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SPSI is excited to announce the release of the latest version of our Business Analytics Tool.  The Analytics Tool is a hierarchical based display of our client's revenue cycle.  For our Tier 3 clients who transmit claims and remittances, we are in a perfect position to provide an independent verification of their revenue cycle. The Analytics Tool, a data mining type tool, provides our clients the ability to evaluate their revenue cycle from various perspectives independent of their practice management system.   

 

Our clients can select from a list of business perspectives such as Claim Processing Results, Payors, Service Locations and Rendering Providers and compare these perspectives relationship to each other over a selected time period.

 

An example might be; Show me my Claim Volume including Rejections for each Payor at each Service Location. Or what is my Claim Dollars, per Rendering Provider, per Payor, per Service Location. 

 

The Analytics Tool is designed to assist management in evaluating business trends over a defined time period while also providing an independent 3rd Party evaluation of their revenue cycle for either internal or external negotiations.   

 

For more information on the SPSI Analytics Tool, please contact your local SPSI representative. 

Business Analytics Terminology
 

Two quick examples below  

 

SPSI is able to send claims and receive electronic remittances from all commercial payers, not just the RBHAs and ACC plans. We have supported clients in sending claims to insurance plans from Alaska to Delaware and everywhere in between. Our support team will work with any payer to get the conduits set up to allow you to submit your claims and receive your remittances electronically (if available from the payer).

Current AZ Payor List
 

SPSI is here to help. We have been in business since 1994 helping businesses just like yours successfully submit electronic claims to the appropriate payers. We are not your typical clearinghouse. We are EDI consultants with local representatives who can and will help you receive compensation for the services you provide. With SPSI, all you need is an internet connection to get started. There is no software to purchase or hardware to update. There is no minimum monthly charge to use our services, no per-user or start-up fees. Our fees are based entirely on your utilization.

 

EDI stands for Electronic Data Interchange and simply means transferring data from one computer system to another in a standard format without the need for human intervention. SPSI specializes in sending healthcare claims to the appropriate payers and delivering electronic remittances back to your organization.
 

Here is a short presentation introducing SPSI:

Presentation Slides
 

Washington Publishing Company:
http://www.wpc-edi.com/

First Pass Software:
http://www.wpc-edi.com/software-firstpass/

X12 5010 Consolidated Implementation Guides:
http://store.x12.org/store/healthcare-5010-consolidated-guides

FQHC Billing Guide (Noridian):
https://med.noridianmedicare.com/web/jea/provider-types/fqhc/fqhc-billing-guide

Availity Payer List:
https://apps.availity.com/public/apps/payer-list/#/advanced

Change Healthcare Payer List:
https://access.emdeon.com/PayerLists/
 

SPSI archives your data for audit purposes for a period of no less than seven years. Electronic remittances are available for download for four months after they are received. After that, they are archived, but can be made available as needed.

 

Each payer has a specific ID that functions as an electronic address to ensure each claim reaches the appropriate payer. SPSI’s Arizona office maintains an updated list of hundreds of different payers utilized by our clients. If you need to submit claims to a payer not currently on our list, we will help you figure out how to send in those claims and register to receive remits from that payer (if available).
 

Although SPSI specializes in electronic billing, it can be helpful to tie the segments in your claim files back to the fields on the 1500 billing form:

1500 Form

1500 Form map to 837p segments

1500 form Completion instructions

 

There are some important differences in billing the RBHA (Regional Behavioral Health Authority) and other commercial payers.

RBHA vs. Other Payers
 

Sending in claims is the easy part of electronic billing. More complicated and involved is getting set up to receive ERAs (Electronic Remittance Advice) back from the payer to close the revenue cycle. SPSI maintains an active database of all of the payers we work with including instructions to register to receive ERA files from the payer. We have years of experience working with hundreds of payers throughout the country and will support you throughout the registration process.

 

SPSI offers detailed reports and analytic data to help you close your revenue cycle and improve your revenue cycle management efficiency. The metrics offered by SPSI include: average days in A/R, outstanding balances by dollars and claim count, claim rejection rates, claim denial rates and amount billed vs. amount paid. SPSI’s local representatives are able to work with your organization to modify and improve existing practices in order to receive compensation for services rendered as soon as possible.

 

The EDI environment has a set of terminology unique to our industry.  Below, you will find some of the key terms that you will hear when working with SPSI and your Practice Management System representatives:

Common Terminology
 

We get asked this question a lot.  The attached document will give you a general sense of your revenue cycle timeline:

Claim Adjudication Timeline
 

AHCCCS Provider Types
 

Practice management systems are software systems specifically designed to generate claim files (837 files) in the appropriate format to send claims to payers. Practice management systems are costly and sometimes prohibitive for smaller practices. SPSI gives you the option of sending in batch claim files, either professional or institutional, or using our OnLine Claim Entry tool.
 

The OnLine Claim Entry tool is often utilized by smaller clients with lower claim volume and will allow you to send your billing claims electronically without the need for an expensive practice management system. SPSI’s local representatives are available to help set up the tool and train your staff on its use. We also have detailed guides available for reference to help you maximize the efficiency of the system.

 

Verifying active coverage for patients prior to rendering services is more important than ever before.  SPSI has a robust tool to verify insurance coverage for patients in regular intervals and/or according to upcoming appointments.  Our system utilizes a process we refer to as cascading to follow the trail of likely coverage in instances where the patient does not have coverage with the original designated payer.  For instance, if we do not find active coverage with the primary insurer, but the patient is over 65, we will automatically check Medicare for coverage.

SPSI also offers the ability to do individual eligibility checks in real time in the event of walk-in patients or last-minute scheduling.  One of the first, and most vital steps, in maintaining an efficient revenue cycle is verifying insurance coverage prior to providing services.  SPSI has you covered. 

 

SPSI's cost structure is 100% based on the utilization of our services. There are separate costs associated with sending in claims, receiving electronic remittances, and verifying patient eligibility. We utilize a tiered pricing structure that offers discounts for larger providers who submit a high volume of claims. Please contact SPSI's local representatives for more information.

 

SPSI is more than just a clearinghouse, we are EDI consultants. We are committed to supporting your organization throughout setup, implementation and any issues you encounter while sending claims through SPSI. Unlike many other clearinghouse organizations, we have a local presence in Arizona and staff with over 20 years of public behavioral health work experience. We offer training and support to our clients as well as online videos and a comprehensive FAQ section on our website that is updated regularly as additional information becomes available. Our local office focuses solely on Arizona providers and as such, bring unparalleled expertise to our clients.

 

SPSI does far more than the average clearinghouse. In fact, we do not think of ourselves as a clearinghouse, despite serving that function. We are EDI consultants. The difference is the support you will receive from local representatives with 20+ years of combined EDI healthcare experience. We offer training, education and ongoing support for our customers. In addition, we provide advanced statistics, offer eligibility checking and maintain a robust library of videos and resources to help your organization maximize your billing efficiency and minimize the time it takes to get paid for the services you provide.

 

HCIC:
https://www.stewardhealthchoiceaz.com/providers/claims/

CIC:
https://www.cenpaticointegratedcareaz.com/providers.html

Mercy Care RBHA:
https://www.mercycareaz.org/providers/rbha-forproviders/claims
 

Arizona Council of Human Service Providers:
http://www.azcouncil.com/

AHCCCS Health Plan Contact Information:
https://azweb.statemedicaid.us/healthplanlinksnet/hplinks.aspx

AHCCCS Acute Care Contractors:
https://www.azahcccs.gov/Resources/OversightOfHealthPlans/AdministrativeActions/acute.html
 

AZ Complete Health:
https://www.azcompletehealth.com/providers/resources/claims-payment.html

Banner UFC:
https://www.banneruhp.com/en/materials-and-services/claims

Care 1^st:
https://care1staz.com/az/providers/network_overview.asp

Molina:
https://www.molinahealthcare.com/members/az/en-us/mem/medicaid/medicaid.aspx

Mercy Care:
https://www.mercycareaz.org/providers/completecare-forproviders/claims

Health Choice AZ:
https://www.healthchoiceaz.com/

UHC/CP:
https://www.uhcprovider.com/en/health-plans-by-state/arizona-health-plans/az-comm-plan-home/az-cp-claims.html