Find Member – the new name for Membership Enquiry

If you access our services through the Veda hub and also have a subscription to one of our Financial Management Solutions this is a quick and easy way to check the membership details of your patients.

This feature has recently had a facelift and, in line with our modern brand, it’s one of the first services to use our API first development promised by our Transformation Programme. You can now also navigate using your keyboard.

Getting started

Click the Records & Reporting tab, then Find Member. This section can also be accessed from the Quick Links menu on the Status page or by clicking the blue square Menq button at the bottom of the menu bar on the right-hand side of the page.

This’ll open Healthcode Authorisation in a new tab which you can leave open in the background. The first time you access the feature you’ll get a welcome message explaining what this feature offers (the ability to view any existing and request new pre-authorisations is coming soon) which you can choose not to see again.

Find your patient’s insurer membership details

• Click on Find a Member or press A on your keyboard
• Select the insurer by clicking the tile or pressing the corresponding letter on your keyboard
• Using your mouse to click into each field or pressing the tab key on your keyboard, complete the insurer’s mandatory fields as a minimum – these will be marked with an asterisk
  • First Initial
  • Last Name
  • Sex
  • Date of Birth – you can either type this in or use the date picker
  • Postcode
  • Membership Number
  • Group ID
  • Policy Active On – by choosing the date of treatment you can make sure the policy will be valid
• Click Search or press Enter on your keyboard
• You’ll get an instant response

We’ve found a match

This is split into two sections – patient information and policy information. The info shown is what the insurer has made available and we have no control over this.

Patient information

• Name
• Other Initials
• Sex
• Gender Identity
• Date of Birth
• Address

Policy information

• Indication of whether the policy is active or not
• Cover valid from and to dates
• Membership number*
• Insurance scheme/plan*
• Indication of whether the policy has expired
• Expiry date
• Group ID*
• Benefit limit
• Benefit used
• Member excess
• Excess used
• Member co-payment
• Insurer email address*
• Insurer phone number*

^{*There’s an easy to use copy function next to these fields – simply click the icon and paste the info wherever you need it.}

When you’ve reviewed and copied any relevant info click the Home icon at the top left of the screen. Any searches that you’ve done today will be shown on the right-hand side. You can click these at any point throughout the day to view the results again.

No match and multiple matches

If we can’t find a match we’ll let you know and give you further guidance.

The post VEDA | Authorisation – Find Member appeared first on Healthcode.

Membership number formats

We’ve got access to the membership databases for Aviva, AXA Health, Bupa and Vitality and invoices are validated against these. The other insurers validate against membership number formatting rules.

The validation format criteria are set out for each insurer and use the following key:

• A = Letter
• N = Number
• X = Letter or Number

A couple of examples:

• AANNNN = 2 letters followed by 4 numbers
• NNNNNNXXA = 6 numbers, followed by 2 characters than can either be a number or a letter, followed by a letter

Where other letters and specific letters or symbols are used, this is clearly shown.

Alliance Health

There are three formats that are recognised.

• NNNNNN = 6 numbers
• NNNNNNN = 7 numbers
• NNNNNNNN = 8 numbers

Allianz Partners

The letter P followed by between 4 to 9 numbers.

As Allianz are now processing invoices on behalf of Aetna for their Americas policy holders, the following formats are also recognised. More information on what that means can be found here.

• WNNNNNNNNN = the letter W, followed by 9 numbers
• WNNNNNNNNN-NN = the letter W, followed by 9 numbers, followed by a hyphen (-), followed by 2 numbers
• WNNNNNNNNNN = the letter W, followed by 10 numbers
• WNNNNNNNNNN-NN = the letter W, followed by 10 numbers, followed by a hyphen (-), followed by 2 numbers
• WNNNN⎵NNNNN = the letter W, followed by 4 numbers, followed by a space, followed by 5 numbers
• WNNNN⎵NNNNN-NN = the letter W, followed by 4 numbers, followed by a space, followed by 5 numbers, followed by a hyphen (-), followed by 2 numbers
• WNNNN⎵NNNNNN = the letter W, followed by 4 numbers, followed by a space, followed by 6 numbers
• WNNNN⎵NNNNNN-NN = the letter W, followed by 4 numbers, followed by a space, followed by 6 numbers, followed by a hyphen (-), followed by 2 numbers

Bupa Global

Must be 17 characters long.

• XX-NNNN-NNNN-NNNN = 2 characters (often the letters BI), followed by a hyphen (-), followed by 4 numbers, followed by a hyphen (-), followed by 4 numbers, followed by a hyphen (-), followed by 4 numbers

Exeter Friendly

There are seven formats that are recognised.

• NNNNN = 5 numbers
• NNNNNN = 6 numbers
• NNNNNNN = 7 numbers
• NNNNNNNNNN = 10 numbers
• NNNNNNNNPPNN = 8 numbers, followed by the letter P, followed by the letter P, followed by 2 numbers
• WINNNNNNNN = the letter W, followed by the letter I, followed by 8 numbers
• WDNNNNNNNN = the letter W, followed by the letter D, followed by 8 numbers

WPA

There are five formats that are recognised.

• NNNNN = 5 numbers
• NNNNNN = 6 numbers
• NNNNNNN = 7 numbers
• NNNNNNNN = 8 numbers
• NNNNNNNNN = 9 numbers

The post Validation Rules | Membership numbers appeared first on Healthcode.

Authorisation number formats

Getting your patient pre-authorised gives you peace of mind that their policy allows them to have the requested treatment. But remember, it’s not a guarantee of payment. Adding the pre-authorisation number (sometimes also known as claim number or patient assessment number) onto your invoice shows the insurer that someone has been in touch prior to treatment to let them know what’s going on. If you’re going to add it you need to make sure the format is correct to stop your invoices failing validation.

The pre-authorisation number is optional for the insurers, unless otherwise stated. The only insurer that doesn’t validate these is AXA Health, so we haven’t included the format requirements in this guide.

The validation format criteria are set out for each insurer and use the following key:

• A = Letter
• N = Number
• X = Letter or Number

A couple of examples:

• AANNNN = 2 letters followed by 4 numbers
• NNNNNNXXA = 6 numbers, followed by 2 characters than can either be a number or a letter, followed by a letter

Where other letters and specific letters or symbols are used, this is clearly shown.

Alliance Health

There are two formats that’ll pass validation.

• AAANNNNN = 3 letters, followed by 5 numbers
• A-ANNNNN = a letter, followed by a hyphen (-), followed by a letter, followed by 5 numbers

Allianz Partners

There’s no set length – it can be a combination of letters, numbers and can also include a hyphen.

Aviva

There are four formats that’ll pass validation.

• NNNNNN/NN/NNNN/NNN = 6 numbers, followed by a forward slash (/), followed by 2 numbers, followed by a forward slash, followed by 4 numbers, followed by a forward slash, followed by 3 numbers
• NNNNNN\NN\NNNN\NNN = 6 numbers, followed by a backslash (\), followed by 2 numbers, followed by a backslash, followed by 4 numbers, followed by a backslash, followed by 3 numbers
• NNNNNN/NN = 6 numbers, followed by a forward slash (/), followed by 2 numbers
• NNNNNN\NN = 6 numbers, followed by a backslash (\), followed by 2 numbers

Bupa

There’s no set length – it must be all numbers.

Bupa Global

There are two formats that will pass validation, both must start with the letter A:

• ANNNNNNN = the letter A, followed by 7 numbers
• ANNNNNNNN = the letter A, followed by 8 numbers

Healix

There’s no set length – it can be a combination of letters and numbers.

Trust in Health

You must include a pre-authorisation number on any invoice. It must start with THP, followed by a letter and 6 numbers.

VitalityHealth

There are three formats that’ll pass validation and all must start with the number 1, 5 or 9.

• NNNNNN = 6 numbers but the first must be a 1, 5 or 9
• NNNNNNN = 7 numbers but the first must be a 1, 5 or 9
• NNNNNNNN = 8 numbers but the first must be a 1, 5 or 9

WPA

There are two formats that’ll pass validation.

• NNNNNNNNN = 9 numbers
• XXXXXX = 6 characters – can be any combination of letters and numbers

The post Validation Rules | Authorisation numbers appeared first on Healthcode.

It’s all about billing

This tab allows you to access all the information about your invoices – from submitting them, viewing and amending the ones that have failed validation to viewing responses and remittances from payors. It’s split into four sections:

• Billing Files
• Bills
• Insurer Feedback
• Failed Bills

Billing Files

This is split into two sections:

• Submit Billing File
• View Billing Files

Submit Billing File

This is one of the methods used to submit invoices to the Clearing Service and is most widely used by hospitals. Check with your system provider if this is the method used by them.

Generate your invoices on your Patient Administration System (PAS) or Practice Management System (PMS) and produce the file to be exported – ask your system provider for instructions on how to do this. Depending on the system you use this file will either be in an XML or ASCII format. ASCII is a legacy file format and won’t be available to new providers.

The XML file format is the preferred Industry Standard method. A single XML file can contain invoices for all insurers and for multiple providers when submitting to the same billing site – for example, a central billing site for all hospitals within a group.

Simply follow these steps.

• Click the Billing tab, then Billing Files > Submit Billing File
• In the Add File section click Browse… to search on your computer or network for the billing file you wish to submit
• Once you have located the file, click Open – the selected file will appear in the Add File box
• Click Add and the file will appear on the Files to Submit pane on the left-hand side of the page
• You can repeat these steps if you need to – a maximum of ten files can be added. When you’re ready to submit click Submit All

If the submission is successful the list of files will appear in the Submitted Files pane on the right-hand side of the page and you will see a message displayed at the top of screen. The invoices will now go through the validation process and you can view the status.

View Billing Files

This feature allows you to check on the progress of the invoices that have been submitted for validation through the Clearing Service.

• Click the Billing tab, then Billings Files > View Billing Files
• Select the required billing file from the left-hand Submitted Files pan and the invoices that were submitted will be displayed in the right-hand File Details pane, each showing a Status indication
• You can visually see the status by the colour-coded boxes, but you can also use the mouse to hover over the boxes for further information
  • One green box = Validated, Awaiting Output to Insurer
  • Two green boxes = Awaiting Collection by Insurer
  • Three green boxes = Collected by Insurer
  • One red box = Awaiting Error Correction

If an invoices shows a red box it means it has failed validation and needs to be corrected. You can view the invoice and the reason it failed by highlighting the invoice and clicking View Bill.

View Billing Files page defaults to show files submitted on the day you are viewing, but you can use the Filter Submitted Files section at the bottom of the page to search for any submitted files using any or all of the following criteria: Date, File Name, Status. Select Filter to display the files that match your criteria.

Bills

Click the Billing tab, then Bills.

At the top of the screen you will see a list of payors that are currently accepting electronic invoices, with columns showing how many invoices you have submitted in each of three categories:

• Completed Bills = invoices that have passed validation
• Failed Bills = invoices that have failed validation
• Cancelled Bills = invoices that have failed validation and you’ve then cancelled

Highlight a payor and all the invoices relating to them and these categories are displayed at the bottom of the screen as tabs: Completed, Failed and Cancelled. The Failed tab will always be the first to open – you should correct the errors on these invoices as quickly as possible so they can be resubmitted. Alternatively, you can cancel them. From this page you can do the following:

• Correct a failed invoice from the Failed tab
• Cancel a failed invoice from the Failed tab
• View and print an invoice from all tabs

Correct a failed invoice

• Highlight the invoice you want to correct and click View Bill
• The invoice will open in a new window
  • The top half of the screen is patient and payor information and the bottom half is what is being charged (charge lines)
  • The field(s) with errors will be highlighted in red, with the error and suggestions for correction displayed in the Bill Errors box on the right of the screen – see Invoice errors and how to fix them for further information
• Click on each field that needs changing and amend the information
• Once everything has been corrected, click Update on the top right of the page and the invoice will be resubmitted for validation

If you are having difficulty correcting errors just contact us for help.

Cancel a failed invoice

• Highlight the invoice you want to correct and click View Bill
• The invoice will open in a new window
• Click Cancel Bill on the top right of the page
• A box will pop up asking for a cancellation reason – select this from the drop-down list and click Confirm Cancellation
• The invoice will now appear in the Cancelled tab

View and print an invoice

• Highlight the relevant payor and click on the category tab where the invoice is listed (Completed, Failed or Cancelled)
• Find and click on the invoice required
• The invoice will open in a new window – the top half of the screen is patient and payor information and the bottom half is what is being charged (charge lines)
• To print, click Print Bill on the right of the page

Insurer Feedback

This is split into four sections:

• Remittances
• Shortfall Collection Service
• Unread Responses
• All Responses

Remittances

Electronic remittances can be viewed and printed. They are currently sent by Aviva, AXA Health, Bupa, Bupa Global and patientzone (if you are using Online Payments or Shortfall Collection Service) and VitalityHealth (for hospitals). We only hold remittances for three months before archiving them, but these can be retrieved for a fee. If you have a subscription to the standard Financial Management Solutions package, remittances can also be download into your own system.

Click the Billing tab, then Insurer Feedback > Remittances. The page has two tabs:

• Remittance Files = displays a list of payors with the total number of remittances available for each in the All column and an indication of those that are Unprocessed
• File Downloads = displays a list of processed remittances with an indication of whether the file has been downloaded

View remittance files

• Click on the Remittance Files tab and highlight the required payor
• A list of available remittances (both processed and unprocessed) will be displayed in the right-hand viewing pane
  • In the Processed column the processed invoices are indicated by a green box – the white box signifies that the remittance is unprocessed
  • To only view unprocessed remittances click the View Unprocessed button – the remittance must be processed to enable it to be downloaded
• Highlight the required remittance and click View
• The full details will display in the viewing pane on the bottom right of the page – use the scroll bar to move through it

 Print remittance files

• Click on the Remittance Files tab and highlight the required payor
• A list of available remittances (both processed and unprocessed) will be displayed in the right-hand viewing pane
  • In the Processed column the processed invoices are indicated by a green box – the white box signifies that the remittance is unprocessed
  • To only view unprocessed remittances click the View Unprocessed button
• Click on the remittance you want and click Print.
• A green Print Document pop up box will appear – choose whether you want a summary or detailed print out from the drop-down menu and click Print
  • The summary version will only show you the key details including the total amount paid and when, with no invoice specifics

Process a remittance

You process a remittance so you can download it. The download facility is only available if you have a subscription to the standard Financial Management Solutions package.

• Click on the remittance you want and click Process
• The box in the Processed column will change from white to green and you will be prompted to click on the File Downloads tab to view them

If you have several unprocessed remittances for the selected payor, click Process all Outstanding at the bottom of the Remittance Files tab to save you time.

Download a remittance

• Click on the File Downloads tab to see the list of all available remittance files
  • You can click the Insurer filter at the bottom of the screen to only show those from a single payor
  • You can also filter by file name if you know it
• Select the remittance file and click Download – a dialog box will display
• Click Save and a Save As dialog box will open – save the remittance file to the appropriate folder

Once you have downloaded a file it will be removed from the list. To view files that have already been downloaded click Show Downloaded.

Shortfall Collection Service

Available to those with a subscription to this service that automates the shortfall notification and collection process. See Shortfall Collection Service for help on how to use it.

Unread Responses

Responses are updates on the processing status of electronic invoices and are currently sent by AXA Health, Bupa and Bupa Global. They are sent until the invoice has reached the final stage of processing i.e. rejected, part-paid or paid and can be viewed and printed.

Unread Responses | mark as read

• Click the Billing tab, then Insurer Feedback > Unread Responses to see a list of response files on the left-hand side of the screen, detailing the date they were received and the number of invoice responses available in each
• Select a file and the list of responses will display in the preview pane on the right-hand side of the screen
• Select the invoice you want to view – the details will display in the viewing pane below
• To indicate you have read the response simply click Mark Read at the bottom of the preview pane

Unread Responses | print

• Click the Billing tab, then Insurer Feedback > Unread Responses to see a list of response files on the left-hand side of the screen, detailing the date they were received and the number of invoice responses available in each
• Select a file and the list of responses will display in the preview pane on the right-hand side of the screen
• To print the whole response file click Print at the bottom of the response file pane
  • A green Print Document pop up box will appear – choose whether you want a summary or detailed print out front the drop-down menu and click Print
    • The summary version will only show you the details you see on the preview pane
    • The detailed version will show you the specific details of each invoice
• You can print an individual response by following the steps in mark as read and clicking Print at the bottom of the viewing pane on the right-hand side

All Responses

Responses are updates on the processing status of electronic invoices and are currently sent by AXA Health, Bupa and Bupa Global. They are sent until the invoice has reached the final stage of processing i.e. rejected, part-paid or paid and can be viewed and printed.

• Click the Billing tab, then Insurer Feedback > All Responses to see a complete list of response files on the left-hand side of the screen – these are files that have either previously been marked as read or that still require attention
• The instructions on how to read and print the files or individual responses are detailed in Unread Responses | mark as read and Unread Responses | print

Failed Bills

Part of the Financial Management Solutions, the Failed Bills Management Tools are available to those with a subscription to the Premium package.

The post VEDA | Navigation – Billing tab appeared first on Healthcode.

Search and Request

For hospitals pre-authorisation is an essential part of invoicing but can be a time-consuming and laborious manual task. Using our automated service to securely pre-authorise eligible Aviva and Vitality patients for treatment is easy. Please remember that receiving pre-authorisation from the insurer is not a guarantee of payment – it simply means that the patient’s policy allows them to have the requested treatment.

To help you streamline your work, there’s a Pre-Auth section on the Status Page that shows you numbers of Accepted and Unread pre-authorisations. Clicking on one of these will take you directly to the relevant list.

Everything is available from the Pre-Auth tab. Clicking on this gives you two options:

• Find/ Request to search for a pre-authorisation for a specific patient or to request a new one
• List Pre-Auths to either view all pre-authorisations for a specific patient or to search for all pre-authorisations received on a certain date or within a 30-day date range

All pre-authorisations will have a status:

• Unread – this is a new pre-authorisation that has been sent through to you but no-one from your hospital has marked it as read yet
• Read – this pre-authorisation has been reviewed by someone at your hospital but it hasn’t been accepted yet
• Accepted – someone at your hospital has accepted the details
• Requested – a request sent by you that hasn’t been authorised by the insurer yet (the pre-authorisations showing this status are only available when using the List Pre-Auths option)

Search for an existing pre-authorisation

Click the Pre-Auth tab and then click Find/ Request. You’ll need to complete the search parameters in the top Select Patient section – use the keyboard tab key for faster navigation. The fields required are:

• Family Name
• First Initial
• Gender
• Date of Birth
• Postcode
• Insurer

If you already know the pre-authorisation code you can search using the following four fields:

• Auth. Code
• Gender
• Date of Birth
• Insurer

Click Search and all available pre-authorisations for that patient will be listed in the bottom Pre-Authorisation List section.

Viewing

Click on the required pre-authorisation and both the Selected Patient Details and Pre-Authorisation Details sections will be filled. 

The patient details section will include the policy cover type and the start and end dates. The pre-authorisation details section will include the authorisation code, the issue date and a Network Inclusive Package indicator.

Clicking on the + symbol next to the service(s) in the Service Items section will display important pre-authorisation details:

• Setting – whether Daycase, Inpatient or Outpatient
• Treatment From Date
• Treatment To Date
• Authorised From – the start date of the approved treatment period
• Authorised To – the end date of the approved treatment period
• Procedures – the approved procedure(s)
• Treatment Sites – the approved treatment site(s)
• Specialists – the approved practitioner

You’ll see a Notes section at the bottom. This is where any queries you’ve sent to the insurer will be saved. See the section below on Sending a query to find out more.

Changing the status

You can only change the status of a pre-authorisation that you’ve received from the insurer. Make sure you’re viewing it and then click on the Change Status drop-down menu at the bottom of the screen. Your hospital may have a process to follow to determine when these statuses are changed and/or who should do this.

Sending a query

You may need to ask the insurer for some clarification on what they’ve authorised or perhaps you’ve got to make some changes to your request. This is easily and securely done.

The status of the relevant pre-authorisation must be Accepted, so you may need to change this first (see above). Click Query – found next to the Change Status box at the bottom of the Pre-Authorisation Detail pane. This opens a text box for you to type in anything you want the insurer to review. Once ready click Submit Query – you’ll now see the text in the Notes section and the insurer will be sent all the information to review.

They’ll respond using Secure Messaging if they have any questions or will make a new pre-authorisation available to you. Just regularly check your Status Page for updates.

Printing

Click Print at the bottom of the Pre-Authorisation Detail pane. This will generate a PDF that you can download and will work whatever the status.

Copying

Whatever the status, you can copy a brief summary of the pre-authorisation to your clipboard and paste where required. Click Copy at the bottom of the Pre-Authorisation Detail pane.

Request a new pre-authorisation

Before requesting a new pre-authorisation you should check that the patient has been in contact with the insurer first.

Click the Pre-Auth tab and then click Find/ Request. You’ll need to complete the search parameters in the top Select Patient section – use the keyboard tab key for faster navigation. The fields required are:

• Family Name
• First Initial
• Gender
• Date of Birth
• Postcode
• Insurer

When you click Search if no existing pre-authorisations are found the new pre-authorisation request form will automatically open on the right-hand side of the page. If there are existing pre-authorisations simply click Request New to open the form.

The fields with a red asterisk are mandatory:

• Service Code – choose from the drop-down menu
• Setting – choose from the drop-down menu
• Treatment From Date – the date the patient is expected to come into the hospital for treatment
• Treatment To Date – the date the patient is expected to leave the hospital after treatment
• Treatment Site – where the treatment will take place

The Inpatient Nights field will automatically calculate depending on the dates you’ve entered.

The more information you give helps the insurer decide whether to authorise without needing clarification. The additional areas available are:

• Condition (ICD)
  • Click on the + symbol
  • A separate window will open – search for the diagnosis using the code (if you know it) or the description
  • Highlight the correct one and click Select to add 
• Procedures
  • Click on the + symbol
  • A separate window will open – search for the procedure using the code (if you know it) or the description
  • Highlight the correct one and click Select to add 
• Treatment Site
  • This will default to your hospital unless you are controlling more than one, in which case you can choose from the drop-down menu
• Controlling Specialist
  • Click on the 0 symbol
  • A separate window will open – search for the practitioner using at least one of the available filters: First Name, Last Name, Specialty and Prof. Code (e.g. GMC registration number)
  • Click Search
  • The practitioners who match your criteria and are mapped to your hospital will be listed in the Search Results box
  • Highlight the correct one and click Select to add

Click Add Service Item to add to the Service Items list. You can add further service items if required.

You can now click Save Pre-Auth at the bottom of the pane to submit it – at the top of the screen you’ll see a message in a green box showing you that your submission has been successful.

When the insurer receives your request it will either issue a pre-authorisation or will respond using Secure Messaging for further clarification. Just regularly check your Status Page for updates.

List pre-authorisations

Click the Pre-Auth tab and then click List Pre-Auths. You’ll need to complete the search parameters in the top Search Pre-Auths section – use the keyboard tab key for faster navigation.

To list all the pre-authorisations for a specific patient simply type at least three characters in at least one of the following fields.

• Family Name
• Membership Number

Typing in the Auth Code (if you know it) will only list the pre-authorisations that used it.

To list all the pre-authorisations issued on a specific date or within a 30-day date range simply type in the relevant dates into the Issue Date and to boxes.

You can refine your search further by using three more filters:

• Status – change from All to
  • Unread
  • Read
  • Accepted
• Treatment Site – useful if you can see pre-authorisations for multiple hospitals
• Type – change from All to
  • Received only – the pre-authorisations you’ve received from the insurers
  • Sent only – the pre-authorisations you’ve requested but haven’t had approved yet

Once you’ve set your parameters click Search to see all the matched results. Follow the steps above for Viewing.

Want more support?

We’ve put together a video playlist that may be useful to see these processes in action.

The post VEDA | Hospitals – Pre-Authorisation appeared first on Healthcode.

Using Guideline Pricing to set up your Pricing Matrix

Take a bit of time to save lots of time and effort in the future. Setting up your Pricing Matrix means your charges can be automatically entered when you raise invoices by clicking the calculator icon next to the fee box. You can easily set up price lists for all your payors and even set different fees for your locations.

Getting started

Click Accounting on the left-hand menu and then click Guideline Pricing. The Guideline Pricing grid will display with columns for “Self Pay” and “All Other” already available. If you want to charge most payors the same you can use the All Other column.

Adding new payors

Click Manage Payors either at the bottom right of the screen or the top left of the grid. The Manage Payors screen will open and you’ll see “All Other” and “Self Pay” at the top of the pane as Selected Payors.

Click the drop-down menu under Select Payor Type to select from the available options – these are the same ones as used for your Contacts (more information on this can be found here).

To add an insurer, you’ll see that the Insurer option is at the top of the list with the rest in alphabetical order. Click on Insurer and an alphabetical list will appear in the Select Payors section at the bottom of the pane. This is split into two – the insurers at the top accept electronic invoices using the Clearing Service with the rest appearing below these. Then follow these steps – these stay the same whatever payor type you’ve chosen:

• Click on the required payor
• Click on the + symbol on the right-hand side of the Select Payors bar
• The payor will appear in the top Selected Payors list
• Click Save

Adding your services – all professions

You now need to add the items you want to invoice for. You can do this all in one go or start with the ones you require more often adding the rest as you come across them. You may find that some “Services” are already pre-populated on the left-hand side of your grid.

Click Manage Services either at the bottom right of the screen or the top left of the grid. The Manage Services screen will open – just follow these steps.

• At the top of the pane, enter a code (if you know it) or a description to search for a service e.g. consultation, physiotherapy, counselling etc
• A Services box will open listing all the options – simply scroll through to find the correct one
• Click it to add to the list
• Click Save to return to your grid or repeat to add more services

Adding procedures – surgeons and anaesthetists

If you’re a surgeon or anaesthetist before you can add any procedures you must first add the code for “Surgeons Fee For Surgery” or “Anaesthetists Fee For Surgery”. Follow the steps above and type “surgeon” or “anaesthetist” into the search box and choose the relevant option. Once this is in your list, you’ll see there is an option to Add Procedures/Treatments.

• Click Add Procedures/Treatments
• A list of suggested procedures will open in a new box based on your specialty
• Scroll through ticking the ones you want to add – you can also use the search option at the bottom of the pane to search for a specific procedure
• Click OK
• The selected procedures/treatments will now appear on the right-hand side of the Manage Services pane
• Click Save to return to your grid or repeat

Adding your fees

Your grid will now be larger from top to bottom and left to right. There’s a fee box for each service under each payor. Click on Add/Edit Fee for each one. The Add/Edit Fee screen will open and you should add the price you want to charge. You also have the option to tick the box “Vary Fee By Treatment Site”, if you don’t charge the same everywhere. This will show all the locations where you see patients and you should enter the different fees charged for each site.

Once you’ve entered your fee click Save.

Editing your fees

Click on Add/Edit Fee for the service and payor you want to edit. Make amendments and click Save.

Vitality fees

Depending on your current recognition status with Vitality you may either see the usual Add/Edit Fee in their column, in which case you proceed as above, or Set Fee if they want to validate the procedure code for your profession/specialty.

• Click Set Fee
• A message will pop up giving you a guideline range of fees typically charged by other recognised practitioners for this service – this message is provided and maintained by Vitality
• Type your fee in the Agreed Fee box – this must be the maximum you’ll charge
• If you work at multiple treatment sites there’s an option to charge different rates at each one – if this is required tick the box next to Vary Fee By Treatment Site
  • A list of where you see patients will appear in the Location pane
  • Add your fee for each one – this mustn’t be higher than your stated Agreed Fee
• If you’ve entered a fee higher than the guidelines suggested you’ll be shown a further message from Vitality and will need to change the fee you’ve entered
• Click Save
• The fee will be added to the pricing matrix – the only option to Edit Fee will be to change the fees you’ve set at various treatment sites
• Continue setting fees for your other procedures and services

Removing a payor

If you’ve added a payor in error or simply wish to use the “All Other” option going forward rather than list the same prices multiple times, it’s easy to remove it. If you’d added any fees these will be lost once you’ve deleted the payor.

• Click Manage Payors at the bottom right of the screen or the top left of the grid
• Highlight the payor you want to remove from the top Selected Payors list
• Click the x symbol on the right-hand side of the Selected Payors bar
• Click Save

Want more support?

Our Service Delivery Associates at the Healthcode Academy offer practical and relevant modular 1-2-1 training on ePractice functionality. Want to know more about the settings available in ePractice and how to configure it for you? Then Electronic billing & collection | Module 1  (30 minutes) is for you. For those who just want to focus on creating your Pricing Matrix we offer a 15-minute bite-size option – you’ll need module 1C.

The post ePractice | Guideline Pricing appeared first on Healthcode.

Invoice errors

When you send invoices through the Clearing Service they’re validated against the criteria set by each insurer. Invoice passed? No problem, it’s ready to be collected by the insurer into their system. When the invoice fails, you’re alerted to the errors. But how do you identify and fix them?

There are two types of errors – bill and charge line.

Bill Errors

These are found in the top section of your invoice – outlined in green below. They pick up any problems in the Episode & Invoice and/or the Patient & Bill To tabs.

The errors are displayed in the Bill Errors box on the bottom right of the screen (outlined in blue) – the number of errors are shown in the top line. If there’s more than one, clicking the >> symbol will take you to the next one and the << will take you back. You’re given three pieces of information for each error:

• Field – the field that’s causing the issue; this is also highlighted in red in the relevant section of the invoice
• Error – a short description of the problem
• Suggestion – an idea of how to fix it

When you make a change always remember to click the Update button at the top right of the invoice.

Episode & Invoice tab errors

There are three areas in this tab where common errors occur:

• Episode Details
• Diagnosis Codes
• Invoice Details

Episode Details

1. This error relates to the Controlling Spec: field.

Error details: Field = Specialist + Error = Invalid Code + Suggestion = Amend Value

This means: Either the practitioner identifier code listed in this box (which relates to the person you put on the invoice as the Controlling Specialist) isn’t mapped on our system or it’s mapped but they aren’t recognised by the insurer. Hover over the field and if a name pops up that means the code’s mapped.

Solution – if the practitioner isn’t mapped: If you’re a hospital you’ll need to map the practitioner yourself using The PPR. Our guide will show you how. If you’re not a hospital just contact our Customer Services team, who’ll be happy to help – they’ll need the following details:

• the practitioner’s name
• their regulatory/professional body code e.g. GMC number
• the practitioner identifier (the code listed in the Controlling Spec. field)
• the name of the insurer being invoiced

Solution – if the practitioner is mapped: Send the following details to Customer Services requesting an insurer recognition update:

• the practitioner’s name
• their regulatory/professional body code e.g. GMC number
• the practitioner identifier (the code listed in the Controlling Spec. field)
• the name of the insurer being invoiced

2. This error relates to the Treatment Site: field.

Error details: Field = Hospital Number + Error = Not Mapped + Suggestion = Map Code

This means: Either the treatment site identifier code listed in this box (which relates to where the patient was seen) isn’t mapped on our system or it’s mapped but it isn’t recognised by the insurer. Hover over the field and if a name pops up that means the code’s mapped.

Solution: Send the following details to Customer Services requesting either for the site to be mapped or an insurer recognition update:

• the treatment site’s name
• any insurer provider numbers
• the treatment site identifier (the code listed in the Treatment Site field)
• the name of the insurer being invoiced

Invoice Details

1. This error relates to the Payee Provider field.

Error details: Field = Payee Provider + Error = Invalid Code + Suggestion = Amend Value

This means: Either the payee provider identifier code listed in this box (which relates to the practitioner or practice/clinic that’s recognised by an insurer for electronic billing and receives payment directly from them) isn’t mapped on our system or it’s mapped but it isn’t recognised by the insurer.

Solution: Send the following details to Customer Services requesting either for the payee provider to be mapped or an insurer recognition update:

• the payee provider’s name
• any insurer provider numbers
• the payee provider identifier (the code listed in the Payee Provider field)
• the name of the insurer being invoiced

We’ll need you to complete and sign sections 1 and 2 of our Data Consent Form before we can map a payee provider – when done just return it to Customer Services with the required information.

2. This error relates to the Bill / Auth No: field.

Error details: Field = Authorisation Code + Error = Must be in the format ***** + Suggestion = Amend Value

This means: The format of the authorisation number given isn’t recognised using the validation criteria set by the insurer.

Solution: Check the authorisation number and amend it. An alternative solution is to remove it as it isn’t necessary to include it on an invoice. Click Update.

Diagnosis Codes

This error relates to the diagnosis code you’ve added to the invoice.

Error details: Field = ICD + Error = Code not Mapped + Suggestion = Map Code

This means: The diagnosis code used isn’t valid for the insurer.

Solution: Diagnosis codes are only required on invoices for Bupa, Bupa Global, AXA Health and Vitality. If you don’t need to send one the easiest option is to click Edit Code, highlight the code and delete it. Click OK and then click Update.

Look up an alternative diagnosis code and click Edit Code. Type in the new code, click OK and then click Update. If the invoice still fails email the codes you used and the name of the insurer to our Coding team for advice.

Patient and Bill To tab errors

The most common reason for errors in this section are patient membership details. We’ve got access to the membership databases for Aviva, AXA Health, Bupa and Vitality and invoices are validated against these. The other insurers validate against membership number formatting criteria – click here for our handy guide.

Database errors | Aviva, AXA Health, Bupa and Vitality

1. This error relates to the policy attached to the membership number

Error details: Field = Subscriber Reference + Error = The membership number is not valid for this claim + Suggestion = Please check your patients insurance details

This means: Although the membership number has been found on the database, the policy it’s attached to isn’t a private medical insurance and can’t be used for the services you’ve billed – for example, it could be a dental policy.

Solution: Run a Membership Enquiry if this option is available or contact the patient or insurer.

2. This error relates to membership number not being found

Error details: Field = Subscriber Reference + Error = No matching membership details can be found + Suggestion = Please check your patients insurance details

This means: There’s no matching membership number on the insurer database.

Solution: Run a Membership Enquiry if you have this option or contact the patient or insurer.

3. This error relates to the patient details

Error details: Field = Subscriber Reference + Error = Patient demographics do not match registration number + Suggestion = Amend Value

This means: Although the membership number has been found on the database, the patient details don’t match. This could be the patient’s name, date of birth or the postcode.

Solution: Double-check the patient’s details, especially the date of birth, postcode and name – it’s quite common for the first name and surname to be entered the wrong way round. If everything looks right run a Membership Enquiry if this option is available or contact the patient.

Membership number formatting errors | Other insurers

This error relates to the formatting of the membership number

Error details: Field = Subscriber Reference + Error = Invalid Format + Suggestion = Amend Value

This means: The membership number has failed validation because the format doesn’t match the criteria set by the insurer.

Solution: Check the membership number against the validation formatting criteria. If everything looks right run a Membership Enquiry if you have this option or contact the patient.

Charge Line Errors

These are found in the bottom section of your invoice – outlined in green below. They pick up any problems with the charge or service items in the Charges tab.

Invoices with multiple charges can have a mixture of charge lines that pass and fail validation. To see the error and fix it you’ll need to click the red line underneath each charge that’s failed – if there are a lot of charge lines you can filter these by ticking the box next to “Failed only”.

When you make a change always remember to click the Update button on the individual charge line and then click the Update button at the top right of the invoice.

There are three types of errors in this section:

• Service Code/Charge Item details
• CCSD details
• Tariff errors

Service Code/Charge Item details

1. This error relates to the Charge Item field not being mapped.

Error details: Field = Provider Chargecode + Error = Code not Mapped + Suggestion = Map Code

This means: The service or charge isn’t mapped to one of our Industry Standard Codes (ISCs) – you’ll know this because the Charge Item box is empty.

Solution: Email the following to our Coding team:

• The Service Code and a detailed description of what this is
• The ISC number you want this mapped to (if you know what it is)

Wait for confirmation that this has been mapped – then simply click the Update button on the charge line and then click the Update button at the top right of the invoice.

2. This error relates to the Charge Item field not being valid.

Error details: Field = Provider Chargecode + Error = Code not valid for Insurer + Suggestion = Amend value

This means: The ISC listed in the Charge Item box isn’t valid for the insurer.

Solution: If the insurer is AXA Health, Aviva and Bupa you’ll have to contact them directly first as they need to contact our Coding team to validate a code. For all the other insurers codes can usually be added by us so email the following to our Coding team:

• The Service Code
• The Charge Item code
• The name of the insurer being billed

Wait for confirmation that this has been validated – then simply click the Update button on the charge line and then click the Update button at the top right of the invoice.

CCSD details

1. This error relates to the code in the CCSD field not being valid.

Error details: Field = OPCS Code + Error = Invalid Code + Suggestion = Amend value

This means: The CCSD procedure code listed in the CCSD box isn’t valid for the insurer.

Solution: You’ll need to check the insurer’s online fee schedule.

If the CCSD code is shown then it shouldn’t fail so email the following to our Coding team:

• The CCSD code
• The procedure description
• The name of the insurer being billed and the fact that you found the code on their fee schedule

If the CCSD code isn’t on the insurer’s fee schedule you’ll need to contact them directly. They will either ask us to make the code valid or advise you of another one to use. If they ask us to make the code valid, wait for confirmation that this has been done – then simply click the Update button on the charge line and then click the Update button at the top right of the invoice.

If they advise you of another code to use click the Edit button, type in the code they gave you, click the Search >> button then click Use Code >>. Click the Update button on the charge line and then click the Update button at the top right of the invoice.

2. This error relates to the code in the CCSD field being empty.

Error details: Field = OPCS Code + Error = Invalid Code + Suggestion = Amend value

This means: The CCSD procedure code is shown as “missing” in the CCSD box.

Solution: Click the Edit button, type in the description of the code (if you know it), click the Search >> button, if you used a description scroll to find the correct one, highlight it then click Use Code >>. Click the Update button on the charge line and then click the Update button at the top right of the invoice.

If the Charge Item is an ISC that doesn’t require a CCSD code but this message is still showing, it could be that you’ve previously removed a second code. Try clicking the Update button on the charge line and then clicking the Update button at the top right of the invoice. If this doesn’t work, follow the solution for the first CCSD error.

Tariff errors

Some of the insurers send us files with your contract prices that are used to validate your invoices. Depending on your third-party practice management system (PMS) the tariff file will either contain your Service Codes or our ISCs – but you don’t need to worry about this.

1. This error relates to your charge being too high

Error details: Field = Tariff + Error = Net total exceed insurer tariff for service + Suggestion = Please cancel and re-submit invoice with amended net total

This means: Your charge is more than the contract price the insurer has provided to us.

Solution: Carefully check that the price you’ve added and the units of service (UOS field) are correct. If they are, you’ll need to contact the insurer directly and ask them to send us an updated version of your contract prices. Wait until this has been done – then simply click the Update button on the charge line and then click the Update button at the top right of the invoice. If you’ve made a mistake and put in the wrong charge you need to cancel the invoice by clicking Cancel Bill at the top right of the screen, make the changes to the invoice in your PMS and resubmit it.

2. This error relates to this service having no set fee

Error details: Field = Provider ChargeCode + Error = Service code is not billable (*) + Suggestion = Contact insurer

This means: The insurer has put an exclusive validation on this service and haven’t provided us with the fee you’re able to charge.

Solution: You’ll need to contact the insurer directly to agree a price for this service as only they can make the change. If they agree your fee, wait for confirmation that the change has been put in place – then simply click the Update button on the charge line and then click the Update button at the top right of the invoice. If they don’t agree you’ll need to cancel the invoice by clicking Cancel Bill at the top right of the screen, make the changes to the invoice in your PMS (if there were more charge lines on the invoice that hadn’t failed) and resubmit it.

3. This error relates to your charge being invalid

Error details: Field = Provider ChargeCode + Error = Service code is not billable + Suggestion = Contact insurer

This means: The insurer hasn’t included this charge in your tariff file.

Solution: You’ll need to contact the insurer directly to add this charge. If they agree they’ll have to send us a new tariff file. Wait until this has been done – then simply click the Update button on the charge line and then click the Update button at the top right of the invoice. If they don’t agree you’ll need to cancel the invoice by clicking Cancel Bill at the top right of the screen, make the changes to the invoice in your PMS (if there were more charge lines on the invoice that hadn’t failed) and resubmit it.

The post VEDA | Invoice errors and how to fix them appeared first on Healthcode.

Recognition

If your PPR profile lists your profession as a surgeon, when applying for recognition with Vitality you’ll need to enter the fees you’ll be charging their members for services and procedures. You’ll need to do this within 21 days otherwise they won’t recognise you. Under the Insurer Specific tab of your profile the status for VitalityHealth will show as “Pending – Awaiting Fees”.

Fee amendments can’t be done by us, only Vitality – all guideline pricing and messages about fees are provided and maintained by them. Information about applying for recognition and the fees you can charge can be found on their website.

These fees will become your contracted rates and only Vitality can amend them. If you’re already recognised, your contracted rates should automatically be loaded, although sometimes you may still be asked to set them.

To enter your fees you’ll have access to Guideline Pricing (found in ePractice). We’ve given you simple instructions, but more detailed guidance is found here.

Add Vitality to your Pricing Matrix

• When logged in click on Accounting from the left-hand menu
• Click Guideline Pricing from the drop-down options and a new screen will open
• Click Manage Payors – a pop-out box will appear
• Click the arrow under Select Payor Type and choose Insurer from the drop-down options
• Your options will appear in the Select Payors pane
• Scroll down the list and highlight VitalityHealth
• Click the green + symbol on the right-hand side to add Vitality to the Selected Payors list (All Other and Self Pay are already there)
• Click Save
• Three columns are now visible along the top of the matrix (Self Pay, All Other and VitalityHealth)

Add your list of procedures

• Click Manage Services – a pop-out box will appear
• You must first add the generic code for “Surgeons Fee For Surgery” before adding any procedures – type “surgeon” in the box and click Search
• A pop-out box will appear – click on Surgeons Fee For Surgery to add this to the system
• Click Add Procedures/Treatments on the right of the screen – a pop-out box will appear
• Type in the CCSD code or description of the procedure you want to add
• Click in the box next to the right procedure to insert a tick – when using a description the list of options will be much longer
• Click OK
• The chosen procedure will now appear in the right-hand pane
• Continue to add more procedures now or come back to it later
• Consultation with Minor Treatment may also be listed as one of the Services – to avoid issues when saving your Procedures/Treatments under Surgeons Fee For Surgery you should remove this by clicking the red x symbol next to it
• Click Save

Add your list of services

• Click Manager Services – a pop-out box will appear
• Type the code or description in the box (e.g. consultation) and click Search
• Click in the box next to the right service to insert a tick
• Click OK
• The chosen service will now appear in the right-hand pane
• Continue to add more services now or come back to it later
• Click Save

Setting your fees

You’ll now have some procedures and/or services listed in the left-hand column. In the VitalityHealth column you’ll have to add a fee where it says Set Fee. Where it shows Add/Edit Fee you can add a fee if you provide this service but note you can only invoice for this if the service exists on Vitality’s fee schedule. Check with them if you’re unsure.

• Click Set Fee
• A message will pop up giving you a guideline range of fees typically charged by other recognised practitioners for this service – this message is provided and maintained by Vitality
• Type your fee in the Agreed Fee box – this must be the maximum you’ll charge
• If you work at multiple treatment sites there’s an option to charge different rates at each one – if this is required tick the box next to Vary Fee By Treatment Site
  • A list of where you see patients will appear in the Location pane
  • Add your fee for each one – this mustn’t be higher than your stated Agreed Fee
• If you’ve entered a fee higher than the guidelines suggested you’ll be shown a further message from Vitality and will need to change the fee you’ve entered
• Click Save
• The fee will be added to the pricing matrix – the only option to Edit Fee will be to change the fees you’ve set at various treatment sites
• Continue setting fees for your other procedure and services

Your recognition status

Your recognition status will now change to “Pending” and Vitality will process your application. Once they’ve done this the status will change again to reflect your recognition status with them.

Want more support?

Our Healthcode Academy offers a 15-minute training session (Module 1C) on setting up Guideline Pricing. More information on this can be found here.

The post The PPR | Setting your Vitality fees appeared first on Healthcode.

Online Payments | Sending an invoice – Advanced Bill

If you would prefer to use the Advanced Bill process click Create Bill either from the Patient List on the right in the Patient Details Preview when a patient has been highlighted or from the Patient Details on the right-hand side of the page.

The process is the same as billing an insurance company except that a diagnosis is not mandatory and instead of showing insurance company details, the details will be of the patient and other linked contacts that can be billed (e.g. next of kin, embassy, employer etc). It’s essential that the person being sent the bill has a valid email address and mobile number. If not, you will be prompted to add these before proceeding. Ensure that the mobile number does not have any spaces in it e.g. 07789123456.

Complete the fields, if necessary, and then click Advanced Bill and proceed as normal. 

When sending invoices to an organisation it’s best to have a named person, with a contact number and unique email address. This will allow for a smoother process.

The final step will be to click Save & Send. You can also choose to click Save as Draft or Save For Review if you wish.

The post Online Payments | Sending an invoice – Advanced Bill appeared first on Healthcode.