Transcription of EMDEON OFFICE USER GUIDE - CLAIMS
1 OFFICE - CLAIMS EMDEON OFFICE user GUIDE - CLAIMS September, 2014 CONTENTS EMDEON OFFICE user GUIDE - CLAIMS EMDEON OFFICE - CLAIMS September, 2014 Page 2 of 192 1 INTRODUCTION .. 9 OVERVIEW .. 9 IMPORT .. 9 CREATE .. 9 LIST .. 9 SUPPLEMENT .. 10 REPORTING & ANALYTICS .. 10 Un-Worked claim Rejections .. 10 claim STATUS .. 12 MORE .. 12 2 SEND CLAIMS .. 13 BENEFITS .. 13 SEND CLAIMS REQUIREMENTS .. 13 ADD PROVIDERS OR PAYERS .. 13 CHANGE OR REMOVE PROVIDERS OR PAYERS .. 15 Change Information for Providers or Payers .. 15 Remove Information for Providers or Payers.
2 16 Remove Providers or Payers .. 18 Remove a Practice/Facility .. 18 Remove a Provider .. 19 Remove a Payer .. 19 SUBMIT A claim FILE FOR PROCESSING .. 19 SEND CLAIMS TIPS .. 21 VERIFY CLAIMS TRANSMISSION .. 21 3 claim ENTRY .. 23 BENEFITS .. 23 SYSTEM AUTOMATICALLY CHECKS IF PROVIDER AND SUBMITTER ORGS ARE SETUP .. 23 PROVIDER SETUP .. 24 National Provider Identifier (NPI) and Tax ID Qualifier .. 26 Set Up NPI for claim Entry .. 26 Set Up Tax ID Qualifier for claim Entry .. 27 NEW claim .. 29 SERVICE LINES .. 31 Enter Attachment Information .. 32 Single Digit Documentation Indicator.
3 33 Single Letter Documentation Type Code .. 33 3 to 30 Character Attachment Control Number .. 33 claim LIST .. 33 Use claim List .. 34 Customize claim List .. 35 PATIENT LIST .. 36 Add a Patient .. 36 Search for a Patient Record .. 38 Edit a Patient Record .. 38 Delete a Patient Record .. 39 CONTENTS EMDEON OFFICE user GUIDE - CLAIMS EMDEON OFFICE - CLAIMS September, 2014 Page 3 of 192 4 CHECK CLAIMS .. 40 OVERVIEW .. 40 KEY 40 CHECK A claim S STATUS .. 40 claim STATUS INFORMATION .. 43 claim ADJUSTMENT .. 43 Request a claim Adjustment from Check CLAIMS .
4 43 Request a claim Adjustment from Batch Manager .. 46 claim FINANCIAL INQUIRY .. 47 Request a claim Financial Inquiry .. 47 5 SUPPLEMENT CLAIMS .. 48 OVERVIEW .. 48 SECONDARY CLAIMS .. 48 Secondary CLAIMS .. 48 Secondary CLAIMS Workflow .. 49 Alternate Workflow using claim Entry .. 50 Email Notifications .. 50 Troubleshooting GUIDE .. 50 Output 51 BATCH LIST .. 51 Action Column .. 51 claim LIST .. 54 NSF CLAIMS .. 55 claim Summary Secondary claim .. 55 claim Level Entries NSF .. 56 Line Level Entries NSF .. 57 Insurance Information NSF 59 Primary CLAIMS .
5 59 Secondary CLAIMS .. 60 Payer Search .. 61 Swap Payers .. 61 Provider Data NSF .. 62 Copy to Remaining Lines .. 63 Specialty Find .. 63 Save and Reset Page .. 63 NSF+ 64 claim SUMMARY .. 64 claim Level Entries NSF+ .. 66 Adjustments .. 67 Line Level Entries NSF+ .. 68 Insurance Information NSF+ .. 69 Primary CLAIMS .. 69 Secondary CLAIMS .. 69 Payer Search .. 71 Swap Payers .. 71 Ambulance Data .. 71 4010 CLAIMS * .. 72 Provider Data .. 73 CONTENTS EMDEON OFFICE user GUIDE - CLAIMS EMDEON OFFICE - CLAIMS September, 2014 Page 4 of 192 Patient Data.
6 74 Ambulance Data .. 75 Sample Error Messages .. 76 Abbreviations Used in Remittance Advice Notices .. 77 TROUBLESHOOTING GUIDE .. 78 6 REPORT .. 80 OVERVIEW .. 80 PROVIDER REPORTS .. 80 Report Details - Field Definitions .. 83 RPT-00 (Customer Service Alerts) .. 83 RPT-02 (File Status Report) .. 84 RPT-03 (File Summary Report) .. 84 RPT-04 (File Detail Summary Report) .. 85 RPT-04A (Amended File Detail Summary Report) .. 86 RPT-05 (Batch & claim Level Rejection Report) .. 87 RPT-05A (Amended Batch & claim Level Rejection Report) .. 88 RPT-08 (Provider Monthly Summary).
7 89 RPT-10 (Provider claim Status) .. 90 RPT-11 (Special Handling/Unprocessed CLAIMS Report) .. 91 7 REPORTING & ANALYTICS .. 92 INTRODUCTION .. 92 FUNDAMENTALS .. 92 Access Reporting & Analytics .. 92 Use Search Date Ranges .. 93 Limit a Search .. 93 Filter a Search by Tax ID or Site ID .. 93 Use claim Quick 94 Export Entire Report .. 94 Set user Preferences .. 95 View a Selected Report .. 95 View Tiles .. 96 Change Tiles .. 96 Set Up a user Preference (Default) Search .. 97 Cancel a user Preference (Default) Search .. 97 Customizable Alerts .. 98 Email Alert Frequency.
8 99 Setup Alerts .. 99 Receiving Email Alerts from Reporting & Analytics .. 100 Do Not Reply to Alert Email .. 100 Alert Email Format - Alert 1 .. 100 Alert Email Format - Alert 2 .. 100 Alert Email Identification .. 101 Use the Worked claim Feature .. 101 View Worked vs. Unworked CLAIMS .. 101 Update claim Worked Status .. 102 Reporting & Analytics Home Page .. 102 Change View with Date Range .. 102 Landing Page and Preferred Reports .. 102 CONTENTS EMDEON OFFICE user GUIDE - CLAIMS EMDEON OFFICE - CLAIMS September, 2014 Page 5 of 192 Change Display in Home Page Preferences.
9 102 Access Service Enrollment Matrix .. 102 Which Payer Services are Available? .. 103 Review Payer Offerings .. 103 103 Not 104 Payer Functions .. 104 DASHBOARD OVERVIEW .. 104 Dashboard Views .. 105 claim Status Summary .. 106 Top Payers by Sum of Rejected Dollar Amounts .. 107 claim Charge Amount .. 107 Top 5 claim Rejection Reasons .. 108 claim DATA SEARCHES .. 108 Options by Search Type .. 109 Search Fundamentals .. 110 Run a Search .. 110 Working with Dates .. 111 Date Criteria are Retained across Searches .. 111 Single Date Search .. 111 Default Date Range.
10 111 Date Format Options .. 111 Date Entry Shortcut .. 111 Audit History Search .. 112 claim Quick Search .. 112 Allowed Search Criteria .. 112 Combining Criteria .. 113 Launch a Quick Search .. 113 Search Results .. 114 claim Quick Search Results .. 114 CLAIMS with ERA Search .. 115 File Summary Search .. 117 Payment Detail Report .. 118 Payer claim ID in claim Detail Report .. 118 View Audit History .. 119 Workers Compensation Attachments .. 120 Overview .. 120 Locate CLAIMS .. 121 Payer Allowed Response Period .. 121 Access Attachments Functionality .. 121 Workers Compensation Attachments Interface.
