Claims Submissions: A Game of Assists

Follow these tips to help us help you

In basketball, a player that passes the ball to a teammate who successfully makes a basket is credited with an “assist” for helping score those points. The more the players help each other, the better chance the team has to score points.

Emdeon is in the business of offering assists to our channel partners. We’ve created products, services and a system of support, and we pass those on to you so you can score points with your providers. Of course, an assist works best when all team members are on the same game plan and giving it their all on the court. As Emdeon aims to support you in every way, it’s helpful to make sure all our efforts are collaborative—the essence of teamwork.

Here are some pointers regarding best practices for support issues. You can apply these tips to make sure Emdeon has everything needed to offer the best assists for your business.

•Deal with unpaid claims promptly.
When your providers face claims that remain unpaid, you often turn to Emdeon for an assist in the form of timely filing letters. Though we’re on the ready to help, our timely filing letters are only effective if sent as soon as possible upon detection of nonpayment.

Much like the shot clock in basketball counts down a player’s opportunity to shoot, payers impose limits on the timeframe in which claims can be reconciled. That’s why it’s essential that you work with your provider partners to keep an eagle eye on claim status. The sooner you alert us about unpaid claims, the sooner we can offer a timely filing letter to aid in adjudication.

•Have all details ready for timely filing letters
By the time it’s necessary to submit a timely filing letter, that aforementioned shot clock is really ticking. When you come to us to request a letter, have all the pertinent details on hand so we can act as fast as possible on behalf of you and your providers. Those pertinent details include patient name, insured ID, claim amount, date(s) of service, date of submission and payer name. Armed with this key information, we’re able to move ahead.

Please bear in mind that timely filing letters serve only as confirmation to payers that Emdeon received the claim and do not guarantee payment.

•Offer key information to help find ERAs that are MIA
When a remittance goes missing, turn to Emdeon to initiate a search within our system, and have the appropriate details handy—particularly in case we need to expand the search to payers’ systems.

At Emdeon, we just need to know payer name, check number, check date and payment amount to start looking. If we can’t find the missing remittance, payers can often start searching with only this basic information, as well. However, bear in mind that other details and protocols may be required. Here are examples.

- Medicare payers typically require a PTAN (Provider Transaction Access Number ) in order to offer support.
- Some payers require the NPI(National Provider Number) and/or payer-specific provider IDs.
- If payment was made via EFT, payers often ask for an EOB , Cigna requires a DDAR (Direct Deposit Activity Report).

Note that some payers will not generate an electronic remittance if they have not received and processed an electronic claim (e.g. - paper claims or claims generated via OCR/scanned claim information).

•Remember you have a stake in your provider’s claims process
While the claims submission process takes teamwork to complete successfully, it’s in the provider’s court to properly handle the initial legwork—accurate, prompt filing, diligent record keeping, etc. The smoother the provider’s claims submission process, the better payment outcomes and results will be for all involved.

Because you’re the provider’s direct link to claims submissions solutions and expert industry knowledge, it’s in your court to train and guide the providers’ processes. You can share our “How to Avoid Claims Rejection” quick-reference tool with your customers to help them navigate the challenges of claims filing.

When you play an active role in guiding providers to submit clean claims, you help ensure those claims pass the secondary evaluation by payers. We may reject claims based on our basic editing, as well as the use of some payer-specific editing. However, there are occasions in which claims pass our system yet are rejected at the payer level. If a claim does get rejected by a payer, please contact us with the Emdeon Claim Reference number or Emdeon File Reference number so we can assist in getting to the root of the problem.

•Keep track of the trace number to troubleshoot in real-time
To help you troubleshoot a real-time claim status, eligibility or referral transmission, we need the Transaction Reference Number, also known as the Trace Number. With that key bit of information, we can hit the ground running to help you help your customers.

If you don’t have this number, the next best information will be the eligibility logs 270/271 reporting, claim status logs 276/277 reporting, and referral logs 278 reporting. Make note: you can resubmit eligibility and claim status transactions to obtain the transaction or trace number, but providers should not retransmit referrals.

Remember to take advantage of the claim visibility and support tools available to you via Emdeon Vision and Emdeon ON24/7. Emdeon Vision for Claim Management provides your customer service staff with an end-to-end view into all claims from the point of submission to Emdeon through payer adjudication, while Emdeon ON24/7 provides flexible support tools that give you the service and support you need, when you need it, letting you submit requests online anytime or you can call into our office where our support staff will be happy to assist you quickly and effectively.

Follow these tips to help us help you, and together, we’ll achieve a truly winning strategy.

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