Release Notes 08/01/2023

This release was focused on logic updates for claim status and task updates.

Enhancements & Filled Gaps

Create tasks for Practice/Provider based on workflow triggers

Task automatically triggered when there is a claim validation issue, including:

• Invalid date of birth

• Expired insurance

• Eligibility checks - only create a task when an RTE check is initiated from insurance coverage create/update

  • Invalid date of birth

  • Expired insurance

  • Eligibility checks - tasks are created only when an RTE check is initiated from insurance coverage create/update

  • Policy not found

  • Unsupported payer

  • Inactive member

The created tasks will request the provider to update/validate the information. Updating the information will result in another eligibility check.

Close task after the insurance coverage update

Close the task automatically once an updated insurance coverage is received.

Fixed Bugs

Unable to manually allocate the ERA transactions

Gentem users are unable to manually allocate the ERA transactions. We resolved the issue with the UI menu showing the option for "Allocate transaction" instead of "Unallocate transaction.”

Update “Clear All Filters” in the remittance table

Fix duplicate EOB Line Item

When adding the EOB transaction, PR 2 and PR 3 are duplicated with the same amount.

SimplePractice Specific Updates

Post ERAs to the /DocumentReference endpoint

• When payment is received through Trizetto

• Pull EDI files

• Process and post in Gentem

• Store the information in a table (similar to export remittances)

• POST to the /DocumentReference endpoint

• Validate: RCM to review the payments received for that day and verify and validate payment posting (this will be a manual check in the beginning)