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[Demo] ABILITY CHOICE® All-Payer Claims

December 22, 2015

Do you need an all-payer claims application that will take your medical billing efficiency to the next level? Watch this video to see a demonstration of ABILITY | CHOICE All-Payer Claims, which gives you the power to:

  • Easily submit professional and institutional electronic claims, with or without billing software, to over 2,200 commercial payers, Medicare and Medicaid
  • Use a corrections tool to easily edit and resubmit claims
  • Define rules in a crosswalk tool for mapping ICD-9 codes to ICD-10 codes
  • Reduce rejected claims with multiple levels of claim validation
  • Use billing and coding analysis tools that give you a snapshot of your organization’s performance
  • And more!



Great, thank you so much for the intro, Sarah. I want to give a little bit of background on the service here before we get into the demonstration. What we're putting up here is really the core features of the service that we're going to be demonstrating for you today. It's also going to serve as a little bit of an outline of what we're going to go over in the demonstration. Obviously this is a service that can help you send your claims electronically, and the most important thing that we want to be clear about is that we can service you regardless of your claims format. Whether that be 837, both the more recent 5010, and older 4010 versions of 837 as well as print image and NSF formats. You can also receive your ERAs/electronic EOBs through our service.

You can track your claims as they process through the adjudication process, and we can really help you manage your rejections. You know those rejections are really the ones that you need to get on top of, start working immediately and make sure that you make the corrections so you can get paid as soon as possible. We've also got a variety of intuitive reporting tools that we really think focus on the key metrics of your revenue cycle performance. We're not giving you, throwing a bunch of things at you that might be confusing. We're just really focusing on those key metrics that we think can really help.

Next I want to mention we're going to be demonstrating for you today our newest feature—our claims editing or claims correction feature. This is a feature that's going to help you correct your claims directly in the CHOICE All-Payer Claims product, and then immediately resubmit those to the payer, so we really think it can streamline your claims correction process. We're really happy to demo that for you today. Lastly I just want to mention that we've got a variety of other features such as secondary claims processing and our ICD-9 to ICD-10 Crosswalk that can help users that may not be able to export ICD-10 codes on their claims natively.

With that, I'm going to go ahead and start the demonstration. To start off, we're on the myABILITY login screen here. This is where you would log in to any of the myABILITY products that you might decide to use. Really the benefit here is that you'll be able to have one login for CHOICE All-Payer Claims or any other ABILITY service that you decide to use, and go ahead and click log in here. The CHOICE All-Payer Claims application is located under the billing tab, so I'm going to go ahead and hover over that, and then click the launch CHOICE All-Payer Claims link. Now I've launched the CHOICE All-Payer Claims application and I'm logging into the CHOICE All-Payer Claims portal.

You'll see on the right side of the dashboard here, you'll see information that's going to be relevant to your organization or about the CHOICE All-Payer Claims service. You might see things here like surveys. We really like to do a lot of surveys to our customers to assess whether they like a new feature. There’s messaging here about things like payer delays. If they're having a delay in processing claims, or if there's something like a maintenance window where we're going to be ... The product's going to be offline for a half hour, or late at night, or something to that effect.

On the left hand side here is where you'll be most of your work. This is where you will access all of the core features of the service. The first feature I'm going to show you is our “send claims” feature, so this is what you'd use to send your claims naturally. It’s a really simple interface. We really designed this to be a lot like the way you'd attach a file to an email. You just go ahead and click choose file, and then you'd click the file that you've exported probably from your practice management system or a different billing system that you'd like to send to payers through our service. I'm going to go ahead and click that. I'm going to pause for a moment and tell you that we also have secure FTP available if that's your preferred method of submitting claims, so to you folks that answer 10,000 claims a month to our poll question, you might be interested in the secure FTP option of submitting your claims.

I also want to mention that you don't have to separate your claims into individual batches for each payer, so you can submit a file that includes commercial claims, Medicare claims, Medicaid claims, Blue Cross Blue Shield claims all in one batch. We're going to separate them out and we're going to make sure that they reach the appropriate destinations. At this point, I'm going to go ahead and click Send which is going to begin the processing of the claims. What we're doing while we're processing this is applying a library of validation rules against your claims, so if we know that a payer is not going to accept the claim because you're missing some required field or some piece of information is ill formatted, we're going to let you know right away immediately on the screen that you see here. That way you can correct that issue as soon as possible and therefore prevent any delays in your reimbursement for that claim.

Also I want to mention on this summary screen, we tell you the number of claims that were just submitted through the service. What that allows you to do is to ensure that what you thought you sent is what you actually sent, so if you were expecting this to be a batch that included 14 claims, you'd know right away that there was an issue. As you'll see here, 6 of the claims that I sent through this test file were processed correctly and are now going to be sent off to the appropriate payers. Seven of them were rejected, so there was obviously some issue that we found with those claims, and we'll get into how the service can help manage those rejections a bit later in the demonstration.

Next, I'm going to move on to our session results. Session results is our claim tracking dashboard. We've often referred to this as FedEx-like tracking since we think it's very similar to the way that you might track a package online through FedEx, or UPS, or another carrier. You'll see that you can easily track your claims as they go through the adjudication system, so each batch that you've sent represented by an individual row in this table. You'll see the total number of claims there. Then you'll see for example the number that are in process, the number that are accepted, the number that are acknowledged. Hopefully the claims will go from in process, to acknowledged, and then finally to accepted, and then you'll receive your electronic remittance advice, that electronic version of the explanation of benefits.

If claims are unfortunately rejected, then they'll end up in this column here. You'll see that we've highlighted this column because again, we know that the rejected claims are those that are most important for you to take action against. Clicking on this link here would launch our rejection center which we're going to demo a bit later in the presentation. What I'm going to demonstrate for you next is our session report. Our session report is essentially the detailed information on each claim that was submitted through our system. You'll see here in this table, each row represents an individual claim, and you'll see some information about the patient, about the provider, and other information on the claim such as the total amount of the claim.

Most importantly, we've included the claim status information for each individual claim. You'll see here that a few of them are in process which means they're still in the process of being sent to each appropriate payer, and then some are rejected. For the rejected ones, we can click on this link which will show the most recent claims status message. That claims status message will include the big reason that the claim was rejection, so in this instance it was because there was a facility NPI that was required but missing on the claim.

Today what the user might do is go back, add that facility NPI on to their claim, send a new batch of claims through the system that would then not be rejected, and they would make their way onto the payers. Later in this demonstration we'll be showing you our new claim editing feature which can streamline that process by allowing you to edit that claim directly in our system. Also on this page, we've included a variety of tools that we think are very beneficial to our users.

First, we've got our claim notes feature. I'm actually going to save the detailed information about our claim notes features for when we demonstration our rejection center. Next, we've got our timely filing and appeals letters here, the clock and the legal scales icons here. The timely filing and appeals letters allow you to create pre-filled timely filling and appeal letters which then you can use to send to print and send to a payer if you're having a timely filing issue or an appeals issue. We've pre-filled all the pertinent information from the claim onto this form including the patient name, insured ID, et cetera, so it makes it really easy for you to just print this off, send it, and then you can close those timely filing or appeals issues.

The last tool that I want to demonstrate for you is our email support tool that we've included here. If I click that, what I can do here is create a support ticket that has pre-filled the information about my organization including the tax ID, doctor's name, et cetera, and most importantly the session tracking number for the batch of claims that you're having an issue with. Then obviously you can type in the exact issues that you're having. What this does is it allows our support team to go ahead and research the issue prior to reaching back out to you, so instead of taking a lot of time out your day or reach out to our support department and have a conversation that might last 10, 15, 20 minutes. When they call you back, they're most likely will already have the answer to the question that you have. Really it saves you a ton of time. It saves them time as well, so it's really beneficial for everyone.

Lastly I want to mention that we have a variety of sorting options on this page so that you can sort the claims by any one of the fields that appear in the table, and that way you can bring to prominence the claims that are most important to you. Next, I'm going to move on to demonstrating our rejection center. I mentioned previously that you can launch the rejection center from the session results page by clicking on the number in the rejected column. You can also launch it by clicking on the rejection center on the left hand navigation here. The difference being if you access it from the navigation here, it's going to display all the rejected claims from a particular time period. It defaults to the last 2 weeks, but you can change it to whatever time period you wish.

I'm going to go ahead and click on the rejection center from an individual batch, one that was processed earlier today. You'll notice that the rejection center looks very similar to the session report page that I just demonstrated for you. The key difference aside from the fact that this only includes rejected claims is that we include the rejection details on this page as well, so you'll so here before we had to go one click away to find out that the rejection reason was that the facility NPI was missing. Now that's zero clicks away. We can see it right with the information about the claim.

The other key difference is that we've included any claim notes that you've added to the claim. I promised that I was talk about the claim notes when we got to the rejection center, so here we are. You'll see that someone previously put a note that this claim was resolved. Also, note the difference in the claim notes icon from the claim that was resolved versus those that no action has been taken on yet, so you'll see the green check mark here representing that this claim is now resolved, and this icon tells you that you don't have to go back and worry about that claim any further.

Also, the claim notes feature is useful to assign work to different staff members. For example, you might want to say that, "Steve please work this claim," and then when Steve went in here, he would see that note and he would know that you've now assigned this claim to that person. Also, the number of notes for each claim is included in the icon as well. You'll see that icon changed a bit after I added the notes. I also want to mention that this is one of the 2 screens, session report screen being the other, that you'll be able to launch our new claims editing feature that I've mentioned a few times. What I don't believe I've mentioned yet is that that feature is actually being launched tomorrow, so some of our customers will be able to access the claim editing feature as soon as tomorrow. Again, we'll be getting into detail about the claim editing feature a bit later in this presentation.

Next, I'm going to demonstrate for you our view messages inbox. View messages is a feature that contains claim status messages, so that same information we saw when we clicked on the claim status link in session report, or that we were able to view in the rejection center. It also includes communications from ABILITY such as information about new feature releases, maintenance windows, et cetera. Lastly, it contains your ERAs, those electronic remittance advice, or the electronic versions of your explanation of benefits. I'm going to go ahead and limit the display to only show ERAs by clicking in the ERA/EOB radio button.

There's a few different actions you can take against ERAs. The most common is to click here and download the ERA which would then be processed through your billing system and then used to reconcile that ERA information against the claims that you submitted previously. I want to be clear that that would be the EDI compliant 835 version of the ERA. Next, we provide some summary information about the ERA that you see in your inbox, so if I hover over the summary link, you'll see the information that's displayed. One key point to make about this as well is that we provide custom ERA grouping that allows you to group your ERAs by payer, by provider, or by tax ID, or the standard which would be check, check number.

Difference being is if you use one of those custom sorting options, you can end up with an ERA that contains multiple checks. Therefore you can hover over this summary link and you can see the information about each one of those checks, so for example this ERA had 4 different checks contained in it, and you can see the payer name. Again, it could contain multiple payers. Payment date, payment amount, check number, and the type of check whether that's ACH which would be sent electronically, or whether it would be a paper check that you'd get through the mail.

Lastly, we have our ERA viewer, so if you click view, you can see we call a human readable version of the ERA, so this very closely mimics what you might expect to see from a paper EOB. This is a feature that I really think would be useful for the folks on the phone that said that they're still submitting their claims on paper today. I know you're obviously used to seeing paper EOBs as well then, and this exactly mimics those paper EOBs. You could choose to just view them electronically, or if you'd like to continue with that paper process you could print these out, and then you'll have a very close representation to the paper EOB that you're used to having.

All right, that concludes the demonstration of our view messages feature. Next we're going to move on to our patient search feature which we're actually not going to get too deep into today, but I think that it's worth mentioning. This patient search feature allows you to search for any claim by patient name or other information about the patient such as patient control number or insured ID. You'd simply just type in the patient name and then you would be able to see any detailed information about any claim that was sent for that particular patient. In the interest of time, again I'm not going to get too deep into that, but if this is something you're really interested in, please contact your sales representative and they can give you a detailed demonstration of this particular feature or any feature that you're very interested in.

Next, we're going to move on to our payer claim statistics report. As we go into the payer claims statistics report, we're now kind of veering away from the core functionality of the product which is sending claims, tracking claims, managing rejections and receiving ERAs through the product. Now we're going to demonstrate some of the reporting and analytics tools that are included in the service. We really think these tools can help you assess the current state of your organization's revenue cycle, so how well are you doing at getting paid correctly and getting paid accurately, and hopefully these tools can help you both get paid more and get paid faster which is everyone's goal.

Getting back to the claims statistics page, the claims statistics report displays aggregate information about your claims on a monthly basis. This includes a breakdown of the status of your claims, so how many were accepted versus rejected versus still in the adjudication process of either in process or acknowledged. In this demo account, this biller is not doing a great job. It's 67% of their claims are rejected. Obviously this is just for demo purposes. In a real life scenario you could use this to measure if that percentage of rejections is going up or going down hopefully. You can also see a breakdown of claims and bill them out based on payer, so this helps you assess who are the payers that I send the most claims to from a number of claims perspective and also from a dollar value of those claims perspective.

Very similarly, we also provide breakdown of your claims of commercial versus noncommercial which would be government claims such as Medicare and Medicaid as well as the billed amounts for those claims. There's also a month over month, we call our trend analysis, available of this report by clicking on the trends link in the upper left hand side here. Next, we're going to move on to demonstrating our revenue center. I click here on revenue provider center. The first section of the revenue center is what we call our billing analysis. The billing analysis gives you a snapshot of your practice's financial performance each month including metrics such as total billings and total billing per visit. It helps you see am I billing more this month? Am I billing less this month? How many visits do I have and like I said, what's the average billing for each one of those individual visits?

The second section is the coding analysis. The coding analysis compares your coding practices to an aggregate of your peers that are also using ABILITY services, so this could be referred to as benchmarking. For any given diagnosis, the report will display the top procedures performed for that diagnosis by your peers with an indication as to whether or not your office is also performing that procedure. You'll either see a red if you're not performing it or a green check if you are. Also included is the aggregate average billed amount for your peers as well as your average billed amount, and the Medicare allowable for your particular locality.

This is kind of a lot of complicated stuff that I said, but to boil it down ... What this report can really help you do is discover procedures that you could be billing for that you're not billing for today, or discover that you're underbilling for certain procedures. In both cases it can help you bill more and in turn get reimbursed more without having to provide any additional, do any additional work. If you'd like a more detailed demonstration of this feature, I'm sure your sales representative could provide that as well.

The next thing that we're going to demonstrate for you is our ICD-9 to ICD-10 Crosswalk tool. As I mentioned briefly in the intro, this is a tool that allows you to convert ICD-9 codes to their ICD-10 equivalents. Many of our customers were able to avoid a potentially expensive practice management system/EMR upgrade that would be required to natively support ICD-10 by just using this Crosswalk instead. Users just have to follow a really simple 3 step process to create rules about an ICD-9 code, and then we'll just kind of replace it with the ICD-10 code. I think the easiest way to think about that is almost like the find and replace feature in Microsoft Word or in Microsoft Excel. What we're doing is finding and replacing V-91.29 and replacing in with O-30299. Again, all these rules are defined by each individual user, so you could have a completely custom setup.

I also want to mention that this tool's an example of many other tools we have that helps our users get the correct information out of their claims even when their practice management systems/EHR or whatever your billing system is that those systems cannot produce. Other examples are augmenting claims with NPIs. We still have some offices that can't get NPIs out on their claims natively. Also adding things like pay to address which was new to the 5010 837 format. I won't get too deep into it, but a variety of different tools that can help you.

At this point, we're going to switch gears here, and we're going to demonstrate that new claims editing feature that you'd seen me talk about, heard me talk about a few times now. If it's not obvious, I'm pretty excited about this new feature. I think it's going to be very beneficial to our users. Now I'm going to be logging into a different demonstration system where I can show you the claims editing feature. Like I said, it can be launched from either the session report or the rejection center. In this demo, I'm going to launch it from the rejection center.

We can see here as we learned previously from the demonstration of the rejection center that this page contains the reason that the claim was rejected. In this case, it was rejected because I attempted to use an ICD-9 diagnosis code prior to the date of service of 10/1/2015 which we know was the transition date for ICD-10. All claims with a date of service prior to 10/1/2015 should use ICD-9 codes. Through this new feature, I'll be able to go in and simply change those ICD-10 diagnosis codes to ICD-9s with really just a few small clicks. I'm sorry, I jumped ahead a little bit there. To access the claim editing feature, you'd simply click on this icon here which looks like a pencil writing on a piece of paper.

We've color coded this icon to help you understand what the current status of that claim is. If it's red, that means the claim you're editing was rejected. If it's grey, that means that the claim you're editing is not rejected. Beyond that, we color coded as yellow if you have a pending editing claim, so that means that you've started to edit this claim and you saved those edits, but you haven't clicked send to actually send the claim out to the payer. If you see this icon is green, that means that you've successfully sent the edited claim onto the payer and no further action is needed.

I'm going to go ahead and click that icon, and now I've launched the claim editor. You'll see on the claim editor that we allow editing for about 30 fields. Not every field on the claim, but we've specifically targeted the fields that most commonly cause rejections. I also want to be clear that this feature includes support for both professional and institutional claims. The fields that are editable differ slightly for professional versus institutional claims in order to best accommodate the most appropriate fields for each one of those types of claims. Okay, so now on the claim editor here, I'm going to scroll down to the diagnosis information section. You'll see that my diagnosis code qualifier is ICD-10 which is incorrect, and then my diagnoses codes down here are ICD-10 as well. I'm going to go ahead and switch to ICD-9. It's going to tell me that by doing this, it's going to wipe out these codes because again, they're in ICD-10 format, so I'm going to go ahead and do that quickly before I go ahead and actually select the correct diagnoses.

I'm going to demonstrate for you the validation that we provide for you while editing claims. Obviously, one thing that we really don't want to happen is that you go ahead, edit your claim and it gets rejected again. That would be kind of the worst thing that can happen. What we do is we validate and ensure that all required fields are filled in, and that they are also correctly formatted. Every date looks like a date, every name looks like a name, every ICD-9 code looks like an ICD-9 code. I'm going to go ahead and try to click save. It's going to say validating form, and then it's going to say this field is required. Because I need at least one diagnosis code on the claim in order for it to be valid. Now I'm going to go ahead and click on the magnifying glass icon, and I'm going to choose the appropriate ICD-9 codes.

Obviously in a real world example you'd go and search for the correct codes here, but just in the interest of time I'm just going to go ahead and click the first 2 codes that appear here. I will make it clear that you can search by both code or description. All right, so now I've got my ICD-9 codes there. As long as I take the appropriate equivalence of the ICD-9 codes from the ICD-10s that were originally on the claim, I shouldn't have to edit my diagnosis pointers because it should still map correctly.

All right, at this point I'm going to go ahead and click save and add to queue. Now you'll see the new claim that I just added here. That was the claim that we just edited is in this queue along with 2 other claims that I edited previously but I haven't submitted. The reason I split it up like this is so that I can demonstrate for you that when you edit a claim, you can either send that claim through individually as its own claim, or you can batch it with other claims that you've edited previously and send a new batch of claims through that way. I'm going to ahead and just select the one that I just edited.

Also I want to mention if you choose to edit claims and not send them right away, you'll be able to access this screen which also allows you to edit the claims further or delete the claims by clicking on the pending edited claims link which will appear under the actions section of your menu. To be clear, this link will only appear if you have pending editing claims. All right, so now I'm going to go ahead and send the selected claims off to the payer. All right, so at this time the claims are processing. They're going through that same process that any other claims you sent to the system would do.

You'll see here you get again, that same session summary screen that you'd get if you batched your claims and set them from your billing system like we showed at the beginning of this demonstration. You'll see that one claim was received. This claim is going to be sent electronically, and you're one click away from the session results. If I click on that, I'll launch my session report, and that'll give me the information about this claim. If I wanted to, I could edit it some more.

The one key thing I wanted to show you on this page is this icon here in the current status column that looks like a chain link. By clicking on this, this tells you that for one, that this was an edited claim, the result of editing. If you click on it, it'll give you information about the original claim, so this would be that claim that got rejected originally because it had the wrong type of diagnosis codes. Then below, you can click to go to the session report for that original claim. There it is, and that the individual claim gets highlighted so you know exactly which one we're talking about. All right, so that concludes the demo portion of this webinar. I hope that this was informative and demonstrated the robust capabilities of ABILITY's CHOICE All-Payer Claims service.

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