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Revenue Manager Setup - Initial and Additional Practices and Additional Technical Information (Medisoft v17)

This is also documented in the Revenue Manager User's Guide!


Revenue Manager is an add-on that is included with v17 of Medisoft.  Revenue Manager (RM) allows for processing electronic claims and reports using the ANSI standard for electronic transmission.  There is an extra set of configuration steps for a practice to work with RM correctly.  You will first want to contact your Clearing House to gather information about their transmission options (Step#5) and for a copy of their companion guide (preferably ANSI 5010 companion guide), which will outline the Clearing House specifics for the ANSI standard (Step#6).  Once you have that information, open the practice you want to configure first in Medisoft.

 

(For this tutorial we will be setting up using the configuration for Relay Health electronic submission.  Anywhere Relay Health is referenced in this tutorial you can replace with your Clearinghouse or Payer-Direct's specific information)

 

Also this tutorial assumes that:

  • You are aware of if the Billing Provider is filling claims as individual or group
  • You are aware of if the Billing Provider uses a separate Pay-to address for payments to be mailed
  • The ID's for the Practice, Providers, Facilities, and Referring Providers are all correctly setup in Medisoft

If you are unsure about any of these items, please contact us to help you determine this information before trying to setup Revenue Manager for electronic claims.  Without knowing this information and being sure Medisoft is correctly setup for these items, there will almost certainly be claim errors when submitting or trying to track down errors will prove difficult and cumbersome if these items are not setup correctly first.

 

  1. Setup a Medisoft user, if you are not already using Medisoft security logins.
    Navigate to File->Security Setup
                           


          

Click the "New" button and fill out (at least) the:

           

Login Name and Password & Reconfirm and click the "Save" button.


Close Medisoft and re-open, you should be prompted to enter a user name and password

          

Login with the information you entered and continue with the practice setup.
ADDITIONAL TECHNICAL INFORMATION AVAILIBLE AT END-1 & -2
 

  1. Create two new EDI Receivers, this way you can clearly determine how a claim was sent out and if it was sent using RM, and will allow your currently used EDI receiver to remain unchanged (and working in theory)
    In Medisoft; List->EDI Receivers
                    

 

           

Click the "New" button and create a 5-digit code and fill in the Name for each:

           

C4010 - ClearingHouseName 4010
C5010 - ClearingHouseName 5010
(note this is just a recommended naming convention, it is not required, you can name the code or name however you would like to easily discern them)
 

  1. Create two new procedure comment codes
    In Medisoft; Lists->Procedure/Payment/Adjustment Codes
                    

 

                    

              Click the "New" button

 

                    

                Fill in Code 1, Description and change the Code Type to 'Comment'

                You will need to have two comments added:

       Code1='COINS' & Description='Coinsurance Amount'

       Code1='DUECOPAY' & Description='Copayment Amount'
 

  1. Open RM
    In Medisoft; Activities->Revenue Management->Revenue Management
                    

If this is the first time Revenue Management has been run under this user account you will be prompted with the following options (Connect, Create, and Cancel)

            

 

  1. If the RM-Database has already been created, you will select 'Connect' and browse to the RM-Database location (CMDBList.add will be a file in the root directory of the RM-Database, this will be where you will point Revenue Manager to on connecting)
     
  1. If the RM-Database has not already been created, you will select 'Create' and browse/'create a new folder' for the RM-Database to be stored.  Please note for Network Professional version of Medisoft you MUST use the network share path to correctly allow other users to access the database.
                  

 

First the Database Root Folder will be created

                  

 

If you receive the 'Upgrade Prompt', you will click the 'OK' button

                  

 

If you receive the 'Terminal Server Prompt', you will click the 'Yes' button

                  

 

4b-2. Then you will be prompted to add the practice to the RM-Database, verify the practice you are working with is highlighted and click the 'OK' button

                   

 

Once the practice has been added you will then will be prompted if you want to configure practice, you will select the 'Cancel' button

(we will configure everything inside Revenue Manager and will be easier to follow than the "Configuration Wizard")

                   


Then the RM Practice list will be displayed

                    

 Make sure your practice you want to setup is highlighted and click the select button

 

                    
                   If prompted for a password you will use the Medisoft Practice Username and password

 

                   

You are ready to continue to the next step
 

  1. If your RM-Database has already been created and the practice you are in has already been added to the RM-Database and this user has already been connected to the RM-Database on this workstation then you will be presented with the Claims window of RM and are ready to continue on to the next step
                            


  1. Configure Communication Session
                    

 

  1. Click the 'Configure' button and then select 'Communications' from the drop-down menu
                            

                 Revenue Manager comes with a number of pre-defined communication sessions to various Clearinghouses and Payer-Directs

 

  1. First Check to see if your clearinghouse or payer-direct is already listed, if so you may add the User ID and Password to the 'User ID 1' field and the 'Password 1' field respectively and then continue on to the next step 6 'Configure Receivers'

 

  1. If it is not listed, click the 'Add Session' button
                            

 

              Then add a Name code, Description and select the Type of connection (Dial-Up, FTP, Internet, Manual)

                             

 

Next you will click the 'Details' button

                  
  1. For Internet you will be prompted to enter the web address
                                     
  1. For Dial-up you will be presented with a terminal where you can set the number under the 'Settings' tab
                                      
  1. For FTP you will be presented with a Client FTP where upon successful connection the settings will be saved for the communication session
                                    
  1. For Manual you will be prompted to choose the custom program you want to run
                                     
  1. When the communication session has been tested and configured, click the 'Save' button and then close the Communications window
                             

             ADDITIONAL TECHNICAL INFORMATION AVAILIBLE AT END-3
 

  1. Configure Receivers
    1. First click the 'Configure' button and then select 'Receivers' from the drop-down list
                                      

 

  1. We will be configuring the receivers we created in step 2 of this tutorial, if other receivers are listed they can safely be ignored and nothing should be changed for those receivers as it will update the corresponding Medisoft data for the Receiver and may cause problems processing claims or using that receiver for it's original purposes

 

  1. Normally both 4010 and 5010 receivers will be configured with the same options for everything except the Iguide they use to compile the claims with, you will want to check with the clearinghouse or payer-direct to verify this will be the case for your claims and receivers

 

  1. Program File
                            

              For this field you will want to type in 'SENDCLM.exe'

 

  1. Group Practice
                            

             Check this box, if the Provider is set to 'File Claim as GROUP' in the Provider IDs under the Provider (or if the receiver will be used to file Group claims in general)

 

  1. Use Billing Service
                            

             Check this box if the Practice uses a PO-Box or separate pay-to address for the billing provider
             (note in 5010 it is a new requirement that PO-Boxes must be listed as a Pay-To address with the Billing Provider's physical address being sent as well)

 

  1. Claim Number Format
                             

               This field's default value of 'Claim Number' can be left as is, however using 'Chart Number' is highly recommended if you are using Revenue Manager to post your 835 ERAs or Electronic EOBs

 

  1. Suppress Legacy
                           

              This  field is used to restrict Legacy numbers from being sent electronically, normally if you are sending an NPI number, most payers will reject for sending the legacy numbers as well.  

              It would be recommended to remove these legacy numbers from the IDs tabs instead of relying on this check box to correct a problem with the IDs setups. 

 

  1. Send Drug Codes
                           

             This field is used to alert Revenue Manager to include the NDC loop information when sending a code with an NDC number attached.
              You will find more information about 5010 NDC on our tutorial page.

 

  1. Entity Type
                            

              This field should be set depending on the Billing Provider is a 'Non-Person' (etc. Company/Group Name) or a 'Person' (Individual Provider)

 

  1. Comm Session
                            

              For this field you will either select your pre-defined Clearinghouse/Payer-Direct Session or you will select the session you created for your Clearinghouse/Payer-Direct in 5c-d

 

  1. Header Info
                            

This drop-down menu has several fields to define, you can find out more information as for what is required in these fields by referencing your clearinghouse/payer-direct companion guide for 5010/4010 claims.  The following information is what is required for Relay Health's Header Information, others may require different or other information for this section.

  1. Contact (PER02)-Biller's Name
  1. Type (PER03)-Contact format type (Telephone is normal standard)
  1. Number (PER04)-Biller's contact number or information formatted to type selected
  1. Sender ID Type (ISA05)-ZZ
  1. Sender ID (ISA06)-Relay Health's Submitter 1 ID
  1. Receiver ID Type (ISA07)-ZZ
  1. Receiver ID (ISA08)-CLAIMSCH
  1. Acknowledgement (TA1) Requested (ISA14) - Checked (request 999/997 after submission)
  1. Application Sender Code (GS02)- Relay Health's Submitter 1 ID
  1. Application Receiver Code (GS03)-ECGCLAIMS
  1. Submitter Primary ID (1000A NM109)-Relay Health's Billing ID followed by Relay Health's Submitter ID (normally will be the same unless billing for multiple practices is under a single Relay Health account, with separate Submitter IDs)
  1. Submitter Name- Billing Provider Name
  1. Receiver Primary ID (1000B NM109)-4300
  1. Unique Submission Number- 0

ADDITIONAL TECHNICAL INFORMATION AVAILIBLE AT END-4

 

  1. Transaction guide
                            

             In this drop-down menu, you will first click the 'Add' button and then will fill out the following fields.

                             
  1. Iguide-Select the Iguide that fits the claims you are trying to send (for 5010 837p claims, you will select the 'Outbound Claims(MS17 5010 Prof Claims Direct Connect, for 4010 837p claims you will select the 'Outbound Claims(MS17 Prof Claims Direct Connect)' for UB04/Institutional Claims you will select either the 'Outbound Claims(MS17 Inst. Claims - General UB04)' or 'Outbound Claims(MS17 5010 Inst Claims - General UB04)' or if you see a specific Iguide that meets your claims definition closer (etc. Ambulance or AVAP) you can select these Iguides instead)
  1. Filename-This will be the file name created by Revenue Manager for this claim file
  1. FilePath-defaults (blank) to RMData\PracticeFolder\Outbound or you can browse to a custom location, if you are using Medisoft Network Pro, make sure the path is accessible to everyone creating claim files in Revenue Manager
  1. ZipFile-Relay Health request zip files by default this box is checked to create a zip file of the claim file after creating the claim file and then send the zip file to the clearinghouse/payer-direct
  1. ZipFileName-name of the zip file Revenue Manager creates
  1. ZipPassword-password protect the zip file (note the clearinghouse/payer-direct must be able to unzip the file or they will normally just drop the file as if they never received it)  This option should only be set if the Clearinghouse/Payer-Direct explicitly requires it
  1. Comm Session -This field can be left to (None) as it is an over-ride Session field, to be safe you can set it to the same session you set in step 6k when configuring the receiver.

 

  1. Save receivers

 

  1. Configure Preferences
    1. Click Configure, then select Preferences in Revenue Manager.
                                       

 

  1. The options available under the Medisoft tab of the Preferences can be left as is or updated as needed.
                            

 

  1. Click on the Revenue Management tab to view the following options
                            
  1. Report Settings
    1. Define a common export folder for remits.
    2. Indicate to Revenue Management this practice should use the RMData\Folders structure instead of the RMData\Practice\Folders structure (i.e. using the common RMData Download or Outbound folders instead of the practice specific folders in the RM dataset)
    3. Additional Import folders for RM Reports to monitor for new files.

 

  1. Archive Options
                                     
  1. Here you can adjust how often RM Reports auto-archives reports (we prefer to set these either Immediately or 1 hour and then adjust them as needed when working with older reports, we have found RM Reports runs much smoother when reports are kept archived and managed)
  2. Optional you can have RM Reports auto-archive files of a certain type.

 

  1. Remit Posting Options
                                     
  1. These options define how RM Reports handle posting ERAs and other reports back to Medisoft.  These options will adjust how it matches patients to claims and service dates and the options for posting payment codes.  These are the options we prefer to set as default.
  2. You can also set the default posting code RM Reports selects when posting a default payment code.

 

  1. These settings don't necessarily have to be correct or apply to your practice or services particularly, they will just need to be set to something for the 'Check Claims Process' to complete without error.
                            

 

  1. Set the Location-Choose your state.
                                    

 

  1. Medicare Payers-Choose your normal Medicare Provider.
                                     

 

  1. Coverage Topics-Here are the defaults we normally select.
                                     

 

  1. CCI Type and Global Period Option-Here are the defaults we normally set.
                                     

 

  1. Completes the Claims Editor setup once you hit the 'Finish' button.
                                     

 

  1. The settings will still not be completed until you hit the 'Save' button for Preferences.
                                     

 

  1. You can press save now to make sure no settings are lost or you may continue to the next Preferences tab.
                                     

 

  1. Remittance Codes
                             
  1. Here you can view, adjust or add additional Adjustment Codes or Remark codes for use in RM Reports.
  2. Note when you add or change codes here, you must save the Preferences for them to be available in other Preference tabs or in RM Reports.

 

  1. Assign Posting Codes
    1. Here you assign the default posting codes for RM Reports
    2. The recommended setup initially is:
      1. 1=(DE)
      2. 2=COINS
      3. 3=DUECOPAY
      4. 42=(WO)
      1. 45=(WO)
      1. A2=(WO)
    1. You will add and adjust more codes as you process ERA reports in RM Reports.

 

  1. Status Codes
                              
  1. Here you can add, adjust or change status codes and status categories.
  1. We have not come across a situation where this has been needed.

 

  1. Save the Preferences to be sure your changes are taken properly.
                             

 

  1. Configure Insurance Assign Edits
                   

 

  1. Click Configure, then select the Insurance menu and pick the 'Assign Edits' option.
                             

 

  1. This section will define for individual insurances what Edits will be run when performing 'Check Claims'
  1. The Medicare Edits, Check DX and Check CPT are subscription based services and the errors/warnings they generate are normally outdated unless you are subscribing to the updates for these edits.  We normally un-check these for all insurances.
  1. The Global Periods and CCI Edits are useful if you are taking advantage of either of those in Medisoft, however it is normally easier to manage without the warnings at the claim level, so we normally un-check those edits for all insurances as well.
  1. The Common Edits are normally the only check box we leave checked for all insurances.  This checks for common data entry issues and alerts you before sending the claim out to correct these issues if needed.
  1. Our normal setups will look like this after checks are un-checked
                             

 

  1. Click the 'Save' button to complete the setup of Assign Edits.
                             

 

  1. To setup additional practices in RM, you will perform:
    1. Steps 1-3 again to configure the security, receivers, and comment codes for that practice.
    1. Step 4 you will open RM and it should prompt you the same as in step 4b-2 to add the practice, then complete step 4b-2.
    1. If the practice will use the same communication session with the same user name and password,
      1. you can continue to Step 6 to completion. 
      1. Otherwise you will want to configure an individual session for this practice specifically by performing Step 5 to completion.

 

Additional Technical Information

  1. Revenue Management requires a user name and password to open and access the data, this is to increase security when working with the items in RM.  Since Medisoft does not have permissions built-in for Revenue Manager, it assumes you must first have a login for the practice you want to work with.  Then working with the various permissions in Medisoft (i.e. claims, patients, add/edit/delete, etc.)  to allow the user to work with the items in RM.
  1. To further lock down RM, you can easily do this by uninstalling RM from the systems which do not need to access the RM dataset.  You also have the option to use Windows Share and File/Folder permissions to lock down security of the RM dataset.
  1. Communication sessions also have the ability to be scripted.  This works very well for the BBS connections, however it is much more difficult to script a web portal.  There are a few scripts setup for some of the default carriers.  If you are interested in learning more about these, we recommend you review the defaults and try to copy/mimic their setups.  The Relay Health and the Colorado Medicaid communication sessions both have scripts setup for their types to send and receive claims and reports.  We normally do not do custom scripting since sending claims is fairly straight forward for most communication sessions we have setup.
  1. Companion Guides and Iguide header information can be a task to setup in the beginning but once it has been configured it normally will not need to be updated.  Depending on the type of claims you are sending you will be using an 837 Iguide, either Institutional for UB04 claims or Professional for HCFA claims.  You will almost always want to select the 5010 version of the Iguide and then select a specific category if your service applies (i.e. ambulance claims have a specific 837 5010 professional Iguide for ambulances).  The other Iguides available are used to process reports that can be used in RM.  You can make changes and updates to the Iguide you select to have items always selected or vary information sent using defined logics.  If you make any changes to the Iguide we recommend you make a copy of the Iguide renamed first so when RM updates are done the Iguide changes will not be over written.

 

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