Electronic Remittance Advice

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ELECTRONIC REMITTANCE ADVICE
ERA is a software application that retrieves remittance advices from a payer system and automatically applies payments and adjustment to the hospitals patient accounting system. This product is available for both Medseries4 and HBOC.

Creates a Remittance Advice Report.
Creates Remittance, Payment, and Adjustment batches in your Receivable System.
Creates Adjustment transaction from adjustment amount shown on Remittance Advice.
Creates Electronic Remittance Error Report indicating the error type. i.e. "Account Record Not Found" - "Bad Debt Account" - "Carrier Not Found on Account" - "Payment Code Not Found".
Creates Archive copy of Remittance Transmission.
Creates an Adjustment Discrepancy Report when adjustment posted to account at time of billing does not match adjustment amount shown on the Remittance Advice.
Ability to create an Account Note from the Remittance transaction.
Produces a report of claims which are Denied, Pending or Withdrawn.
Ability to trigger On-Demand Datamailer based on claim status.
Ability to trigger a re-bill for Secondary Carrier.

HIPAA 835

Long before HIPAA standards were established, the healthcare community was sharing paper and electronic data with standards developed just for this purpose. The NSF, UB92, HCFA and HL7 standards (and their variations) became generally accepted between healthcare providers and payers to handle the industry's enormous volume of data.

The new EDI HIPAA standard format has emerged along with Government mandates to put it into use. The HIPAA compliance law requires ten different documents to be sent and received electronically using the ANSI standards. These include patient health claims as well as eligibility, claim payments, status documents and several workers' compensation forms.

As HIPAA has progressed EDI standards were developed to assist in the free flow of information between the service providers and insurance carriers. Service providers benefit greatly by utilizing EDI and specifically the HIPAA standard when processing claims and remittances.

Human Error virtually eliminated as payment data is sent from the carrier to the service provider.
Vast amounts of time are saved since all files are processed electronically.
Historical data is collected and available for viewing and reporting.
Inexpensive and easy to implement.
Can Post electronic remittances from collection agencies and lock boxes.
Environmental: less paper, less land fill, more trees.

We are now assisting clients in posting remittances for Section 1011 Program for Federal Reimbursement of Emergency Health Services for services rendered to undocumented aliens. This represents significant savings for providers. Electronic Remittance files can be posted in seconds rather than hours or days. The set up cost for additional payers is minimal.

EDI - 835 Process

Premier Software offers full service turn key operation or we can assist you if you would like to do it yourself.

Step 1:	Contact Premier Software and let them show you how simple and inexpensive it can be. Ask for a demo of Electronic Remittance. Other products that dove tail neatly with ERA is Claims Submission, and our newest product Denial Management.
Step 2:	Contact the carrier and tell them you would like to begin processing EDI transactions with them. They will provide all the information you need and explain how the file transfers work. Generally they will post the files in a location where someone at your facility will be able to down load them to a PC or directly to a shared folder on your iSeries machine.
Step 3:	Contact your financial institution and set up EFT capability between them and your carrier. This usually takes 10-30 days to set up and test. Deposits can be viewed online with most banks. Discontinuation of the paper checks will be coordinated with the successful implementation of the EFT transfers.
Step 4:	Based on the frequency that your carrier posts the remittance files someone at your site will download your carrier files to a specified location on your iSeries machine. Usually this is done Daily.
Step 5:	Review your Remittance History or Denials if you chose the DM package.

Here is an example of how United Health Care posts their remittances. The Service Provider logs into the UHC web site and sees this screen. Once the file you wish to down load is located, click on the download link and save the file to your PC or to a shared drive on the iSeries machine. To set up UHC for your facility call the provider payment relations department. Their phone is 800-730-7682.

To set up EDI Remits with other carriers you can click on their respective logo to visit their web site. You can learn of their process and how it will work for your facility.

Payer Name	Claims	Remits	Eligibility	Claim Status	Ref/Auth
Cigna	Yes	Yes	Yes	Yes	Yes
United Healthcare	Yes	Yes	Yes	Yes	Yes
Oxford Health Plans	Yes	Yes	Yes	Yes	Yes
Connecticare	Yes	Yes	Yes	Yes	Yes
CHN of CT	Yes	Yes	Yes	Yes	Yes
LandMark Healthcare	Yes	No	No	No	No
Fidelis Care of NY	Yes	Yes	No	No	No
Fallon Community Health Plan	Yes	Yes	No	No	No
SafeGuard Dental and Vision	Yes	Yes	No	No	No
UCCI	Yes	Yes	No	No	No

In addition to saving thousands of hours and getting your payments in days instead of weeks or months there are lots of other intangible benefits to consider, such as:

If you are using a clearing house you are probably paying a fee either monthly or on a transaction basis. One of our clients with 4 facilities and about 600 beds now saves over $20,000 per month by using our software.
Admissions offices have some of the highest turnover. By reducing the redundancy and the sheer amount of work job satisfaction is increased. Less turn over means less training costs.
AR days were reduced 50% in the hospital mentioned above.
Some facilities borrow against their receivables. Because AR days are reduced the associated finance charges can be reduced or eliminated.

Premier Software makes HIPAA compliance easy and affordable. We offer the most flexible cost-effective EDI healthcare solution on the market. Do you need help mapping 837s? Are HL7 and NSF standards foreign to you? Are you looking to convert the new HIPAA transactions back into your old UB92, NSF, HL7 or HCFA format in while you work towards updating your applications programs to handle the HIPAA format? Fear not � our EDI professionals can do the mapping for you, and we offer easy to follow HIPAA transaction templates should you decide to do it yourself.