Collection Transfer / Write-off & Agency EDI Download
Last Revised 8/7/2012
Overview:
This set of programs are designed to transfer delinquent patient accounts to multiple collection agencies based on the first letter of the surname. The process requires two steps; In step one, the delinquent accounts are specified by last transaction or billing date and the number of statements received after the last transaction date.
Once an account has been qualified for collection, the balance is transferred to the daily log transaction file and stored under the date the transaction was issued. This step can be run at any time. The transaction used for collection transfer can also be issued manually through any posting program on a patient by patient basis.
Step two; which is run on a monthly or PRN basis, will create multiple EDI download files for the agencies as specified in the EDI Interface table for a given site code. The transaction for EDI are specified by a range dates that pulls the transactions from the transaction log, much like a balance report.
This step can be run multiple times, if required, in the course of transferring the files to the collection agency.
Procedure:
For each site, a table of collection EDI destination files must be specified.
At least one destination must be specified per Job Site code in order to run Step 2 as stated above.
Select Collection Upload Interface Specifications - #2 on the Collection Menu.
- At the SITE CODE prompt,, enter a site code.
Example “SJH”
- Now enter the path for the EDI files to be stored in field #1.
Example: E:\EDI\collections
- Now specify a range of surnames in Field #2
Example A-Z
- Now specify the filename for he EDI accounts
Example: NATIONWIDE.txt
Example screen:
Up to 16 different collection EDI download files can be specified.
All the files will be populated with the completion of the collection download program (STEP 2 )
Click on the green “OK” check mark or press escape to save the interface table.
Step 1: Run Collection Write-off / Transfer
Select #2 from the Collection Menu – Collection Write-off/Transfer
- Select Separate Patient Amounts / Insurance Amounts or Combined
- Enter Patient Cutoff amount: Amounts below this amount are ignored.
- Enter Insurance Cutoff Amount. ( if applicable )
- Enter transaction codes for processing
( Collection Code must be a Function 6 – Patient adjustment )
( Insurance Transfer Code must be a Transfer – Function 7 )
- Enter Statement cutoff date – Accounts with the appropriate number of statements after this date will qualify for collection. His is also referred to as the date of the last transaction. The last transaction can also be a note.
- Enter the number of statements to count after the last transaction.
Click the green “OK” check mark to start the write-off program sorting.
When completed, the program will prompt for a printer and the list of qualified accounts will be printed.
After the list is complete, the program will prompt again before performing the write-off step.
Example Report Format from Collection Transfer:
05/07/2005 Collection Transfer/Writeoff PAGE: 1
PT CUTOFF AMT: 10.00 TC INS CUTOFF AMT: 0.00
________________________________________________________________________________________________________________________________
NAME SITE ACCT # PT AMT INS AMT STMTS LAST PYM AMOUNT LAST TX DATE
________________________________________________________________________________________________________________________________
ANOTHER, PATIENT 01052005 TEST 000020 80.50 2 00/00/0000 .00 01/05/2005
TEST, PATIENT 01072005 TEST 000010 40.60 2 00/00/0000 .00 01/05/2005
================================================================================
TOTALS $121.10 $.00
-------------------------
TOTAL TRANSFERRED TO COLLECTION: $121.10
TOTAL # OF ACCOUNTS: 2
Step 2: Building the EDI collection File:
- Select #4 – Transfer Patients to EDI
- Enter Site Codes:
- Enter starting and ending dates. These are the dates the write-off / collection transfer codes were posted – Date of Entry.
- Enter the code used for collection write-off
- Verify.
Example Screen:
The EDI interface files are defined in the table for each site will be populated with the appropriate collection information from “TC” transactions that were entered for the Site codes selected and date ranges specified.
Additionally, a note will be placed on the ledger of each patient transferred, stating the date of service and collection agency placed.
Example note from ledger:
EDI to FIRSTFED on 08/07/2005 for $40.60 DOS: 01/07/2005 by SAS
Example Report format for Collection File Download:
COLTXXFER 08/07/2005 2:14:13 WORKING DATE: 08/07/2005 Page: 1
EDI COLLECTION FILE DOWNLOAD & REPORT - v8.7i
_____________________________________________
MIN DAYS=0 - CUTOFF=5 - A/R DATE: 01/01/2005-08/07/2005
TEST TEST JOB SITE
183 BLUE CARE NETWK OF MICH
--------------------------------------------------------------------------------
PATIENT CLAIM DATE INSURANCE BALANCE
--------------------------------------------------------------------------------
TEST, PATIENT 01072005 183 BLUE CARE NETWK OF M PT 40.60
000010 INS 45.00
85.60
__________
SUBTOTALS 1 PT 40.60
____________
INS 45.00
85.60
_____________
ANOTHER, PATIENT 01052005 BS BCBS MICHIGAN OR ILL PT 80.50
000020 INS 0.00
80.50
__________
--------------------------------------------------------------------------------
PATIENT CLAIM DATE INSURANCE BALANCE
--------------------------------------------------------------------------------
TOTALS 2 ALL PT 121.10
_________ ___
Example EDI File for Collection Interface:
20050807TEST 0000100000TEST, PATIENT TEST, PATIENT 123 HILL STREET CLINTON TWP. MI48038 5865551212 183 BLUE CARE NETWK OF MICH 01072005 40.60 45.00123 HILL STREET CLINTON TWP. MI48038 5865551212 379443302 09161956M379443302 TEST, PATIENT 1 08072005 0000000000
20050807TEST 0000100001TEST, PATIENT TEST, PATIENT 123 HILL STREET CLINTON TWP. MI48038 5865551212 183 BLUE CARE NETWK OF MICH 01072005 40.60 45.00123 HILL STREET CLINTON TWP. MI48038 5865551212 379443302 09161956M379443302 TEST, PATIENT 1 08072005TCBalance sent to collectio08072005Balance sent to collectio 40.60-01072005OMNI6
20050807TEST 0000100002TEST, PATIENT TEST, PATIENT 123 HILL STREET CLINTON TWP. MI48038 5865551212 183 BLUE CARE NETWK OF MICH 01072005 40.60 45.00123 HILL STREET CLINTON TWP. MI48038 5865551212 379443302 09161956M379443302 TEST, PATIENT 1 08072005TCBalance sent to collectio01072005BCBS DEDUCTIBLE 20.60 01072005OMNI7
20050807TEST 0000100003TEST, PATIENT TEST, PATIENT 123 HILL STREET CLINTON TWP. MI48038 5865551212 183 BLUE CARE NETWK OF MICH 01072005 40.60 45.00123 HILL STREET CLINTON TWP. MI48038 5865551212 379443302 09161956M379443302 TEST, PATIENT 1 08072005TCBalance sent to collectio01072005CO-INSURANCE BALANCE 20.00 01072005OMNI7
20050807TEST 0000100004TEST, PATIENT TEST, PATIENT 123 HILL STREET CLINTON TWP. MI48038 5865551212 183 BLUE CARE NETWK OF MICH 01072005 40.60 45.00123 HILL STREET CLINTON TWP. MI48038 5865551212 379443302 09161956M379443302 TEST, PATIENT 1 08072005TCBalance sent to collectio01072005W O INS BAL .00 01072005OMNI8
20050807TEST 0000100005TEST, PATIENT TEST, PATIENT 123 HILL STREET CLINTON TWP. MI48038 5865551212 183 BLUE CARE NETWK OF MICH 01072005 40.60 45.00123 HILL STREET CLINTON TWP. MI48038 5865551212 379443302 09161956M379443302 TEST, PATIENT 1 08072005TCBalance sent to collectio01072005BLUE SHIELD PAYMENT .00 01072005OMNI4
20050807TEST 0000100006TEST, PATIENT TEST, PATIENT 123 HILL STREET CLINTON TWP. MI48038 5865551212 183 BLUE CARE NETWK OF MICH 01072005 40.60 45.00123 HILL STREET CLINTON TWP. MI48038 5865551212 379443302 09161956M379443302 TEST, PATIENT 1 08072005TCBalance sent to collectio01072005DOS CHARGES .00 01072005OMNI0
20050807TEST 0000200000ANOTHER, PATIENT ANOTHER, PATIENT 123 HILL RD. HARRISON TOWNSHIP MI48045 5865551212 BS BCBS MICHIGAN OR ILLINOIS CLAIMS DI 01052005 80.50 0.00123 HILL RD. APT 100 HARRISON TOWNSHIP MI48045 5865551212 123321232 06281965FQWE123321232 ANOTHER, PATIENT 1 GMAC TRUCK & BUS 7632 PRODUCTION PONTIAC MI48013 08072005 0000000000
20050807TEST 0000200001ANOTHER, PATIENT ANOTHER, PATIENT 123 HILL RD. HARRISON TOWNSHIP MI48045 5865551212 BS BCBS MICHIGAN OR ILLINOIS CLAIMS DI 01052005 80.50 0.00123 HILL RD. APT 100 HARRISON TOWNSHIP MI48045 5865551212 123321232 06281965FQWE123321232 ANOTHER, PATIENT 1 GMAC TRUCK & BUS 7632 PRODUCTION PONTIAC MI48013 08072005TCBalance sent to collectio08072005Balance sent to collectio 80.50-01052005OMNI6
20050807TEST 0000200002ANOTHER, PATIENT ANOTHER, PATIENT 123 HILL RD. HARRISON TOWNSHIP MI48045 5865551212 BS BCBS MICHIGAN OR ILLINOIS CLAIMS DI 01052005 80.50 0.00123 HILL RD. APT 100 HARRISON TOWNSHIP MI48045 5865551212 123321232 06281965FQWE123321232 ANOTHER, PATIENT 1 GMAC TRUCK & BUS 7632 PRODUCTION PONTIAC MI48013 08072005TCBalance sent to collectio01072005SERVICE NOT A COVERED BEN 10.00 01052005OMNI7
20050807TEST 0000200003ANOTHER, PATIENT ANOTHER, PATIENT 123 HILL RD. HARRISON TOWNSHIP MI48045 5865551212 BS BCBS MICHIGAN OR ILLINOIS CLAIMS DI 01052005 80.50 0.00123 HILL RD. APT 100 HARRISON TOWNSHIP MI48045 5865551212 123321232 06281965FQWE123321232 ANOTHER, PATIENT 1 GMAC TRUCK & BUS 7632 PRODUCTION PONTIAC MI48013 08072005TCBalance sent to collectio01072005BCBS DEDUCTIBLE 20.50 01052005OMNI7
20050807TEST 0000200004ANOTHER, PATIENT ANOTHER, PATIENT 123 HILL RD. HARRISON TOWNSHIP MI48045 5865551212 BS BCBS MICHIGAN OR ILLINOIS CLAIMS DI 01052005 80.50 0.00123 HILL RD. APT 100 HARRISON TOWNSHIP MI48045 5865551212 123321232 06281965FQWE123321232 ANOTHER, PATIENT 1 GMAC TRUCK & BUS 7632 PRODUCTION PONTIAC MI48013 08072005TCBalance sent to collectio01072005W O INS BAL .00 01052005OMNI8
20050807TEST 0000200005ANOTHER, PATIENT ANOTHER, PATIENT 123 HILL RD. HARRISON TOWNSHIP MI48045 5865551212 BS BCBS MICHIGAN OR ILLINOIS CLAIMS DI 01052005 80.50 0.00123 HILL RD. APT 100 HARRISON TOWNSHIP MI48045 5865551212 123321232 06281965FQWE123321232 ANOTHER, PATIENT 1 GMAC TRUCK & BUS 7632 PRODUCTION PONTIAC MI48013 08072005TCBalance sent to collectio01072005BLUE SHIELD PAYMENT .00 01052005OMNI4
20050807TEST 0000200006ANOTHER, PATIENT ANOTHER, PATIENT 123 HILL RD. HARRISON TOWNSHIP MI48045 5865551212 BS BCBS MICHIGAN OR ILLINOIS CLAIMS DI 01052005 80.50 0.00123 HILL RD. APT 100 HARRISON TOWNSHIP MI48045 5865551212 123321232 06281965FQWE123321232 ANOTHER, PATIENT 1 GMAC TRUCK & BUS 7632 PRODUCTION PONTIAC MI48013 08072005TCBalance sent to collectio01072005DOS CHARGES 50.00 01052005OMNI0
Record Layout for Nationwide Collection EDI Files.
Per Patient Section
OUTSOURCED_DATE:C(8)
ENCOUNTER_NO:N(2) # Remarks: “00” for First Encounter, “01” Second Encounter, etc
SITE:C(4)
PATIENT_NUMBER:C(12)
PATIENT_NAME:C(25)
GUARANTOR_NAME:C(25)
GUARANTOR_ADD1:C(25)
GUARANTOR_ADD2:C(25)
GUARANTOR_CITY:C(25)
GUARANTOR_STATE:C(2)
GUARANTOR_ZIP:C(15)
GUARANTOR_TELE:C(15)
PRIMARY_INS:C(10)
PRIMARY_INS_DESC:C(35)
SECONDARY_INS:C(10)
SECONDARY_INS_DESC:C(35)
CLAIM_DATE:C(8)
PATIENT_BALANCE:C(10)
INSURANCE_BALANCE:C(10)
PATIENT_ADD1:C(25)
PATIENT_ADD2:C(25)
PATIENT_CITY:C(20)
PATIENT_STATE:C(2)
PATIENT_ZIP:C(11)
PATIENT_TELE:C(13)
PATIENT_SSN:C(10)
PATIENT_DOB:C(8)
PATIENT_SEX:C(1)
PRIMARY_CONTRCT:C(25)
PRIMARY_GROUP:C(25)
PRIMARY_SUBSCRIBER:C(25)
PRIMARY_RELATION:C(1)
SECONDARY_CONTRCT:C(25)
SECONDARY_GROUP:C(25)
SECONDARY_SUBSCRIBER:C(25)
SECONDARY_RELATION:C(1)
EMPLOYER_NAME:C(35)
EMPLOYER_ADD1:C(25)
EMPLOYER_ADD2:C(25)
EMPLOYER_CITY:C(20)
EMPLOYER_STATE:C(2)
EMPLOYER_ZIP:C(11)
EMPLOYER_TELE:C(13)
DATE_IN_COLLECTION:C(8)
LAST_TX_CODE:C(2)
LAST_TX_DESC:C(25)
Multiple records (Ledger) section – All records for the service date transferred.
TX_DATE:C(8)
TX_DESC:C(25)
TX_CODE:C(2)
TX_AMOUNT:N(10)
TX_DOS:C(8)
TX_OPID:C(4)
TX_FUNCT:C(2)