The Electronic Media Remittance (EMR) software allows adjudication detail to be collected from multiple electronic trading partners and loaded into an extensive database residing on the IBM® AS/400. From this database, payment detail can be accessed. In addition, the payment and denial information can be used to generate payments, adjustments, and comments to an existing patient information system. Our company has written interfaces for several patient information systems including McKesson® Series, Keane® First Coast Systems, and Siemens® MedSeries.
There are several benefits of payment processing on the AS/400:
1. The software resides on the same AS/400 platform used for the patient information system; therefore, no additional interface engines or downloads are necessary.
2. Data elements which are required for posting may be written directly to the patient information system's AS/400 database.
3. As payment detail is posted, notes and comments may also be written to the patient information system residing on the AS/400.
4. Security which is being used for the existing patient information system and the AS/400 may also be utilized for this system.
5. Programs and procedures for the software may be accessed from existing menus or desktops.
6. Additional networks are not required; existing AS/400 workstations are utilized.
7. Due to the extensive storage capabilities of the AS/400, large amounts of history may be stored in the database.
None of my electronic payers are the same, how are my payments translated?
The method used to receive the adjudication files may be customized for each payer. In addition, each electronic payer utilizes a separately maintained translator. This detail may be translated using ANSI X12 835, NSF, or proprietary EDI standards. Table definitions allow payer specific adjustment segments to be used for charge and contractual computations.
How is the adjudication detail posted to my patient information system?
The payment detail received is posted to the patient information system from a prompt which allows selection of specific active vouchers. The payers contained in each payment file received are compared against a translation file and the appropriate posting information is determined. If the payment detail is not specific, an insurance lookup may also be used. As payments and/or adjustments are posted, they are updated with a posted flag and given a unique date-and-time stamp. These posted records remain in the database. The interface to the patient information system will post payments, adjustments, and notes identifying any payment exceptions. The exception notes include:
1. Intermediary number and name
2. Payer number and name
3. Claim bill type, provider, and service dates
4. Payer document control number and paid date
5. Payment and adjustment amount
6. Denied and noncovered charge amounts
7. Coinsurance and deductible amounts
8. Prior payments and patient responsibility
9. Claim and service level denial descriptions
How do I display the payment detail?
Maintenance modules are provided with the EMR software. Either number or name may be used to access any of the adjudication detail which has been received. Information which was used for posting, including exception amounts, may be displayed. In addition, the segment detail for each payment is also stored within these records. An EOMB may be printed from either the name or number maintenance function. In addition, a hot key is provided which allows access to the patient information system.
Is reporting provided?
A reporting module for the remittances is also provided with the EMR system. All report functions include a prompt which allows active and posted payments to be printed in different orders with multiple selection criteria. The following reports are provided:
1. Summary listing of the present status (active, posted) of any group of payments.
2. Hard Copy print of EOMBs for any group of payments.
3. Summary listing of any group of payments which have either a coinsurance or deductible identified.
4. Summary of any group of payments which have either denied or noncovered charges identified. The denial descriptions will also list for each record.
5. Summary of any EDI codes which contained monetary detail.
Allow us to provide your facility with a cost free, no obligation trial of this system.