Transcript Work Comp - Practice Insight

eBills 101
May 2012
Presented By:
Deidre Fryfogle – Product Manager
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What is an eBill?
eBill = Claim + Attachment(s)
Historical recap of eBill
EDI submission of medical bills has been around for 30+ years
in the Group/Commercial claims segments
There have been several small pilots of Property &Casualty
eBilling – mainly bills-only since early 1990’s
First real “eBilling” solutions for payers came about in
1999/2000 – Internet enabled
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So, why eBills?
Acceptance that other industries have tamed the “paper
beast” – embracing HIPAA standards
Attachments needed for specific claims types: Work Comp,
and Auto Medical (Property & Casualty)
Government Mandates!! The government is transitioning to
an all electronic billing system for claim and eBill
submissions.
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States with Mandated eBills
Currently, 2 states have already mandated electronic eBills:
Minnesota, and Texas
California is set to mandate this in October of 2012.
Georgia is running pilot programs and will mandate likely in
2012.
Illinois passed a mandate for this in May-June of 2012, but are
not yet allowing implementation.
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Benefits of eBilling
Replacing paper bills and attachments with EDI transactions
using a clearinghouse your providers currently utilize (Onestop-shop)
Minimizing rejections by allowing the WC claim to pass
through front end edits to catch errors
Increasing cash flow by eliminating mail submissions and
freeing up time within the workplace for other functions
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Benefits of eBilling
Reducing your bill (claim) submission costs by over 55%!
– Cost to submit paper bills: $6.63 X 6,200 = $41,106.00
– Cost to submit electronic bills: $2.90 X 6,200 = $17,980.00
– Annual savings per physician from automating Bill (claims)
submission: $23,126*
* Based on annual average of 6,200 claims submitted for a single physician. Source: Milliman, Inc.,
‘Electronic Transaction Savings Opportunities for Physician Practices.” Technology and Operations
Solutions. Revised: Jan, 2006. Pulled from ama-assn.org
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Sample Key Connected Payers
National Payers – all bills, all states
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Gallagher-Bassett
Travelers
Liberty Mutual
Safeco
ESIS
Heritage Group
Texas specific payers
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Texas Mutual Insurance
Texas Association of School Boards
Texas Municipal League
Texas A&M
Practice Insight Solution
Creating eBills the EASY WAY!
1) Send the WC Claim (same method as non WC Claim)
- claim will be invalid until the attachment arrives
2) Send unlimited Attachments (electronically or manually)
- Send Electronic ANSI 275 File
- Send Image File Electronically
- Upload the Image directly on the claim.
If the Claim is VALID, the eBill will be READY to go!**
**The Claim is sent in an ANSI 837 transaction and it is followed by an ANSI
275 transaction containing the attachment.
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Practice Insight Solution
Upload your claim like you normally would.
The claim will be INVALID, missing an
attachment. The “!” field will be blank.
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Practice Insight Solution
Double click on the red tester rejection, and
you will be taken to the Attachments screen.
Click on ATTACH Electronic to attach your
electronic attachment to the claim.
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Practice Insight Solution
The system will ask you which file you want to upload.
Once you select your file, and hit OPEN the file will
upload.
You will then get the Report Type screen and will be
asked to enter what type of attachment this is.
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Practice Insight Solution
Once you select your Report Type and click on
the Save icon, you will see your attachment line
details in the Attachments screen.
To view your attachment, click on the VIEW
button.
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Practice Insight Solution
Your
attachment
will come up
in the
Attachment
viewer webbrowser.
It will be
populated
with all of
the
information
that is
included on
the original
report.
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Practice Insight Solution
Once you save your claim, the claim will re-test as
VALID, and the “!” field will become populated
with a paperclip, indicating that the claim now
contains an electronic attachment.
The claim can be set to READY!
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Practice Insight Solution
Benefits
Easy to Track the Claim and Attachment
Statuses of the Claim and Attachment get tied back to
the Claim
The Attachment remains attached and viewable from
the claim
Receive ERAs from some of the W/C carriers!
You can identify your WC claims easily through use of
our Task Manager product
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Getting started with eBills
Sign the Contract Amendment
PI will load Work Comp/Auto Medical payers in to your
database
Assign customer Permissions and Fee Records
Focus efforts on mandated states
Upload Claims!
No Enrollment for sending eBills is required
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Specialties to focus on
Orthopedic Surgery
Physical Therapist
Physical Medicine & Rehabilitation
Hand Surgery
Occupational Therapist
Sports Medicine
Diagnostic Radiology
Orthopedic Surgery of the Spine
Physician Assistant
Chiropractor
Family Practice
General Practice
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Additional eBill Information
We are live with Professional claims.
– Interested in testing Institutional claims? Email Martha
Johnson at [email protected]
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Questions?
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