Ei Deep Dive User Training: Insurance A/R with MedEvolve PM
In depth user training video highlighting the steps to manage claims using Effective Intelligence.
VIDEO SUMMARY
The video discusses insurance A/R module with the MedEvolve PM and how it can be used to track and manage claims. It explains how the administrative view displays representatives and their assigned work lists and claims. The video also explains how to work on claims, customize the display, and access additional information about patients and their insurance. It covers features such as checking eligibility, adding insurance information, updating demographics, and managing appointments. The video also discusses the claim information tab, which allows users to view and edit insurance information, diagnosis codes, prior authorizations, and other claim details. It explains how to make charge line patient responsibility, update diagnosis pointers, add modifiers, and refile claims. The video concludes by explaining how to complete the claim and add tasks or notes to it.
(0:00)
Administrative View – Worklists by Rep
Today we're going to discuss insurance AR with the medval PM and how it's bolted. Onto that PM and how you can work your claims and make sure that you are tracking work effort of your staff and understanding what they're doing and following up on insurance AR claims. Here you're displaying the administrative view so we can see the representatives in which we have assigned work list and claims to. You can see the claim count, the number of claims that they've worked today, claims that they have put in follow-up claim, balance, cash opportunity here and if you wanted to get a little more granular, you can click on the insurance AR by work list. What this is going to allow you to do is to see the granular detail of the actual work lists that are assigned to individuals. Again, you're going to be able to see that claim count, the number of claims that they've worked today, follow up, claim, balance, and cash opportunity.
(0:56)
Representative View
When you want to go in as an end user or even as an administrator and either work some claims on an account or be able to see and monitor what the staff are doing, simply double click on the work list name. It's going to take you to the actual work list where claims have been qualified for that work list. Based on the configurations for the work list that the administrative team has created. The representative will need to work the claims in the order that they're displayed On this account work list, you can see account numbers, name payer insurance information, dates of service visit, IDs, claim amounts. As you continue to scroll over, if there were any denial codes, you could see that claim statuses, financial class locations, insurance categories, a whole host of things. An end user can drag and drop these columns to place them in any order that they would like them to display on the screen.
You can also click on this column chooser and remove any columns that you don't want to be seen here, so this is fully customizable for the end user representative to see. To start working on your work list, you can either simply double click on the first name on the account or you could click on this action tab here. As you click on the action tab, this is going to be where you start and stop every working of a claim. The reason I say this is down here at the bottom it will show in display any notes that come from the MedEvolve PM that anybody has put on the account at any point in time, any work list notes from when somebody may have previously touched this account in workflow and you're able to see some basic information on the account. The reason I say we're going to stop here is you do have to choose the activities status action code, follow-up and note on the account. Let's move on to the account tab. This is where you're going to see additional information demographics about the patient.
(3:54)
Insurance view & eligibility status
You'll able to see here the primary insurance, secondary insurance, wherever this teal dotted box is around on the insurance that denotes for the end user what insurance they're working this claim for, so in this example I'm working this for a primary insurance claim. Had the box been around this Blue Cross Blue Shield secondary insurance, I would know that I'm working this account as a secondary insurance claim. If there's been any documents such as driver's license insurance cards scanned into the medval pm, you would see file folders here below this document and you could open those up and see those images here directly within workflow. The end user's also able to see the patient insurances here you can resequence activate inactivate any insurance here. You can check eligibility directly from here. If eligibility had been ran previously, you would see the status here and the date in which that status was ran.
You could click on the hyperlink here for the eligibility status and it would display the benefits that were pulled when that eligibility was originally pulled. You can also continue to come over here. You can add the copay if there's a copay on the insurance and the copay box. Then it'll go back to the PM in five to 10 seconds. You also can update your relationship to the whole insurance holder. You can update any of these boxes, addresses, subscriber id, anything here within the PM and everything workflow and everything will transfer back to the PM in eight to 10 seconds. You can click on this plus sign and it'll allow you to add an insurance to the plan here. You just have to make sure that anything with the red asterisk does have a information in it so that it will be a required field. You can update any demographic information here and it'll go back to the PM and update that if there's any managed visits present in the pm you would see those here. Any future appointments you would see those displayed here and if there's any pop-up reminders on the account, you would see those displayed here as well.
(5:10)
Claim information tab
Next, you can come to the claim information tab. Your claim information tab again is going to show you your insurance information. You'll see pointers, diagnosis codes here. You can delete the diagnosis code. You can add a new diagnosis code here. Just simply type it in and it will add the diagnosis code here as well. You can add any prior authorizations to the prior authorization field if you need to type anything in the Hifa Box 19 to display on the claim. You can any illness dates, hospital dates, accident dates, anything here we'll display on the Hifa Box 19. You will be able to see down here at the bottom transactions, you will see charges, payments, adjustments. If you need to make a charge line patient responsibility instead of insurance responsibility, you can click on the bill status and change that to bill, which will change it to the patient responsibility. It also will move it to patient responsibility. Within the pm you can update diagnosis pointers, you can add modifiers, you can add NDC numbers, change insurance providers locations, all of that here within the transactions tab you're able to see any memos that are associated with that account. You can refile a claim by choosing the data service. You can choose the insurance and choose the secondary insurance, so we'll choose the primary insurance's. Blue Cross Blue Shield, secondary. Actually choose the insurance, press the tab button. It'll allow you to choose your secondary. You can choose your refile method. If it's an electronic payer, I always suggest you do transmit.
(6:58)
Claim status
If you need to print it, you can either print it now, provided that you have a designated printer that has HFA paper in it. If you don't and need to print it later to change out that printer paper, you can do print later and that will add it to the jobs up here and you can do that at the end of the day. Your ICN number will automatically pop up. If you need to void this claim, you can type void there and it will also void the claim for you. You're going to be able to see any claim status history here on the claim status history tab, any claim filing history here. If there's an available EOB in the pm it will be displayed on the available EOBs tab. You simply double click on this EOB and it will pop it up into another web browser tab for you to be able to see the EOB with any codes and information that you may need to use to work the claim.
(7:48)
Action tab
Once you have completed working the claim, you'll come back here to your action tab. You'll choose your activity code, you will choose your status code, your action code. Let's say we just refiled the claim. You can then put your follow-up date here within the follow-up date and press their tab button in order to get this to the correct follow-up date. Let's go ahead and just pull it up here. You can also choose it on the calendar there. Then you will type your note that you rebuild the claim and you'll click next and it'll take you to the next account in the workflow. If you needed to add a task to it, you could click the plus sign here and you would be able to add a task to that account as well. By choosing your category, your subcategory, and typing your comment here and clicking save.