Electronic claim confirmation reports'

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UHIN Welcomes You 2008 Provider Fair
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Agenda

• Getting The Most From Your Electronic Reports
• Testing for Success-Claredi
• Guidelines for Sending COB Claims
• Verifying Benefits Eligibility-Electronically
• Attachments-Ensure arrival/improve timeliness
• Payer Panel
• Credentialing Made Easy-UHINSpeedi
• UHIN Educational Offerings
• Announcements

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Electronic claim confirmation reports

• When you send claims to payers you should receive
  a confirmation from the payers within 24 hours.
  This comes in a variety of reports.

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Status UP means the payer received claim. If
you see something other than UP the claim file
contained error(s) and will need to be resent.
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Other Common Status CodesFSC Failed Security
Check. Call UHIN EDI Support. Possible
password issue.LF Login Failure Call Payer
who you are trying to send claims too.NDR No
Data Received. This could be due to an empty
file.NDRE Not Deliverable Router Error. Try
again later. Payer may not be responding due to
outage.UX Unexpected error. Could also be a
result of a duplicate file.
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AR (Archive Successful) FRNF (Record Not Found)
FSC (Failed Security Check) LF (Login Failure)
NA (Not Archived) ND (Not Delivered) NDR (No
Data Received) NDRE (Router Error) NF (File Not
Found) NPR (No Partner Response) NRF (No Route
Found) PENDING (Pending) SD (Scheduled
Downtime) UD (Undefined Error) UP (Upload
Successfull) URFXML (Unrecognized XML) URS
(Undefined Route Server) UX (Unexpected Error)
Could also mean duplicate file.
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Claim Confirmation Reports997

• 997 ACKNOWLEDGEMENT
• Note 997 reports are at the Batch level.
• If you receive a Rejected Status on this report
  it means the payer did not keep any claims within
  this batch
• If you receive an Accepted Status on this
  report, it means the payer accepted the batch for
  processing, however it does not mean they kept
  all of the claims within the batch.

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This is an example of an Accepted 997. If the
status showed Rejected then the payer did not
accept any claims within this batch.
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Claim Confirmation Reports

• 277FE Claim Acknowledgement (Error Report)
• Note 277FE reports are at the Claim level.
• A1 A2 Payer Accepted claims into adjudication
  system for processing.
• A3 A4 Payer did Not accept claims into
  adjudication system for processing
• The next line should show a claim status code
• Please refer to your 277FE reports for acceptance
  at the claim level
• 835 Claim Payment / Remittance
• 864 Unformatted Claim Acknowledgement

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This example shows a rejected 277FE report. Note
the A3 category code. Description shows 153
and what that code means. This claim was not
accepted and will need to be corrected and resent
to payer for processing.
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Verify the number of claims received were all
accepted. If claim was rejected there should be
additional rejection information on the report.
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QUESTIONS?
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How to use Claredi through UHIN

• In order to start sending transactions to Claredi
  there are two requirements that you must meet.
• Be a UHIN member.
• Second, complete and return Attachment A
  (Claredi Addendum) and the associated fees to
  UHIN. This is located on the UHIN website
  www.uhin.com.

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What is Claredi ?
Claredi is a third party testing entity that has
formed an alliance with UHIN. UHIN members can
test and certify their transactions at a
significantly reduced price.
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The Advantages of Testing your Electronic
Transactions
When you submit a transaction you can pin-point
exactly where the errors are. You can use the
testing process for quality control. It helps you
identify missing data, evaluate training issues
and identify where performance can be improved in
order to reduce delays in claim payments from
errors
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Sending Files to Claredi
Direct Connections Create a transaction header
with Claredi as the payer. The ISA08 must be
HT005555-001. The rest of the transaction can be
created the same way you would when sending it
to the desired payer (ie PEHP, Medicaid,
Medicare, Select Health)
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ANSI X12 EXAMPLE
ISA00 00 ZZHT000346-001
ZZHT005555-001 0101221253U00401001037003
1TGSHCHT000346-001HT005555-00120050922131
01037003X 004010X098A1 ST8370021BHT001900
0123200509151200RPREF87004010X098A1NM141
2ZIRMEDCOM46HT002245-001PERICLINDATE80
15552222EX231NM1402UHIN46HT005555-001
HL1201NM1852TEST CLINIC24870218917N
32000 N 1900 WN4LAYTONUT84041HL21220SBR
P18GTP4545CINM1IL1DOEJOHNMI5555
55555N3837P - P3 - 0025 TEST 1N4SALT LAKE
CITYUT84108DMGD819611209MNM1PR2CLAREDI

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Sending Files to Claredi with a Practice
Management System

Using UHINt with a Practice Management System
You can send the transaction directly to Claredi
or You can have UHINt redirect your
Transaction to Claredi.
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Sending the transaction directly to Claredi using
UHINt

• Create a transaction with Claredi as the payer.
• The ISA08 and GS03 must be HT005555-001. The
  remainder of the transaction can be that of any
  transaction to any payer you send to.

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ANSI X12 EXAMPLE
ISA00 00 ZZHT000346-001
ZZHT005555-001 0101221253U00401001037003
1TGSHCHT000346-001HT005555-00120050922131
01037003X 004010X098A1 ST8370021BHT001900
0123200509151200RPREF87004010X098A1NM141
2ZIRMEDCOM46HT002245-001PERICLINDATE80
15552222EX231NM1402UHIN46HT005555-001
HL1201NM1852TEST CLINIC24870218917N
32000 N 1900 WN4LAYTONUT84041HL21220SBR
P18GTP4545CINM1IL1DOEJOHNMI5555
55555N3837P - P3 - 0025 TEST 1N4SALT LAKE
CITYUT84108DMGD819611209MNM1PR2CLAREDI

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The Monitor is used to submit claims created by a
Practice Management System.
Click on Start Button to begin Process
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Use the following steps to send a copy of a
transaction to Claredi while billing a
payerusing UHINT and a practice management
system

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Sending Hand Entered Transactions Using UHINT
Open UHINT and choose the appropriate transaction
form. Select Claredi as the payer
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Sending Hand Entered Transactions Using UHINT
Continue filling out the form as you would for
the desired payer. Click on Submit to send the
file to Claredi.
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Viewing Files
Open an internet browser and go
to https//www.claredi.com/
.
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Enter your username and password then click on
Login Note Your username will be your Trading
Partner Number.
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Click on the history of submissions option on the
left hand side of the Screen
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To view a file click on the blue file name. This
will take you to the Claredi summary report.
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The Claredi reports have two views. There is a
summary view and a detailed view
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To view the detail report click on the Click
here for the analysis report
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The detail report separates segments of your
transaction into the appropriate loops
andsections such as Transaction Header,
Submitter, Provider, Patient, Subscriber, Payer,
andService Line Level Information.HIPAA and
X12 errors show in Red. Warnings and suggestions
show in Brown and Lightblue. Payer specific
errors appear in Purple.
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Double click
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Sends you to the implementation guide
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Last Name or Organization Name
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Benefits

• Send data correct the first time
• System changes can be tested prior to
  implementation
• Convenient You can test online from anywhere
• 835 (Claim Payment), 837 (Institutional,
  Professional and Dental Claims), 270/271
  (Eligibility), 276/277 (Claims Status), 834
  (Enrollment) and 278 (Review and Response).

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QUESTIONS?
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Electronic Submission of COB Claims

• Purpose of the Standard
• Crosswalk of 835 to an 837 secondary claim
• Finalizing the claim with the primary before
• passing it on to as secondary payer
• National codes on Paper Remittance Advice
• Timeline
• Working with your vendor

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Electronic Eligibility

• More robust responses to queries
• Includes benefits
• Working on accumulators
• Faster turnaround
• Improved accounts receivable
• Faster claims timeliness

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Electronic Eligibility

• Can use a variety of systems
• Practice Management systems
• Proclaim
• UHINt
• Follow standard format of 270/271, UHIN
  Standard 31 v.2.4

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Electronic Eligibility

• Minimum information needed
• Name
• ID or
• Date of birth
• Information provided
• Current eligibility
• Benefit information

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Electronic Eligibility
Fields in red are required
Standard request
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Electronic Eligibility Response
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Electronic Eligibility
Extended request
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Extended 270 eligibility request (continue)
Is required
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Electronic Eligibility
Routine Physical
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Electronic Eligibility Response
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QUESTIONS?
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Electronic Attachments
The UHIN gateway is payload independent
allowing the exchange of any document between
trading partners including clinical information.
Records can be linked to claims using an
attachment control number or ACN. Examples of
exchanges are DICOM (digital imaging and
communication in medicine or x-rays), rendered
images (clinical notes or discharge summaries) or
scripts.
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Electronic Attachments
The UHINt tool can be used to send these
attachments. The sender will attach a file much
like you attach a file to an email and complete
addressing information (metadata) such as the
receivers trading partner number or TPN and
identifying information of the document
(Subscriber ID, Date of Service, Claim , etc.).
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Electronic Attachments
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Electronic Attachments
You can check the status of your transmission in
the Transmitted Files tab
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Electronic Attachments
The Receiver can pull their files from the Local
Clinical Files tab
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Electronic Attachments
The Receiver can view the Addressing Information
or Metadata and the Payload
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Electronic Attachments
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Electronic Attachments

• Medicaid accepting
• Medical Records
• Dental x-rays
• Preauthorizations
• Call UHIN to get set up!

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QUESTIONS?
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Credentialing Made Easy with UHINSpeedi
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Are you tired of managing provider data for
enrollment and credentialing purposes? We have
the Solution!
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Click on link
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Print Name sign and date
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Fax them to [phone]
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UHINSpeedi Overview

• Utilization a standard data set
• Easy to use drop down menus
• Developed using the latest technology Looks and
  feels like no other web-based application
• Secure electronic submission of provider
  information
• Providers submit provider information once
• Web-based-Providers can submit from their home or
  office at a time most convenient to them
• Includes attachments

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One-Stop Solution

• Problem Time-consuming paperwork, including
  multiple applications, associated with
  credentialing and submitting provider
  information.

UHINSpeedi Solves this problem
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One-Stop Solution

• Solution
• Providers complete submit only one
  credentialing application, one time
• Provider authorizes who to share information with
• Healthplans other healthcare organizations
  receive collected provider data

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Accessing UHINSpeedi

• Providers receive unique log-in and password from
  UHIN access UHINSpeedi through UHINs website.

Protected with secure user name and password
system. Site is physically and digitally secured
at all times.
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Go to uhinet.com log in
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Uhin member
click on Speedi
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Welcome to UHINSpeedi

• Begin at Index Page which shows provider first
  and last log-in dates.
• Allows for quick access to application sections.
• Providers review and update Personal Information
  before beginning Credentials Information
  Interview.

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Practice Information Education
Postgraduate Training Board Certifications
Other Board Certifications Other
Certifications Medical Licensure/Registrations
Professional Liability Previous Liability
Carrier(s) Hospital affiliations Peer
References Work History Gaps in Work
History Professional Organizations
Disclosure Questions
This is the information that is added
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To start Click on any application item at the
Index
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Providers Personal Information Page
Review and update Personal Information
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Select the plus button to add an entry.
To save the entry select add
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Save the information
Review and click the save button
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Select the next button
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Status bar indicates percentage of application
completed.
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• Providers
• Complete Submit One App and Authorizes Who to
  Share Info With

Health Care Organizations Receive Provider Data
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Check the box next to the payer you want to
receive your credentialing information
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Once the Submit button is selected, an
Authorization to Release and Verify form and
Supplemental Document Cover Sheet will pop-up
for printing
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You can reprint these documents and print a copy
of your Credentials printout by selecting the
following radio buttons (You will want to
retain a copy of this document to verify your
submission.)
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QUESTIONS?
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UHIN Training that is Available
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UHINt 101 Class

• About UHIN
• Getting Started
• Setting up UHINT 2.5
• Keyboard entry into UHINT 2.5
• Understanding Payer Reports/Responses

• Linking Practice Management Systems to UHINT 2.5
• Requesting claim status
• Requesting patient eligibility
• Downloading/Installing UHINT 2.5

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UHINt 300 Class

• About UHIN
• Archiving Reports
• Creating Backups
• Tips to speed up your process
• Understanding Payer Reports/Responses

• Requesting claim status
• Requesting patient eligibility
• Clinical Information Exchange
• How to add/subscribe to a national clearinghouse

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The Privacy and Security Training

• An overview of the Health Insurance Portability
  and Accountability Act of 1996 (HIPAA) Subtitle
  F, Privacy and Security Sections. It is neither a
  legal review, nor a substitute, for competent
  legal counsel.
• 1. Privacy Rule What is the Privacy Rule? Whom
  does it apply to? What does Privacy Do? Review of
  terminology.
• 2. Security Rule USET CD (UHIN Security and
  Education Tool) Overview of how to use USET What
  is Security? How Security can create a "history"
  of your company.

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Eligibility-Reduce your calls-Increase your
revenue

• Eligibility-Reduce your calls-Increase your
  revenue
• Learn the basics of an electronic eligibility
  request and response, 270/271. Items covered
  include
• What is the minimum information needed?
• When is a more focused request beneficial?
• What type of response will be sent?
• How long is the response valuable?
• What tools are available for me to use?

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Announcements

• State Farm Property Casualty
• Claims now EDI!
• cHIE update
• 5010 format-April 2010
• ICD 10-October 2010

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Thank you for participating! We appreciate
your time.

• Please visit payer tables
• Complete the Provider Fair surveywe want your
  feedback
• Enjoy your Lunch