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Resolving Revenue Management “Connect, Create, Cancel”

Reconnecting Revenue Management in Medisoft

When attempting to connect to Revenue Management, you may encounter an error like the one shown below.

12

Typically this occurs when the system has lost its connection to the database due to either a reboot of the server or an outage at the office.

If your Revenue Management has been previously configured and connected, but has become disconnected, this video will show you how to reconnect to the database.

Reconnecting Revenue Management when it becomes disconnected in Medisoft

reconnect-revenue

 

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Eligibility Verification Medisoft

Electronic Claims – Add Outbound Claims Folder To Your Favorites

Want A Time Saving Tip For Your Electronic Claims?

When you are using the Revenue Management tool for your Electronic Claims in Medisoft or Lytec, you frequently need to access your ‘Outbound Claims’ folder.  You can set this folder as a favorite so that you can access it much quicker saving you valuable time when you need to upload files to your clearinghouse.

Watch the short video here:

Revenue Management for Medisoft or Lytec - outbound claims folder

 

 

 

 

 

 

 

 Video Transcript:

This video will show you how to add your Outbound Claims folder in Revenue Management to a favorite spot so you won’t have to go browsing throughout your whole network and your whole computer every time you go to upload that claim file to your clearinghouse.

First we need to actually get to that folder that we’re talking about, and it’s usually found in your Metadata folder. Your Outbound is right here, and what we want to do is, this is where it’s always going to be, so we’re going to go up here to your favorites and right click and add current location to Favorites. That way next time we go looking for it we just click on the Outbound folder in your Favorites, and there’s your claims.

Revenue Management Support Video – Change the Medicare routing receiver code

Support Video: How to change the Medicare routing receiver code in revenue management program for either Medisoft or Lytec.

Recently Medicare has required a change to their receiver codes and because of this, it is causing problems in Revenue Management.  If Medicare has sent you a new receiver code, this video will show you where you need to change that inside of Revenue Management.  The Medicare receiver code is a 4 digit code that is unique to your practice.  In this video, when we make the change, we just put in a random 4 digit number.  Please note that is not the correct code for you to use.  You will need to use the code that Medicare sent to you.

medicare receiver routing code

 

Video Transcript

Hello everyone, today I’m going to go ahead and show you how to change your receiver code here in Revenue Management. We’ve been getting a lot of phone calls lately on how to get that changed due to the fact that Medicare has pretty much said, “Hey, we have a new code to use, you’ll need to go ahead and update that with your software.” Here is a quick look on how to change the receiver code.

Basically what you would do is you would open up your Revenue Management program, I have mine opened up here and you’re going to click on the Configure tab on the top. Once you clicked on Configure you’re going to go ahead and click on the Receivers, this is going to take you to the Receivers.

Within Receivers you’re going to look for Medicare and you’re going to go over to the row that say … or the column that says Header, then you’re going to click on the row for Medicare … or Headers. Once you click on that it’s going to open up the Contact Info information, your Interchange, and so forth, you’re going to scroll down to where it says Functional Group and you’re going to look for the Application Receiver Code, GS03.

To change that you’re just going to click on where the previous code is and you’re going to put in the new one. Once you put in the new code you’re just going to go ahead and click Save and you are good to go, and that’s how you change the Receiver Code here in Revenue Management.

 

Using The Support Audit Tool In Relay Health

AZCOMP Support Video: How to re-queue an ERA using the support audit tool in Relay Health for Medisoft and Lytec

tips and tricksThis video will show how to re-queue an ERA (electronic remittance advice) using the support audit tool in Relay Health.  This feature does not come standard, so you would need to request this to be set up on your system.  Relay Health is a clearing house for electronic claims, and works with our AZCOMP revenue management/electronic claims tool.

Did you know that when you are watching these videos you can make the video the same size as your entire screen?  If you want to watch this video using your whole screen, then click where the red arrow is pointing to in the little picture just below this sentence while watching the video.

youtube_expand_screen_button

Or in other words, click the button in the lower right hand corner of the YouTube viewing screen while watching the video.  By clicking on that icon the video will be larger.

If you like this video or if you thought it was helpful, be sure to click the “like” or “thumbs up” button in YouTube.  If you want to see more videos like this you can subscribe to our channel to get the new videos when they come out.  Leave us a comment or ask us a question below in the comments section if you need help with anything else.

Here’s what you’ve been waiting for…time to watch the video!

How To Assign Posting Codes in Revenue Management (EDI) for Lytec & Medisoft

AZCOMP Support Video: Learn how to assign posting codes in our electronic claims program for Medisoft and Lytec.

This video will show you how to assign posting codes on your electronic claims if you are posting ERA’s (electronic remittance advice). In the video you will see how to add a posting code that has already been entered, and also how to enter in a new posting code if it doesn’t already exist in your program.  Revenue Management is our electronic claims program for Medisoft and Lytec patient management programs.

If you like this video or if you thought it was helpful, be sure to click the “like” or “thumbs up” button in YouTube.  If you want to see more videos like this you can subscribe to our channel to get the new videos when they come out.  Leave us a comment or ask us a question below in the comments section if you need help with anything else.

Now watch the video!

How to Increase Your Diagnosis Codes Range In Electronic Claims Program

AZCOMP Support Video: In your electronic claims program for either Medisoft or Lytec (Revenue Management), learn how to increase the range of your diagnosis codes.

tips and tricksYou can increase the number of diagnosis codes to 12 codes on a single claim if you know how to do it.  So in this video you will learn how to increase your diagnosis codes selection, or range of codes up to 12.  This is done in your Revenue Management program, which is the program for sending electronic claims in Medisoft and Lytec.  So watch this short video which is just barely over 1 minute long to learn how to do this.

If you like this video or if you thought it was helpful, be sure to click the “like” or “thumbs up” button in YouTube.  If you want to see more videos like this you can subscribe to our channel to get the new videos when they come out.  Leave us a comment or ask us a question below in the comments section if you need help with anything else.

Watch the video now:

How To Filter Specific Claims In Revenue Management

AZCOMP Support Video: How You Can Select Specific Claims To Filter In Revenue Management (for Lytec & Medisoft)

 

tips and tricks

When in Revenue Management (which is our electronic claims program, or EDI), you are able to select and filter specific claims. If you’re staring at hundreds of claims and need to only view one or a certain amount of them Josh, one of our phenomenal support technicians, helps us understand how to filter those claims in under two minutes.

 

 

Video: How To Filter Specific Claims In Revenue Management

Notices from Clearinghouses Regarding Print Images

In order to comply with the April 1, 2014 deadline for the change to the new CMS 1500 02/12 claim form, many Medisoft and Lytec users are getting notices from their clearinghouses explaining that they will no longer be accepting print image files and that users must begin submitting claims in the ANSI 5010 format.

Here is a sample of what you may see when you are sending claims that notifies you that you are sending a “print image” text file.

Print Imgae

If you are sending claims using a print image format you are essentially printing the old claim form to a text file and sending that “print image” to your clearinghouse who is then converting the information from the print image into the ANSI 5010 format for you. Since there are significant changes to the claim form and the data captured on the new form (new qualifier codes and fields that have been converted to include data that was not reported on paper before) it may not be feasible any longer for clearinghouses to convert the file for you and many clearinghouses are now requiring that users send their claims already in the ANSI 5010 format.

The good news is Medisoft v19 and Lytec 2014 are both equipped with, not only the new 02/12 claim forms, but also with Revenue Management which can be configured to send claims to any clearinghouse or even directly to the payers in the 5010 format. In addition Revenue Management has features such as claim scrubbing and ERA posting that your practice can take advantage of as well.

While the Revenue Management application is included with Medisoft v19 and Lytec 2014, it does require setup and configuration to successfully utilize it. If you need to get setup on Revenue Management please call us at 888-988-7796 to schedule configuration and training with an EDI Professional!

We highly recommend contacting your clearinghouse directly to discuss this change and to coordinate the switch from the print image file to the ANSI 5010 format.

As a final note, If your clearinghouse indicates that they will continue to accept print image files please verify with them whether or not the print image file has to be producing the fields and data captured in the new CMS 1500 02/12 claim format, or if they will still accept the 08/05 claim format. If they are requiring the 02/12 format then you will still need to get setup on Revenue Management as CMS11.exe is not programmed to produce the new claim form.

 

Change claims from production to test mode

Step 1: Open Revenue Management

  • In Medisoft go to List
  • Click on Activities
  • Click on Revenue Management

Step 2: Go to the receiver screen in Revenue Management

  • Click on Configure
  • Go to Receivers

Step 3: Uncheck the test mode box

  • Click on the receiver that you use to send claims with
  • Scroll to the far right of the screen
  • Go to the Transaction tab (2nd to last tab)
  • It will give you a drop down list of fields in two columns
  • Check the box in the Test Mode row (4th row down)
  • Click save at the top of the screen

test1

Revenue Management (EDI) Common Rejections and Fixes

PATIENT MUST BE THE SUBSCRIBER – For this insurance, relationship to insured MUST be S – Self. Spouses of the insured will have their own insurance card and a different member number.

INVALID PATIENT RELATIONSHIP – 3 places to check. 1 and 2. Go to patient, billing tab, confirm relationship to guarantor and relationship to insured is correct. 3. Pull up the claim line item on the ledger, click detail in the top right hand corner, then click on More Detail – correct relationship code on right if needed.

MISSING PRIOR PAYMENT AMOUNT – This was transmitted to the secondary insurance before the primary insurance’s payment was attached to the claim. This will almost always show up with INVALID OTHER SUB ADJ OR PMT DT.

INVALID OTHER SUB ADJ OR PMT DT – Could be a typo in the date of the primary insurance payment, or it is missing altogether.

MISSING PAYER CLAIM CONTRL NUMB – There is a valid Freq Type code being used, but the insurance cannot replace the old claim unless it has the claim control number assigned to it. This will be entered in the first field below the freq type field, and can be found on the Acknowledgement report from the transmission the claim was paid on. (Ex, Pt comes in 01/06/12, gets keyed, but there is a typo in the procedure, so it’s entered as a 99212 instead of 99213… claim goes through and gets paid. While posting payments you catch that the wrong code was used, so you want to resubmit it. Go pull the Acknowledgement report on the claim when it was paid and grab the “TSH CLAIM ID:” for this claim. It’s always a long number starting with 12. looks like this: 1207316105933097972.)

In Medical Billing, go to Ledger > Edit Charge > Additional > Additional 1 tab, enter the claim reference number in the appropriate Claim REF# field as follows:

Claim Ref # (1)  – Enter the claim reference number when resubmitting a prior claim for the primary carrier (as specified in the charge billing order).

Claim Ref # (2) – Enter the claim reference number when resubmitting a prior claim for the secondary carrier (as specified in the charge billing order).

Claim Ref # (3) – Enter the claim reference number when resubmitting a prior claim for the tertiary carrier (as specified in the charge billing order).

NOTE: When claim frequency type code is 7 or 8,  the claim control number should be sent in <OriginalRefNumber>123456789012</OriginalRefNumber> (HCFA > ClaimCore > Item > OriginalRefNumber) to populate Loop 2300 REF (Example: 2300  REF~F8~123456789012).

INCORRECT CLAIM FREQ TYPE CODE – In the line item of the claim, go to the Additional button. the Type Code box will be in the top right hand corner. This carrier does not like the choice that is in there. This field should only be used after an insurance has made a payment and something was keyed incorrectly on the claim. This allows you to re-submit the claim with the corrections.
**A corrected claim is a claim that was originally submitted with incorrect information and is being resubmitted.
When submitting a corrected claim electronically, update the Claim Frequency Code with:
7 = Replacement (replacement of prior claim).
8 = Void (void/cancel of prior claim).
The Explanation of Benefits (EOB), Explanation of Payment (EOP) or Claim Control number of the claim being disputed.
Reason why you are disputing the claim.  Claim will be rejected if Claim Control number is missing, too.

MISSING/INV DIAGNOSIS CODE POINTER – Usually a diagnosis code was listed twice. I advise reviewing the claim and removing the duplicate. If that fails, re-enter  the claim and then bill it.

MISSING PRIMARY DIAGNOSIS CODE POINTER – Make sure there is at least one diagnosis. probably just a typo when keying the charge initially.

MISSING SUBSCRIBER GROUP NAME –  The 2000B SBR04 is missing for the carrier’s group name.
1. Make sure that the carrier plan name was filled in.
2. The plan name needs to be entered into the insurance carriers profile
3. Create a new insurance account plan on the patients account in order to select the account plan name.

MISSING SUBSCRIBER GROUP NUMBER – Pull up the patient, then click on the insurance button at the top. In the top left corner, there is the group number.

INVALID AMT/COB OUT OF BALANCE – This just means the math does not add up. Usually this is because the adjustment code (Maintenance – Configuration – Definitions- Adjustment) is missing a Group Code X12 or a Reason Code X12. If these are both present, this can be corrected by deleting and re-keying the adjustment on the claim.

INVALID SL PAID AMOUNT – This is almost always with the INVALID AMT/COB OUT OF BALANCE. Correcting one will correct the other, IF NOT  Claim core > ServiceLine2 > ProfessionalService > AdjudicationInfo > ClaimLevelAdjustments > ClaimLevelAdjustment > Quantity. – Hardcode a 1 for the payor specified

INVALID ACTIVE SUB MEMBER ID – The Payor ID (CPID) found under Insurance – Billing Tab – Advanced Claims Tab is not a valid number. The active numbers can be found here.

INVALID INSURED ID NUMBER – The insurance member/plan number entered for the patient is not an active number – usually this is caused by billing an insurance that the patient did not have coverage through at the time of service.

INVALID ADJUSTMENT GROUP CODE – (Maintenance – Configuration – Definitions) The Group Code X12 selected for the adjustment on this claim is not valid for this type of adjustment and needs to be changed.

SERVICE NPI SAME AS BILLING NPI 
1. If this claim is for Place of Service 11 or 12, remove the facility.
2. If this is not at PoS 11 or 12, then compare the practice and facility names and addresses. They must be character for character identical for RH to scrub out the NPI.
3. The facility may have the wrong NPI.

DESTINATION PAYER MUST BE PRIMARY – Whatever insurance this was being sent to (in this case, Mutual of Omaha) has to be the primary insurance in order to receive payment.

INVALID ZIP CODE – Three places that could cause this. Check for a country code of USA and a 9-digit zip-code.  Note: If you find that one of the zip code fields requires the full 9 digit zip code then you can find it by entering the 5 digit code into the USPS Zip Code Lookup Tool – http://www.usps.com/zip4/
1. The Practice Information
2. The Provider Profile
3. The Facility

Loop   –   Segment    –   Description   –   Zip Code Length
2010AA – N403 – Billing Provider Name – 9
2010AB – N403 – Pay-To Address Name – 5
2010AC – N403 – Pay-To Plan Name – 5
2010BA – N403 – Subscriber Name – 5
2010BB – N403 – Payer Name – 5
2010CA – N403 – Patient Name – 5
2310C – N403 – Service Facility Location Name – 9
2310E – N403 – Ambulance Pick-up Location – 5
2310F – N403 – Ambulance Drop-Off Location – 5
2330A – N403 – Other Subscriber Name – 5
2330B – N403 – Other Payer Name – 5
2420C – N403 – Service Facility Location Name – 9
2420E – N403 – Ordering Provider Name – 5
2420G – N403 – Ambulance Pick-Up Location – 5
2420H – N403 – Ambulance Drop-Off Location – 5

MISSING OTHER SUBSCRIBER INFORMATION – When re-billing the charge (print, print/review insurance claim), set the BYPASS PAYMENTS/ADJUSTMENTS (bottom option) to Y, to bypass that payment/adjustment

INVALID SERVICE LINE DESC – There is usually an invalid character in the Procedure Description. More often than not, it is a > or < to designate a shot for children under or over a certain age.

INVALID SL THROUGH DATE  – There was a typo in one of the dates on this claim.

INVALID ADJ ADJUSTMENTS QTY  – Claim core > ServiceLine2 > ProfessionalService > AdjudicationInfo > ClaimLevelAdjustments > ClaimLevelAdjustment > Quantity. – Hardcode a 1 for the payor specified

MISSING INSURANCE TYPE CODE  – Claim Core > OtherSubscriber > OtherInsuranceTypeCode and OtherInsuranceTypeCodeSpecified. – Unsuppress.

INVALID SL ADJUD OTHER PAYER ID – This is usually because the 2ndary or tertiary insurance has a bad CPID in the advanced claims tab.

SL PRIOR PAY NOT ALLOWED – This is happening when sending a primary claim after the patient has made a payment and it has been attached to the charge line. There IS a setting to suppress Pt. payments when sending to the primary (Maintenance – Configuration – Settings – Insurance) If this is already turned on, resend the claim after making sure there are no insurance payments on it.

MISSING CLIA NUMBER – 

Open the ClaimConfigurationUtility in PPART. Under ClaimCore > Item > ClaimSupplimentalInfo > CLIANumber
Select the option that says Practice User Defined CLIA.
Verify that in Practice Maintenance, Other Data Tab that the PCLIA ID id present and populated with the CLIA number.