ZyWin® Automated Posting System

ZyWin® Automated Posting System (APS) is available for carriers that offer HIPAA 5010 and 4010.A1 compliant 835 Electronic Remittance files for Electronic Data Interchange (EDI).

ZyWin APS retrieves an Electronic Remittance Advice (ERA) file from the insurance carrier and posts the Explanation Of Benefits (EOB) directly to patient accounts for claims submitted electronically via ZyWin ECS. APS eliminates the need for manual posting of claims with non-zero approved amounts.

How long does it take your staff to manually post a 10, 50 or 100 or 500 claims on an EOB? ZyWin processes at a rate of over 12,000 lines per minute on a typical computer!! This equates to a processing rate of over 200 service lines in one second! Or 100 claims per second in most practices.

As ZyWin APS takes care of the posting for those paying claims, billing staff can spend this regained time improving collections in more productive ways. This includes concentrating on delinquent accounts or keeping abreast of insurance policies and procedures, concentrating on reviews, follow-ups and educating patients. In some cases, staff hours can be reduced saving payroll expense. Think what your office could do with that extra time and money! Typically, ZyWin clients have reduced their Accounts Receivable by 40-60% and drastically improved cash flow!

ZyWin APS savings easily justify the cost of an entire computer system, and improve the financial performance of the practice.

ZyWin® Advantages

ü Faster reimbursement and staff-time savings of over 60 to I!

ü Accurate! No clerical errors!

ü Savings easily justify cost of the entire computer system!

ü Increased staff satisfaction and substantial payroll savings!

ü Electronic Data Interchange with any carrier supporting a HIPAA compliant ANSI 835 file format (electronic claim must be sent using ZyWin)

ü Can be used in as little as one week from system installation!

ü Flags patient balances for billing.

ü Flags coinsurance for batch printing.

ü Informs User of misspelled names and other non-financial data information.

ü APS Report lists posted data in an easy to read format for a selected EOB in HIPAA ANSI 835.

ü Posting Log lists data changes for differing approved amounts and rejected claims within a selected EOB.

ü One RECON Report lists all claims contained within the selected EOB. The report includes HIPAA ANSI codes and explanations sent by the carrier.

ü APS Posts to the INDIVIDUAL Service Line the:

• Approved Amount.
• Deductible.
• Payment.
• Contractual Allowance.
• Billing Note (as defined by the User for each situation).

Major Features

How APS Works

Little training is required. As in all ZyWin programs, simplicity is of the utmost importance. An Electronic Reconciliation Summary Report (aka RECON, ERA or 835) is retrieved from the carrier. The RECON file may contain one or more electronic Explanation of Benefits (EOBs), as well as details on other claims, including those pending or rejected, depending on carrier.

ZyWin analyzes the RECON and displays the check numbers for paid claims and amounts. The User highlights the check number, clicks the POST NOW button and ZyWin does the rest. No complicated programs or language is necessary. The information posts in a second or two and entire process is completed in a couple minutes.

ZyWin will NOT post claims with unusual circumstances requiring further review by a trained operator. This could be a zero approved amount, an existing payment, etc. These claims are set aside and included in the APS Posting Log. Our users report this amount to be very small (under 1% typically).

Accuracy

ZyWin APS makes posting mistakes a thing of the past. Entry errors account for virtually all posting problems and balancing problems at the end of day. Posting a lengthy EOB leads to staff fatigue, boredom and increased errors. APS makes numerous cross-references and verifications here before the data is posted to a service, which ensures accuracy!

Cost Justification

Hours of staff time are normally dedicated to entering EOB statements each week. APS reduces this time to minutes. Concentration on non-ppaying accounts improves cash flow and reduces time-in-A/R dramatically.

APS Posting Log

The APS Posting Log includes items where:

ü Patient name does not match carrier’s records.

ü HIC number does not match carrier’s records.

ü Claims are marked for secondary batch printing.

ü Approved amount differs from normal approved amount.

Also included are payments not posted due to:

ü Rejections.

ü Insurance Company mismatch.

ü Patient ID mismatch.

ü Posting information already exists.

ü Charges were not equal to charge field.

ü Approved Amount from carrier is zero.

ü Interest.

ü Procedure code mismatch between sent and returned CPT code.

Balance Billing

APS will automatically flag claims for Batch Processing where the secondary carrier is responsible for the balance. Medigap and Complementary Crossover carriers are automatically omitted. Flagged claims can be batch printed immediately!

Balances due from the patient are automatically flagged for billing. User defined notes are automatically attached to these services for select situations (i.e. deductible, copay, non-covered) and appear on the patient’s bill.

The result: Coinsurance claims and patient bills are billed immediately after the EOB is posted.

APS Reports

There are several reports that can be generated from the APS system. The Posting Report lists all claims that were updated during the posting session. Information includes:

ü Patient name and account number.

ü Claim number.

ü Insurance coverage.

ü Charges.

ü Approved Amounts.

ü Contractual Allowances.

ü Payments.

ü Deductibles.

ü Balances and who owes them.

Other reports resemble the carriers EOB, where the messages are also printed with the service information. The most commonly used are:

ü Pending Claims Report.

ü Completed Claims, Paid or not Paid.

ü Rejected Claims.

ü All data, which is the same as the EOB!

Requirements

ZyWin Automated Posting System requires ZyWin ECS and the ZyWin Base Package.

Dialup Reconciliation is available to electronic billers exclusively. Paper claims submitted to Medicare and PA Blue Shield Private Business cannot employ automated posting.

As regulations differ between Medicare and Private carriers, please contact our office for specific guidelines.

Top of Page

© 2003 Auditron Electronics Corp – All rights reserved