User Manual December 2007
Contents
1. Up Transaction Codes After you have set up the transaction codes you are ready to preview the remittance file Previewing the Remittance File To preview the remittance file follow these steps 1 Go to the File menu and select Preview remittance file The Please select the remittance file window opens over the Preview remittance file window Click the down arrow to the right of the Look in field to browse to the location of your remittance file The default location of the remittance file is the practice s data folder Note If you do not use a Lytec product to send electronic claims you will probably need to change the Files of Type field from Electronic Remittance Notices to All Files 3 4 5 Highlight the remittance file and select Open You will be back in the Preview remittance file window Preview remittance file Remittance file to preview I E Cancel AUN The check date for posting payments will be At v Enter a date in The check date for posting payments will be list Click Print or Preview to print view the payments that will post from this remittance file 6 Remittance Processing 6 Review the file and make sure it is correct before you post the payments After you have reviewed the file you are ready to post the remittance file Posting the Remittance File Remittance files are named with a Julian date i e the number of the day of the year 1 through 365 the hour2. EFT and have already posted the payments how do I handle the check The check has already been applied so it is already in the system If I get a major error code how does that affect the data gt If you get a major error it means the report does not contain all the information expected and the program will not automatically post the payments You ll have to post these payments by hand when you receive the check and or EOB Chapter 2 Using Remittance Processing 9 Q What effect does changing insurance information in a billing have on how Remittance Processing works A The insurance information must be the same at the time of posting as it was at the time of filing the claim Otherwise the software cannot post accurately If insurance information changes during the billing process of a claim create a new case for the patient containing the new insurance information DO NOT ALTER THE EXISTING BILLING INFORMATION OR YOU WILL HAVE TO MATCH AND POST CLAIMS BY HAND 10 Remittance Processing Appendix A Legal Information Copyrights This Remittance Processing program and documentation O Copyright 2005 by NDCHealth Corporation All Rights Reserved Disclaimer NDCHealth makes no representations or warranties with respect to the contents of this manual and specifically disclaims any implied warranties and warranties of merchantability or fitness for any particular purpose NDCHealth reserves the right to make chang
3. If you send electronic claims with a Lytec electronic claims product refer to the user manual for instructions on setting up and sending claims The claim file that any Lytec electronic claims product generates has all of the information Remittance Processing needs to match charges and payments from the remittance file After you have begun sending electronic claims you can download the remittance files from the insurance company Skip to the Downloading Remittance Files section for information Without a Lytec Product If you do not send electronic claims with a Lytec product you can still use Remittance Processing You must however include certain information in the claim file Regardless of the claim file format you send print image file ANSI or NSF it must include a Line Item Control Number for each charge When an insurance company processes a claim file and returns the remittance file it uses the Line Item Control Number to tie a payment to the charge The claim file must include this information so the remittance file can post the correct payment to each charge Chapter 2 Using Remittance Processing 3 Lytec automatically generates the Line Item Control Number It is stored in the Claim Detail Detail ID field You cannot edit this field in Lytec but it is available to be sent with your claim file m Print Image Files If you send print image files to the insurance carrier you must include the Claim Detail Detail ID field
4. on the custom report form you use to generate the file Each insurance company individually determines where this information goes so you must contact the company to find out where to put the field on the custom form m ANSI Claims If you send ANSI claims you must include the Claim Detail Detail ID field in the REF segment 6R qualifier record m NSF Claims If you send NSF claims you must include the Claim Detail Detail ID field in the FAO record field 4 After you have begun sending electronic claims with the Claim Detail Detail ID field in the claim file you can download the remittance file from the insurance company Note If you do not use a Lytec Electronic Claims product to process claims the Remittance Tracking Information screen will not be automatically populated with the payment and adjustment information when you post remittance files You will have to enter the information manually to send the payment and adjustment information with secondary electronic claims Downloading the Remittance File With a Lytec Product How you download the remittance file depends on the insurance carrier clearinghouse to which you send There are two methods to download the remittance file To determine the method you need to use perform the following test 1 Go to the Billing menu in Lytec and select Electronic Claims 2 Inthe Find EDI Receiver window that opens select the EDI receiver for which you want to download the remit
5. on what needs to be included in your claim file to post remittance files with Remittance Processing Note After you have received approval from the insurance company it could take up to three 3 weeks before you receive your first remittance notice The Manual This manual is for Remittance Processing integrated with Lytec 2008 It includes information on set up and basic features For the most current technical information go to the Lytec Knowledge Base at www lytec com kb Technical Support Contact your local Value Added Reseller or technical support at 800 689 4550 There are two important numbers for you to have on hand when calling support You will first be asked for your Customer Number You may then be asked for your Serial Number These numbers should be recorded for easy access 2 Remittance Processing Chapter 2 Using Remittance Processing Overview After you have enrolled for remittance with your insurance company clearinghouse there are five basic steps to posting insurance payments through Remittance Processing 1 Send electronic claims to your insurance company or clearinghouse 2 Download the remittance file from the insurance company 3 Setup the transaction codes to use when posting payments and adjustments Unless you need to modify the codes you should only have to do this once Preview the remittance file 5 Post the remittance file Sending Electronic Claims With a Lytec Product
6. 7 v Chapter 2 Using Remittance Processing I 4 Check the Write off Medicare Medicaid box to write off adjustments and coinsurance amounts automatically for certain Medicare Medicaid claims See the Write Off Medicare Medicaid section on the next page for the criteria 5 The insurance company sometimes sends a zero dollar payment that completes its responsibility In the Handle Complete No Payment line items as section choose either Partial primary payments or Full primary payments to indicate how you want to apply these zero dollar payments If you entered a zero payment transaction code in Set Up Transaction Codes you can also choose Zero payment transactions as a way to apply these zero dollar payments 6 Entera date in The check date for posting payment will be list 7 Click the Post amp Print button to print a report indicating how the program will post the payments A message box appears asking if the posting report printed correctly 8 Read the report carefully If you read the report and determine it is correct click Yes 9 Ifyou read the report and see an error you have two choices You can click No and manually post all the payments Or you can click Yes and fix the posting errors in Lytec 10 If the program encounters errors while posting it will not post the transaction containing the error It searches for the next entry number and continue with the next transaction Any error encountered is noted in the su
7. Disclaimer 2 eee eiecti ei ettet ee o ree License Agreement Permitted Uses eese Prohibited Uses ss Limited ON Chapter 1 Getting Started Introduction Remittance Processing can be thought of as an electronic EOB Your insurance company generates a file for the office containing all the payment information that is seen on a paper EOB Remittance Processing uses remittance files already downloaded from your clearinghouse or insurance company to post the payments to patient accounts To post payments correctly to Lytec the claim file you send must include a Line Item Control Number for each charge When an insurance company processes a claim file and returns the remittance file it ties the Line Item Control Number to the charge s payment The claim file must include this information so the remittance file can post the correct payment to each charge Lytec automatically generates the Line Item Control Number from the billing number and the detail item number It is stored in the Claim Detail Detail ID field Once you post a remittance file the payment and adjustment information is saved for the claim This information will then populate the Remittance Tracking Information screen so the payments and adjustments are sent when you bill the secondary insurance company electronically The Remittance Tracking Information feature allows users to store and access information sent back by the prima
8. Remittance Processing User Manual December 2007 Lytec 5222 E Baseline Road Suite 101 Gilbert AZ 85234 Sales 800 735 1991 Support 800 895 6700 EDI Support 800 689 4550 Local 480 892 5120 Fax 480 892 4804 Web site www lytec com Contents CHAPTER burons 1 GETTING S TARTED ecce OO b c RR M ERR 1 Introduction iuuat tr air saa t Atalan msn 1 Electronic Remittance Sign Up eese tette 2 The Manual ERE SUS cto he dut 2 Technical Support 5 e arco Lp teet oneri lala 2 CHAPTER iie mnn 3 USING REMITTANCE PROCESSING eee ux fis ca cot esate ta E TN e a dT TE Na ean Tuet Sending Electronic Claims coincidan With a Eytec Product osse ihrer itte ar eae NE needs Without a Lytec Product Downloading the Remittance File With ai Lytec Product c uis tton een oes re a eir vessel oo Without a kytee Product tia A Mies ten e E mem Setting Up Transaction Codes Previewing the Remittance File ertet tenter pps Posting the Remittance File deae RO a eee RAH Reading the Remittance Post Report Revising Remittance Tramsactions c ccscscssssesesessseesssesesssesesessssesesesesssessssenesenessseseseeeenens 9 Frequently Asked Questions eene ene neneene nennen 9 APPENDIX A P X aseen 11 LEGAL INFORMATION 445 erecta eerte re reet art i t are repete irren 11 Copyrights utar dise ue lecum
9. and minute received using a 24 hour clock followed by a number representing the sequence in which the report was downloaded i e the first report downloaded in a day is assigned the number 1 the second report in a day is assigned the number 2 etc ending with an ERA extension For example the first file downloaded on January 1 at 8 30 AM would have the name 108031 ERA and the third file downloaded on January 1 at 11 AM would have the name 111003 ERA Note The newest file will have the highest number in any given calendar year To post the remittance file follow these steps 1 Goto the File menu and select Post remittance file The Please select the remittance file window opens over the Post remittance file window 2 Click the down arrow to the right of the Look in field to browse to the location of your remittance file The default location of the remittance file is the practice s data folder Note If you do not use a Lytec product to send electronic claims you will probably need to change the Files of Type field from Electronic Remittance Notices to All Files 3 Highlight the remittance file and click Open You will be back in the Post remittance file window Post remittance file Remittance file to post I El Whiteoff Medicare Medicaid Cancel Handle Complete No Payment line items as Efl Partial primary payments C Full primary payments The check date for posting payments will be 7
10. ce ERA 2 Tf this is the first time you have gone into the remittance program the Set Up Transaction Codes window automatically opens If it does not go to the File menu and select Set Up Transaction Codes The Set Up Transaction Codes window opens Set Up Transaction Codes Primary payment La Usi BIS Es s d y Secondary payment SIP Secondary Insurance Payment x Partial Primary payment PPIP Partial Primary Insurance Payment x Partial Secondary payment PSIP Partial Secondary Insurance Payment x Write ofk w O Write Off v Charge Back ICB Insurance Charge Back KI El Zero payment optional Not assigned Medicare Medicaid WriteDff WO Write Off v Cancel 3 You must enter a transaction code for each type of payment and write off except the zero payment To select a transaction code click the down arrow to the right of the field Chapter 2 Using Remittance Processing 5 D To use the Zero payment optional field you must first create a zero payment transaction code in the Lytec Transaction Codes window Assign Insurance Adjustment as the zero payment transaction code s type If you enter a zero payment transaction code here you can use it when posting zero dollar but complete insurance payments Click OK to save the transaction codes and exit the window If you ever need to change the transaction codes just go to the File menu and select Set
11. es or alterations on this manual without the obligation to notify anyone of the changes or alterations License Agreement NDCHealth grants to the original purchaser Purchaser a nontransferable nonexclusive license to use the accompanying software and associated documentation for the private use of Purchaser Acceptance and use of the software acknowledges Purchaser s agreement to abide by the terms of this License Agreement Permitted Uses Purchaser may 1 Use the software on a single computer unless a Professional or Client Server version was purchased If Lytec Professional or Client Server was purchased Purchaser is authorized to install Remittance Processing on all computers within one network at one location and 2 Copy the software for backup purposes to support Purchaser s use of the software Appendix A Legal Information 11 Prohibited Uses Purchaser may not 1 Distribute rent sublicense or make available to others the software documentation or any copies thereof 2 Modify translate adapt disassemble or create derivative works from the software or documentation or 3 Use the software or permit it to be used on more than one computer at any one time unless using Remittance Processing integrated with Lytec Professional or Client Server The software documentation and all manuals accompanying the software are copyrighted and all rights are reserved by NDCHealth No copyrighted material may be c
12. mmary report 11 Once the file has been posted the program changes the remittance file s extension to PST and stores it in the same folder Caution It is possible to repost a remittance file but it could result in multiple transactions If the need arises to repost a remittance file we recommend that you contact technical support at 800 689 4550 before you proceed m Automatic Medicare Medicaid Write Offs If the following conditions are met ERA will automatically write off a charge s adjustment plus the coinsurance amount 1 The primary insurance is Medicare and the secondary insurance is Medicaid 2 Medicare returns a coinsurance amount other than zero in the remittance file 3 Medicare returns a deductible amount of zero in the remittance file 4 Medicare returns an MA18 or MA07 code in the remittance file These codes indicate Medicare either forwarded the claim to the secondary or forwarded the claim to Medicaid 5 You check the Write Off Medicare Medicaid box in the Post Remittance File window 8 Remittance Processing m Late Filing Fees If the remittance file contains a late filing fee on the patient level ERA will automatically adjust the payment amount Because the insurance actually makes the entire payment and then takes back the late fee amount the program applies the fee as a charge back from the insurance If the insurance company sends a late filing fee on the provider level ERA does not handle it since
13. opied photocopied reproduced translated or reduced to any electronic medium or machine readable device without prior written consent from NDCHealth Limited Warranty NDCHealth warrants to Purchaser that the media on which the original software is recorded will be free of defects in materials and workmanship for a period of thirty 30 days from the date of purchase under normal conditions of use and service Should the media become defective within thirty 30 days of the date of purchase if proof of original purchase can be verified NDCHealth will replace the media or at its option NDCHealth may refund the original purchase price NDCHealth its software suppliers distributors and Value Added Resellers make no representations warranties or guarantees express or implied including warranties of merchantability or fitness for any use or any particular purpose with regard to the software and documentation The software and documentation are licensed to Purchaser on an As Is basis Liability of NDCHealth will be strictly limited to the purchase list price of the software in any case IN NO EVENT SHALL NDCHEALTH BE LIABLE FOR ANY DIRECT INCIDENTAL OR CONSEQUENTIAL DAMAGES INCLUDING BUT NOT LIMITED TO LOSS OF PROFITS LOSS OF BENEFITS OR LOSS OF DATA RESULTING FROM THE USE OF THIS SOFTWARE AND ARISING OUT OF ANY CLAIMED OR ACTUAL BREACH OF WARRANTY Some states do not allow the exclusion or limitation of direct incidental o
14. r consequential damages If you reside in such a state the above limitation may not apply NO OTHER REPRESENTATIONS OR WARRANTIES CONCERNING THE LICENSED PROGRAM MAY BE GIVEN EXCEPT THOSE CONTAINED HEREIN 12 Remittance Processing Appendix A Legal Information 13
15. ry insurance carrier This information may be sent in Electronic Remittance Advice ERA files or on the Explanation Of Benefits EOB When billing a secondary carrier this information may be necessary in order to get paid the correct amount Information sent back in ERA files is automatically posted to the Remittance Tracking Information screen when an ERA file is downloaded or viewed through one of Lytec s electronic claims programs If the information sent in the ERA file is incorrect you can change the information and then resend the secondary claim You can view the Remittance Tracking Information when you send the secondary claims It appears after you select the ranges for the secondary claims Be sure you have completed enrollment with the carrier before sending claim files so that you can receive remittance files Chapter 2 Getting Started 1 Electronic Remittance Sign Up Before an insurance company will generate remittance files for your practice the provider must request the service If you send electronic claims through a direct claims module contact the insurance company to enroll in electronic remittance If you send electronic claims through the clearinghouse contact your local Value Added Reseller or sales at 800 333 4747 You can use Remittance Processing even if you do not send electronic claims through a Lytec product Contact the insurance company directly to enroll in the service Also see page 3 for information
16. tance file 3 The ANSI X12 window opens for the receiver Click the Electronic Remittance button If a message appears that asks if you want to download new electronic remittance files click Yes You will use this method to download electronic remittance files 4 If that message does not appear when you click the Electronic Remittance button you will need to click the Receive Reports button in the ANSI X12 window to download remittance files 4 Remittance Processing Warning You should perform a backup on your data immediately after downloading files in case a problem occurs while posting After you have downloaded the remittance file you will normally go into Remittance Processing to preview and then post the file The first time however you must set up your transaction codes Skip to the Setting Up Transaction Codes section Without a Lytec Product If you do not send electronic claims with a Lytec electronic claims product you must contact your insurance company for information on downloading remittance files After you have downloaded the remittance file you will normally go into Remittance Processing to preview and then post the file The first time however you must set up your transaction codes Setting Up Transaction Codes To set up transaction codes follow these steps 1 Goto the Billing menu in Lytec and select Electronic Remittance Advice Note Remittance Processing is sometimes called Electronic Remittance Advi
17. the program has no information on which patient to apply it to Reading the Remittance Post Report The remittance post report shows how the remittance program will post payments in Lytec When matching up payments and charges the remittance program first looks for a matching Line Item Control Number This number identifies the billing number and billing detail item number for each charge It is sent in the claim file to the insurance company located in FA04 for NSF claims and the REF segment 6R qualifier for ANSI claims When an insurance company processes the claim file and returns the remittance file it ties the Line Item Control Number to the charge s payment If the program does not find a matching Line Item Control Number it then searches the patient s billings to match the service date and CPT code If it finds a match it will post Revising Remittance Transactions Once posted the transactions created by Remittance Processing appear the same in Lytec as if entered by hand If any modifications need to be made the transactions are handled in the same manner as any transaction entered by hand Frequently Asked Questions O IfI use Remittance Processing do I also have to use EFT Electronic Fund Transfer A No however deposit reports would be more accurate if you did use EFT because the date of issue would be entered in the program not the date you received the verification of payment O IfI receive a check instead of an
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