Onboarding workflow

1. Flowchart of the general Onboarding Process
workflow
2. What is the Client Onboarding process?
This process prepares all groundwork necessary for successful electronic transactions from our Practice Management system. We provide end to end assistance to setup the Provider or Practice for electronic claims, electronic remits and eligibility through our partnered clearinghouse.

We provide the necessary paperwork (where additional forms are necessary) and assistance in completing the payer enrollment forms. We also do track and monitor the submitted forms and provide periodic updates regarding the status of your enrollments. We provide assistance in regeneration and refiling of agreement forms declined by the insurance.

3. What should I do to ensure all my enrollments will be processed correctly and on time?
Please always provide accurate information in the online clearinghouse setup form and/or the Practice Enrollment form. Inaccurate or insufficient information can lead to delays in the enrollment. Please carefully go through all the claims or electronic remit forms you receive from us and sign after you have confirmed the information is accurate.

The other reason forms generally get declined by the payer are when Providers or their staff are unaware of their billing setup with specific or certain payer(s) (such as the NPI, Tax ID, SSN, Legacy Provider ID/PTAN). For some payers, this information may be different from their usual billing info. Since, we rely on what is provided in the Practice Enrollment form to complete the payer agreement forms, any inaccurate information can cause delays or the form to be declined by the payer. All declined forms will have to be reworked and resubmitted. Please be on the lookout for any emails from us providing the status of the enrollment.

4. Will anyone contact me to help me with the enrollment. When and How?
Yes, our onboarding team will contact you by email and phone within 48 hrs of the clearinghouse activation or the initiation of the onboarding request by your account manager. We will initiate a welcome call and send you a welcome email as soon as we have your account in our worklist.

You will also be receiving email from our onboarding staff every 2 weeks on the status of all your enrollments – authorized, declined or in process payer enrollments. Any changes in enrollment status will also be notified immediately by the onboarding team. Please be on the lookout for emails from onboarding or support providing status of the enrollment.

Please feel free to contact our Onboarding team directly anytime for any questions or assistance to your enrollments by calling @ (510)284-2424 Option 2 or email – onboarding@practicesuite.com.

5. If I’m not using your partnered clearinghouse, would I receive any assistance on the enrollment forms?
No, unfortunately, we do not have the info or expertise to assist you with the external clearinghouse processes. You would need to contact your clearinghouse support for receiving the enrollment forms and any assistance related to its completion and processing.
6. What assistance can I expect if I do not use PracticeSuite partnered clearinghouse?
For our paid customers, we will provide all necessary assistance to setup the clearinghouse in our system for manual uploads of claims and electronic remits. There is an additional setup fee and a monthly recurring fee to add any external clearinghouse. However, external clearinghouses are not integrated with our application and auto connectivity for one click claims submission, download of electronic remits or claim status tracking is not provided.
7. How do I find the status of a submitted EDI enrollment?
You will be notified by our Onboarding team on the status of your enrollments as and when our clearinghouse receives update from the payer on the status. Payer turnaround time can vary.

If you are on the full edition of our software, you will have access to Enrollment Central to self-check the status of the enrollments. Preview of all submitted enrollment forms and their status can be viewed from this tool.

8. Is there a checklist to print for me to identify all the onboarding/enrollment processes are completed?
Yes, we share the checklist in our welcome email. You can click on the link below to access the checklist.
Checklist
9. How do I know if my account is setup for commercial claims?e
Onboarding team will notify via email when you are setup for commercial claims submission.
10. How long does it take for the commercial setup to be completed?
The commercial setup is completed within 3 working days of us receiving the completed online clearinghouse activation or the Practice Enrollment form from you.
11. Can I start sending claims as soon as my commercial setup is completed?
Yes
12. If I’m on the free version, other than the commercial enrollments, are there any other payers I can enroll with?
No.
13. If I’m on a paid edition, are there any additional enrollments to be done after my commercial is setup?
Yes. Non-par payers and most electronic remit payers require additional enrollment. The forms for submission will be provided to you by our onboarding team. You will receive forms for all the payers indicated in the Practice Enrollment form within 3 working days of the commercial claims setup.
14. How long does it take for the non-par or govt. payers to be enrolled?
Every Payer has their own processing turnaround time. Generally, this can be anywhere between 4 days to 45 days, however, some payers may take less or more. The turnaround time may be indicated on the payer form. If you have further questions on payer TAT, please feel free to contact our onboarding support.
15. Do I need to track the payer turnaround time and notify Onboarding if a response is not received?
Not necessarily, as responses are generally received before the expected turnaround time. Our Onboarding staff do also periodically monitor enrollments that have crossed the payer timeframe and contact our clearinghouse for a status. However, it would be good to keep a track of them at your end too.
16. Do any of the par or commercial payers require additional enrollment?
Yes, a few par payers may require additional enrollment for claims. However, for electronic remits, most par and non-par payers require additional paperwork to be completed.
17. How do I know what payers require enrollment?
All payers requiring enrollment will be notified via email by our Onboarding team. They will also provide completed forms for signature and submission. The instructions regarding info to complete and the submission method will be provided in the email.
18. What assistance can I expect from Onboarding team to enroll the additional payer paperwork?
We generate the payer enrollment forms for the insurances indicated in the online form or Practice Enrollment and e-mail the forms to you. We, fill out almost all sections in the payer forms (using the info we are provided in the Practice Enrollment form) and in most cases, you have to only sign and submit them. If there are any additional steps, this will be indicated in the instructions in the email or on the form.
19. Does the Onboarding team help us in credentialing or registering Providers or acquiring PTANs or Provider Ids?
Credentialing or registration of Providers at payer has to be initiated by the Provider and they need to contact the Insurance company to have this done. We have no expertise in this regard and unfortunately, cannot assist you in this process. Please contact the payer directly for registration assistance.
20. I’m not quite sure what the difference between Provider credentialing and EDI enrollment is? Does Provider registration with the payer allow me to automatically submit claims to the payer through your partnered clearinghouse?
Credentialing is the process of registering the Provider with a payer. Registered Providers can submit claims to the insurance. Registering Provider with a payer does not necessarily give you the ability to submit electronic claims to the Insurance company through our clearinghouse. EDI agreement form or online setup may have to completed for the clearinghouse to be able to submit electronic to the payer.

EDI enrollment or payer agreement is the process to setup the Provider for electronic claims or remits through our partnered clearinghouse. The Provider has to be registered and participating with the insurance to submit electronic claims or receive electronic remits.

21. What if the Provider is not registered with a particular Insurance, what should I do to submit electronic claims?
Please contact the Insurance directly for registration. Once this process is completed at the payer, you can contact us and we will provide the necessary paper work to setup the Provider for electronic claims and/or remits. For Providers that are not setup with payers, the form will be declined with the reason – ‘Provider not Setup at Payer’.
22. If my enrollment form gets declined, what is the next step?
Please carefully read the rejection message. – the reason for the rejection will be indicated in the email. Please contact our onboarding team immediately by replying to the email or call our phone support and provide the information to be updated. If you have questions on the rejections, please email or call phone support. Our onboarding representative will regenerate a new form with the corrected information and resend it to you for submission.
23. Do we have to redo the forms if the enrollment gets rejected?
Yes.
24. If the rejected forms were corrected and resubmitted, what timeline are we looking at for it to be processed/reprocessed?
The normal payer turnaround time will apply for the processing of the resubmitted forms.
25. Once a form is successfully processed, can I switch or turn off the service in the future?
Yes, you can enroll with another clearinghouse anytime in the future. To turn off the service completely, you will need to contact the insurance.
26. Should I submit my forms to the clearinghouse or directly to the payer?
It is recommended to submit the forms to the clearinghouse, as this essentially helps us to track their status and involves lesser follow-ups for you. Clearinghouses forward the form received to the payer for processing and notify us by email of their status. We can contact the clearinghouse to follow-up with the payer if there are processing delays or issues.
27. What if I submit my forms directly to the payer?
You can submit forms directly to the payer, but then, all payer notifications regarding the processing status will be sent to you. Please notify us immediately if you receive any status updates – approvals or rejections from the payer. Please be on the lookout for status emails from the payer.
28. Should I fax or mail the forms?
Most forms can be faxed. Instructions on the submission method will be provided in the form and the email.
29. Do all forms have to be faxed or mailed?
No, some forms are online too. Please refer to the instructions in the email or the form.
30. How do I know where to submit the forms?
The submission method and the destination is provided on the email.
31. Can I authorize Onboarding team to sign and submit forms on my behalf?
No. You will have to sign and submit the forms.

If a form was declined, we may be able to regenerate the form for certain payers from the original submitted info. We will notify you if no action is required for such instances.

32. Do I receive the approval email from the payer or would you receive it from the clearinghouse?
If the form was submitted to our clearinghouse, we generally will receive the approval notification or enrollment status from our clearinghouse. If you’ve submitted the form directly to the payer, you would be notified by the insurance.
33. If there is no update on the submitted forms, what do I need to do?
If you submitted to the payer directly, please contact the payer for a status. If you sent the form to our clearinghouse, please notify us and we will follow-up with the clearinghouse to track the status.
34. What do I need to do if I missed some payer names and need to enroll additional payers?
Please provide Onboarding team with the additional payer names to enroll. Onboarding team will generate the requested payer forms and send them to you.
35. How long does it take for all enrollments to be completed?
This is mostly dependent on the payer processing timelines. However, we persevere to complete all the requested enrollments provided during the enrollment initiation and close the onboarding cycle within 60 days from the start date.
36. How to find a payer or payer id in Relay Health.
Please click on the below link for help.
Help
37. How to look up claims and their status in Relay Health?
Please click on the link below for help.
Help
38. How to look up electronic remit information on Relay health.
Please click on the link below for help.
39. Can I print the claims report or remittance report from Relay Health?
Yes.
40. How can I reset my clearinghouse user password?
You can do that by clicking on the ‘Reset Password’ url on the login page.
41. If my clearinghouse access is locked, what do I do?
Please use the Reset Password url or contact our support team for assistance.
42. How can I view the clearinghouse claim status (acceptance or rejects) in the PM system?
You can view the status by going into the Submit Claims screen and running the Claim Log report.
43. Can I resubmit claims from the Clearinghouse portal?
No, all claims have to be corrected and resubmitted from the PM system.
44. If the claim were submitted successfully from the system and I receive no errors during the upload, does that mean all is well with the claim(s) and it will be processed and paid by the insurance?
No, claims can be rejected by the clearinghouse and by payer. Please run the Claim Log report under the Submit Claims to review the status of your submitted claim. The status may not appear immediately after submission and it is always best to wait for a few hours to review the report.

Please fix any rejects in the system and rebill the claims. It is imperative this process of running the status report and working the claims is followed diligently and if possible, daily to resolve any errors or claim issues and to prevent cash flow issues.

45. What happens if the claim shows as Accepted at the Clearinghouse?
The claim can still be rejected by the Payer and the final payer processing status may not be available in the PM report. It is always a good practice to periodically reconcile the submitted claims by directly logging into the clearinghouse portal and reviewing the status of the claims. You can access the clearinghouse portal from within the application in the Submit Claims Clearinghouse tab.

If you do not see any payer rejections for the claim and it shows Accepted or Acknowledged at the payer, you should receive an EoB (paper remit) or ERA (electronic remit) for the claim with either the payment info or a denial.

46. What if I have a claim that just shows as Accepted at the clearinghouse level but does not have any payer acceptance or acknowledgement status?
Please report such occurrences to Support. This could be a discrepancy in the report or due to other technical reasons. Such issues will have to be raised with our clearinghouse for further investigation.
47. How can I provide a feedback on your Client Onboarding process?
If you have a feedback or a concern with our Customer Service, please email : t1escalations@practicesuite.com. Please do include your account # and contact info in the email

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