EDI Enrollment Webinar for Practice Insight Authorized Resellers
EDI Enrollment Webinar 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 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 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 providers
NPI# or Tax ID # with the payer. 5 Types of ANSI Transactions 837 Claims 835 Remittance Advice (ERA) 270 - Eligibility Request 276
Claim Status Inquiry 275 Attachments (paperwork) 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? Profiling Your New Customer First things first! Login to EDIinsight
Add the NEW CUSTOMER ACCOUNT Get the basics input to the account: Name, Address, Tax ID# Profiling Your Customer Add the Provider Records in EDI Customer Account: Provider Person Billing
Name, Address or Non-Person? or Rendering? NPI# Tax ID# Taxonomy Medicare (Specialty) Code PTAN#, Medicaid ID#
Profiling Your Customer Create a Payer Inventory List Build a list of your Customers Top Payers Make a list of government payers your customer needs: Medicare Part A/B, DMERC, Medicaid, BCBS, Railroad Medicare, Tricare Make a list of commercial payers your customer needs: Aetna, CIGNA, Humana, United Healthcare, commercial Medicaid Managed Care plans (MCO) Profiling Your Customer 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 Customer Add to the list any additional Payers from which the Customer would like to have Electronic Remittance files. 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: [email protected]).
Time to Play Whose Enrollment is it Anyway? 1st Question Name / Describe 2 types of ANSI transactions that we have discussed. Answer: 837 (Claims), 835 (ERAs), 270 (Eligibility), 275 (Attachments), 276 (Claim Status) Whose Enrollment is it Anyway? 2nd Question What should you do BEFORE your customer submits any EDI enrollment paperwork to payers?
Answer: Set up customer in EDIinsight. Add customer and provider record(s). Whose Enrollment is it Anyway? 3rd Question What is a good question you can ask your new customer to learn about how they file claims? Answer: 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? Where are the forms? Web 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.) Fill Out EDI Enrollment Forms for Each Billing Provider
Who is the Billing Provider for this Payer? What NPI# is used to bill this Payer, e.g, group NPI# or individual providers 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! Fill Out EDI Enrollment Forms Electronic Remits
Payers typically deliver ERA files to one trading partner only at a timeno 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 letterheadcheck PI instruction page
ERA delivery to EDI Customer account depends on complete and accurate input of provider Tax ID and NPI numbers What if I dont 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 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 golive date (forms do change) Always check PI instructions for how to deliver forms Always make a copy of the completed
enrollment form 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 Call
can follow-up with payer with your copy of forms in hand Payers often ask for Provider NPI, Tax ID or legacy PIN Time to Play Whose Enrollment is it Anyway? 1st Question What instructions should you refer to when completing and submitting EDI enrollment forms? Answer : The Practice Insight instruction page that
precedes each set of EDI Enrollment Forms posted to the PI Reseller Forms Library. Whose Enrollment is it Anyway? 2nd Question If the Customers Go-Live date is February 1 st, what date should you target to send completed forms to the payers? Answer : January 1st. Allow approx. 30 Days. Enrollment varies from payer to payer. (ERA setups can take longer, 4-6 weeks.)
Whose Enrollment is it Anyway? 3rd Question When following up on an EDI enrollment request, what should you have in front of you? Answer : Copy of the completed forms submitted to the payer. Its also helpful to know the date the request was submitted. Avoiding EDI Enrollment Problems Top 5 Action Top 5 Rejections
(From Payer): Enrolling w/ wrong PTAN (Individual vs. Group) Provider Not Credentialed Unauthorized Signature Missing PTAN, Legacy, etc. Didnt Select Change CH
Needed (From Practice Insight): Missing Signature Missing NPI or TAX ID Nothing Selected on Form Missing Valid Billing Address
Illegible Avoiding EDI Enrollment Problems Always download the latest documents Assist your customer Proof read NPI numbers and Tax ID numbers
Make sure no missing signatures 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. 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.
Time to Play Whose Enrollment is it Anyway? 1st Question If your customer requests a payer and it is not on the EDI payer list, what should you do? Answer: Contact PIs EDI Enrollment dept. Log an issue in Issue Manager, call the Enrollment Dept, or send email to [email protected] Be sure to include the electronic payer id (usually 5 digits) and any information you have about the payer.
Whose Enrollment is it Anyway? 2nd Question Give 2 or more reasons why an EDI enrollment request might be rejected or delayed. Answers: 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. Whose Enrollment is it Anyway?
3rd Question How will you know when your customer is enrolled and can begin submitting claims? Answer: 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. In Summary Take the time to PROFILE YOUR
CUSTOMER to get a complete and accurate assessment of the customers EDI enrollment requirements. SETUP THE CUSTOMER IN EDI (add customer record and provider records) BEFORE SUBMITTING EDI Enrollment paperwork. 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 fees In Summary Manage your customers 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. In Summary Monitor the first batch of claims your new provider sends to Practice Insight react quickly to claim rejections.
Making your customers first experience positive with EDIinsight can be critical to your success. Customers always remember whether the start-up was smooth or rocky! In Summary As with all EDIinsight issues, contact Practice Insight when you need help. To reach PIs Enrollment Dept Log an issue in Issue Manager
Send email to [email protected] Call 713.333.6000 (press Option #2) \ 1 BONUS QUESTION!!!! st What is an ERA? Answer: Electronic Remittance Advice (electronic eob) 2nd BONUS QUESTION!!!! What is a EFT?
Answer: Electronic Funds Transfer (monies deposited in bank) 3rd BONUS QUESTION!!!! What is the difference between an ERA and an EOB? Answer: ERA is received via electronic file. EOB is received on paper.
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