eBills 101May 2012

Presented By:Deidre Fryfogle – Product Manager

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What is an eBill? eBill = Claim + Attachment(s)

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Historical recap of eBillEDI submission of medical bills has been around for 30+ years in the Group/Commercial claims segmentsThere have been several small pilots of Property &Casualty eBilling – mainly bills-only since early 1990’sFirst real “eBilling” solutions for payers came about in 1999/2000 – Internet enabled

So, why eBills?

Acceptance that other industries have tamed the “paper beast” – embracing HIPAA standardsAttachments needed for specific claims types: Work Comp, and Auto Medical (Property & Casualty)Government Mandates!! The government is transitioning to an all electronic billing system for claim and eBill submissions.

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States with Mandated eBillsCurrently, 2 states have already mandated electronic eBills: Minnesota, and TexasCalifornia is set to mandate this in October of 2012.Georgia is running pilot programs and will mandate likely in 2012.Illinois passed a mandate for this in May-June of 2012, but are not yet allowing implementation.

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Benefits of eBilling

Replacing paper bills and attachments with EDI transactions using a clearinghouse your providers currently utilize (One-stop-shop)Minimizing rejections by allowing the WC claim to pass through front end edits to catch errorsIncreasing cash flow by eliminating mail submissions and freeing up time within the workplace for other functions

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Benefits of eBilling

Reducing your bill (claim) submission costs by over 55%!– Cost to submit paper bills: $6.63 X 6,200 =

$41,106.00– Cost to submit electronic bills: $2.90 X 6,200 =

$17,980.00– Annual savings per physician from automating Bill

(claims) submission: $23,126*

* Based on annual average of 6,200 claims submitted for a single physician. Source: Milliman, Inc., ‘Electronic Transaction Savings Opportunities for Physician Practices.” Technology and Operations Solutions. Revised: Jan, 2006. Pulled from ama-assn.org

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Sample Key Connected Payers National Payers – all bills, all states– Gallagher-Bassett– Travelers– Liberty Mutual– Safeco– ESIS– Heritage Group

Texas specific payers– Texas Mutual Insurance– Texas Association of School Boards– Texas Municipal League– Texas A&M

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Practice Insight SolutionCreating eBills the EASY WAY!

 1) Send the WC Claim (same method as

non WC Claim)- claim will be invalid until the

attachment arrives2) Send unlimited Attachments

(electronically or manually)- Send Electronic ANSI 275 File- Send Image File Electronically- Upload the Image directly on the

claim.If the Claim is VALID, the eBill will be

READY to go!** **The Claim is sent in an ANSI 837 transaction and it is followed by an ANSI 275 transaction containing the attachment.

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Practice Insight Solution

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Upload your claim like you normally would.The claim will be INVALID, missing an attachment. The “!” field will be blank.

Practice Insight Solution

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Double click on the red tester rejection, and you will be taken to the Attachments screen.Click on ATTACH Electronic to attach your electronic attachment to the claim.

Practice Insight Solution

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The system will ask you which file you want to upload. Once you select your file, and hit OPEN the file will upload.You will then get the Report Type screen and will be asked to enter what type of attachment this is.

Practice Insight Solution

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Once you select your Report Type and click on the Save icon, you will see your attachment line details in the Attachments screen.To view your attachment, click on the VIEW button.

Practice Insight Solution

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Your attachment will come up in the Attachment viewer web-browser. It will be populated with all of the information that is included on the original report.

Practice Insight Solution

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Once you save your claim, the claim will re-test as VALID, and the “!” field will become populated with a paperclip, indicating that the claim now contains an electronic attachment.The claim can be set to READY!

Practice Insight SolutionBenefits

Easy to Track the Claim and AttachmentStatuses of the Claim and Attachment

get tied back to the ClaimThe Attachment remains attached and

viewable from the claimReceive ERAs from some of the W/C

carriers!You can identify your WC claims easily

through use of our Task Manager product

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Getting started with eBillsSign the Contract AmendmentPI will load Work Comp/Auto Medical payers in to your databaseAssign customer Permissions and Fee RecordsFocus efforts on mandated statesUpload Claims!No Enrollment for sending eBills is required

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Specialties to focus onOrthopedic Surgery Physical Therapist Physical Medicine & RehabilitationHand SurgeryOccupational TherapistSports MedicineDiagnostic RadiologyOrthopedic Surgery of the SpinePhysician AssistantChiropractorFamily Practice General Practice

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Additional eBill InformationWe are live with Professional claims.– Interested in testing Institutional claims?

Email Martha Johnson at mjohnson@practiceinsight.net

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Questions?

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