Availity Reporting Preferences with Revenue Management

Transcription

1 Availity Reporting Preferences with Revenue Management The reports returned by Availity are critical to electronic claims. The reports either verify the claims arrived at the clearinghouse and were forwarded to the payer (insurance company) for payment, or inform you that claims contained errors and will need to be corrected and resubmitted. Claims that are rejected on any of the reports will NOT be forwarded to the payer and the payer will not show the claim on an EOB, so it is extremely important to identify the claim error, correct the claim and resubmit it. Availity offers a variety of reports and report formats that are selectable by the user. For best results when using Availity with Medisoft and Revenue Management, follow these instructions to choose the best reporting options. Log on to your Availity account and select EDI File Management and then EDI Reporting Preferences. From the EDI Reporting Preferences page, select an organization. The settings will have to be set for each organization separately. A series of selections will appear. Descriptions and recommended settings for each report are detailed below with screen shots. Additional report explanations and details are explained on page 4 and 5. File Acknowledgements Choose the Text- Human Readable option as shown below: The Interchange Acknowledgements (TA1) Choose Text Human Readable option: CompuHealth Northwest Inc. (800) edi@chnwmd.com 1

2 The Functional Group Acknowledgement (997) or (999) Under Types UNCHECK the Positive Acknowledgement setting. This will cause the report to only be returned when reporting rejections. If there are no rejections in the file, the report is not returned. Under Format, choose x12 (.997) or (.999). Under Include TA1, check the box to receive the TA1 in this report. The IBR Report In Format choose Data Report. In Grouped by choose All available responses in a single file option. In Delivery Schedule choose Scheduled Response and choose 2AM for the time to receive the report. CompuHealth Northwest Inc. (800) edi@chnwmd.com 2

3 The EBR report In Format choose Data Report and Detail Data Report. In Grouped by choose All responses for an organization, multiple payers. In Delivery Schedule choose Scheduled Response and 2 AM for the time to have the report returned to the mailbox. The DPR report In Format choose Data Report. In Grouped by choose All responses for an organization, multiple payers. In Delivery Schedule choose Scheduled Response and 2 AM for the time to have the report returned to the mailbox. Then select Save at the bottom left. CompuHealth Northwest Inc. (800) edi@chnwmd.com 3

4 Availity Report Explanations: File Acknowledgements If a file ending in.act appears on the reports page of the Availity site after claims are sent, download the file as you would any other and call a CompuHealth representative for assistance. These reports indicate a group of claims or the entire batch of claims, failed edits and need to be resubmitted. The Interchange Acknowledgements If a.tat report is returned, the entire batch of claims has failed and none of the claims will be forwarded to the carrier. Download this file to Revenue Management and review the reason for the failure. Correct, change to ready to send and resubmit all the claims. The Functional Group Acknowledgement Reports are (.997) or (.999). If there are no errors in the file, the report is not returned. If a 999 is received, do not delete or remove it from the Availity site. Call CompuHealth NW for assistance in interpreting this report. (The above 3 report types are rarely received but must be addressed if they are received. If you are new to Medisoft or to Revenue Management you may want to call CompuHealth NW for additional support the first time you get these reports.) The IBR, the EBR and the DPR - are the reports that should be received with every successful claim batch file and will show the individual claim rejections. The following is an overview of each of the three types of reports. The IBR report shows all claims submitted in the claim batch file. It is usually returned the day after claims are submitted, and has the total number of claims and total dollar amount of the claims in the claim batch file. There should be one IBR returned for each claim batch file uploaded to the Availity site. The totals should match the totals shown in Revenue Management before the claims were uploaded. Each claim will have a status Accepted or a status Rejected. Claims with a status of Rejected on the report will show a status of Rejected in the Claim Management screen of Medisoft. Rejected claims must corrected and resubmitted. NOTE: The IBR report is a highly recommended report as it is the only report that shows all claims submitted and allows the user to compare the claim count and dollar amount to the amounts in Revenue Management. However, this report is optional, and if the user wishes to not receive the IBR, simply leave all 3 format options unchecked and the IBR report will not be returned. Printing of the IBR is only necessary if a record of all claims submitted and accepted by the clearinghouse is desired. CompuHealth does not recommend printing the report. CompuHealth Northwest Inc. (800) edi@chnwmd.com 4

5 The EBR report shows further edits on certain sets of claims. The EBR reports are returned in the days after the claim batch file is uploaded. There may be several EBR reports for each claim batch file uploaded to Availity. Individual claims will show in groups based on insurance carriers, and each claim will show a status Accepted or a status Rejected. Claims with a status of Rejected on the report will show a status of Rejected in the Claim Management screen of Medisoft. Rejected claims must be corrected and resubmitted. (Note: some rejected claims shown on an EBR will also have appeared as a rejected claim on the previous IBR report. This is normal, and the claim only needs be corrected once.) Printing of the EBR reports is only necessary if there are rejected claims listed on the report. CompuHealth recommends printing only reports with rejected claims and using the printed report to make the corrections to the claims and resubmitting the corrected claims. The DPR report shows edits from the payer (insurance carrier). Once the claims are sent to the payer, many payers return reports showing claims rejected or accepted at the payer. These reports are returned to the Availity client as a DPR report. Claims with a status of Rejected on the report will show a status of Rejected in the Claim Management screen of Medisoft. Rejected claims must corrected and resubmitted. Printing of the DPR reports is only necessary if there are rejected claims listed on the report. CompuHealth recommends printing only reports with rejected claims, using the printed report to make the corrections to the claims and resubmitting the corrected claims. CompuHealth Northwest Inc. (800) edi@chnwmd.com 5