 | Electronic Response File Reader: Process, View, Filter, Find, Sort, Print and Export (ANSI 835) Claims Remittance Data.
[Also reads 271, 276, 834, and 820 Response Files]/span>
EMS’s Electronic Response File Reader converts and processes (ANSI 835) electronic remittance files and immediately displays the data in a grid format. The grid display is similar to paper remittance advices that are received from health insurance payers. The Reader also reads, translates, and processes NYS supplemental files!
Healthcare service providers can manage EDI responses actively: access, view, filter, sort, search, print, and export details to an Excel file or flat file (which can be imported into another application such as a database or an accounting system).
All essential remittance information is provided including Claims Status (Paid, Denied and Pended), Amounts Paid, Reason Codes and Adjustment Codes. Pended and denied claims can be reworked and resubmitted quickly to payers.
Overview
835 Claim View vs. 835 Detail View
R/A File's Summary View (main screen)
Append Remittance Files
Summary View's Elements
Add, Remove and Reposition Data Fields
Sort, Filter and Find/Search Capabilities
Display Claims Detail Information
Reports: File Summary, Payee Adjustment Details
Exporting Remittance Data to Other Applications
Solutions for Additional ANSI X-12 File Transaction Formats
Overview
The Electronic Response File Reader enables finance and accounts receivable specialists to process, view, filter, search, sort, print and export details of ANSI 835 electronic remittance advices. The relevant information contained in a remittance file is provided with additional ability to analyze, compare and act on claims’ status, reason codes, adjustment amounts, etc.
Receiving valid ANSI X12 835 claims remittance advices provides the ability to:
- Access and use remittance advices within a week of submitting (ANSI) 837 claims files with many payers
- Append multiple 835 R/A files: claims from more than one file can be opened at once and all claims can be displayed, filtered, sorted and reviewed
- Export to other applications (e.g., Excel, Access)
- Optimize revenue cycles: identify, rework and resubmit denied and pended claims within days of an original 837 claims (file) submission
EMS’s Remittance File Reader is a standalone drop-in utility application that enables providers to convert and fully utilize received electronic remittance files from any health insurer/payer.
Upon receipt of a payer’s 835 remittance advice file, the file is accessed and opened with the Remittance File Reader just as a file is accessed using any Windows application.
835 Claim View vs. 835 Detail View
835 Remittance Advice Files have valuable information at the claim level as well as the detail level, and you can manage remittance information at either level. Just choose the appropriate tab.
835 Claim Data Tab: Data on a single claim, regardless of the number of individual procedures that may constitute a given claim, are displayed in the grid. All sorting, filtering, etc. is done on a claim-basis. Claims can have a status of "Paid", "Pended", or "Denied".
835 Detail Data Tab: Data on each procedure (or line) within a claim is displayed in the grid. All sorting, filtering, etc. can be done by individual detail. Note: The status of an individual detail line is not necessarily the same as the status of the claim it belongs to. For example, a claim can have a status of "Paid", but can still have one or more procedures within the claim that were denied, or adjusted. The status of an individual detail line, therefore, is "Paid", "Not Paid", or "Negative Paid".
Remittance Advice File’s Summary View
Illustrated below, the Remittance File Reader’s main (Summary View) screen displays File Summary Information, Grid Summary Information, Payee/Payer Information and essential initial claims information.
Information on a specific claim can be obtained quickly by scrolling through the grid horizontally, vertically and/or using the Find/Search, Filter and/or Sort functions.
Append Remittance File
Multiple remittance files can be combined in the Remittance File Reader. This enables claims from more than one remittance file to be displayed, filtered/searched and exported. When a remittance file is appended, it is combined with the file(s) that are currently open.
Main Screen/Summary View’s Elements
When a remittance file is open, there are three collapsible information sections displayed at the top of the Remittance File Reader window:
First, the File Summary Information section displays important high level elements of the entire remittance advice including the total number of clients (subscribers) and submitted claims, total dollar amounts charged and paid, and counts/dollar amounts of paid, pended and denied claims. This section is expanded by default when a remittance file is opened.
Second, the Grid Summary Information section displays the same information contained in the File Summary Information section but only for the claims that are displayed in the grid. This includes any find, filter or payee selection functions that are performed on the claims. In the event that an 835 R/A file contains two or more payees, then “All Payees” or an individual payee may be selected. The grid summary may be further “drilled down” utilizing the Filter and Sort functions.
Third, the Payee/Payer Information section displays all payees in the remittance file. Selecting a payee displays the associated payer, adjustment amount, check amount, date and account information. It also performs a filter operation on the displayed claims, showing claims for only the selected payee.
Summary View Grid Display
The last section of the main screen consists of the remittance advice file’s Summary View grid display. It presents six essential elements of claims information: Subscriber ID, Subscriber Name, Date of Service, Charge Amount, Paid Amount and Claims Status (Paid/Pended/Denied). This information is displayed in a table format, similar to a spreadsheet.
Information on specific claim(s) can be accessed quickly by scrolling the grid horizontally, vertically and/or using the Find, Filter, and Sort functions.
Data that is displayed in the grid can be printed and exported for further analysis and review.
Add, Remove and Reposition Columns (Data Fields)
Users can add (activate) or remove (deactivate) any of the Summary View grid’s data field columns by selecting from a drop-down list which displays all available columns. The currently-displayed columns are indicated by checkmarks.
Users can also reposition and/or resize any of the activated data field columns.
A user's (modified) data field column arrangement (added, removed, repositioned and/or resized) is saved once the Reader application is closed. The settings are restored when the application is next run.
Sort, Filter and Find/Search Capabilities
The Sort function enables users to select any data field column in the Summary View Grid and list the column’s contents in ascending or descending order (alphabetic, numeric and/or chronological order). The grid’s data may be sorted on multiple columns, for example, sort on Subscriber ID, Date of Service, and Paid Amount.
The Filter function enables users to quickly view all claims or only focus on claims for which certain status criteria are selected (i.e., Paid, Pended or Denied). This flexibility is useful when analyzing and correcting denied claims for resubmission through the submitter’s existing Accounts Receivable system.
Selecting a payee from the Payee List also performs a filtering operation which displays claims for only the selected payee.
The Find function searches through all fields that are displayed in the Summary View grid to display claims matching the criteria entered in the Find box. The search term can be an ID number, name or portion of a name, a dollar amount or a date. Upon entering a search term, click the Find button to display the claims matching the search criteria.
The Find/Search function is not case sensitive. This function searches all columns that are currently displayed (“activated”) in the grid.
Display Claims Detail Information
The detail function enables users to examine information associated with a particular claim.
The Detail View presents all claims data, including individual service lines, claim/line adjustments and errors in an easy-to-read format. The Claim Detail can be generated for any or all claims displayed in the Summary View grid and can be viewed on-screen and printed on-demand.
File Summary Report
The File Summary Report provides an overview of remittance file contents and the payment details for all payees.
Payee Adjustment Detail Report
The Payee Adjustment Detail Report provides detailed information on the payment adjustments for a selected payee or all payees. To view a report for all payees in the currently loaded file(s), choose [All Payees] in the payee list. To view a report for a specific payee, select the desired payee.
Print Summary View Data
The Print function enables users to create print copies of the Summary View grid’s contents for further review, analysis and record-keeping.
The Print button displays a print preview of all data currently displayed in the Summary View grid. The Grid Summary Information is shown above the grid. Performing a filter or find operation before clicking Print enables a user to print only specific desired claims.
Exporting Claims Remittance Data
Users have the ability to export a converted remittance advice file to an Excel spreadsheet or a tab-delimited file which can be imported into an Access database, a SQL database or the client’s existing accounting system.
Exporting data into Excel enables users to complete any additional analysis that may be required. Tab-delimited files are the preferred method for importing data into other analytical applications or your practice management application.
Solutions for Additional ANSI X-12 File Transaction Formats
EMS has extensive experience delivering HIPAA-compliant ANSI X-12 EDI File format solutions for:
271 Health Care Eligibility, Coverage or Benefit Information
277 Health Care Claim Status Notification
820 Premium Payment for Insurance Products
837 Health Care Claim: Institutional or Professional
270 Health Care Eligibility Benefit Inquiry
276 Health Care Claims Status Request
834 Benefit Enrollment and Maintenance
Please contact EMS for more information. |
