Medisoft 17 New and Enhanced Features!
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HIPAA X12 Version 5010 (ANSI 5010)
The following are changes made to Medisoft v17 to accommodate the upcoming change from the Health Insurance Portability and Accountability Act (HIPAA) American National Standards Institute (ANSI) Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010 (referred to as ANSI 5010), as well as the National Council for Prescription Drug Programs (NCPDP) version 5.1 to NCPDP version D.0.5010. ANSI 5010 and NCPDP version D.0.5010 are new sets of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims and remittances. Covered entities, such as health plans, healthcare clearinghouses and healthcare providers, are required to conform to ANSI 5010 standards.
These changes include new windows/tabs, restructured windows or moved fields, menu changes, new fields, additional options, and other changes.
New Windows or Tabs
There are three new windows or tabs.
Edit Claim window, new
EDI Note tab (for Claim level notes)
Restructured Windows and Moved Fields
Several fields have been moved, and windows have been restructured and rearranged to accommodate the moved fields.
Allergies and Notes, as well as EDI Notes, have been moved to the Comments tab of the Case window.
Condition Codes have been moved from the UB04 window, FL 4 to 41 tab to the Condition tab of the Case window to accommodate changes that allow condition codes to be used in professional claims. Condition Codes will not be copied if the user uses Copy Case.
The option for UB-04 Condition Codes has moved from the UB04 Code Lists menu to the main Lists menu.
Additional Diagnosis Codes: The program now allows you to have up to 12 diagnosis codes for a case. The following fields and windows are affected:
Patient/Guarantor, Name, Address Tab, Sex Field: Added the option Unknown
Case Policy 1, 2, and 3 tabs: Relationship to Insured has several new options.
Medicaid Referral Access # field is now called Referral Access #.
Case Window, Condition Tab: First Consultation Date field is now called Initial Treatment Date.
Case Window, EDI Tab: Timely Filing Indicator field is now a drop-down instead of a free-form text field.
Case Window, EDI Tab: The EPSDT Referral Code field is now a drop-down.
Insurance Type Code: Removed this field from the EDI tab on the Case window.
Claim Filing Indicator Code: Added four new items to the drop-down:
Relationship to Insured: Items in the list have been rearranged so that values valid for ANSI 5010 are on top and legacy values for ANSI 4010 are on the bottom.
Timely Filing Indicator: This is now a drop-down with preset values, to ensure that a valid value is always selected.
Revenue Management ERA Changes to Meet ANSI 5010
Changes have been made to Revenue Management electronic remittance advice (ERA) processing to handle the upcoming switch to ANSI 5010. Among these are the following:
The reports include:
Appointment Eligibility Analysis - Detail
Appointment Eligibility Analysis - Summary
Electronic Claims Analysis - Detail
Electronic Claims Analysis Summary
Each of these reports offers several filters for controlling the information that shows. In addition, several summary values appear on each report so that you can see the information at a glance.
Enhancement: Audit Reports
Medisoft v17 includes a feature that allows you to track the reporting and exporting of data when you generate audit reports. A new option on the Audit tab in Program Options allows you to turn this feature on or off. It is turned on by default. Certain reports or grids that are printed or saved to disk will be audited. Note: Previewed reports will not be audited.
The following types of information are included as part of the audit reports:
Custom reports, including claims and statements
When printed from either Transaction Entry or Statement Management, but not the Report menu or Report Designer, the audit reports include.
Office Hours data
Final Draft reports or data printed or saved to disk
Enhancement: BillFlash Integration
BillFlash integration applies to the Medisoft Advanced and Network Professional programs. Medisoft now uses BillFlash to print and mail patient statements. With Medisoft v17, you can enroll in BillFlash directly from within Medisoft, as well as upload your statement files directly from Medisoft automatically. You can view and approve statement uploads to BillFlash by clicking links from within Medisoft. For more information on BillFlash and to learn how to enroll, go to www.BillFlash.com.
Within Medisoft, you can control several aspects of what prints on your statements, including which credit cards you accept, service messages you want to print, printing of account summaries and aging, and printing up to six messages to appear on statements. For more information, go to the Program Options - BillFlash tab.
Options on the Activities, BillFlash menu allow you to enroll with BillFlash, view and approve statements that have uploaded to BillFlash, see your account settings at www.BillFlash.com, and view reports such as the Disposition report. Each one of these menu options will open a different page on the BillFlash website.
The following windows in Medisoft have quick access to the eView page of the BillFlash website via a new View eStatements button. (In addition, when a patient is selected and Ctrl + F7 is clicked, the eView page will open for any statements for that patient.)
Enhancement: Revenue Management Click Reduction
Several changes have been made to the functionality and workflow of Revenue Management to reduce the number of times that the user must click to achieve the desired result. Among these changes are:
Claims will be auto-checked so that the user does not need to click Check Claims. There is a new option on the Medisoft tab in Revenue Management Preferences called Auto Check Claims. Selecting this option will enable the program to auto check the claims when the user selects Process > Claims.
Claim edit checks and Implementation Guide (IG) edit checks have been combined into one step and executed when you select Claims from the Process menu. Errors are displayed on the Claims Preview report, as well as under each individual claim.
One click removal of all claims marked with a red X has been added, eliminating the need to click Remove Claim many times. A red X icon appears next to the Remove Claim button on the Claim Preview window. Clicking this icon will remove all claims marked with a red X.
A Failed Claim report has been added that will be displayed when the Send button is selected from the Claim Preview window. This report will display all claims that were removed, eliminating the need to preview this report separately.
Claims that fail any edit and are removed from the transmission file will be written back to Medisoft and the status in Medisoft changed to Alert. Denial information will be written to the History tab in Revenue Management and the Comments tab on the Claim window in Medisoft.
The OK button that is displayed after clicking Send from the Claim file saved message has been removed. The Transmission Has Been Received button that displayed after the file was sent/received has been removed.
Revenue Management Configuration and Setup Changes
Several changes have been made to Revenue Management to simplify the setup and configuration process. Among them are the following:
Eliminated the Alias table for ERA processing. The user will not need to choose the practice or payor information for ERA processing. Instead, information from the ERA file itself is used to process the ERA file. The Pay To field from Loop 1000B (practice or provider) and the Payer Name field from Loop 1000A Segment N102 (payor information) directly match the information sent out on the claim and will be used, eliminating these steps.
Allow the user to edit the Receiver table directly, bypassing the wizard. Certain sections of the table remain locked, however.
Allow the user to log in to Revenue Management automatically from Medisoft.
Simplify the setup of
ERA. Assign Posting codes will be populated by default with the
appropriate payment codes that reference carrier-specific codes in
Medisoft. In addition, there is a set of default ERA posting
defaults in the Remit Posting Code window in Revenue Management. If
Use Insurance Posting Codes is checked and there are no
carrier-specific codes, these new Default Posting Codes will be