Issue #49
October 28, 2008
Editor: Laura J. Pugh
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Issue #49 October 28, 2008 Editor: Laura J. Pugh |
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“REJECTED!” “ERROR!” “CLAIM NOT PROCESSED!” These are a few of the responses you will receive when your claim cannot be adjudicated by the Clearinghouse or the Payor itself. CPR+ is dedicated to providing you the ability to transmit a compliant transaction. To ensure a successful transmission, CPR+ has many front end edits in place to prevent incomplete claims from being submitted. This will result in a significant reduction of Clearinghouse and Payor rejections. Unfortunately not all Payors require the same information and as a result, REJECTIONS are inevitable. Some additional steps to help ensure claim acceptance are:
Sometimes the response received on the rejection report lacks the information needed to resolve the issue with the transactions. So where do you go from there? First ask yourself where the claim is being rejected or edited. Is it CPR+, the Clearinghouse, TPA (Third Party Administrator) or the Payor?
Next, you need to clearly explain the problem to the Customer Support Rep who is assisting you. Effectively relaying the information will result in a more timely resolution.
The more information you can provide the better! Become familiar with your reports. For every claim submission, you should receive Confirmation Reports from the Clearinghouse and/or the Payor acknowledging that a successful transaction was received or, of course, listing rejections. You may receive several reports at different levels. For example, this is what you will receive for Medicare transmissions from CEDI:
Electronic transactions have many advantages, so hang in there! They improve cash flow, reduce paperwork, save time in preparation and postage, and expedite claims processing. ISP is short for “Integrated Solutions Providers”. It’s a mouthful, for sure, but the term identifies those vendors who provide leading product and service solutions to the Home Infusion and HME industries which are fully integrated with CPR+. Developed earlier this year, the ISP program formalizes the way we interact with certain companies. Currently, we have four ISP partners – B. Braun, McKesson, RemitData and S.H.P. Others are in various stages of discussion or development. For years, we’ve had customers ask us to write interfaces or develop integrations to countless products and services that other companies provide. In many cases, companies contacted us directly, soliciting us to build an interface to their product or service. In still other cases, companies have developed their own interfaces. These types of integrations take a lot of time to design, build, support and maintain. As a result, when we consider whether to build a CPR+ interface to another vendor product, we have to consider the potential value to our customers, the long-term support of the product, and whether the vendor will also commit to support the interface as well. The inclusion of a vendor in the ISP program represents that D.H.S. believes in the value of the vendor product or service to our customers and the commitment of D.H.S. and the vendor to the development and support of the interface. We work very closely with our ISP partners, assuring that the interface is well designed and provides the maximum possible benefit. This close relationship ensures that the integration is maintained as the ISP product and CPR+ continues to develop, and that the delivery of both to our customers are the result of a cooperative effort. A recent example illustrates why this is important. Six or seven years ago, we wrote an interface to a lab company. They’re a great company with a unique and awesome service. Quite a few customers use this company’s lab services and utilize the CPR+ interface to send patient data to the lab and view lab results online. Because this company is not an ISP, it has been years since we have talked to them. Last week, out of the blue, they called us because customers suddenly were unable to send patient data or receive labs. Turns out, they had moved their servers and changed the IP address and no one on their end thought about giving us a call to let us know. This is obviously not the end of the world, but people were inconvenienced and had to change some operational processes that they’d followed for years. We will obviously update CPR+ with the new URL, but it may take months (or even years) before some customers update to the version that will once again "work" correctly. As you learned if you attended our recent User Conference, we have developed sophisticated software interfaces with all of our Integrated Solutions Providers. You can confidently do business with these companies knowing that we believe their products and services offer tremendous value and that the software integrations have our full commitment and on-going support. Stay tuned for future articles on the specific features and benefits of these and other ISP partners. |
Troubleshooting / Resolving What's an "ISP" and Why Upcoming Webinars: Calling All Pumpkin Carvers & Angela's Tech Corner: 2008 User Conference CPR+ Mobile Does your clinical staff waste too much time driving to and from the office to pick up and drop off paper documentation? How many more patients per day could they see if they didn’t have to? Would patient care, inter-office communication and cash flow improve if Assessments, Visits and other clinical documentation were available in CPR+ within hours instead of days? There IS a Better Way! Attend the CPR+ Mobile Webinar CPR+ Mobile is a laptop-based, scaled down version of CPR+ that clinicians can use in the field. Patient data is easily sync'd to the laptop from any internet connection over a secure, easy-to-configure VPN. With CPR+ Mobile, your staff can view and edit a complete clinical record, including Medication Profiles, POT’s, Care Plans, Progress Notes, Custom Assessments, Visit Reports, Labs, Schedules and more. Give us an hour and we’ll show you how easy CPR+ Mobile is to use and how much more productive your field staff can be. Special Pricing for November: Receive 10% off the module price when purchasing CPR+ Mobile during the month of November. Contact Erika Salvato for more information. Calling All Pumpkin Carvers and Costume Wearers! Halloween is this Friday – do you have a pumpkin in your office you’d like to show off? What?? You don’t even have one yet! Time is short – get organized, get your pumpkin at lunch today and start planning. Carve or decorate your pumpkin – we’d love to see the best office / computer / pharmacy / HME category of pumpkins – but anything will do. In addition, does your office have any costume contests during this week? If so, please send us your pictures of those costumes that are original, crazy and just downright awesome. Click here to We’ll put a link to all of the ones that we receive in our next issue of the CPR+ Weekly Infusion. There’s not much time – Get Carving and straighten out those costumes! Let’s find out where the most creative CPR+ customers are working! Since Hotkeys Are Here’s another one you may find to be useful. When the To-Do list is open, by default you only see your own To-Do’s. If you have the permission “User Can See All To-Do’s”, while inside your To-Do list, you can press <ALT+ F8> and see all users To-Do’s, not just your own. (Go to the Main Menu > Databases (7) > Employee Data / Security Setup (8) > Select the User > Privileges > Miscellaneous.) Now isn’t that nifty?! 2008 User Conference Make Your Vote Count! Last week, Conference Participants received an email with a link to our User Conference Satisfaction Survey. We were thrilled to see responses from almost 40% of the participants within the first couple hours of receiving the email. THANKS! If you haven’t already done so, please take a few moments to complete the survey. Remember, this is your chance to pick next year’s conference location.
Care Plans User Conference November Anniversaries
You may contact us: By writing to us at: By Telephone/Fax: By Email: Website: |
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