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
- 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
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.
- Setup a Medisoft user, if you
are not already using Medisoft security logins.
Navigate to File->Security Setup
the "New" button and fill out (at least) the:
Name and Password & Reconfirm and click the "Save" button.
Close Medisoft and re-open, you should be prompted to enter a user name and
with the information you entered and continue with the practice setup.
ADDITIONAL TECHNICAL INFORMATION AVAILIBLE AT
END-1 & -2
- 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
the "New" button and create a 5-digit code and fill in the Name for
- 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)
- Create two new procedure
In Medisoft; Lists->Procedure/Payment/Adjustment Codes
the "New" button
in Code 1, Description and change the Code Type to 'Comment'
will need to have two comments added:
Code1='COINS' & Description='Coinsurance Amount'
Code1='DUECOPAY' & Description='Copayment Amount'
- Open RM
In Medisoft; Activities->Revenue Management->Revenue Management
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)
- 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
- 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
the Database Root Folder will be created
you receive the 'Upgrade Prompt', you will click the 'OK' button
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
the practice has been added you will then will be prompted if you want to
configure practice, you will select the 'Cancel' button
will configure everything inside Revenue Manager and will be easier to follow
than the "Configuration Wizard")
Then the RM Practice list will be displayed
sure your practice you want to setup is highlighted and click the select button
prompted for a password you will use the Medisoft Practice Username and
are ready to continue to the next step
- 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
- Configure Communication
- Click the 'Configure' button
and then select 'Communications' from the drop-down menu
Manager comes with a number of pre-defined communication sessions to various
Clearinghouses and Payer-Directs
- 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'
- If it is not listed, click
the 'Add Session' button
add a Name code, Description and select the Type of connection (Dial-Up, FTP,
you will click the 'Details' button
- For Internet you will be
prompted to enter the web address
- For Dial-up you will be
presented with a terminal where you can set the number under the
- For FTP you will be presented
with a Client FTP where upon successful connection the settings will be
saved for the communication session
- For Manual you will be
prompted to choose the custom program you want to run
- 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
- Configure Receivers
- First click the
'Configure' button and then select 'Receivers' from the drop-down list
- 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
- 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
- Program File
this field you will want to type in 'SENDCLM.exe'
- Group Practice
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
- Use Billing Service
this box if the Practice uses a PO-Box or separate pay-to address for the
(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)
- Claim Number Format
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
- 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.
- Send Drug Codes
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.
- Entity Type
field should be set depending on the Billing Provider is a 'Non-Person' (etc.
Company/Group Name) or a 'Person' (Individual Provider)
- Comm Session
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
- Header Info
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.
- Contact (PER02)-Biller's Name
- Type (PER03)-Contact format
type (Telephone is normal standard)
- Number (PER04)-Biller's
contact number or information formatted to type selected
- Sender ID Type (ISA05)-ZZ
- Sender ID (ISA06)-Relay
Health's Submitter 1 ID
- Receiver ID Type (ISA07)-ZZ
- Receiver ID (ISA08)-CLAIMSCH
- Acknowledgement (TA1)
Requested (ISA14) - Checked (request 999/997 after submission)
- Application Sender Code
(GS02)- Relay Health's Submitter 1 ID
- Application Receiver Code
- 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)
- Submitter Name- Billing
- Receiver Primary ID (1000B
- Unique Submission Number- 0
ADDITIONAL TECHNICAL INFORMATION AVAILIBLE AT END-4
- Transaction guide
this drop-down menu, you will first click the 'Add' button and then will fill
out the following fields.
- 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)
- Filename-This will be the
file name created by Revenue Manager for this claim file
- 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
- 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
- ZipFileName-name of the zip
file Revenue Manager creates
- 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
- 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
- Save receivers
- Configure Preferences
- Click Configure,
then select Preferences in Revenue Manager.
- The options available under
the Medisoft tab of the Preferences can be left as is or updated as
- Click on the Revenue
Management tab to view the following options
- Report Settings
- Define a common
export folder for remits.
- 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)
- Additional Import folders
for RM Reports to monitor for new files.
- Archive Options
- 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)
- Optional you can have RM
Reports auto-archive files of a certain type.
- Remit Posting Options
- 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.
- You can also set the default
posting code RM Reports selects when posting a default payment code.
- 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.
- Set the Location-Choose your
- Medicare Payers-Choose your
normal Medicare Provider.
- Coverage Topics-Here are the
defaults we normally select.
- CCI Type and Global Period
Option-Here are the defaults we normally set.
- Completes the Claims Editor
setup once you hit the 'Finish' button.
- The settings will still not
be completed until you hit the 'Save' button for Preferences.
- You can press save now to
make sure no settings are lost or you may continue to the next Preferences
- Remittance Codes
- Here you can view, adjust or
add additional Adjustment Codes or Remark codes for use in RM Reports.
- 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.
- Assign Posting Codes
- Here you assign the default
posting codes for RM Reports
- The recommended setup
- You will add and
adjust more codes as you process ERA reports in RM Reports.
- Status Codes
- Here you can add, adjust or
change status codes and status categories.
- We have not come across a
situation where this has been needed.
- Save the Preferences to be
sure your changes are taken properly.
- Configure Insurance Assign
- Click Configure, then select
the Insurance menu and pick the 'Assign Edits' option.
- This section will define for
individual insurances what Edits will be run when performing 'Check
- 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.
- 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
- 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
- Our normal setups will look
like this after checks are un-checked
- Click the 'Save' button to
complete the setup of Assign Edits.
- To setup additional practices
in RM, you will perform:
- Steps 1-3 again
to configure the security, receivers, and comment codes for that
- 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.
- If the practice
will use the same communication session with the same user name and
- you can continue
to Step 6 to completion.
- Otherwise you
will want to configure an individual session for this practice
specifically by performing Step 5 to completion.
- 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.
- 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.
- 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.
- 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.