presenter(s) · this allows users to set up codes that are always downgraded by the insurance such...

Confidential—Proprietary Information—For use by authorized QSI | NextGen Healthcare employees only. Not for public distribution Copyright 2012

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Improving Reimbursements through effective Claims Processing – QSIDental™ Web

Monday, November 12 – 3:00PM to 4:15PM

Transition Slide

Dave Roughen – Project Manager Kay Thorpe – EDI Analyst Ron Burke – Dental Product Manager Dave Roughen – Project Manager


Improving Reimbursements through Effective Claims Process

Todays Topics • Proper set up of Fee Schedules, Insurance Carriers, & Insurance Plans

• Batch Claim Processing

• Electronic Attachments (NEA)

• E-Claims Managements

• Reports

• Thank You and Q&A


Proper Set Up for Accurate Claim Processing

Fee Schedules Set Up: Office Fee Schedule Under Set Up -> Fee Schedule Set up you will click on Add a New Schedule Make sure that the Office Fee Schedule type is selected The fee schedule can then be 1. Manually entered into the system by entering the fees for each procedure code. 2. Can be copied from an existing fee schedule. 3. Can be imported using a template provided by QSI.



Office Fee Schedule NOTE: When updating an existing office fee schedule it is important to note that you should first copy the current fee schedule and save the copy as Office fee schedule 2012. Then edit the existing fee schedule and rename it 2013. Editing can be done manually or by using the Increase by ___percent function



PPO Fee Schedule Again click on the Add New Schedule Make certain to select Ins – PPO Use the method of entry, copy, import, or manual entry. Once fees are entered you can also use the AMB code column. The AMB code refers to Alternative Minimum Benefit. This allows users to set up codes that are always downgraded by the insurance such as D2392 Resin Two Surface Posterior to a D2150 Amalgam Two Surface. Like the Office fee schedule PPO plans can also be updated by using the increase function.



Managed Care Fee Schedule Again click on the Add New Schedule and make certain to select Ins – Managed Care Use the method of entry, copy, import, or manual entry. You will notice that these fee schedules are a bit different. You have a Patient column and an Insurance column.



Managed Care Fee Schedules When you enter fees you will always enter an amount in both columns. May times the amount entered into the insurance column is $0. It is important to note that zero means something different than a “blank” or no entry. In some case you are able to get supplemental payments from the managed care company.

Managed Care Fee Schedules cannot use the increase by function. Note: Managed care plans are typically set up to only send claims when a payment is expected from the managed care company.



Fee Schedule Assignment Setting up the fee schedules takes time and is important to getting accurate patient and Insurance estimates. Fee Schedule assignment is the second step that puts the fee schedules to work! Rules to live by: PPO fees are assigned to the Carrier Only one PPO fee schedule can be assigned to a Carrier. Managed Care fee schedules are assigned to Plans Office Fee Schedule is assigned to each patient.



Fee Schedule Assignment Exceptions to the rule : Additional PPO fee schedules can be assigned to the carrier if they are also assigned to a specific provider, or to a specific office or both.



Searching for Fee Schedule Assignments By using the criteria at the top of the search screen you can search for all or specific fee schedule assignments. What does not look correct in the above screen shot??



Assigning Fee Schedules By using the criteria at the bottom of the screen you can assign the fee schedules to the appropriate carrier, plan, provider, or office as needed.



Insurance Carriers: First make sure to search for a carrier so that you are not setting up a duplicate carrier. Default insurance carriers have been set up when you account was set up.

If you don’t find the carrier in the search, then add new carrier.



Adding a Dental Carrier When adding the new carrier the critical item is the payer ID, and the claim type set to E-Claim. To find the correct payer ID go to the Help menu and choose Carrier Payer ID list.



Adding a Dental Carrier

Find the correct carrier and use the payer ID from this list. If you don’t find the carrier or have questions about the payer ID then submit a help call.



Insurance Carrier Set Up Duplicate Carriers Why you need duplicates (Use descriptive names) More than one PPO fee schedule PPO and Managed Care fee schedules Claims payment process and duplicates



Fee Schedule Assignment and Duplicates You would have to assign the PPO fee schedule to all of these carriers.



Carrier Clean Up Utility First get a list of the plans attached to each carrier in the duplicate list. Next use the list to replace all of the duplicate carriers with the one you want to use.



Using the list under Utilities Select the Insurance Plan Carrier Replace



Enter the carrier ID’s and click continue

Then select Replace



Insurance Plans - Search for Insurance plans Under setup insurance plans enter the search criteria



Add a New Plan If the search does not find the plan you are looking for then you will click on add new.



On this screen enter the information to set up the plan Then click the benefits button.



Benefits and Coverage Enter the benefit information Click on coverage



Enter the coverage percentages Note: For Managed Care plans they should all be 0% Then click on fee schedule.



For PPO plans you will not be entering or attaching the fee schedule. For Managed Care plans if the fee schedule has been set up, you may attach it. Then click on save.


QSIDental Web Claims Processing

Batch Claim Processing Under the utilities dropdown you select Batch Claim Processing.


QSIDental Web Claims Processing

The Claims Process

Note: Caution on printing claims


Electronic Attachments (NEA) In the Batch Claim area click on the date of the claim to open the claim Or, Click on the date from the patient ledger to open the claim


Electronic Attachments (NEA)

Using Electronic Attachments with E-claims: Click on the

Claim Fill-Out Information


Electronic Attachments (NEA)

Clicking the Claim Fill-Out Information brings you to this Screen. Enter the NEA # Add any remarks you want To appear on the claim. Click Save


E-Claims Management

Working your Sent Claims: Screen Shots and Instruction on E-Claims Management

Searching

Working Rejected & Error Claims

Caution on printing claims from the Ledger

Additional items from Claims Analysts on Best Practices


E-Claims Management

Best Practices: Know your office team. We are here to help YOU!

A claims analyst will be monitoring your claims for the first 60 days.

Any frustrations you have, call on us to assist.

Three Most common mistakes:

• Wrong, Incorrect, or “Drop to Paper” Payor ID applied

• Invalid or Non-Credentialed Billing/Rendering NPI

• TaxID incorrect


Reports

Reports Under the reports dropdown Select Insurance Reports


Reports

Reports Select the outstanding claims report. Select the date and criteria you wish to see.


Reports

Reports This report will give you the insurance company name and phone number and all the detail you need to follow up on outstanding claims for the patient.


Reports

Claims not Created Select the criteria and click on print / preview


Reports

Claims Not Created Here you can see services charged out but where no claim has been created.


Questions?

presenter(s) · this allows users to set up codes that are always downgraded by the insurance such...

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