address, Tax ID#
Profiling Your New CustomerSlide7
Profiling Your Customer
Add the Provider Records in EDI Customer Account:
Provider Name, Address
Person or Non-Person?
Billing or Rendering?
NPI#
Tax ID#Taxonomy (Specialty) CodeMedicare PTAN#, Medicaid ID#Slide8
Profiling Your Customer…
Create a Payer Inventory List
Build a list of your Customer’s Top Payers
Make a list of government payers
your customer needs:
Medicare Part A/B, DMERC, Medicaid, BCBS, Railroad Medicare, TricareMake a list of commercial payers
your customer needs:
Aetna, CIGNA, Humana, United Healthcare, commercial Medicaid Managed Care plans (MCO)
Slide9
Create a Payer Inventory List
Build a list of
Payers that currently send Electronic Remits
to your Customer.
Note how each ERA is delivered to your Customer:
Clearinghouse, Provider/Web Portal, other direct delivery to CustomerAdd to the list any additional Payers from which the Customer would like to have Electronic Remittance files.
Profiling Your CustomerSlide10
Profiling Your Customer
Create a Payer Inventory List
Compare the inventory list to the Practice Insight payer list and look for gaps.
Pay attention to Professional vs.
Institutional.
If payer is not found, contact us with your request, including payer ID# (log an Issue or email: enrollment@practiceinsight.net).
Slide11
Time to Play
Who
se
Enrollment is it Anyway?
837 (Claims), 835 (ERAs), 270 (Eligibility), 275 (Attachments), 276 (Claim Status)
1
st
Question
Name / Describe
2
types of ANSI transactions that we have discussed.
Answer:Slide12
Who
se
Enrollment is it Anyway?
What should you do BEFORE your customer submits any EDI enrollment paperwork to payers?
2
nd
Question
Set up customer in EDIinsight. Add customer and provider record(s).
Answer:Slide13
Who
se
Enrollment is it Anyway?
Single Office or CBO? Do you share tax ID # with another office? How many billing NPI #s in your office? Do your providers bill as a group or as individuals, and for which payers? Do you bill professional, institutional or both?
3
rd
Question
What is a good question you can ask your new customer to learn about how they file claims?
Answer:Slide14
W
eb page where Practice Insight keeps library of EDI enrollment documents:
http://www.practiceinsight.net/RESELLER_Docs/Enrollment.html
(This site is for Resellers, not Providers!
Go ahead and bookmark this URL.)
Where are the forms?Slide15
Fill Out EDI Enrollment Forms for Each Billing Provider
Who is the Billing Provider for this Payer?
What NPI# is used to bill this
P
ayer,
e.g
, group NPI# or individual provider’s NPI#?Is there more than 1 Billing Provider/NPI?Address should match credentialing at Payer
Signatures must be Authorized
If any question about how the Customer is billing the Payer, CALL the Payer and Ask!
Slide16
Payers typically deliver ERA files to one trading partner only at a time—no duplicate delivery
Once enrolled, Payer will send ERA files for all payments, whether the claim was submitted by Practice Insight or not
Changing
existing ERA authorization may require additional LOA (letter of authorization) on provider
letterhead—check PI instruction page
ERA
delivery to EDI
Customer account
depends on complete and accurate input of provider
Tax ID
and NPI numbersFill Out EDI Enrollment FormsElectronic RemitsSlide17
What if I don’t find forms?
Government Payers
No forms? Contact enrollment department.
Govt. Payers require 6-10 weeks to develop a new direct connection and approval to submit claims or a new transaction type.
Electronic Remits must also be developed or contracts negotiated for Practice Insight to register and deliver these files
Questions? Create an issue.
**Distinguish between Professional vs.
Institutional
Example: Medicare Part A and Medicare Part B
PI may need to test with Medicare Part A “Institutional”Slide18
Managing the EDI Enrollment Forms
Always download a current set of payer enrollment forms (Refer to Reseller Docs URL)
Distribute Forms to Customer (Do not give out URL)
Ideal time frame- 30 days before the go-live date (forms do change)
Always check PI instructions for how to deliver forms
Always make a copy of the completed enrollment formSlide19
Tracking EDI Enrollment Requests
PI will share with Reseller any Payer confirmations or rejections (usually by email)
Some payers send NO notification to Practice Insight or to the provider
Reseller can follow-up with payer
Call with your copy of forms in hand—Payers often ask for Provider NPI, Tax ID or legacy PINSlide20
Time to Play
Who
se
Enrollment is it Anyway?
What instructions should you refer to when completing and submitting EDI enrollment forms
?
1st Question
Answer :
The “Practice Insight” instruction page that precedes each set of EDI Enrollment Forms posted to the PI Reseller Forms’ Library. Slide21
Who
se
Enrollment is it Anyway?
If the Customer’s Go-Live date is February 1
st
, what date should you target to send completed forms to the payers?
2nd Question
Answer :
January 1
st
. Allow approx. 30
Days
. Enrollment varies from payer to payer. (ERA
setups can take
longer, 4-6
weeks
.)Slide22
Whose
Enrollment is it Anyway?
Copy of the completed forms submitted to the payer. It’s also helpful to know the date the request was submitted.
3rd Question
Answer :
When following up on an
EDI
enrollment
request,
what should you have in front of you?Slide23
Top 5 “Action Needed” (From Practice Insight):
Missing Signature
Missing NPI or TAX ID
Nothing Selected on Form
Missing Valid Billing Address
Illegible
Top 5 Rejections (From Payer):Enrolling w/ wrong PTAN (Individual vs. Group)Provider Not Credentialed Unauthorized SignatureMissing PTAN, Legacy, etc.Didn’t Select Change CH
Avoiding EDI Enrollment ProblemsSlide24
Avoiding EDI Enrollment Problems
Always download the latest documents
Assist
your customer
Proof read NPI numbers and Tax ID numbers
Make sure no missing signaturesSlide25
Special Notice for Private Databases
Some Authorized Resellers have a
Private Database with
DIFFERENT SUBMITTER INFORMATION
than standard Practice Insight accounts.
If so, Reseller must modify standard EDI enrollment documents.Check with PI Enrollment Dept. for help.Slide26
Enrolling your Customer for Real-Time Eligibility
Go to PI’s Provider Enrollment Steps web page at
http://www.practiceinsight.net/RESELLER_Docs/Enrollment.html
Click on the link
RT Eligibility forms
which will take you to the Real Time Eligibility web page at http://www.practiceinsight.net/RESELLER_Docs/RealTime.htmlClick on Practice Insight 270/271 Eligibility Registration to open the form to complete and submit your customer’s enrollment request. Slide27
Enrolling your Customer for Real-Time Eligibility
Payers that DO require Eligibility Enrollment:
CMS Medicare including all Medicare A/B, Railroad Medicare and DMERC.
Special Payers – these are found on the PI web site, along with forms and instructions. Slide28
Enrolling your Customer for
Real-Time Eligibility
Payers
that DO require Eligibility
Enrollment
:
Complete Practice Insight 270/271 Registration Form for each customer. For any Special Eligibility Payers, go to the RT Eligibility web page to access Payer form.Slide29
Time to Play
Who
se
Enrollment is it Anyway?
Contact PI’s EDI Enrollment dept. Log an issue
in Issue Manager, call the Enrollment
Dept
, or send email to enrollment@practiceinsight.net. Be sure to include the electronic payer id (usually 5 digits) and any information you have about the payer.
1st Question
Answer:
If your customer requests a payer and it is not on the EDI payer list, what should you do?Slide30
Who
se
Enrollment is it Anyway?
Missing signature. Illegible. Missing or Invalid Provider Numbers,
e.g
, such as Provider ID #, PTAN # NPI #, Tax ID #. Incorrect Provider name. Individual provider information on form instead of billing provider group information.
2nd Question
Give
2 or more reasons why
an
EDI enrollment request might be rejected or delayed.
Answers: Slide31
Who
se
Enrollment is it Anyway?
Watch for an email, fax or letter from the payer.
You (the PI Reseller) may receive a CONF email from Practice Insight. You or your customer can call the payer to get verbal confirmation that the provider is approved to submit claims via Practice Insight.
3rd Question
How will you know when your customer is enrolled and can begin submitting claims?
Answer: Slide32
In Summary…
Take the time to PROFILE YOUR CUSTOMER to get a complete and accurate assessment of the customer’s EDI enrollment requirements.
SETUP THE CUSTOMER IN EDI (add customer record and provider records) BEFORE SUBMITTING EDI Enrollment paperwork.Slide33
In Summary…
Support your provider -- they need your help!
Assist your customer in completing and reviewing EDI enrollment forms.
(Rejected EDI enrollments create unnecessary and painful delays!)
EDI
enrollment can be part of your implementation services and feesSlide34
In Summary…
Manage your customer’s expectations about length of time to complete enrollments and when they will be ready to “go live” with EDI.
Track the EDI enrollments so that you are aware of rejections and confirmations as soon as possible. Slide35
In Summary…
Monitor the first batch of claims your new provider sends to Practice Insight –react quickly to claim rejections.
Making your customer’s first experience positive with EDIinsight can be critical to your success. Customers always remember whether the start-up was smooth or rocky!Slide36
In Summary…
As with all EDIinsight issues, contact
Practice Insight when you need help.
To reach PI’s Enrollment
Dept
…
Log an issue in Issue ManagerSend email to enrollment@practiceinsight.netCall 713.333.6000 (press Option #2)\Slide37
1
st
BONUS QUESTION!!!!
Electronic
Remittance Advice (electronic
eob
)
Answer:
What
is an ERA? Slide38
2nd BONUS QUESTION!!!!
Electronic
Funds Transfer (monies deposited in bank)
Answer:
What
is
a
EFT? Slide39
3rd BONUS QUESTION!!!!
ERA
is
received
via electronic file.
EOB is
received
on paper.
Answer:
What
is the difference between an ERA and an EOB?