TES Edits
The old issues of redundant edits and staff seeing edits they have no control over is history with this workflow. Flexibility in the Preview and Instruction panes and the use of agents will improve the current workflow in TES. ETM’s detailed reporting capabilities allow volume, inventory, and productivity to be tracked. Available in GECB version 4.3+.
PPS Edits
CBO/HPA uses interfaces with the 3M PPS (Prospective Payment System) to support grouping and expected reimbursement calculations for proration. The ETM PPS Edits workflow can be used to track and follow up on edits that occur with PPS. ETM’s detailed reporting capabilities allow volume, inventory, and productivity to be tracked. Available in GECB version 6.0+.
Claim Edits
Do away with stacks of paper lists sorted by claim. Transitioning to ETM organizes the work and eliminates the ‘black holes’ of more manual processes. When users believe they resolved an edit, but it does not allow the claim to produce, ETM returns the edit for rework. ETM’s detailed reporting capabilities allow volume, inventory, and productivity to be tracked. Available in GECB version 5.3+.
Rejections
When either an 835 or a 277CA rejection posts into CBO/HPA this ETM workflow can trigger follow up Tasks. During design, clients decide how multiple rejection codes are prioritized and routed to allow flexibility in work assignment. ETM’s detailed reporting capabilities allow volume, inventory, and productivity to be tracked. Available in GECB version 5.3+.
No Activity
The no activity workflow is responsible for tracking claims that require follow up for common scenarios like late payments as well as less common scenarios like insurance take backs and unexpected scenarios. The workflow triggers follow up as quickly as is desired based upon the last claim activity. ETM’s detailed reporting capabilities allow volume, inventory, and productivity to be tracked. Available in GECB version 5.3+.
Self Pay Followup (includes Statement Edits)
ETM’s ability to categorize accounts by analyzing past activity enhances follow up by breaking out patients that have been previously been sent to collections and accounts where recent payments were made. The workflow includes the ability to assign Tasks that are currently editing as well as follow up on Budgets. ETM’s detailed reporting capabilities allow volume, inventory, and productivity to be tracked. Available in GECB version 5.3+.
Note: Functionality differs by version. Check object availability by version to see when edits, budgets, and follow-up become available for both Visit level and Account level follow-up customers.
Sequence & Dependencies
Many clients want to start the ETM implementation with their most significant pain points, which is oftentimes the insurance follow-up process. If workflows were implemented with minimal integration, the sequencing would not matter as significantly as it does in an integrated workflow. Because of integration points, you may not be able to start with your first choice of workflow. But there is a benefit is starting at less critical workflows because it allows the opportunity for client understanding and acceptance of the tool as well as allowing for an integrated product as a whole.
In CBO/HPA, the Claim Edit and Rejections workflows would need to be implemented before No Activity to account for the integration points. The grid below provides a summary of the individual workflows and their interdependencies.
| Workflow | Dependency |
|---|---|
| Hold Bills/Alerts | none |
| PPS Edits | CBO/HPA 3M PPS integration |
| Claim Edits | none |
| Rejections | CBO/HPA EDI 835 or 277CA |
| No Activity | Most effective following CE, REJ |
| Credit Balance/Refunds | CBO/HPA No Activity |
| TES Edits | none |
| Self Pay Follow-up (includes Statement Edits) | none |
| SIU Interface Edits | SIU Interfaces |
| VM Transfers | VM Application |
| Correspondence | EDM Application |