presented by: shaun mcanulty product training specialist era & denial management training

Presented By:Shaun McAnulty

Product Training Specialist

ERA & Denial Management Training

Goals

• Manage Tables Manage Expects Manage Codes

• Manage Expects Add, edit and lock fee schedule.

• Group Reason codes Flag as expected or not Assign corrective action Assign to specific staff member

• Know how to assign work to staff members Transaction level with Follow Up Status Group/Reason Code level with Manage Codes

• ERA Analytics

Clinical Claim Scrubber!

100% EOB to ERA(835)

ERA & Denial Manager!

PM• Claim created and sent to Practice Insight.

PI

• Practice Insight receives claim (837).• Send Claims (837) to Payer.

PAYER

• Payer receives Claims (837).• Payer sends ERA (835) Response to PI.

PI• Practice Insight receives ERA (835).

ERA

MGR

• ERA & Denial Manager uses ERA (835) data to populate transaction lines.

ERA & Denial Manager

ERA & Denial Manager: Itemizes the ERA response(835) from the PAYER to populate individual workable transactions. Allowing users to select, group, and work specific claim transactions individually.

•Allows users to organize and manage remittance data.o Selection criteriao Line level workability

•Grants users the ability to prioritize, monitor, and work transactions efficiently.o $0.00 paymentso Over/ Under payments

•Allows for routing work to specific users.o Manage Tableso Tasks

Manage Tables

• From here you can access the expects(fee schedule) table using the Manage Expected Amounts.o From this table you can:

View Fees Add Fees Edit Fees Lock Fee rates

• Manage Codes displays all the Group/Reason codes received on ERA’s.o From this table you can:

Flag codes as expected or unexpected Assign codes to specific staff id

Expect List / Fee Schedule

Manually add fees

Creates a report view of fees

This data is used &

maintained to compare to

ERA(835) data as it is received from the Payer!

The Edited column displays if the rate is “Locked” or not.

If an N is displayed the rates will be overwritten if higher

values are present on incoming ERA’s(835).

*For the best analytical data you want to lock your rates! Simply

edit the Expect.

Editing Expects

Here you can build a new expect/fee or

edit(to lock) an existing fee.

Manage Codes

Allows the you to monitor and flag specific codes to be expected or unexpected. From here you can also assign a code to a staff member and lastly assign courses of action for each

code.

Take note that the list is not uploaded or manually added, it is only populated by received ERA(835) data!

Editing CodesThe full code and description

are non-editable.

Assign a Staff member to this code.

Flag the Code as Expected, or Unexpected.

In the Note area you can be as detailed or general as you’d like, this will appear on the View Summary as

the next step to take!

• Transaction Level:ERA Transaction: Update Transaction

Methods to Assign Work

• Group\Reason Code Level:Manage Codes Table: Edit Code

• General Level:Task Manager: Staff ID

Tasking

New Zero$ Paid ERAs

• Description: New 0$ Paid ERAs

• Follow up status: New• Min/Max Amount: 0 (for

both)• Amount Of: Payment• Save

Denials by Type

• Description: CO-16 Denials

• ERA Status: Denied• Group

• Dashboardso Adjudication Summary Grapho Aged Cash Grapho Days Sales Outstanding by Procedureo Denial Rates by Procedureo Top 5 Denial Codes

• Web Browsero Analysis by Procedure and Reasono Analysis by Reason

• Data-Minerso ERA Denial Analysiso ERA Reimbursement Analysis

Analytics

Question and Answer

Thank you for your participation!!!!!