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Care+ Insurance Agency Setup & Authorization Feature guide

April Tawfeeq
Updated

 

 

Care+ Insurance Agency Setup & Authorization Feature guide

 

Admin Settings

Setting up Agencies in Admin View

Creating Job Types in Admin View

User Roles & Permissions

Utilize Authorization

Adding Authorization to Client Profile

Applying Authorization to Schedules

Creating Claims and EDI Files

Steps for any amount not being covered or reimbursed by payer

Authorization Utilization Report

 

 

 

Admin Settings

Setting up Agencies in Admin View

When working with payors like VA, LTCI, Medicare Advantage and Medicare, these payors should be set up as insurance agencies and authorized job types can be created accordingly.   These payors need to be separated from private pay billing to produce required claim files with proper bill codes.  On top of it, the authorization feature can be utilized to track services provided to clients.

Under the Job Types, select the dropdown, Insurance Agency Setting.

 

Click Add Agency and fill in the mandatory fields in the pop-up window.  Remainder details will be filled in once the agency is created.

 

 

 

 

 

 

 

 

In Insurance Agency Settings view, select the Agency was added to complete the details.

Select Edit for each section and complete the details. Once completed hit save.

 

 

 

 

                                                                       

 

 

 

 

 

 

 

Within Insurance Agency Details view, below are the sections highlighted in this document:

  • Agency Address
    • It’s highly recommended to fill out the details especially when it comes to contact email and phone number.  This will assist team members to identify contact information.
  • Invoice Print Settings
    • Some payors have certain information and format requirements. This is the area Care+ provides certain customization on the invoices.
  • Overtime Settings
    • It is important to clarify with payor if overtime is covered by its reimbursement policy.
  • Mileage Settings
    • If the payor provides different mileage re-imbursement rate, please check Override Global Mileage Settings and then enter specified bill and/or pay rates that the payor provided.

  • Authorization Settings
    • If desire to use the Authorization feature in Care+ to assist tracking authorization usage, configurations in this area need to be set-up accordingly.
      • Is Authorization mandatory? When selected, Care+ will require authorization created within client’s profile prior to claim/invoice creation.  
      • Allow schedule creation only if Authorization is valid. When selected, Authorization has to be in place prior to schedule creation.
      • Authorization Method: This will be based on if the authorization is provided by unit or visit. i.e. many Medicaid and VA personal care/Homemaker/Respite Care are authorized based on 15-minute increments and each 15-minute is considered a unit; and many assessment/consultation/RN visits are authorized as per visit.
  • EDI Settings
    • If the payor requires EDI file for claim submission, information in this section will need to be filled in to ensure Care+ generate EDI file with correct information.
  • HIPAA 1500/UBI 04 Parameter
    • Care+ supports “paper form” CMS 1500/UBI 04 output. When payor requires claims being filled out with these output, the fields in this section should be completed.

 

  • Check-in/Check-out Settings
    • Each payor might have different requirements when it comes to Check-in/out time. This setting would assist office be on track.
  • Other
    • This section provides additional configuration.
  • Mobile App Settings
    • Please ensure this setting is updated to Yes so the caregivers can check-in/out via mobile app.

 

Creating Job Types in Admin View

Once insurance agency has been created, job types for the agency can be created. For example, if the insurance agency created was TriWest – VA, HHA G0156 can be created as a job type. If the insurance agency created was Genworth, Personal Care – GW can be created as a job type.  

Job types can be added in two locations, as seen below, on the setting page, or within the Agency Details.

 

 

 

 

Select the Job type and fill in the rates and details associated with that job type.

Within Modify Job type, there is an option to define Units Per Hour.  Use previous example, Medicaid and VA authorizations with 15-minute increment (15-minute per unit), then each hour would have 4 units.  Please also confirm with payor if holiday rates can be applied on invoices and be reimbursed.

 

User Roles & Permissions

If your branch is working with a vendor ex. Paradigm and granting an account manager access to your office and review client accounts/claims, please create a profile from the Admin View > Roles tab and enable the appropriate permissions. Please note that by adding a user for your vendor, this will take a seat for your back office.

 

To create a new User select the Add User button then fill out the following fields:

 

The recommended permissions are listed below, but please review with your vendor to determine what is needed for them handle claims accordingly:

 

Reports Permissions

  • Client Invoice Summary
  • Invoice Monthly Report
  • Invoice Report
  • Invoice Summary
  • Payment by Territory
  • Payment Report
  • Receivables Aging Report

 

Accounting Permissions

  • Bill/Pay Reconciliation
  • Clients Accounts
  • Payments Reversal
  • Receive Payments

 

General Permissions

  • Insurance Agency Payers & Authorizations

 

Utilize Authorization

Adding Authorization to Client Profile

In back-office view, authorization is required to be created when “Is Authorization Mandatory?” is selected in the admin settings.  

Client Profile > Schedule > Authorization is where the authorization can be added per payor, per authorized job type per client.

 

If “Is Authorization Mandatory?” is selected but no authorization was created for the client, Care+ will provide warning message to provide the opportunity adding Authorization on the Spot.

 

 

 

 

 

Once you add authorization, you will need to authorize schedules. Select authorized schedules directly next to the add authorization button. You will fill out the authorize box and save.

 

 

 

Enough authorized units have to be entered with defined date span.  Below example illustrates a client was authorized with 28 hours per week for 4 weeks and the payor defines 15-minute as one unit (4 per hour).  Thus the unit per week would be 112 and Total Authorized Units and Units per month would be 448.

 

 

Applying Authorization to Schedules

Towards the bottom of the client authorization info, check the box of ‘schedules in authorization period’ then details of authorization and current schedules will be displayed.

When Authorization is created after schedule creation this is the place to manually apply authorization to existing visits.  Simply select the visits that don’t have Authorization number associated then click save. If there are any unauthorized schedules, please verify the Total Authorized Units, Units per Month, Units Per Week and the created visits are correct.

You can also manage Existing Authorizations by selecting Authorized Schedules, which will open a new window and then click the specific Available Authorization that you are looking to approve and/or authorize for.

 

 

Note: Please ensure that your schedule(s) have the correct times and  amount of units in the authorization, otherwise you will receive the following warning that the authorization cannot be approved since the hours exceed the units allocated in the authorization.

 

Creating Claims and EDI Files

Disclaimer:

  • If your office is working with a vendor ex. Paradigm to process claims, review the Invoicing Steps and pull any necessary reports for the vendor to file the claims.
  • If your office is working directly with payer ex. Optum/TriWest, review the Invoicing steps as well as the EDI/837 directions to upload or submit any documentation required for processing. 

 

  • Invoicing
    • Please refer to  Care+ Billing & Payroll Guide.pdf for details on invoicing in Care+ and ensure you sure selecting each VA Payer for the Billing Period
    • If your office is working with vendor such as Paradigm, the Invoice Summary by Job Report is available in the office view under the Reports tab > Invoice > Invoice Summary by Job.
      • Select the Invoice Date (enter the date(s) to reflect the invoice you generated for the claims you are submitted).
      • Filter by Payer (ex. TriWest, Optum.
      • Print the PDF and provide to the Payer.

 

  • Creating the EDI/837 File
    • After the invoice has been created, go to Accounting > Client Accounts and find the invoices for the Payers and then click the ‘Save EDI’ button

  • Review any errors and then Care+ will create the EDI file

 

  • Viewing the EDI/837 File
    • To view the EDI file go to Accounting > EDI File
    • Enter your search parameters (date span & payer)

Please contact the Products team about any additional setup for clearinghouses that you are working with, such as HHAeXchange or SanData.

 

 

Steps for any amount not being covered or reimbursed by payer

  • Manual Invoices
    • To create a manual invoice for any items that won’t be reimbursed by the VA payer go to Accounting > Create Invoice & specify the billable items for the client

 

 

Authorization Utilization Report

A great way to track if the authorized units/hours are over utilized or underutilized is to run Authorization Utilization Report.  This report provides details between authorization and schedules per client.  

This report is located under - Reports > Clients > Authorization Utilization Report

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