Misys Payerpath

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Misys Payerpath Claims Processing 101Basic
User Workflow and Reporting
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IntroducingComplete Revenue Cycle Management
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Misys Payerpath Solutions Improve Reimbursement
Cycle

• Misys Payerpath provides a comprehensive set of
  technology solutions that address all steps in
  the reimbursement cycle. Our innovative,
  Internet-based solutions

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Misys Payerpath Advanced Reports! Reports!
Reports! (90 mins)

• This course is designed for the more advanced
  Misys Payerpath users. This class is looking to
  answer everyones burning question what is with
  all the reports?
• - What are payer reports and how can I view,
  print, save or delete them?
• - What is the purpose of payer reports vs. Misys
  Payerpath Management reports?
• - Are there reports that will help me track my
  claim data?
• - Where can I locate my EOB/835 files in Misys
  Payerpath
• - Code Correct/Code Check a more advanced look
  at what this does
• - Tips Tricks to using the product using
  filters

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Misys Payerpath Improves Claims Accuracy, Speeds
Payment Cycle
Claims are uploaded from PMS and submitted via
secure encrypted Internet connection to Misys
Payerpath
Feedback in minutes.
Payer reports are normalized for ease of use.
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Unique Multi-level Editing System Sets Us Apart

• Certain Medicare/CPT combinations require CLIA
• Certain CPT codes require referring provider
• Place of service required
• Bill type must be valid

• Insurance ID required
• Service date must not be before patient date of
  birth
• Service-from date must not be greater than
  current date

• Resubmission code required
• Release of information indicator required
• Admission date required with bill types and
  places of service

• Date last seen required on podiatric claims
• Physical therapy claims require UPIN of
  supervising physician
• Initial treatment date required on chiropractic
  claims

CCI LMRP edits
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• Policy updates
• Newsletter archive

• Medical necessity
• Proper modifier usage
• Diagnosis specificity
• Bundling issues

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Misys Payerpath Implementation Steps

• After contract is signed there is a five-step
  process to implement Misys Payerpath
• 1 Setup The client completes Profile form
  and payer enrollments so Payerpath can build
  client provider tables.
• 2 Go Live We recommend not sending claims 48
  hours before the live date. The sending process
  is done the same way as FastClaim. You will no
  longer receive reports in Misys Tiger, all
  reports are worked out of Payerpath.
• 3 - Live Training one-on-one guidance on how to
  work initial reports and fix claims with your own
  data.
• 4 - Carrier Report Training - 48 hours after the
  Live training, this session reviews carrier
  reports. These reports are the same reports
  received on paper from FastClaim. The benefit of
  Payerpath is all the reports are normalized
  (formatted in the same way) in plain English and
  are viewable, able to be sorted, and downloadable
  to RTF, Excel, or PDF.
• 5 Follow Up Trainings
• One week later a follow up training is done to go
  over questions
• Two week follow up as a final review

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Steps in the Misys Payerpath Workflow

• Transmit claim files as you do today.
• Reconcile to upload detail report (UDR).
• Correct edits on failed claims update PM.
• Transmit passed claims.
• Download payer reports (fast notes) 24 hour
  turnaround.
• Download payer remits (fast remit) as delivered
  by payers.

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Account Security and Permissions
This filter allows for multiple users per
practice.
Each user can be set up with their own
permissions and access to functionality as
determined by the practice manager.
Return to Mgmt Controls
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On Line, Real Time Reporting
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Steps in the Misys Payerpath Workflow

• Transmit claim files as you do today.
• Reconcile to upload detail report (UDR).
• Correct edits on failed claims update PM.
• Transmit passed claims.
• Download payer reports (fast notes) 24 hour
  turnaround.
• Download payer remits (fast remit) as delivered
  by payers.

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Report Totals Provide Audit Control
The cumulative total line serves as an initial,
primary audit control in the claims process.
Sub-totals by payer provide a quick chance to
validate that intended files uploaded correctly
and completely.
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Reconcile Claims Uploaded With Those on Your
Internal System
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Screen Report Provides Details of Uploaded Files
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Use Upload Summary Report to Identify Trends
Report provides status summary for claims that
passed/failed, along with the associated
financial impact
Report provides at-a-glance trend analysis
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Error Trend Report Opportunities For
Operational Improvement
Report provides top ten specific errors and their
frequency for given time period
Return to Mgmt Controls
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Claim List Filter Enables Efficient Workflow
Eliminates need to manually sort through claim
error reports to identify claims that need
attention.
Multiple sort criteria speed up the selection
process and refines workflow.
Return to Mgmt Controls
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Claim List Provides Flexibility to View a
Snapshot of the Claim
Work according to your own internal processes by
having flexibility to sort by any column
The claim list allows users to view different
claim statuses
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Claim List Also Allows Additional Flexibility to
View Claim History
Selecting H allows users to see the history of
the selected claim
Reviewing the history window allows convenient
access to everything that has occurred in the
life of the claim
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Steps in the Misys Payerpath Workflow

• Transmit claim files as you do today.
• Reconcile to upload detail report (UDR).
• Correct edits on failed claims update PM.
• Transmit passed claims.
• Download payer reports (fast notes) 24 hour
  turnaround.
• Download payer remits (fast remit) as delivered
  by payers.

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Claim Form Replica SimplifiesEditing Process
With the easily-recognized claim form replica,
the system is easier to learn and train
The error dialog ensures that errors are
corrected before re-submitting claim
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Claim Form HIPAA Field Help
HIPAA field help immediately available for your
reference.
Reduces support calls and increases compliance
with payer data elements.
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Codecheck / CodeCorrect

• CodeCorrect
• Online manuals with easy to use searchable
  indexes
• Codecheck
• Medicare claim code scrubbing
• CCI edits
• LMRP
• Medical necessity

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On Screen Claim Form Delivers Powerful
Functionality
Errors are highlighted in red for easy
identification
CodeCheck application identifies potential
compliance issues on Medicare claims
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System Provides Tools to Ensure Coding Compliance
Payerpath links you directly to documentation
that details compliance issues for your research
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Direct Access from Claim to Coding Guides
One click brings you to the PROPER SECTION of the
coding guides!!
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Claims Aging Analysis

• Manage the edit process
• Insure timely filing
• Maximize cash flow

Includes Failed, Passed, Withdrawn and Held Claims
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Steps in the Misys Payerpath Workflow

• Transmit claim files as you do today.
• Reconcile to upload detail report (UDR).
• Correct edits on failed claims update PM.
• Transmit passed claims.
• Download payer reports (fast notes) 24 hour
  turnaround.
• Download payer remits (fast remit) as delivered
  by payers.

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Claim List Provides Flexibility to View a
Snapshot of the Claim
Claims are transmitted at next available payer
send time and 997s reconciled.
The claim list allows users to view and select
claims to transmit.
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Billing Summary Tracks Progress of Each Claim
A key audit trail component tracks which claims
have been transferred from Payerpath to the
individual payers
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Drill Down into Specific Transmitted Claims
Use this filter to search for details about
specific claims that have been transmitted to a
payer
Assists in timely filing without the need to pour
through manual reports
Return to Mgmt Controls
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Report Delivers All Details of Transmitted Claims
The filtered report gives clear, easy-to-read,
comprehensive detail about each claim
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Steps in the Misys Payerpath Workflow

• Transmit claim files as you do today.
• Reconcile to upload detail report (UDR).
• Correct edits on failed claims update PM.
• Transmit passed claims.
• Download payer reports . (fast notes) 24 hour
  turnaround.
• Download payer remits (fast remit) as delivered
  by payers.

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Filter Your Payer Response Detail on Rejected
Claims
Within 24 hours after claims are submitted, payer
responses are available in system
Selectable report allows you to view rejects
according to your administrative flow.
Return to Mgmt Controls
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Detail on Rejected Claims Immediately Available
All fields are searchable to drill down further
into the Payer Response.
Data on all reports are normalized, with errors
in plain English.
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Steps in the Misys Payerpath Workflow

• Transmit claim files as you do today.
• Reconcile to upload detail report (UDR).
• Correct edits on failed claims update PM.
• Transmit passed claims
• Download payer reports . (fast notes) 24 hour
  turnaround.
• Download payer remits (fast remit) as delivered
  by payers.

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Electronic Remittance Advice

• Misys Payerpath provides 835 remittances for many
  payers in the same normalized format for viewing
  and autoposting.

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Filter Your Payer Response Detail on Rejected
Claims
As remits are delivered from the payers they will
be available for viewing, sorting, and
downloading.
Selectable report allows you to view remits
according to your administrative flow.
Return to Mgmt Controls
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Remittance Report Provides Important Disposition
Detail
Normalized data is available for viewing and
posting to internal systems
Patients are sub-totaled and highlighted for easy
identification
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