HSP E-Claiming Guide - Send / Receive Claims

HSP E-Claiming Guide - Send / Receive Claims

1.1    ­­­­HSP E-Claim Export/Import Overview 

When a file is created to send to HSP it marks the claims as 'Pending' and locks it so it can’t be changed. When HSP returns the file, and it is imported to Manage the following happens:

·     The claim status is changed to Accepted or Rejected based on the feedback from HSP

·     For Rejected claims no payment details are recorded. The “Sent” trx  # will be prefixed with "Reject".  



       For Accepted claims, the claim is marked as 'Approved' and no further edits can be made. 

·      The receive claims screen prompts the user for a method of payment.  This is used to apply the payment to the accepted claims. 

The payment date is in the file that we receive from HSP and that is the date that we use when processing the payment method supplied.  It may be in the bank tonight and will show up tomorrow. Use the same date as it appears on your statement.


  

1.2    Exporting HSP Claims in Manage

Sales > HSP Claim Options > E-Claim Options > Send Claims

The SEND CLAIMS menu option allows users to send claims to the HSP portal that have been marked READY.

Leave the 'Export Trx #' blank to create a new batch. 

Tick Ignore Claims with Future Date Items:

 

 

** Search icon - click on it to select a previous batch example if you lost the batch file  

 **The CONNECT Icon will connect you to the HSP website.

 Press CONTINUE.




The Submit box can be unchecked to remove a claim from this batch. Click CONTINUE.

At the message CREATE E-CLAIM FILE? click YES.

The filename will display or you will be prompted to save it.

Save it to the HSP e-claiming folder > Send Claims folder (create a folder on the desktop named SEND Claims and SENT Claims).

You must send it to HSP and allow it to be rejected or returned.  Log onto the HSP Website and upload the batch file from Manage.
*When you have uploaded the batch file, move the file from Send Claims to the Send Claims folder.

1.3    Receiving HSP Claims in Manage

Log onto the HSP Website and download the response file from HSP.
Save the response file to the HSP e-claiming folder > Receive Claims folder (create a folder on the desktop named Receive Claims and Received Claims).
*When the response file has been uploaded to Manage move the file from Receive Claims to the Received Claims folder.

Navigate to SALES >HSP CLAIM OPTIONS > E-CLAIM OPTIONS > RECEIVE CLAIMS allows users to receive claims from HSP. 



Navigate to File to Import > find and select the response file that is saved in the Receive Folder.

The local client refers to the machine the user is currently using and the application server is the server location where Manage data resides.

 Click Choose File and Upload


Once the claim file you wish to import is selected, select the PAYMENT METHOD you are receiving. The user must indicate the appropriate method of payment for the HSP deposit.

Click CONTINUE and answer YES at the Are You Sure prompt. A list of imported details will appear:


Click CONTINUE or PRINT.

If you receive this message, it means there are Rejected Claims


Review the resulting report carefully. Here is an example


Go back to that claim and examine the history to determine what the error may be.


Note:

·         After receiving claims, a report will print showing the processed claims as 'accepted' or 'rejected'.

·         At this stage, the HSP balance has been updated with the payments, which will display on the Payments and Deposits report, during the Daily Close, and also on the Account Inquiry.

Review the report after importing, as displayed in HSP E-Claim Inquiry.

1.4    HSP E-Claim Inquiry

Within SALES > HSP CLAIM OPTIONS > E-CLAIM OPTIONS > HSP E-CLAIM INQUIRY  the latest imported batch will display. 

The purpose of this function is to be able to:

1) reprint accept and reject reports

2) tell the status of the claims that are included in this run.

In the CLAIMS tab, double-clicking on a claim will display the status NOW.

In the TRANSACTIONS tab, information about the transactions will display as they were in that batch.

Search for & view previous batches. Note that there are two tabs, as highlighted in red, in this screen.

When you select your Export Trx# you will be given a list of all the HSP claims that were in that run and their CURRENT status.

If you then click the transactions tab you will see the accept and reject reports as they existed at the time they were received.

For example if a, claim shows as approved on the first tab this means that it is now approved. If the batch # displayed is different to the one being viewed, the Transactions tab will display that it was rejected at that time, in this batch.

Double-clicking the message in the Transactions tab will display further details and allow a reprint of the document. Use these reports, not the ones emailed.



1.5   HSP Claim Status Report

REPORTS > REPORT OPTIONS > HSP CLAIM STATUS REPORT

This report is designed to report on HSP Claims, by Status, by either a single location or on all locations within a date range

**Note that this report completely ignores Voided or Reversal Claims**

It can be printed to a pdf file or exported to Excel for further manipulation. It can be printed for all Status Codes, or for a selection.


FAQ: Why doesn’t the Accounts Receivable Balance report have the HSP Payment on it?

If an Accounts Receivable Aged Balance report is run today after the import, the accounts will display as unpaid. If run for tomorrow’s date those accounts marked as paid.

 

FAQ: What if I can’t find the batch I just created?

Go back to SEND claims and search for the batch number. Re-run it.

 

FAQ: Can I skip Batches when sending files to HSP?  No, you must upload them in order.

Batch numbers cannot be skipped. For example, if batch 2 is created and not used, and batch 3 is sent, the portal will return the error: "You are attempting to lodge a file that contains a batch sequence number that is not in the correct sequence. You will need to call HSP for information on how to resolve this issue."

Do not call HSP, either call  Auditdata support or upload the previous batch.

 

***Note about HSP generally:

•        Relocation maintenance does not require 3FAHL

New HSP patients take 2-3 days for Medicare to obtain the patient's voucher number, so there is no point sending claim on the day of assessment i.e. Claim 600 and 610, best to wait 2-3 days, otherwise it'll just get rejected.