Objective of HIM HIM at Work A Quick Refresher Keeping HIM Enhanced – Recent Enhancements • Real-Time Editing with Epic 2015 • Empowering HIM End-Users
• Q&A
Host Interface Module (HIM) for Epic Update HIM OBJECTIVES • Utilize EHR billing system (Epic) as primary claim workflow application • Create process to capture and fix errors upfront, thus reducing host error rate
Host Interface Module (HIM) for Epic Update HIM AT WORK
Host Interface Module (HIM) for Epic Update HIM AT WORK
Host Interface Module (HIM) for Epic Update No. Of FACILITIES Per EHR Software - TOP 7 35.00% 30.65% 30.00%
25.00%
20.00%
15.00%
14.52%
13.44%
10.00%
5.91%
5.38%
4.30%
5.00%
3.23%
0.00% % of Clients Cerner
CPSI
Epic
Healthland
HMS
Meditech
Soarian
Host Interface Module (HIM) for Epic Update HOST CLEAN CLAIM RATE AMONG TOP 7 EHR SOFTWARE 100.00%
Host Interface Module (HIM) for Epic Update HIM – A QUICK REFRESHER
Host Interface Module (HIM) for Epic Update Claims Without Errors • Claims dropped into Xpeditor with no errors present will fall into an “R:
Released to Quadax” status
• Claims will auto-release to payers without manual intervention • Notification sent back to Epic indicating the claim was released clean
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Host Interface Module (HIM) for Epic Update Claims with Errors • Claims with errors will fall into Xpeditor with an “I: Interface” status • Claims will auto-archive to Xpeditor History via Communicator • Notification is sent back to Epic indicating errors fired on the claim • Corrections made within Epic and new claim dropped to Xpeditor
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Host Interface Module (HIM) for Epic Update Workflow Exceptions • Advanced Workflow or After Edit Converts can be written to workflow
exceptions within Xpeditor
• Useful for claims that cannot be fixed within Epic, contain high dollar
amounts, or have been re-processed multiple times without resolution
• Notification sent back to Epic indicating claims will be worked in
Xpeditor
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Host Interface Module (HIM) for Epic Update Host Response Files • Batch Response (HIM_BATCH_mmddyyy.txt) o Contains Interface claims with an Xpeditor related response such as released
claims, claims with pre-bill batch errors, and Xpeditor workflow exceptions
• Payer Response (HIM_PAYER_mmddyyy.txt) o Contains Interface claims with a “Payer Approved” or “Payer Rejected”
tracking record
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Host Interface Module (HIM) for Epic Update
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Pos1 Patient Account Number
Pos8 Claim Amount Paid (blank)
Pos2 Status Date (yyyyMMdd)
Pos9 Workflow Status Code
Pos3 Payer Control Number
Pos10 Error Code
Pos4 Payer Name
Pos11 Claim Information Code (blank)
Pos5 Clearinghouse Reference Number (Doc#)
Pos12 Transmitted Medium
Pos6 Clearinghouse Name (Quadax)
Pos13 Clearinghouse Sent Date (yyyyMMdd)
Pos7 Claim Total Charges
Pos14 Payer Received Date (yyyyMMdd)
Host Interface Module (HIM) for Epic Update Workflow Status Codes • Four digits in length • First digit identifies if the status is related to a payer accept/reject (8) or an Xpeditor accept/reject (9). • Workflow Status Codes and Error Categories can be modified using XpressBiller
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x000 = Clean Claim
9050 = Claim worked in Xpeditor
x100 = Registration Error
x200 = Billing Error
x250 = Medical Necessity Error
x300 = Coding Error
x400 = Unmapped Error
x500 = Eligibility Error
x600 = Pre-auth/cert Error
x700 = Missing Info Error
x800 = Non-covered Service Error
x900 = Miscellaneous Error
x910 = Timely Filing Error
x920 = Duplicate Error
x930 = Ignore Error
9950 = Print & Mail Claim
9990 = User Deleted Claim
9995 = Claim Forced to Quadax
Host Interface Module (HIM) for Epic Update Error Category Mapping
• Excel® spreadsheet displays a listing of all error codes and the
associated Error Category • Custom mappings appear in bold and italic font with the associated XpressBiller Error Category Rule number
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Host Interface Module (HIM) for Epic Update HIM – A QUICK REFRESHER
Host Interface Module (HIM) for Epic Update HIM –Real-Time Editing with Epic 2015
Host Interface Module (HIM) for Epic Update Real-Time Editing with Epic 2015 • Epic to be the one stop shop for fixing all the errors reported by Quadax Claims Management • Reduces the need to play the “waiting game” after claims are fixed and resubmitted • Reduces days in Epic Claims Management before the claim is transmitted to the payer
Host Interface Module (HIM) for Epic Update HIM — User-Controlled Settings • Ability to turn the process ON/OFF • Ability to select ‘p-tables’ for HIM • Switching HIM ON/OFF for Batch Errors, Payer Errors, or both. • Controlling ASP creation process • Custom split for response files • … More
Host Interface Module (HIM) for Epic Update HIM — User-Controlled Settings*
