Contents - Healthonomy

TRAINING
Contents
Welcome to Healthonomy
2
Patient Information
3
Reports
12
Appointments
20
Billing
25
Workflow & Referrals
33
Welcome to Healthonomy
It’s a powerful, cloud-based tool for managing your Workers’ Compensation
practice -- this Guide contains searchable, step-by-step instructions for
Healthonomy’s many functions.
With Healthonomy, you have an integrated tool to manage your practice. This
Guide will help you take advantage of all that Healthonomy offers.
SCHEDULING
REPORTING
BILLING
IS JUST THE BEGINNING
The main navigation tabs organize Healthonomy into major function groups:
Home
Organize tasks from your Dashboard, and filter encounter
information for an in-depth view of your practice.
Patients
View and filter data relating to your patient information.
Reports
Filter data on all reports generated in your Healthonomy.
Appointments
Schedule appointment and manage clinic schedules.
Documents
Manage documents sent, received and uploaded.
Referrals
Refer patients to other Healthonomy users.
Billing
Access billing analytics.
Tasks
Manage tasks and workflow.
Administration
Limited access for administrators only with features such as
usage statistics and user management tools.
FEEDBACK
Click the feedback button from anywhere in Healthonomy to
send an e-mail to support.
TRAINING
Patient Information
Patient Tab Functions
4
Patient Page Functions
5
Create a New Patient
6
Assign PTP and Facility
7
Create Referring PTP Practice
8
Injury Information
9
Add to Your Databases
10
Edit Patient Information
11
Patient Information
BACK TO CONTENTS
Patient Tab Functions
Filters are a powerful tool
for analyzing workflow,
productivity and other
data. See “Using Filters”
for more detail.
Click to create a new patient
To find a patient, begin typing
name, DOB or SSN here.
Click to watch “How To” videos
Click these links for helpful features related to your patients.
Lost
List of inactive patients with no future appointments.
Refer
Refer multiple patients to another Healthonomy user.
Recently Referred In
List of patients referred to your practice from another Healthonomy user.
Recently Referred Out
List of patients referred from your practice to another Healthonomy user.
Lock Patients
Lock multiple patients.
Full List Download a .csv file of all patients in your Healthonomy tenant.
Master List
Download an Excel spreadsheet of your Master Patient List.
The list section offers several useful links.
Name/Phone
Click to sort alphabetically. Click the patient’s name to go to his/her page.
Birthday/SSN
Click to sort list by date of birth.
Latest Encounter This column contains scheduling and encounter links for each patient.
Patient Page Functions
Click to upload patient photo
Print demo sheet
Encounter summary
See demo details
Create a new patient
Add a note
Find a different patient
Create an appointment
View documents & records
Click these links for helpful features related to your patients.
Edit
Click to edit patient information
Info Updates
See a list of patient information updates.
Alert/Lock
Add an alert and/or lock patient.
Delete
Delete patient; this function is only available to Administration.
Refer/Send Documents
Refer patient and/or send documents to another practice
in Healthonomy.
This section organizes appointments in chronological order, and features several important links.
Type (Follow Up Visit, etc)
Click to access chart notes. See Reporting for more details.
Date/Time
Click for Scheduling pop-up window. See Scheduling for more details.
State
Useful link for tracking the status of the patient’s visit and reports.
Documents/Reports
Links to all documents and reports related to the appointment.
Create reports by clicking “New.”
Create a New Patient
It’s very important to create patients with accurate information and punctuation because
many functions in Healthonomy use this information.
For instance, when you select PTP in Provider Role on Case Information, Healthonomy knows
to create all reports as PTP-specific. The demo sheet and history section pull text from the
patient information exactly as typed. When a patient is referred from one practice to another
in Healthonomy, important case information like Insurance Company, Phone/Fax numbers
and Claim number will be referred as well.
1. Click “New” button to the left of the “Find Patient” search box.
2. Enter patient demographic information. Gender and Date of Birth are required. Healthonomy will warn you if you try to create a patient without this information.
3. Assign PTP and Case Information. [more details]
4. Enter injury information. [more details]
5. Click create.
See the following pages for more detail.
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Case Information
Healthonomy allows multiple cases for a patient, so that you can group injuries by case type.
For example, if a patient has a Work Comp (WC) injury as well as a Personal Injury (PI), you
should create 2 cases for that patient.
1. Name the Case: Case Name defaults to “1,” however, you may also name the case.
It is recommended to identify cases by case type. Example: 1-WC, or 2-PI.
2. Select Provider Role from the dropdown menu.
3. Select Case Type
4. Enter referral information.
5. If necessary, click “Add Case” to add another case.
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Assign PTP and Facility
In the case information section, you will assign the patient’s facility and Primary Treating
Physician.
If the PTP is part of your Healthonomy tenant, begin tying the name in the box below.
A dropdown menu will appear with all relevant facilities; simply choose the correct facility
and Primary Treating Physician.
If the patient was referred to you from his or her PTP, see NEXT PAGE for instructions on
adding referring PTP information.
Create Referring PTP Practice
For PTPs who refer patients into your practice:
1. Click “New PTP Medical Practice” button in the Case Information section.
2. Enter practice name in the pop-up window.
3. Notice the “Did you mean...” box. As you type the practice name,
any existing practices with simliar names will be shown here.
It is important not to create duplicate practices.
4. Cick Add Address.
5. Enter address information.
6. Click create.
7. Begin typing the practice name to select.
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Injury Information
1. Select Case.
2. Select Injury Type.
3. Enter Date, or Dates for a Continuous Trauma injury.
4. Enter Injured Body Parts. Note that text entered here will output in the history
portion of narrative reports, so type it in as you would have it appear in a sentence,
(for example, do not use capital letters or abbreviations).
5. Enter WCAB and/or EAMS # number.
6. Select preference for Authorization Request: Insurance or Utilization Review
7. For the Employer and Insurance information:
- Click in the “search by” text box.
- Begin typing the name.
- If the company or law firm already exists in your database, it will appear
in a dropdown menu. Check first before creating a new entry.
- If the Employer or Insurer does not appear, create a new one.
- See “Add to Your Databases” for more information.
8. To add an additional injury, click the “Add Injury” link in the bottom left corner.
9. To delete an injury, click the black ”X” at the top right corner.
Add to Your Databases
Healthonomy creates a unique database for the following entries in Patient Information:
o Applicant Attorney
o Referring PTP
o Collector
o Employers
o Defense Law Firm
o Billing Reviewer
o Utilization Reviewer
Once you save the information, Healthonomy stores it in a database in your
Healthonomy tenant. The next time you need to fill in, for example, Applicant Attorney
“John Doe,” just begin typing and the name will auto-fill from the database.
It’s important not to create multiple entries in the databases because many of the
advanced analytic features in Healthonomy rely on accurate data input. For example,
if you want to see a list of patients represented by Applicant Attorney John Doe, it is
important that there is one entry in the App Atty database for all the patients.
For creating new entries in your database for all of the above, the process is as follows.
We’ve used Applicant Attorney as an example.
1. Click “New Law Firm”
2. In the pop-up, enter name.
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3. Notice the “Did you mean...”
box. As you type the name, any
existing practices will be shown
here. This tool helps prevent
duplicate entries.
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4. Cick Add Address.
5. Enter address information.
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6. Click create.
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Edit Patient Information
Click Edit
Edit Patient Demo
1. To edit an existing entry,
click the the name and
edit in the pop-up.
Edit A Database
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2. To remove the name and
change to a new company,
click “change.”
Databases
o Applicant Attorney
o Collector
o Employers
o Defense Law Firm
o Billing Reviewer
o Utilization Reviewer
INSURANCE DATABASE
Your Healthonomy has the Lockard
Industrial Insurance Companies List
as your insurance database, if you
requested it. It’s best to use the
database entries as they already exist
and add information such as adjuster
and claim number. This helps prevent
duplication in your database. If you
would like more information, please
contact support.
TRAINING
Reports
Case Information
7
Reports Overview
13
Report Functions
14
Chart Tab Functions
15
Report Page Functions
16
Edit A Report
17
“Prepare Report Again”
17
Edit A Finalized Report
17
Updated RFA Form: March 1, 2014
18
Create RFA with MTUS References
19
Reports
BACK TO CONTENTS
Reports Overview
Reports in Healthonomy are organized around Appointments and Encounters.
Appointment
In Healthonomy, an “Appointment” is defined as a patient visit. They are also
listed in the scheduling tab, called Appointments.
Appointment types may include (depending on your Healthonomy setup):
o Initial Visit
o Follow-Up
o Therapy
o Procedure/Surgery
Reports that can be generated on an Appointment include billable reports,
addenda and other important non-billable reports.
Billable Reports:
Form 5021
Doctor’s First Report of Occupational injury or Illness
Initial reports
PR-2 Follow Ups
PR-2 Permanent & Stationary Report
Addenda (Non-Billable)
RFA: Request for Authorization for Medical Treatment
Customized Surgery Submission or Fax Proof
Referral Sheet
Proof of Service
Additional Non-Billable Reports (customized for your needs)
Patient Packets
Future Appointments
Mileage report
History & Complaints
Subjective Complaints
MPN Questionnaire
Encounter
All supplemental reports are created on an “Encounter” so that they do not
appear in the appointments schedule.
Encounter types may include (depending on your Healthonomy setup):
o PR-2 Medical Record Review
o Medical Team Conference
o Phone Call Supplemental Peer-to-peer
o Denial Supplemental
o RFA (to create a specialized Request for Authorization form)
o Supplemental
Report Functions
Reporting in Healthonomy is organized around appointments and encounters, just
like a physical chart. When a patient is scheduled for an appointment, all reporting
tools necessary for that appointment type and specialty are contained within the
appointment or encounter, as configured for your particular practice.
Let’s look at an initial chiropractic visit for example.
Initial Visit
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1. Click Appointment Type
2. Chart Tabs appear
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Chart Tabs
The Chart Tabs are configured by encounter type and specialization.
The general content is as follows:
Patient Info
Demographics, Case Information and Injury Information.
History Detailed History of Injury, including impact of injury on ADLs; Medical
History; Occupational History; and Social History. This tab outputs for Initial
reports, PR-4s (Permanent & Stationary) and QME reports.
Complaints Includes present complaints by body part, pain aggravators, treatments and
improvements.
Examination Physical examination configured for your tenant by speciality type.
Diagnosis Most common ICD-9 codes are loaded into Healthonomy; just start typing a
code or name and a dropdown of choices appears. Also, if you choose, the
Diagnosis tab can have reference to MTUS and/or ODG guidelines.
Medical Records Type in your reviews for two types of records: Diagnostics and Medical
Records. Add in time spent in review for automatic output into the report.
Treatment Plan Treatments and recommendations, complete with MTUS/ODG references
and CPT codes for RFA output.
Medications For prescribing medications.
RFA Depending on your tenant customization, you may have an RFA tab where
ICD-9s and CPT codes from the encounter will populate; you just need to tell
Healthonomy how you’d like them formatted.
Superbill To be used by the doctor to fill in the superbill for the visit or report.
SBR/IBR Create an SBR or IBR with just a few clicks.
Chart Tab Functions
Chart Tab
Save Your Work
Open tab is orange.
Click here or click on a tab.
Encounter Info & Navigation
• View appointment information
• Click patient name to return to
patient page
• Click State link to update
encounter state (“Scheduled” in
above example).
Records Reviewed
Sortable list of medical record reviews.
Sections
• Go to top of tab
• Expand all
• Collapse all, and expand only
the section you want to view by
clicking that section title.
• Go to any section by clicking in
section nav table.
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Click “Other Encounters” to
compare and copy previous tabs.
Click “Documents” to upload new
and view uploaded documents.
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Report Bar: Visible at the bottom of every tab within an encounter.
1. New Report: Click here to create a new report, or to choose a previously
prepared report from the dropdown menu.
2. Report Type: Report to be prepared.
3. Report Date: Defaults to encounter date.
4. Prepare:
Prepare or Reprepare the report. This will create an editable
prepared report from all data entered into all tabs.
5. Save:
Save your work, or reset the tab to previous version.
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Report Page Functions
When you prepare or re-prepare a narrative report, a draft report with “DRAFT” watermark is
created on a unique url. Here, you may review and edit the report before finalizing.
Click for pop-up to
update state, assign to a user
or group, and/or make a note.
Preview, Re-prepare and Finalize
Navigate to report sections
Find a different patient
Create a new patient
View documents & records
Click these links for the functions/features below, or right click and open in a new tab.
Patient Name
Return to patient page.
Chart Notes
“Follow Up Visit” above -- click to return to chart notes.
Appointment (date)
Click for Appointment pop-up, where you can view patient
information, edit encounter nformation, change encounter date,
change provider, assign to a different user or group, make a note,
see encounter history and delete the encounter.
Report
(with type, number, state)
Click for Report pop-up, where you can view patient information,
review report information, change encounter and report dates or
delete the report, if you have access for deleting reports.
Edit A Report
The prepared report page looks like this, with “DRAFT” watermarked on it.
To edit a report, follow these steps.
Double Click
on the section to edit.
Type in your edits
and click OK.
“Prepare Report Again”
This button re-prepares the report by pulling all data
from the Chart Tabs; clicking here will overwrite any
edits you may have made on the prepared report.
Edit A Finalized Report
Only Administrators can unfinalize reports. Also, if a report has been billed,
please check with your Billing Administrator before unfinalizing a report
Click Unfinalize
A NOTE ON EDITING REPORTS
It is preferable to make changes
in the chart notes, especially if
the information might be copied
forward into the next report.
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1. Update the state
2. Assign to a user
or to a group
3. Make a note, if
desired.
4. Unfinalize report
For example, changes to the
patient’s Diagnosis should be
made on the Diagnosis tab, not
by editing the prepared report.
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Updated RFA Form: March 1, 2014
Beginning March 1, 2014, the DWC is requiring a new Request for Authorization for Medical
Treatment (DWC Form RFA), which has been implemented in Healthonomy.
There are two major differences
in the new form:
1. ICD-9 codes aligned with
corresponding CPT/HCPCs
are now required, rather
than grouped together in one
section as on the previous
DWC Form RFA.
2. “Other Information” is now
separated by line item as well,
rather than the one large text
box on the previous RFA form.
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To further support your
treatment requests,
Healthonomy now
offers the ability
to import MTUS
Guidelines by ICD-9 and
CPT code, which prints
out as an additional page
with your RFA.
NEW:
Create RFAs
supported by
MTUS
Guidelines
Any text that does not fit in the
Requested Treatment section of the
RFA also prints on the attached form.
Next Page: See how to encorporate
MTUS references with your RFA.
Healthonomy is prepared for
the change, and we have added
features to help our clients
create stronger RFAs.
Create RFA with MTUS References
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Select MTUS References
1. Start on the Diagnosis tab.
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2. Enter ICD-9 & Diagnosis as usual.
3. Click MTUS link beside Diagnosis for
a list of corresponding treatments by
CPT code. Click for the MTUS entry for
that ICD-9 and CPT.
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4. Select the desired CPT code from the
list. Then Click “Include in Report.”
5. On the Diagnosis tab, you may review
a summary of MTUS references to be
included in the report and RFA. Click
“Remove MTUS” button to delete
the reference from both the
report and the RFA.
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COMING
SOON:
ODG Guidelines
Create DWC Form RFA
1. Click on the RFA tab.
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2. Select Diagnosis from the drop-down
menu; this list is from the Diagnosis tab.
3. Refer to the MTUS summary list for
corresponding CPT codes, as choosen on
the Diagnosis tab.
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4. Enter CPT codes that correspond to the
selected ICD-9 codes.
5. Enter other information, if desired.
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6. Enter additional notes, if desired.
7. Prepare report as usual.
Please note that if more than 5
Treatment Requests are created, or
if Other Notes is filled, Healthonomy
will automatically create an “Overflow
“Section on the additional page(s).
TRAINING
Appointments
Appointments Overview
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Schedule An Appointment
22
Edit An Appointment
23
Delete An Appointment 23
Create Recurring Appointments
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Appointments vs. Encounters
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Appointments
BACK TO CONTENTS
Appointments Overview
Date
Print, Print Extended List
Date: Forward, Back
Appointments
View By: Day, Week, Month
Calendar View Types
Providers
Facilities
DETAILS:
Date
Select date for calendar view.
Date: Forward, Back
Easily navigate between dates.
View By: Day, Week, Month Select type of calendar view by day, week or month.
Providers
List of all active providers in your Healthonomy tenant. You can easily
sort the list, and the calendar view, by selecting: Hide, All, None or Only.
For example, clicking “Only” beside a doctor’s name will change the
calendar display to only show those appointments. Also, the colored
bars on this list are the key for the schedule’s color coding.
Facilities
List of all active facilities in your Healthonomy tenant. It works like the
Providers list. For example, clicking “Only” beside a facility name will
change the calendar display to only show appointments for that facility.
Print, Print Extended
Click to print out a simple list or extended list, which includes more
information and any encounter notes.
Appointments
Click on the appoint to see the pop-up, where you can edit and update
the appointment status.
Calendar View Types
Click to set your desired calendar view.
Ask your Healthonomy rep about available calendar customization options.
Schedule An Appointment
There are two locations in Healthonomy from which you can create an appointment.
Appointments
Patient’s Page
Patient
Fill out the
New Appointment
pop-up window,
and click Create.
Begin typing patient name (from scheduler only). This field will be filled in
automatically if you start from the patient’s page.
Provider
Select the doctor/provider for the visit.
Specialty
Select specialty. Future appointments will automatically select specialty.
Facility
Select facility. Future appointments will automatically select the patient’s
facility.
Type
Choose appointment type: Initial Visit, Follow-up, Therapy, etc. These options
will be configured for your tenant
Date/Time
Enter date and time. The date will be filled in automatically if you start from
the scheduler. You can also click on the calendar, and Healthonomy will
automatically fill in the appointment time.
Duration
How long is the appointment? Healthonomy will automatically fill in your
default appoint duration.
Encounter Memo A permanent memo that will be viewable from the scheduler and patient
page, and will print out on the appointment list.
Case
Choose the case as defined on the patient information page. Example: WC for
Workers’ Compensation or PI for Personal Injury.
Interpreter
Check if Interpreter needed for this appointment. It will be viewable from
the scheduler and patient page, and will print out on the appointment
list. If Interpreter is indicated on the Patient Information tab, this will be
automatically checked as well.
Transport
See note for Intrepreter.
Repeats
Set up repeat appointments with just a few clicks. See “Create Recurring
Appointments” for more details.
Encounter State Update status of the appointment.
Assign To
Assign the appointment to another user or group for next steps.
Note for Update This note will be viewable only until the state is updated again. For example,
if you’ve changed the state to “No Show” and assigned to Office group, you
might note here: Call patient to reschedule.
Edit An Appointment
There are two locations in Healthonomy from which you can edit an appointment.
Patient’s Page
Appointments
Click Edit
Delete An Appointment
From the Schedule pop-up (above):
Click Delete
Create Recurring Appointments
Create or Edit Appointment
Click Repeats
Fill in the repeat
appointment
information,
and click Create.
Appointments vs. Encounters
Reports in Healthonomy are organized around Appointments and Encounters.
In Healthonomy, an “Appointment” is defined as a patient visit. They are also listed in the
scheduling tab, called Appointments.
All supplemental reports are created on an “Encounter” so that they do not appear in the
appointments schedule.
See “Reports Overview” for more information.
TRAINING
Billing
Create A Bill
26
Create A Bill (continued)
27
RVRBS: The New Fee Schedule
28
RVRBS: Fee Calculator
28
Add A CPT Code
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Print Patient Ledger
29
Post A Payment
30
Second Bill Review 31
Billing Analytics
32
Billing
BACK TO CONTENTS
Create A Bill
Click Create Bill
Bill state will update to
“Ready to Bill” when a
report is finalized.
1. Patient and appointment information
automatically populates.
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2. Any CPT codes entered on the
Superbill Tab populate here. You
can also enter CPT and HCPCS codes
below.
3. Bill Type, Date and Report populate
automatically here.
4.“Show report” opens the report to be
billed in a new tab.
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5.Information for CMS-1500 boxes
populates automatically. You can also
set values manually; for example,
the dropdown menu for Original/
Duplicate/Appeal (Box 10d) includes
all necessary options.
6. Fee schedule is set automatically to
the appropriate schedule depending
on the date of service; for dates
after January 1, 2014, the default
is CA DWC RVRBS. The exception is
users who have a custom Usual &
Customary fee schedule entered.
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7. See next page for details.
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See next page for more details.
8. Information for CMS-1500 boxes 24J,
29, 32 and 33 is set by default in your
tenant, but can be changed here if
necessary for the specific form you
are creating.
9.Click to create bill. Healthonomy
automatically fills in the CMS-1500.
Create A Bill (continued)
The “Service Line” section fills out Box 24 of the CMS-1500 for you, up to 6 lines per form.
Click Show Diagnosis
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Check all Dx.
1. Date and provider information
automatically populates.
Check specific Dx.
2. Modifers for selected code.
3. Click “Details” to see calculation:
Diagnosis Auto-Populates
Add New Diagnosis
4.Click the number link (in blue) under
Charges/Mult to see details regarding
Multiple Procedure Cascade, Modifier
Multipliers.
Choose Code From List
OR
Add From Superbill
5.Totals for each Service Line and Total
Charges for the bill (CMS-1500 Box 28)
update automatically.
RVRBS: The New Fee Schedule
On January 1, 2014, the California Division of Workers’ Compensation (DWC) began
using a resource-based relative value scale (RBRVS) based physician fee schedule, which
is applicable for services rendered on or after January 1, 2014.
To address the impact of this decision on all of our clients, Healthonomy has created
the following resources and calculators within the software:
Healthonomy
oIf you are using the billing function of Healthonomy, the new fee
updates automatically
schedule is already loaded and transitioned for you.
as new Fee Schedules
oThe new fees update at least quarterly; some code values update
are published.
weekly. The actual fee will change based on date of service; fees
are calculated from regularly updated government resources (roughly
6 different resources). Healthonomy updates fee schedules for you.
oHealthonomy also features a convenient fee calculator; see below.
For CPT and HCPCS definitions, we recommend that you acquire copies of the
official AMA code books, which are generally updated yearly.
Healthonomy Billing offers a comprehensive billing module that includes the many
variables required for billing calculations, as of January 1, 2014:
oConversion Factors
oCalifornia-specific Codes
oFacility and Non-Facility
oModifiers
oCCI Edits
oGAFs
oRVUs
In addition, Healthonomy Billing will continue to address dates of service retroactive to
the 1997 fee schedule.
RVRBS: Fee Calculator
Healthonomy’s RVRBS Calculator quickly and easily calculated what is due based on
California’s new RVRBS Physician Fee Schedule. The calculator includes all six (6) fee
schedules currently in effect; plus, we update the calculator and billing function as new Fee
Schedules and Regulatory changes are announced.
Administrators may access the Fee Calculator from the Adminstration Tab:
Add A CPT Code
Your Healthonomy is loaded with most commonly used codes. Billing Administrators
can add any extra codes in a few easy steps.
From the Administration Tab:
Find
Add New
Print Patient Ledger
Staff with a Billing or Billing Administrator login can print the patient’s
billing ledger with a few clicks.
1. From the patient’s page, click “Download xls.”
2. In the dialog box, choose to Save or Open the document with MicroSoft
Excel® and click OK.
3. An Excel sheet with all ledger data will open. You may then edit any
information that you do not wish to share on the ledger.
Print Ledger
Post A Payment
1
Users with Billing or Billing
Administrator permissions may
post credits in Healthonomy.
From the patient’s page:
1.Click “Post Credit.”
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2. In “Credit(s)/Response”
section, choose the relevant
items. In this example, we have
a payment (partial) as well as
an EOB. *It’s important to fill
this section out correctly, as
the content of the window
changes based on what you’d
like to do.
3. Note that you may upload a
scan of the relevant documents
at this point in the process.
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4. Log payment information
including From, payment type,
check number and a memo
if desired. Dropdown menus
populate automatically from
demo info.
5. In the case of an EOB/EOR
only, spaces for Denial Text and
Denial response will appear.
6.Click to automatically fill out a
Second Bill Review form.
7. If desired, note Bill State,
Assign To, create Update Note.
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8. Enter Amount, with options to:
Clear All
Write-Off Balance
Distribute Payment (evenly)
Pay All CA DWC
9.Enter payment, penalties/
interest, balance to write off.
10. Click Create.
Second Bill Review
When you post a payment,
Healthonomy fills in the
Second Bill Review (SBR) tab
for you.
Also, you can go to the SBR
tab on any encounter to
create the SBR; for example,
if you receive an EOR/EOB
with no payment, simply go
directly to the SBR tab on the
appropriate date of service to
create the SBR.
State of California
Division of Workers’ Compensation
Provider’s Request for Second Bill Review
California Code of Regulations, title 8, section 9792.5.6
The Medical Provider signing below seeks reconsideration of the denial and/or adjustment
of the billed charges for the medical procedures, goods, or services provided to the injured employee.
Employee Information
Employee Name (Last, First, Middle): Demo, Bill
Date of Birth (MM/DD/YYYY): 07/07/1977
Social Security Number: 123-45-6789
Date of Injury (MM/DD/YYYY): July 7, 2013
Claim Number: 123456789
Provider Information
Provider Name: John Q. Provider, M.D.
Contact Name:
Address:
City: Anaheim
State: CA
1234 Euclid Ave
Zip Code: 92805
Phone: (888) 999-7777
Fax Number: (888) 999-7776
E-mail Address: [email protected]
NPI Number:
Claims Administrator Information
Claims Administrator Name: GALLAGHER BASSETT SERVICES, INCORPORATED Contact Name:
Address: P.O. Box 22348
City: Tucson
State: AZ
Zip Code: 85734
Phone: (818) 846-5297
Fax Number: (818) 846-1153
E-mail Address:
Employer Name: Joe's Garage
Bill Information
Provider’s or Claims Administrator’s Bill Identification Number (if any):
Was Billed Service Authorized?
Yes
No
Date Explanation of Review Received by Provider: 01/10/2014
List of disputed procedures, goods, services (attach additional pages if necessary):
Treatment/Service/
Amount
Date of Service
Item in Dispute
Amount Paid Amount in Dispute
Billed
1/01/2014
(include modifier, if any)
62278
358.32
150.00
358.32
Additional Supporting
Information/Documentation
Attached?
Yes
No
Reason for Requesting Second Bill Review and Description of Additional Supporting Information/Documentation:
Denial response goes here.
Date of Service
Treatment/Service/
Item in Dispute
(include modifier, if any)
Amount
Billed
Amount Paid
Amount in Dispute
Additional Supporting
Information/Documentation
Attached?
Yes
No
Reason for Requesting Second Bill Review and Description of Additional Supporting Information/Documentation:
Signature:
DWC Form SBR-1 (version 12/2012)
Date:
Page 1
Billing Analytics
Billing or Billing Administrator users can view important data on the Billing tab.
Billing Tab
The Bills tab lists
all billing data and
can be filtered for
the specific data
you require.
Bills
Bill Aging
On the Billing
Analytics tab,
you can see and
download your
billing data,
organized by
Patient, Provider,
Facility, Collection
Agency, CPT code
or report type.
The Bill Aging tab
breaks out bills
with a positive
balance -- and you
can click on the
age range to see
more details.
Billing Analytics
TRAINING
Workflow & Referrals
Refer A Patient From Patient Page
34
Refer Multiple Patients
35
Upload Multiple Documents
36
BACK TO&
CONTENTS
Workflow
Referrals
Refer A Patient From Patient Page
Click “Refer Out”
1
1. Fill out referral:
- To Client & Facility
- From Provider & Facility
2. Select the injuries you
want to refer.
3. Select the documents
you want to send.
4. If desired, you can also
designate specific CPT
codes to Refer for.
2
5. Make a note (not
required); the referral
will see the note in their
Healthonomy tenant.
3
6. Click “Refer Patient.”
4
Referral Summary on Patient Page
5
6
Refer Multiple Patients
Healthonomy makes it easy to refer multiple patients to the same Healthonomy client.
1. From the Referrals tab, click on “Refer Multiple Patients.”
2. Select the Client to refer to, and enter all patients.
3. Then click “Refer Patient,” and all patients will be referred.
Refer Multiple Patients
Upload Multiple Documents
Documents Tab
Upload Documents
Drag and Drop Multiple Docs Here
Click “Upload”
Assign Uploaded Documents to Patients