Managing Organization Admin

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What is the Managing Organization Admin?

The Managing Organization Admin is the central location to adjust settings, configuration, and users that span across all organizations for a given managing organization. 

To access, click on Admin and choose Managing Organization Admin.
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Let's review the three different sections: Organizations, Configuration, and Users. 

Organizations

This section list all Organizations that are under the umbrella of this Managing Organization. 

Configuration

The Configuration tab hosts all the higher-level configurations such as Claim Queues, Claim Statuses, Claim Issue Sources, Claim Issue Types, Account Settings, and VOB Settings.

Profile

The Profile consists of the Managing Organization’s Name, Website, and Logo.

Claim Queue Types

Claim Queues are used to manage the claim follow-up process more effectively.  Here you can Create Claim Queue Type and Edit existing claim queues as needed. Click here to learn more.

To create a new claim queue, you will need to click Create Claim Queue Type

Claim Status Types

Claim Status is a tag indicating the claim's current lifecycle stage. In this section, you can choose to Create Claim Status Type or Edit existing Claim statuses from this tab. Click here to learn more.

 

Claim Issue Sources

A Claim Issue Source is a category that describes the root cause of the issue when there is a problem with a claim. Each Claim Issue Type is tied to a Claim Issue Source. In this section, you can choose to Create Claim Issue Source or Edit existing Claim Issue Sources. Click here to learn more.

Claim Issue Types

Claim Issue Types are used to further specify what is preventing the claim from being processed. In this section, you can choose to Create Claim Issue Type or Edit existing Claim Issue Types. Click here to learn more

Account Settings

Account Settings allow you to set the Default options for claim submission and resubmission. These settings can be updated these settings Edit. Please note any changes made will only impact claims moving forward. 

Available Account Settings include: 

  • Default Claim Queue for First Claim Instance: This is the queue the claim will be placed in after the first submission.
  • Default Claim Queue Upon Claim Resubmit: This is the default queue that a claim will be placed in when it is resubmitted (regardless of the resubmission type).
  • Default Claim Queue Upon EOB Receipt: When a payment is matched or posted to a claim, the claim will be placed in this queue and the follow-up date will be set to the next business day.
  • Default Claim Queue Upon Claim Reject: When a claim is rejected by either the clearinghouse or the payer's electronic system, it will be assigned to this queue.
  • Default Claim Queue Upon Payer Hold: Payers may send back an electronic notification through the clearinghouse that a claim’s processing has been placed on hold. This will be the default queue for the claim when that status is sent.
  • Default Claim Queue Upon Unbalanced Payment: The queue the claim will be assigned to when a payment throws a claim off balance. 
  • Default Claim Queue Upon Balance Ignore: The queue the claim is assigned to when the off-balance alert is ignored. 
  • Default Claim Status for First Claim Instance: The claim status assigned to the claim after its first submission.
  • Default Claim Status Upon Claim Resubmit: The status assigned to the claim after the claim is resubmitted.
  • Default Claim Rate: Claim Rate Types are used to aid in the invoicing process. The item selected here will be the default rate type applied to all claims. You can create custom claim rates under Managing Organization Admin > Configuration > Claim Rate Types. This is set to Default. 
  • Days to Follow-Up on Claim Submit for First Instance: The number of days the follow-up date is set for after the initial claim submission. This defaults to 30.
  • Days to Follow-Up Upon Claim Resubmit: The number of days the follow-up date is set for after a claim is resubmitted. This defaults to 15.
  • Maximum Charge for New Multi-Day Claim ($): The maximum dollar amount allowed per claim. Any services added to the claim over this dollar amount will be added to a new claim.
  • ICD-10 Requirements Effective Date: The date ICD-10 coding is required.
  • Require Dual Coding on ICD-10 Requirement Effective Date: The effective date requiring both ICD-9 and ICD-10 codes.

VOB Settings

With this section, a Managing Organization Admin can configure the Hours of Operation, Create an Eligibility Schedule, and set the Time Zone for the Verification of Benefits. These hours of operation combined with the SLA set in the Practice Admin will determine when a Patient's VOB is marked as overdue in the Management Center.

Service Level Agreements are configured for each practice by an Avea Staff Member and their configuration is displayed here. The Verification SLA (in Business Hours) field means that after those number of hours have passed, the patient will be placed into the Overdue section of the Management Center.

Users
See User Permissions.

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