EZClaims bridge

Discussion in 'Synapse' started by Graham, May 23, 2010.

  1. Graham

    Graham Developer Staff Member

    The original EZClaims bridge synced patients added or updated in EZclaims (EZ) to Synapse. This was a little tricky because the EZclaims ran on the user's PC, but the Synapse database was often in the cloud. It was a one way transfer of patient demographics to Synapse.

    But then I found people were adding patients in Synapse first, and hoping that they would sync back to EZvia the bridge. So, this facilty was also added. But once you have two way syncing, issues can start appearing.

    And now, there are some users who want to add the patient and insurance in Synapse and have it appear in EZ!

    Now the problem with this is that the patient insurance in EZ appears in the patient table as an integer. This is a lookup to the Payer Table where the insurance companies appear. But if the insurance which is entered as text into Synapse does not match exactly the name in the Payer Table, then the bridge can't add the insurance ... unless it adds another payer .. so we now have one payer appearing twice under different names.

    So, for instance Blue Cross might appear in EZ as BCBS but is entered in Synapse as Blue Cross.

    If that is acceptable, the user can manually fix this up later on.

    Insurance Mappings

    If the patient is Medicaid, they should not have any other insurances.
    If the patient is Medicare, they can have other insurances.
    If the patient is neither, they can have other insurances.

    For Medicaid, the Medicaid ID should be the EZ PatientMemberID.
    For Medicare, the Medicare ID should be the EZ PaientMemberID.
    The Medicare secondary insurance is then the EZ OtherInsuredIDNo.

    let me know if this is wrong ....
  2. georgibox

    georgibox New Member

    Re- insurances

    There are cases, when you can see Medicare as primary insurance and Medicaid as secondary. The reason for that is that Medicare is age based, while Medicaid is income based insurance. So, only if Medicaid is primary, there will be no other insurance.

  3. Graham

    Graham Developer Staff Member

    I've made the following changes relevant to EC2 users importing patients into EZclaims:

    1. The primary insurance key is added
    2. The SSN of the patient is also added
    3. The secondary insurance ID, if present, is put into the OtherInsuredIDNo
    4. The secondary insurance data is placed into Notes

    Needs testing ...
  4. Graham

    Graham Developer Staff Member

    Since I now have two areas where the insurance information is potentially duplicated .. does it make sense to abolish the Insurance tab?

    I could add more fields to the CMS1500 to hold group ID ..., and also details of secondary insurance.

    And insurers could be added as providers so that instead of entering their name, you do a lookup ...
  5. Jerry

    Jerry Administrator Staff Member

    I agree with adding insurance companies as providers if that simplifies the lookup. Just make the specialty "insurance company". Would it still make sense to have the exisiting insurance tab just to display (or maybe select?) the primary and secondary insurance vs doing it all from the CMS 1500 form? Doing it all from the CMS 1500 makes sense to me if it simplifies things. The ability to have more information, like the group ID is good.
  6. Graham

    Graham Developer Staff Member

    Possibly. So, the insurance tab could be used to pull out the data from the cms1500.

    What is the group ID good for? It doesn't appear on the CMS1500 ...
  7. Jerry

    Jerry Administrator Staff Member

    The insured's policy group # or FECA number is box 11 on on the CMS 1500 form. To quote Cigna's instructions regarding filling out the CMS 1500 "11. Insured's Policy Group or FECA Number. This field is optional. The Group or FECA number can be found on the insured's I.D. card." In the case of BC/BS, I think the policy number tells them everything they need to know for billing, but any doctor's office I see myself always asks for the group number. It's assigned by employer group. Not sure if mainly just the lack of putting the group number on the CMS 1500 can be used as an insurance co. delay tactic.
  8. Graham

    Graham Developer Staff Member

    So from what you say I could remove the insurance tab as long as I have some place to put the secondary insurance details?
  9. nirlesh

    nirlesh New Member

    EZ Claim

    It makes sense to remove insurance tab and just keep CMS1500
    as doctors understand that form more
  10. Jerry

    Jerry Administrator Staff Member

    Well, that makes a lot of sense to me. Staff is going to record details of who they argued with at the insurance co. in the patient's note anyway, so just an address, a couple of phone numbers, and a memo field or something for the insurance co. is fine by me, which is pretty much what we have with the providers tab. Organizing it around the CMS1500 is very direct.
  11. alpesh

    alpesh New Member

    i agree

    i like what jerry says we should have a inurance company list that staff can select as they go this can be duplicated for cms 1500. also i agree with nirlesh about removing insurance tab.

    possible future bug would be if pt changes insurance company
  12. Graham

    Graham Developer Staff Member

    I don't think that's a big issue because the billing is being done from EZ.
  13. Graham

    Graham Developer Staff Member

    I'll look at working on these changes for 218 ..
  14. Graham

    Graham Developer Staff Member

    As I understand it, since a patient can be billed twice for the same service. You bill the primary insurance using the cms-1500, and then create another cms-1500 to bill the secondary insurance the residual.

    So, this means I do have to track the primary and secondary insurance separately from the cms-1500 form.
  15. Graham

    Graham Developer Staff Member

    I've got a new version almost ready. It uses a different GUI library that I am trying.

    This relates to importing a patient from the web portal:

    1. If marital state is present, this is added
    2. If medicare and medicaid numbers are available, then medicare is made primary insurance
    3. If SSN is filled in, it will be added
    4. If it is not medicaid, or medicare, and there is an insurance company, then that insurance company will be added to the Payer List if an exact match is not found
    5. These details are also added as a note in the 3rd tab

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