NikoHealth News

Welcome to this week’s update from NikoHealth! We’re excited to bring you the latest features, enhancements, and improvements designed to make your experience even better. Whether it’s a new tool, an upgrade to an existing feature, or a behind-the-scenes tweak, we’ve got you covered. Read on to find out what’s new and how it can benefit you!

Whats New?

HCPCS Automated Replacement Rule

We are excited to introduce the HCPCS Automated Replacement Rule, which enables you to create payer- and plan-specific rules to automatically replace the HCPCS code on claims when the payer requires a different HCPCS than what is associated with the product.

Key Features:

• Automated HCPCS Replacement: You can now define HCPCS substitution rules for specific payers and plans, ensuring that the required HCPCS code is automatically applied when a claim is generated for that payer.
• CMS 1500 and Electronic Claims: Whether submitting paper claims or submitting electronically, the HCPCS reflected on the claim will be the replacement code as per the substitution rule. The invoice will still display the original HCPCS, while the generated claim will reflect the replacement HCPCS code.
• Situational Use Case: This functionality is especially useful for payers such as Medicaid, which may require a different HCPCS than what is billed to commercial payers. You can now easily configure the appropriate replacement rule to meet these requirements.

Vendor Status Enhancement

We’ve enhanced the Vendor Management feature by introducing a new Vendor Status option, allowing you to easily set a vendor to Inactive.

Key Features:

• Vendor Inactivation: You can now mark a vendor as Inactive, helping you better manage and track vendors who are no longer active or relevant to your business.
• Improved Vendor Management: The ability to set a vendor’s status to Inactive streamlines vendor tracking and helps prevent the use of outdated or unavailable vendors in your purchase order processes.
• Flexibility: This enhancement provides flexibility in managing your vendor base, allowing you to keep records for future reference while preventing inactive vendors from being used in purchase order transactions.

Provider Adjustment Permission

We’ve introduced a new permission, Billing Invoice Provider Adjustment Edit, to provide greater control over who can perform write-off and adjustment transactions on invoices.

Key Features:

• New Permission – Billing Invoice Provider Adjustment Edit: This permission allows you to control which users have the ability to conduct write-offs and adjustments on provider invoices.
• Granular User Access Control: You can now control user access to invoice adjustments and write-offs, ensuring that only authorized personnel are able to make changes to invoice records.
• Improved Financial Oversight: This feature enhances your ability to manage financial transactions by ensuring adjustments are made only by users with the appropriate permissions, improving accuracy and accountability.

Inventory Stock Adjustments

We’re excited to introduce the Inventory Stock Adjustments feature, which makes it easier than ever to view, reconcile, and adjust your inventory levels.

Key Features:

• Customizable Adjustment Reasons: You can now define and customize inventory adjustment reasons to better track and categorize inventory changes. This ensures clear documentation of the reasons behind any stock adjustments.
• Easily Adjust Stock Levels: With this new functionality, you can easily increase or decrease stock levels as needed, providing a straightforward process for conducting stock counts and making adjustments.
• Improved Inventory Reconciliation: This feature streamlines the inventory reconciliation process, helping you maintain accurate stock records and perform adjustments efficiently.

Electronic Medical Attachments

We’re excited to expand our Electronic Medical Attachments functionality to now include support for a growing list of commercial payers. This enhancement builds on our existing capabilities for electronic submission of medical attachments for Workers’ Compensation claims.

Key Features:

• Expanded Support for Commercial Payers: In addition to Workers’ Compensation, you can now electronically submit medical attachments for a ange of commercial payers, streamlining your claims process and reducing manual work.
• Enrollment Required: While the process for submitting electronic medical attachments remains unchanged, enrollment is required before you can access this functionality. To find out if electronic commercial attachments are beneficial for your organization or to get an updated list of supported payers, please contact your account manager.

Scheduling Enhancements

We’ve made several scheduling improvements to streamline the management of user and service location schedules. These enhancements are designed to provide greater flexibility and control over scheduling, making it easier to manage appointments and avoid conflicts.

Key Features:

• Copy Team Member Schedules for Future Dates: You can now copy a team member’s schedule to future dates, regardless of time blocks. This saves time and makes managing the scheduling availability easier.
• Create Appointments for Patient Home Delivery: You can now create an appointment for a “patient home” delivery and assign it to a team member, even if they are assigned to a service location at the same time. The system will automatically flag any scheduling conflicts related to existing appointments, ensuring you are aware of potential issues before finalizing the schedule.

Shipment Label Creation Enhancement

We’ve enhanced the Shipment Label Creation process by adding the ability to mark an address as “residential”, which may be required by certain carrier service levels when creating shipping labels.

Key Feature:

• Mark Address as Residential: You can now easily designate a shipment address as residential. This is important for carriers that have specific requirements for residential deliveries, ensuring the shipping label is accurately created according to carrier guidelines.

Hospital Discharge on Orders

We’ve introduced the ability to manually enter the hospital name and address directly on orders, even if the hospital is not listed in the available directory.

Key Features:

• Flexible Hospital Entry: You can now manually enter the hospital name and address in the order delivery information, even if the hospital is not available in the predefined directory.
• Improved Order Flexibility: This enhancement ensures that orders can be processed smoothly without needing to rely on a hospital being listed in the directory, making it easier to handle hospital discharge orders.

Customizable Footer Text for Shared Documents

We’ve added a new feature to enhance document sharing via fax or email: Footer Text on the Cover Page.

• Customizable Footer: When sharing documents, you can now add custom footer text to the cover page.
• Default Disclaimer: A default disclaimer will appear in the footer, but you have the option to modify it during the document sharing process.

Mobile App Update – New Features & Enhancements

We’re excited to announce a new update for both iOS and Android devices! This release introduces several new features and improvements aimed at enhancing your experience with the mobile app:

What’s New:

• Appointment Scheduling: You can now schedule appointments directly from the app for added convenience.
• Patient Record Details: View detailed patient records and documents, making it easier to access essential information on the go.
• Updated Order Design: A redesigned order layout that improves functionality and user experience.
• Order-Related Information: Easily access order details associated with appointments, including prescription information and documents attached to an order.

We’re committed to making your app experience even better with these new updates. Make sure to download the latest version and enjoy these new features!

Ongoing System Performance Improvements, Bug Fixes, and Optimizations

We’ve made continuous improvements to the system’s performance, including bug fixes and optimizations to enhance the overall user experience.

Welcome to this week’s update from NikoHealth! We’re excited to bring you the latest features, enhancements, and improvements designed to make your experience even better. Whether it’s a new tool, an upgrade to an existing feature, or a behind-the-scenes tweak, we’ve got you covered. Read on to find out what’s new and how it can benefit you!

What’s New? 

Batch EDI 837 Download
This new feature enables you to batch download 837 EDI claim files for claims that aren’t electronically submitted via NikoHealth.

Key Features:

• Claim Submission Options: When submitting claims that are not configured for electronic transmission in batch, you will be prompted to select either a CMS1500 or an EDI file for generation.
• External Systems: This functionality is particularly useful for users working with 837 claim submission files in external systems outside of NikoHealth.

Tasking Visibility on Patient and Invoice Queue
We’ve enhanced tasking functionality by expanding it from the Orders Queue to the Patient and Invoice Queues.

Key Features:

• Task Visibility: You can now view any open tasks directly within the Patient and Invoice Queues.
• Quick Task Creation: Easily create new tasks without navigating away from the queues, streamlining workflow and improving task management.

Multi-Piece Shipment Label
We’ve introduced the ability to create multi-piece shipment labels, making it easier to manage orders with multiple packages.

Key Features:

• Multiple Labels from One Order: If your order contains more than one package, you can now generate separate shipping labels for each package directly from the same order.
• Cost Savings: Shipments with multiple parcels sent to the same destination can be grouped together into a single multi-piece shipment, helping you save on shipping costs.

This feature simplifies the shipping process, improves efficiency, and offers potential cost savings when handling multi-package orders.

New Order Status: “Ready to Fulfil”
We’ve introduced a new order status, “Ready to Fulfil”, to help streamline order processing.

Key Features:

• New Status for Enhanced Workflow: The “Ready to Fulfil” status can be used to indicate when an order is prepared for the next step, such as shipping, delivery, or dispensing.
• Flexible Use Cases: This status can be customized for a variety of business needs, providing greater clarity in managing orders at different stages of fulfillment.

This update helps you better track and manage orders as they progress through the fulfillment process.

Discontinue Products
We’ve updated the functionality for managing discontinued products in your catalog. Discontinued items can no longer be added to orders. Once an item is marked as discontinued, it will no longer appear as an option when creating either sales or purchase orders.

Key Features:

• Physical Inventory Display: Discontinued items will only appear during the order process if they are still in stock and available in an inventory location.
• This update ensures that discontinued products are no longer inadvertently selected during order creation, improving accuracy and efficiency in the ordering process.

Ongoing System Performance Improvements, Bug Fixes, and Optimizations

We’ve made continuous improvements to the system’s performance, including bug fixes and optimizations. These updates enhance the overall user experience by ensuring smoother functionality, faster processing, and greater reliability across the platform.

We’re excited to share the latest updates with you! In this release, we’ve introduced new features and made several improvements to enhance your experience. Check out the highlights below to learn about the latest enhancements designed to improve functionality, efficiency, and ease of use.

What’s New?

Transmission of Universal Product Number (UPN) on Claims

We have introduced functionality to transmit the Universal Product Number (UPN) on claims, providing enhanced support for identifying specific products when required by the payer. The UPN is a unique identifier that specifies the exact item on the claim.

Key Features:

• Service Line Support: The UPN can now be added to the service line of an invoice in the DRUG/MEDICAL Supplies Information Field.
• Situational: To ensure compatibility with payer requirements, you can select the appropriate qualifier and enter the UPN identifier as needed.
• Payer Compliance: This update ensures you can meet payer-specific requirements when submitting claims that involve products requiring a UPN.

This enhancement helps streamline claim submissions and ensures that claims are accurately processed.

Enhanced Custom Field Import

We’ve enhanced the custom field import functionality to provide more control over the data in your records. When importing custom field values, if a custom field value in the import file is empty, the corresponding data in the record will be deleted within the application—if data for that custom field was previously available.

Key Enhancements:

• Data Deletion for Empty Custom Fields: If a custom field value in the import file is empty, the system will remove the existing value for that field in the record.
• Improved Data Management: This update ensures that custom field values are accurately maintained and cleared when necessary, improving data consistency.

Redesigned Management Navigation

We are excited to announce a complete redesign of the management navigation section within the application. The updated design aims to improve user experience, streamline navigation, and make it easier to access key features.

Key Updates:

• Improved Layout: A more intuitive and organized layout to help you find and access tools quickly.
• Enhanced Usability: Simplified menu structure with search functionality for smoother navigation and faster workflows.

Improved Inventory Transfer Functionality

We are pleased to introduce enhanced functionality for inventory transfers. The updated feature now provides visibility into Quantity on Hand during the inventory transfer process. This improvement ensures that users can view the available stock levels of inventory when performing transfers, reducing errors and improving inventory management.

Key Enhancements:

• Visibility of Available Stock: Users can now see the Quantity on Hand while transferring inventory, allowing them to make informed decisions based on current stock levels.
• Improved Accuracy: This enhancement helps ensure accurate inventory transfers by providing real-time visibility into available quantities.
• Enhanced User Experience: The updated functionality streamlines the transfer process and makes it easier for users to track and manage inventory levels.

Service Span Date for Prior Eligibility Verification 

We’ve enhanced the process for verifying prior insurance eligibility on patient records. You can now specify a service date range in the eligibility request (270). This enhancement allows you to request coverage details and additional information specific to the service dates provided.

Key Benefits:

• Service Date Span: You can now include a range of service dates when submitting the eligibility request.
• Enhanced Payer Response: The payer’s response will include coverage information and relevant details specific to the indicated service dates.

This improvement streamlines the eligibility verification process and ensures more accurate and date-specific coverage information.

ERA Transaction Report

We are excited to introduce the Electronic Remittance Advice (ERA) Transaction Report, which provides detailed information on ERAs processed and received within the system. This report helps you track remittance transactions efficiently, ensuring better visibility into transaction details.

Key Features:

• Enhanced Reporting: Easily access data on ERAs that have been processed and received.
• Streamlined Tracking: Quickly identify and resolve discrepancies by reviewing ERA transaction history in one place.

API Endpoint for Task Document Downloads

We’ve introduced a new API endpoint that allows you to download documents attached to a task. You can now retrieve these documents using the following endpoint:

GET /v1/tasks/{id}/documents/{documentId}/download

This provides a convenient way to access and download task-related documents programmatically

Document Management APIs

We are excited to introduce a new set of APIs designed to streamline document management and offer greater control over document-related actions. These APIs are intended solely for the document management functionality and should not be used for interacting with documents stored in patient records.

Below is an overview of the newly available endpoints:

1. DELETE /v1/document-management/{id}

• Description: Delete a document by its ID.
• Use case: Delete documents from the system using the document’s unique identifier.

2. GET /v1/document-management/{id}

• Description: Retrieve detailed information about a document by its ID, including file name, notes, and tags.
• Use case: Return information associated with a specific document.

3. PUT /v1/document-management/{id}

• Description: Update the document’s note, tags, and file name by document ID.
• Use case: Modify an existing document including adding a tag, note or file name.

4. GET /v1/document-management

• Description: Retrieve a paginated list of all documents.
• Use case: List documents with pagination support for easier browsing and filtering of documents.

5. GET /v1/document-management/{id}/download

• Description: Download a single document file by its ID.
• Use case: Directly download a specific document file programmatically.

6. POST /v1/document-management/upload

• Description: Upload a file to the system and receive a document ID in return.
• Use case: Facilitate the uploading of new documents and obtain a reference ID for future interactions.

Webhook Event Notification for Patient Document Changes

We are excited to introduce a new webhook event notification feature that allows you to receive real-time updates when patient documents are created, updated, or deleted. This feature enables seamless integration and ensures that your system stays synchronized with changes to patient documents.

Key Features:

• Event Notifications: Receive notifications for the following document events:
  • Create: A new patient document is added.
  • Update: An existing patient document properties is modified.
  • Delete: A patient document is deleted.
• Real-Time Updates: Stay informed about changes as they happen, with immediate webhook notifications sent to your system.
• Easy Integration: Easily integrate the webhook notifications into your existing systems to track and respond to changes in patient documents efficiently.

Webhook Event Notification for Task Changes

We are pleased to introduce a new webhook event notification feature that provides real-time updates when tasks are created, updated, or deleted. This feature enhances task management by keeping your system synchronized with changes to task data.

Key Features:

• Event Notifications: Receive notifications for the following task events:
  • Create: A new task is created.
  • Update: An existing task is updated.
  • Delete: A task is deleted.
• Real-Time Updates: Get immediate notifications as task changes occur, ensuring timely and accurate tracking of task status.
• Seamless Integration: Easily integrate the webhook notifications into your systems to automate task workflows and stay informed about task changes.

Extended GET /v1/products/{id} API Endpoint

We have extended the functionality of the existing API endpoint GET /v1/products/{id} to return additional product details. In addition to the product information specified by the id parameter, the endpoint now also returns:

• Product ID
• Category ID
• Manufacturer ID
• Group ID

Key Benefits:

• Enhanced Product Information: The updated endpoint provides more comprehensive details for each product.
• Streamlined Data Access: Access all relevant product attributes in a single API call.

This enhancement makes it easier to retrieve detailed product information, improving integration and data management.

Payer Pricing Group and Price Option Group Reporting

We have added new fields—Payer Pricing Group and Price Option Group—to the following reports, allowing for more detailed analysis and insights:

• Payment Remittance
• Payer Adjustments
• Denials Detail

Key Enhancements:

• Payer Pricing Group: This field now provides insights into the pricing group associated with the payer.
• Price Option Group: This field captures the price option group information tied to the price option.

Authorization Handling for Pending Invoices

We’ve enhanced the authorization process to allow users to specify whether to update invoices that are on hold pending authorization. When entering an authorization on a pending authorization, you can now choose to apply the authorization to invoices that are on hold for authorization required.

Key Updates:

• Update Pending Invoices: When entering an authorization on a pending authorization, you can select the option to update invoices that are on hold.
• Authorization Application: The selected authorization will be automatically populated on the applicable invoices.

Ability to Clear the Service Description Field on an Invoice

We’ve added a new feature that allows you to clear the Service Description field on an invoice. This functionality is particularly useful in situations where a payer requires the service description to be empty for claims processing.

Key Updates:

• Clear Service Description: You now have the ability to delete the service description information on an invoice when needed.
• Payer-Specific Requirement: This option addresses payer-specific requirements where leaving the service description field empty is necessary for successful claims processing.

Improved Scheduling Validations for Patient Address Appointments

We’ve enhanced our scheduling validations to provide greater flexibility when scheduling appointments. You can now schedule an appointment at a patient address even if the team member is assigned to a patient service location. This update allows team members to be assigned to a service location while also having appointments scheduled at patient addresses.

Key Updates:

• Flexible Scheduling: Team members assigned to a service location can now be scheduled for appointments at a patient address without conflicts.
• Improved Validations: Scheduling validations have been updated to allow for greater flexibility, ensuring appointments are correctly scheduled regardless of the team member’s assigned service location.

Enhanced Collect Plus Integration for Non-Customer and Advance Payments

We’ve improved the Collect Plus integration to automatically post non-customer and advance payments into NikoHealth when the NikoHealth Patient Account ID is included in the payment transaction sent by Collect Plus.

Key Updates:

• Automatic Posting: Non-customer and advance payments processed in Collect Plus will now be automatically posted as unapplied payments to NikoHealth, eliminating manual posting for payments that don’t directly correspond to an invoice in the Collect Plus system.

Explore key features and functionality to stay up to date

Claims containing Dates of Service on or after January 1, 2025 must begin to use the following Payer ID for claims submissions.

TRICARE East Region 

Payer ID: 99727

TRICARE West Region

Payer ID: 99726

In addition the following states are moving to the TRICARE West Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin. 

Claims containing dates of service prior to December 31st, 2024 must continue to use the previously submitted Payer IDs.

Reenrollments are required for this Payer ID. Please contact payerenrollment@nikohealth.com to assist in this process.

We want to make you aware that this Sunday, November 3rd,  between the hours of 4:30-7:30 AM ET there will be scheduled down time for up to 3 hours.

We will be using this time to do system maintenance to our infrastructure in order to continuously improve system performance, ensure uptime and stability of the platform. During this maintenance window, NikoHealth will be inaccessible.

Check out some of the latest features and updates released.

What’s New?

Playbooks

• With the playbook feature, your team now has an easy way to capture and organize the knowledge in your business process to help guide end users workflows when processing orders. Create SOPs by payers and products to streamline, centralize, organize and delegate responsibilities. Document processes, assign out tasks, and manage required documentation to track your order lifecycle to completion.  Learn more

New fields added to the following reports:

Patient Details Report

• Patient Inactive Date
• Inactive Reason
• Care Team Member

Service Maintenance Report

• Care Team Member

Claim Submission Report

• Last Report Date

Custom Purchase Order Statuses

• You can now create and manage custom statuses which can be used to manage purchase orders.

Inventory Par Level Rules

• You now have the ability to automatically add items triggered by par level rules to update existing open purchase orders by toggling on “update open purchase orders” within your par level rules settings.

Updated Notes Functionality

• With added functionality and an updated design to improve the end user experience, you now have the ability to pin notes, manage custom note subjects, and more.  Learn more 

Custom Note Subjects 

• You can now create and manage custom note subjects which can be used when adding notes in the patient, order or invoice record.

Payer Submitter ID

• A submitter ID field is now available under the payer management setup. This submitter ID should only be used when the payer requires a client specific sender submitter ID to be sent in the 837 in order to process claims electronically.

API Updates

• Inventory Items group of APIs is now available to allow you to work with inventory enabling the ability to receive and transfer items.
• Purchase Order Audit APIs is now available to allow you to return purchase order details and activity.
• Purchase Order Statuses API is now available to allow you to return custom purchase order statuses.

Tweaks 

• Hospital Discharge Date is now an optional field.
• Added the name of the signer to the delivery documentation footer when completing delivery paperwork either on the web application or mobile app.

This latest update brings improvements to the way your teams work.

What’s New?

Updated New Patient Create & Edit

• Redesigned workflow to create and edit a patient record. This updated functionality improves the user experience and allows a user to navigate and save changes easily with enhanced functionality. Learn More

Task Categories

• Create custom task categories and assign tasks to your teams in order to group and manage across functions and departments. Learn More

Care Team Member  

• Assign a user as a care team member to a patient record to associate a teammate in your system to patients. Learn More

New Permissions

• A new permission allowing you to add a restriction on the Order View/Edit/Delete to limit users who are added as sales rep on an order to only see orders associated with them. You can go to the user field associated with these permissions and select the user(s) either based on roles created or on a specific user permission.
• A new permission allowing you to add a restriction on the Patient View/Edit/Delete to limit to users who are assigned as a Care Member on the patient record. You can go to the user field associated with these permissions and select the user(s) either based on roles created or on a specific user permission.

Ring Central Fax Integration

• Ability for customers to connect a Ring Central fax account to be used for inbound and outbound faxing.

Unit of Measure Product Selection on Resupply Programs 

• When adding an item to a patient’s resupply program you can now select the Unit of Measure (UOM) with which you wish the future order to be generated.

New Form and Documents Functionality 

• Forms and documents have been combined to live within the documents tab of a patient record. The forms tab will be deprecated in a future release but for the time being previously generated forms are still accessible under the forms tab. New forms added will be stored within the documents tab of a patient record. Learn More
• Creating and editing form templates is now available under management/application settings / forms.
• To upload documents to a patient record or generate a form for a patient click on “Add Documents” on the + blue button action dropdown. This will bring you to a redesigned workflow where you can upload documents or add forms. Forms generated will now require you to select a document type.
• Share functionality has been added within the documents tab of the patient record. This allows you to select a document to share outbound via fax or email. There is a share icon available next to the document for this action.

New Fields added to the following report:

Refund Reports

• Patient Address (Line 1)
• Patient Address (Line 2)
• Patient City
• Patient State
• Patient Zip
• Responsible Party Type
• Responsible Party Name
• Responsible Party Address (Line 1)
• Responsible Party Address (Line 2)
• Responsible Party City
• Responsible Party State
• Responsible Party Zip

Invoice Detail Report

• Patient Zip Code
• Patient City
• Account Primary Payer (GL Account of the primary payer on the invoice)
• Account Current Bill To (GL account of the current Bill TO on the invoice
• Price Option Group (from price option)
• Patient Location
• Patient Tags

Tweaks 

• When creating purchase orders automatically from par level rules an update has been made to exclude items that are in a reserved status for available stock.
• Fixed the “unsaved changes” popup that is displayed when trying to navigate through tabs within management/corporate setup/inventory locations.
• Customers who drop ship items such as CPAP through VGM – we have added the ability to pull back in the serial # of the item that was shipped.
• Resupply limit notification updates.
• The plan selection field on a patient insurance record has been updated to allow for autocomplete and drop down selection.
• Modifiers have been added as an autofill field to forms.

We want to make you aware that this Sunday, April 28th between the hours of 5:00-7:00 AM ET there will be scheduled down time for up to 2 hours.

We will be using this time to do system maintenance to our infrastructure in order to continuously improve system performance, ensure uptime and stability of the platform. During this maintenance window, NikoHealth will be inaccessible.

Built for you – that’s our focus. While our customers are busy with running their business, we are working hard to deliver more and more features and functionality.

What’s New?

Payer Rule for Service Facility Location

• A new payer rule has been added to allow you to customize how the service facility location is reported on the CMS 1500 and EDI 837 electronic claim transmission.  Learn More

New Permission

• A new permission has been added to restrict a user from being able to add a new tag in the system. Within the permissions management you can now choose to enable or remove the “Tags Create” permission. Learn More

New Fields added to the following reports:

Order Financials Report

• Price Option ID

Claim Submission Report

• Clearinghouse

Invoice Detail Report

• Invoice Balance

Revenue Summary Report

• Invoice Tags
• First Submission Date

Provider Adjustment Report

• Patient and Posted Date filter

New Integration Page 

• An integrations page has been added under Management/Application Settings/Integrations. We will be expanding integration configuration settings for services used by our customers moving forward in this section. At this time, Shippo integration credentials have been moved here.

New Insurance Verification Functionality 

• A new feature has been released allowing to verify insurance eligibility benefits for a prior service date. On the insurance page within a patient record, you will notice a calendar icon next to the benefits button of an insurance record which you can click. Here you will be able to indicate a prior service date to check for benefit coverage details.
• An alerts section has been introduced when doing an electronic insurance eligibility verification. These alerts will indicate information including whether other payer coverage has been identified or if a Medicare member is a Qualified Medicare Beneficiary.

New Report

• A new user report is available where you can report on users in the system.

Medicaid as Secondary – Carrier Codes 

• When billing Medicaid as secondary payer, a Carrier Code for each primary insurance may need to be reported on electronic and paper claims. The Carrier Code reported is used as an identifier for Medicaid to recognize the primary payer. Additional functionality has been added to support this for Illinois Medicaid. Learn More

Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Electronic Claims Support 

• State Medicaid’s such as in Alabama require that when an EPSDT qualified service is provided, the related condition code is transmitted on electronic claims. This information is now available to report on the insurance record of a patient which will transmit on the 837 claim.

Bypass Claim Submission

• We have added the ability to submit an electronic claim directly to a secondary or other payer when the destination payer’s cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in Loop ID-2330B on the 837 claim. When submitting a bypass claim, the 837 claim submission will report to the payer that it is Noncovered Charges from the prior payer.

Tag Functionality added to Document Management  

• The ability to add tags to documents uploaded into the my documents and all documents pages is now available. Learn More

Ordering Provider on an invoice 

• The ordering provider field has been added to the invoice. No user selection is required unless otherwise applicable. When transmitting electronic claims the referring provider on the claim is reported as the ordering provider on each service line. In the event an ordering provider should be reported different than the referring provider you can indicate it as needed.

API Updates 

• A new Tasks group of APIs have been added Learn More
• Get/v1/invoices/{id} – the Name field within the service lines block has been depreciated and replaced with Service to match the field name on the user interface.

Tweaks 

• Provider adjustment selection has been sorted to display in alphabetical order.
• Plan section within a patient insurance record has been sorted to display in alphabetical order.
• Menu action buttons on the patient, order and invoice have been sorted to display in alphabetical order.
• Reports within the billing, revenue and payment categories have been updated to reflect the display invoice id (Invoice) and the unique invoice id (Invoice Id).