As part of the new claims processing system, the Receivers screen provides a way to setup records for receivers that your agency submits claims to electronically. These receiver records can than be associated with an applicable payor by using the Receiver ID field (in Master Files | Payors / Plans | Payors). If any non-Medicare receiver records are associated with multiple Submitter IDs, agencies must also ensure the correct payors and offices are associated with those corresponding records. For more information about the billing enhancements related to this screen, refer to the 17.4.1 release guide.
firstREV Revenue Cycle Management
To supplement the updated Download Claims screen, a new revenue cycle management provides agencies with more freedom to manage their entire revenue cycle. firstREV is completely optional and is available at no additional cost. For questions about the firstREV revenue cycle management interface, check out a variety of FAQs to learn about firstREV. For a complete set of instructions on preparing receiver records and enrolling in firstREV (at no additional cost), please read the Billing Enhancement Instructions topic.
Adding receiver ID records for payors used for electronic submission
Complete the following process to enter receiver ID records for each payor that is submitted to electronically:
This process is only required for non-billing clients and should not be completed if receiver ID records have already been created for your agency.
1.Navigate to Master Files | Receivers.
2.Click New to create a new receiver record.
3.Use the appropriate data to complete all of the following fields for the corresponding receiver:
●Receiver Name— Name of the receiver associated with the new record (e.g. NGS, PGBA, Medicare) and ID— ID number of the associated receiver.
Commonly Used Commercial and Medicaid Receiver IDs
●Submit Name— Name of the agency submitting claims for the associated receiver. and ID— ID number associated with the submitting agency for the record.
●Contact Name— Name of the person designated as the contact for the submitting agency.
●Contact Phone— Phone number used to contact the submitting agency. and Ext.— Extension used to reach the designated contact for the submitting agency (if applicable).
●Contact Fax— Fax number used to contact the agency.
●Contact Email— Phone number used to contact the submitting agency.
This section is notenabled until the record is saved and should not be used unless the Submitter ID (ISA06andGS02) and Receiver ID (ISA08andGS03) is known to be different.
4.Establish how the software will interact with claims associated with the receiver ID:
●Using the File Transmission drop-down menu, select which file transmission method the software will use to handle claim files for payors that are associated with this receiver ID record. Furthermore, you can click the question mark icon to view additional help text that provides details about each option.
File Transmission setting
The File Transmission drop-down field (in Master Files | Receivers) indicates how the software handles claims for payors associated with the receiver ID. Each receiver ID record can be setup with one of the following file transmission options:
●HCF Transmits: Enrolled in firstREV — Indicates that claims associated with these payors are edited using firstREV. HEALTHCAREfirst will submit completed claims for this payor from firstREV.
If this option is selected, all corresponding claims will never go to Download Claims.Claims will be completed managed using thefirstREV interface.
●HCF Transmits: Not enrolled in firstREV (Medicare only) — Indicates the payor associated with the receiver ID is Medicare and is not enrolled in firstREV (not required for Medicare payors). If this is selected and the “firstREV Claim Editor” box is checked, claims will be sent to firstREV (for editing).
oUsers will edit these claims in firstREV (if applicable) and transmit them within the EE software.
oAfter editing and successfully validating claims in firstREV, users can retrieve clean claims in the Download Claims screen by clicking . A “Send” option will then display in the Action column at the far left of the display grid.
oWhen “Send” is clicked, the software will automatically submit the clean claims to Medicare via the ABILITY tunnel using the provider’s own Submitter ID.
oFor claims that have been sent, a “Resend” option will display in the Action column at the far right of the grid. When “Resend” is clicked, the software will resend the claims to Medicare.
oAfter clean claims are sent to Medicare, a “Download” link will display in the Action column at the far left of the display grid. Users can click “Download” to manually download the 837 electronic claim file. This is optional, as agencies are not required to download the claim file.
●User Download Only — Enables the software to automatically return claim files to Download Claims so users can manually download the claim files and send them to another clearinghouse or directly to the appropriate payor.
oIf thefirstREV Claim Editorbox is checked (Refer to section below), users will be able to send claims to firstREV (for editing) and then retrieve the claims by clicking in the Download Claims screen. Clean claims retrieved from firstREV will display in Download Claims and users can click the "Download" link to download the corresponding claim files. Users can then upload the files to the appropriate vendor.
oIf the firstREV Claim Editor box is not checked, claims will not be sent to firstREV and will immediately display in Download Claims after they are submitted (in Post Batches tab). Users will not be able to edit claims with this setup.
The firstREV Claim Editor checkbox (in Master Files | Receivers) indicates that claims associated with this payor are edited using the firstREV interface. The software automatically sends corresponding claims for this payor to firstREV (after they are submitted in Accounts | Billing | Post Batches):
●This is checked by default (and cannot be edited) if “HCF Transmits: Enrolled in firstREV” is selected in the File Transmission field.
●This is not checked by default (but is editable) if “User Download Only” or “HCF Transmits: Not enrolled in firstREV (Medicare only)” is selected in the File Transmission field.
Unlike all other fields in Master Files | Receivers, users are able to edit the File Transmission and firstREV Claim Editor settings for each receiver ID record — even if it's already associated with a submitter ID record (in Master Files | Agency | Electronic Submitters).
File Transmission Scenarios
The software handles claims for each payor based on the settings established for the receiver ID record that is associated with the payor. In general, agencies can choose to manually submit claims or have HEALTHCAREfirst submit their claims. The following two charts contain details regarding the difference between an agency manually submitting claim files and HEALTHCAREfirst transmitting claims for an agency. Each chart details several scenarios regarding claim files, including the File Transmission setting associated with the scenario, if the firstREV Claim Editor box is checked, as well as related instructions.
6.Repeat steps 1-4, as necessary, for each receiver your agency uses for electronic submission of claim files.
If there is more than one submitter ID for a receiver, create a receiver ID record for each one. The example seen in the sample image shows how ABC Home Health and Hospice electronically submits to CGS for Medicare, Iowa for Medicaid, and Zirmed for Commercial.
If not already completed, this verification process should be performed after the billing enhancement transition date for your agency's jurisdiction:
1.Navigate to Master Files |Payors / Plans | Payors.
2.Select a payor that your agency submits claim files to electronically.
3.Ensure that the Send Electronic 837 Bill box is checked for the payor.
4.Verify that the correct receiver record is selected in the Receiver ID drop-down field. If there is no receiver ID selected (or the incorrect record is selected), select the correct receiver ID record that the payor is assocaited with.
5.Click Save.
6.Repeat steps 2-5 for all payors that your agency electronically submits claims to.
. A “Send” option will then display in the 
