presented by: shaun mcanulty product training specialist era & denial management training
TRANSCRIPT
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Presented By:Shaun McAnulty
Product Training Specialist
ERA & Denial Management Training
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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
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Clinical Claim Scrubber!
100% EOB to ERA(835)
ERA & Denial Manager!
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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.
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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
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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
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Expect List / Fee Schedule
Manually add fees
Creates a report view of fees
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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.
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Editing Expects
Here you can build a new expect/fee or
edit(to lock) an existing fee.
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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!
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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!
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• 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
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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
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• 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
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Question and Answer
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Thank you for your participation!!!!!