Friday, April 10, 2009

Topic: I have many claims that need organizing and updating, i'm confused (From Mike)

Dear RxDME2000 Hme software user,
 
There is an update to our Rxdme2000 Export/Purge program.  You probably didn't even know you had this program!   We have added a feature several clients have asked for - build a spreadsheet file, so you can manipulate your own data.
 
I suggest you first review the article explaining the update check out "I have many claims that need organizing and updating, I'm confused" on DMEFree & Simpleclaims Support Forum   .  To view it, please click this link:

Thank you and enjoy
 
Mike
DMEFree / PCSolutions

Topic: I have many claims that need organizing and updating, i'm confused (From Mike)

We have updated the Import/Export/Purge Module for Rxdme2,
to get the update click this link

http://www.dmefreeserver.com/files/export217c.exe

this was in response to a client request as follows

In many businesses there are claims with unknow dispositions, was it billed, was it paid, did we rebill it after denial etc.
You can use the reconcile system to identify what is out standing,, but what about other issues with claims.

The new function in Export module is the ability to export claim records from the Transaction History file to a spreadsheet file. Why do we want this file if we use reconcile? Becuase you may want a print out of everythng for a large range of dates,, and work the claims thru payment, ie
use the spreadsheet to mark, when it's submitted, when paid, when denied , etc. Kind of like a worksheet to give you the confidence to know what the status of your claims are..


What happens,,,
The transaction history function on the Reports menu of Rxdme2 allows you to build a database of All claims for a range of dates, then sort this set of claims and search through it for reports and more. What makes transaction history so great is , it takes the 1500 form and recreates the claims in a separate file where all lines of the 1500 form are broken down or separted into their own claims. whereas rxdme2 holds upto 6 line items in one claim. This breakdown allows you to search right down to the individual procedure code.

Here is an example;
In transaction history menu we start by clearing the Transaction history file
then we build the transaction history for a range of dates, lets use 01/01/2008 thru 12/31/2009.
We now have the file built, we can use the View transaction history to see what claims are in this range.

We leave the Transaction history menu and go to Utitlies menu and Export menu.
Once in the Export program, we select Export - Transaction history
Now we can click the Step 1 button to search for just the date range or procedure code or insurance plan we want.
Once the claims are selected we can go to Step 2 to view them
Then Step 3 to export the data to a spreadsheet file.

You pick the fields to export, arrange their order and complete the export.
You then find the fle you created , click on it and Excel should open.

Now you have a spreadsheet you can sort, add columns and generally manipulate.

Claims: CPID 2112 Value Options and CPID 5941 ENTRUST: New Claims Connections

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format. 
 
Effective immediately, claims can be submitted as follows.
 
CPID Payor Name Transaction Type Enrollments
2112 Value Options Professional No
5941 ENTRUST Institutional No
 
CPID
 
FOR COMMERCIAL PLANS
First you need to create or modify the plan in the insurance file.
 
You will need the CPID number which is found at
 
 
You put this CPID # into the plan as follows;
 
in the Change or Add mode in the INSURANCE PLAN click PLAN
DATA TAB
Leave Provider# field blank unless instructed to enter a provider#
 
Put the CPID# into the 2nd field labed: GRPNO:
Set the PLAN TYPE to COMMERCIAL
 
 
 

Thursday, April 9, 2009

from mike

The following new CPID(s) have been added for electronic claim submission using the 4010A1 ANSI format.  Effective immediately, claims can be submitted as follows.
 
CPID 4879
 
Molina Healthcare of Florida
 
Professional
 
 

Thank you
 
Mike Feldman
PCSolutions
fax 860 974 1886

Friday, February 20, 2009

Accreditation Tools at DMEFree Forum

Several new additions to our Accreditation tools found at DMEFree Forum.

click this link

Have a great weekend!

Thank you
 
Mike Feldman
PCSolutions
fax 860 974 1886

Friday, February 13, 2009

Notice: Presidents Day Office Closed

To:  DMEFree and RxDME2000 users and clearinghouse clients.  
 
In observance of President's Day, the National Government Services our office will be closed on Monday, February 16, 2009.   No Claims or Reports will be processed.  We will reopen Tuesday Feruary 17, 2009 at 9:00 am est.
 
Thank you
 
Mike Feldman
PCSolutions
fax 860 974 1886

Friday, February 6, 2009

DMEFree Clearinghouse News Friday February 6th, 2009

Dear DMEFree and RxDME2000 Clearinghouse users,
 
This note is to bring you up to date on the status of the CEDI reports transfer process.
 
CEDI has extended the Phase II GenReports introduction until February 27th, 2009.  
On that date, the new front end GenReports will contain the claim control# (CCN#) to be issued by CEDI.  You will no longer get DMAC Front end reports FOR CLAIMS from the 4 DMACs.  You will continue to get CMN reject reports from the 4 DMERCs.
 
For the last week or so you have been receiving two set's of reports.  The DMAC Front end reports and the new GenReports.  IT IS EXTREMELY IMPORTANT YOU READ AND UTILIZE BOTH REPORTS.  Here's why......
 
The process works like this...
1. You send claims to the DMEFree clearinghouse.
 
2. We send back an email (or display web page if sent via web) to confirm receipt.
 
3. Next morning we process your claims and send them to CEDI.  We send you a STATUS CODE REPORT which has a number like 1234G743  (your account number a year and day code)
 
4. The following morning we obtain the Front end reports from CEDI, You should be getting two types of reports at this time.
 
DMAC Front end report
CEDI GenRpt  (Genreport)
 
5. CEDI processes the claims first.  If a claim is rejected it will not send it to CMS Medicare for processing.  You will see the rejection on your GENRPT.   This report has a glossary at the end to explain what the errors mean.
 
The claims are then further processed by the individual DMACs (Regions A,B,C,D), you may find additional errors on the DMAC front end report.  This is why it's important to review both set's of reports.  The edits at CEDI are different than at the DMACs.  
 
After Feb 27th, only CEDI will be editing your claims for errors,, all accepted claims will go to DMAC for CMS Adjudication.  At that point if your GenReports has a Claim Control# (CCN#) you will get an ERN/ERA for that claim - paid or denied.
 
We hope this helps you understand the current situation and helps you catch and identify errors that you were not previously getting.  
 
Have a great weekend

Thank you
 
Mike Feldman
PCSolutions
fax 860 974 1886