For the general process of Bulk merging claims, please see this article on the Bulk-merge process.
This article will discuss the particular nuance for TriCare submission within CentralReach’s, Bulk-merge process.
Backstory: as you know, if you are here TriCare is a little different regarding how it requires submission for claims electronically. These differences can vary based on region as well and also via providers. If you typically submit via mytricare.com, this process in CR will make a little more sense. This is not the answer to every possible scenario, but it will definitely help with ABA claims and RBT submission in particular.
There is one main thing you will need set up prior to doing claims, and that is to input the TriCare ID number for every RBT you have registered with TriCare. The ID number is often the staff’s SSN, but it can vary. If you use NPI numbers, these are even easier, but regardless, you will need whatever number/alphanumeric TriCare has on file for your RBT before you proceed, to be input into the system, attached to their contact profile.
Once you have the TriCare ID number you will goto each individual staff an enter it under, Edit contact, Claim settings. In this section you will enter the First Name, Last Name, State, and then way at the bottom you will select the Custom identifier: ‘G2 – Provider Commercial Number’.
With that entered we are ready to generate claims.
Methodology: just like when submitting on mytricare.com, you will need to submit each staff with each client, individually, i.e. just like when you login to do an ‘xpress claim’, you select the office, then staff, then client, and then the individual codes etc. It is just like that here. You will have to generate the individual claims with the exact same methodology. If you have 2 RBTs with one client, the claims will need to be generated individually for each staff.
That said. The next steps assume you have performed any audit/scrubbing to your billing data as normal.
We will use the following data for our example.
For our claims we will need to submit 2 individual claims. 1 for Bob and Monica, and 1 for Beth and Monica. To do so, select the individual you want to start with. We will do Bob first. Select the 4 lines of data with Bob and then, Actions, Bulk-merge.
We examine this as normal. All the columns look good. The one change we need to make is to the Provider Supplier column. This is the data for box 31, signature box. We want this column of data to be the same as the Provider column. Note: remember the Provider column is the actual person who performed the appointment, and in this case, it is also the person we want to ‘sign’ the claim. In this case for the Provider Supplier column, we will click on the little trashcan icon to remove the data from that column to look like this:
Now that we have emptied that column, we will Merge/Move to inbox. Once we get there we should have 3 errors. They are being triggered by the Provider Supplier data being ’empty’.
Click on the edit pencil to open the claim in the editor. Now we can see the error are in the Provider/Supplier area by the 3.
Navigate to the Provider/Supplier section.
Now in the Last/Organization Name box, start typing in Bob’s name, when you see it in the list, select it. And it should now drop in as shown, notice the ‘TcareID’ set up as the G2 identifier at the bottom.
Almost there. On this screen we need to change the ‘ID Type’ box, to say ‘Choose’. The reason for this, is because if it says XX-NPI or something else the system will not go down to grab the G2 identifier.
Now save the claim and return to the Claim Manager Inbox. When you get there you should now generally show the claim to have 1 or 2 errors depending on your settings. This is normal, and one of the couple instances where you will submit the claims with errors from our system. The errors are due to the system looking for an NPI and not finding one. Yes, you can create settings to turn off this error and if TriCare is your only insurance we can talk about that, but in general, do not adjust your settings, you want those error catches turned on. This is what the claim will look like when submitted:
As you can see the G2 number populates in 24j, and provides the 1:1 correlation between the signature box, 31, and the line item identifier in 24j. Note: this is paper and in 31, the G2 is not visible, when you send this claim electronically there are hundreds of other fields that transmit, and one of them is that the name in 31, with the G2 identifier as well.
Notes: then go back and do the same thing for your other RBT’s. If you additionally need to add the short time stamp notes, with the claims, those go in box 19. It is accessed from the claims editor under Claims, Details.
Just as on TriCare’s system, there is a similar character limit imposed here of ~80 characters. If your note is too long you will get an “!” warning. In this case you will need to break the claim into smaller pieces.
New feature was added to get time into the claims, it is in BETA, and as we get more feed back we will pass that on as well.
In a further effort to make TriCare claims easier, our system can now add times to the claims automatically. The times pulled are from the timesheets in the system. To use this feature, just check the box during the bulk-merge process. (The screen shots here will utilize the same dates for consistency)
The timesheet times then get added on the individual lines notes section.
Note: if the time is split the multiple times will appear as well. TriCare states they will train their staff to read time here, it should be a game changer for this part of the claims process, if this works.
As you can see on paper, it adds them there as well.
Recommendations if you want to try it. Pick one or two clients and a date range to test it with.
See what happens. Let us know.
We often get asked where the time savings is with these claims, because it is still labor intensive. The savings is in not having to transcribe every line item for every claim, as well as, if you get the 835/ERA files to come back electronically, the semi-automatic reconciliation feature built into CentralReach is a game changer for the AR processing.