Are you sending the majority of your claims electronically with CPR+? If not, this series - The ABC’s of Electronic Billing - should encourage you to get started. Sending an electronic claim with each Delivery or Rx is the fastest and easiest way to quickly lower your DSO. While electronic billing can be confusing, I'm here to help you every step of the way.

My name is Lauren Berlin. As the eBilling Implementation Specialist, my primary goals are to help you understand each part of payor enrollment and to assist you through the process.  I feel that if I can teach you the steps and help guide you through, then it is a much easier task. The eBilling enrollment can be tedious, but with my support at CPR+, you CAN get it successfully.

Step 1 – Enrollment

The first step to billing electronically through CPR+ involves getting enrolled with the clearinghouse, Emdeon, formerly known as WebMD.  Now, when I say, “enroll with the clearinghouse”, I simply mean that we add your company as a provider so that Emdeon is aware that you’ll be transmitting claims to your payors through them.  For you, this is a very simple step because I do most of the work for you!

All I need to enroll you with Emdeon is a completed CPR+ eBilling Enrollment Form.  This form can be found on our website or by clicking the following link: CPR+ eBilling Enrollment Form.  After completing enrollment with Emdeon, I will receive an “ITS (Internet Transaction Services) Login and Password”.  I will forward these to you via email, and I will typically log in to your system and show you where to enter your ITS login and password. I'll also explain any other items needed to complete your electronic setup.

As you probably know, CPR+ can send two types of electronic claims: Pharmacy and Medical.  Electronic pharmacy claims are for drugs and will be sent in the NCPDP v5.1 format.  Electronic medical claims can also be for drugs, as well as supplies, equipment, per diems, etc., and are sent in ANSI X12 format, also known as 837P or 4010A1.

Step 2 – Payor Agreements

The second step in the process of electronic billing is Payor Agreements.  Most government (Medicare, Medicaid, and BC/BS payor) and some commercial payors require a payor agreement before they will begin processing your electronic claims.  Now, payor agreements are NOT payor contracts!  Just because you have a contract with a payor doesn’t mean you have a valid payor agreement in place.  Likewise, just because you’ve completed a payor agreement does not mean that you are a contracted provider.

Payor agreements are simply different variations of documentation that are required by some medical payors before you can transmit to them through a clearinghouse.  At this time, I know of no payors who require payor agreements in order to transmit pharmacy claims.  Most payor agreements ask for the similar information, but because different payors create them, there is no standardized format.

The biggest thing you need to understand about payor agreements is that they can take up to 8 weeks for processing and approval!

I believe that payor agreements can be one of the most overwhelming parts of enrollment, so I always emphasize that I'm here as a resource so that you can ask questions.  I want you to get payor approval as soon as possible and having the agreement filled out properly in the beginning definitely helps that process.

During the enrollment process, I’ll review your payors and will help you determine which agreements you’ll need.  A complete list of all payor agreements can be found at the following link: Medical Payor Agreements.

To see a complete list of all the payors that you can transmit Medical claims to, click on this link: Medical Payor List.

For a complete list of payors that you can transmit Pharmacy claims to, click on this link:  Pharmacy Payor List.  In order to access the pharmacy list, please use: Login: cprplus, Password: 2689559.

You can also find helpful electronic billing links and document downloads on our website. Visit www.cprplus.com and go to the Support tab.  Once there, please click the Billing Support Team link on the left side.

With all of the information I’ve provided, I hope that you can understand the enrollment and payor agreement differences. 

To sum it up, enrollment with the clearinghouse allows you to send claims via the Internet.  However, payor agreements may need to be in place with certain payors in order to transmit claims to them successfully.  I am here to help you get through the process of electronic billing enrollment, so please don’t hesitate to contact me with any questions and/or comments.  My work schedule varies somewhat as I am currently enrolled full-time in college; however, I am available most days by phone at 877-277-4876 and my email address is lauren@cprplus.com.

Although it can be a little overwhelming, sending electronic claims is not as hard as you think it is. Start today!

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Last week, D.H.S. sent 16 employees to Phoenix for the 2008 NHIA Conference.  We were pleased to be a corporate sponsor this year, sponsoring the conference’s reimbursement sessions.  During the conference exhibit hours, we visited with hundreds of customers and quite a few new prospects.  On Monday evening, we held our annual CPR+ User Group Meeting.  Over 100 attendees enjoyed some great food and drink, and (we hope) an informative 90 minute presentation.  Co-Owner Stuart Crane began the presentation with a reminder to all customers that the annual CPR+ User Conference will be held in Columbus, Ohio this year (October 3rd-5th).  Don’t miss it!

Will Fleshman talked about our new “Plus Points” program; a new offer from D.H.S. that enables you to earn points that can be applied toward training.  Will continued with a demonstration of CPR+ Web Portal. This new product allows your patients, physicians and referral sources secure access to your CPR+ data via the Internet. With Web Portal, you can receive referrals; your patients can order refills, and much more.

John Mathis reviewed the “Chat” feature that we introduced into the Customer Support Department last fall.  With CPR+ Chat, you can get a support question answered without ever picking up the phone. Click on the blue plus sign on your CPR+ toolbar and select the “Chat Session” option.

Next, Stuart returned to the lectern to discuss the new CPR+ Backup Service (see the newsletter archives for more information) and the coming Resource Center. The Resource Center is a “Google-like” knowledge base that we are building to combine all available documentation into one, easy to use interface. The Resource Center will search on-line Help, On-Demand videos, Step-by-Step tutorials, the Weekly Infusion newsletter, User Manual and more to provide you with quick, accurate and up-to-date information about CPR+. Look for more information later in the year as this project comes to completion.

“You Deliver. We Deliver.”  That is our new marketing theme and you’ll be seeing it in flyers, advertisements and other marketing materials.  We think it accurately captures the essence of our relationship.  Everyday, CPR+ customers go above and beyond to give their patients whatever they need, whenever they need it.  Everyday, we do our best to deliver the finest software, training and support in the industry - and not just to the Infusion Industry!  Over 100 customers also use CPR+ to manage their HME business.  Derek Kennard made a presentation of our new “HME Only” version of CPR+. If your company does HME, you owe it to yourself to schedule a one hour demo today.  You will save time and money by running your entire business on one system.  With the CPR+ for HME enabled for your HME employees, they can focus more easily on HME related tasks without having to navigate functionality designed for Infusion providers.  Click here to register for the free CPR+ for HME Webinar on April 1st.

Next up, Darren Young, Director of Product Development, spent about 10 minutes discussing some of the upcoming enhancements we are currently working on for v8.1, scheduled for release in October 2008.  Customer feedback was very positive, but without a doubt, the highlight of the evening was the demonstration by Ted McGraner of the new “Line Item Financials” functionality that will be released later this year.  To thunderous applause, Ted demo’d how this new feature will allow you to have outstanding balances from the same invoice owed by multiple payors at the same time, how to move a single line item (or several) to another payor, and much more.  You can look forward to the completed version in our annual release in October.

Other highlights included the timely announcement between B. Braun and D.H.S. regarding the new CPR+ interface with the B. Braun Pinnacle TPN Compounder.  Training & Implementation Specialist Kelli Berzett staffed the B. Braun booth during the exhibit, answering questions and demonstrating the interface.  Other highlights included discussion with various home infusion companies, including interest from a Canadian company. We also had good conversations with some of our large "National Account" customers and their successful implementations of CPR+, and high interest in our McKesson Direct Ship interface.

Again, we want to thank everyone that stopped by our booth.  Look for us at upcoming trade shows around the U.S. including MedTrade Spring in Long Beach, CA, May 6th-8th and our 5th Annual CPR+ User Conference in Columbus, OH, October 3rd-5th.

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