All AppealsPlus users rejoice! Introducing version 2.0.35, an improved version of our denial management solution. This version introduces two new features, four new improvements, and one bug fix. Let’s get right into what to expect from this deployment.
Overview of AppealsPlus 2.0.35
New Features
Denial note export for MedHost
Rule to block partial pay denials
Improvements
Payer mapping automation
Updates to McKesson/Paragon note format
Bug Fixes
User login session timeout bug
Not Da Nile, Denial
Medhost Denial Note Export
We’ve added a new format for the AppealsPlus note export that is designed to work with MedHost's existing collection note interface. The note export feature allows us to export the notes users leave on denials in AppealsPlus to your PM/HIS system so that they exist in both locations.
In addition to several generic formats, we have custom exports for:
HMS/Medhost
McKesson/Paragon
Nexgen
Meditech
If you’re interested and would like to take advantage of the AppealsPlus note exports, please let us know.
#1 Rule, Don’t Talk About Denial Club
New Rule for Invalid Denials
When determining if a payment qualifies as a denial we can evaluate a number of variables including CARC/RARC code, payer, procedure code, claim status, provider, etc.
We’ve updated these rules to also include the ability to block denials if there is any paid amount. Essentially only allowing the denial to be created if it is a zero pay.
If there are any CARC codes where you only want to see the denials if they are zero pay, let us know.
Not All ANSI That Wander are Lost
Updates to Payer Mapping
There is no guarantee that two claims sent to a payer will come back with the same identifying information on the 835. For example, if two claims are sent to UHC the 835 for one might be saying "UHC" while the other says "United Healthcare".
Payer mapping is the process that standardizes these disparate responses so that once in AppealsPlus the two claims are treated as coming from the same payer. When the 835s have a valid payerid the process is fairly simple but it's also necessary to account for cases where there is no payer id or there are multiple spellings of a payer's name (like in the above example).
Up until now, this has been a manual process we undertake every Friday. This is why payments from a new payer (or a new spelling of an existing payer) could take several days to appear in AppealsPlus. You can see how many payers were waiting to be mapped via the Admin Monitor on the home screen.
This update switches this process from a manual one that occurred once a week to an automatic one that is running constantly. This change brings with it several benefits.
An increase in consistency and a reduction in the potential for errors.
A significant reduction in the time it takes to set up a new database.
The elimination of the occasional delay it took for a new payer's denials to show up in AppealsPlus.
Despite the above benefits, there will be no visible changes to the system.
Formats! Formats! Formats!
Updates to McKessen/Paragon Note Exports
In addition to adding a new format to the note export feature, the McKesson/Paragon format has been updated so that the user who left the note will be visible. This change moved the name of the user from the "status change" section of the exported file to the "note" section of the file.
You Can Come Out of Timeout
User Login Session Timeout Bug
Under certain circumstances, if a user’s login session was timed out for inactivity once they logged back in they would be presented with an error message. This issue has been resolved.
