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This release was focused on enhancing RCM workflows.
Enhancements & Filled Gaps
New RTE check failures should re-open existing tasks instead of creating new tasks
When new RTE check failures are received, the previous related task is re-opened instead of a new task being created. This will greatly reduce the number of eligibility-related tasks assigned Gentem customers.
Enhance claim auto-submission to include secondary claims with primary ERA check date greater than post date
We received an error due to the PAID DATE RECEIVED LESSER THAN DOS OR PAID DATE GREATER THAN PROCESSED DATE AT LINE LEVEL'
Logic has been added to determine if the primary ERA exists and check date has passed (equal today or in past) and submit the claim if this is true. If the check date for the primary ERA has not passed, a billing note reading Pending auto-submission: Check date greater than post date is added to the claim.
Added additional ERA DOS logic
An ERA that we received did not show a DOS in Gentem but it was present in Trizetto. Additional logic was added to use a combination of dates for UI display.
Enabled adding $0.00 adjustments
Previously, logic was put into place to block the ability to add $0.00 adjustments. Due to new scenarios this feature wad reimplemented to support RCM denial workflows.
“GENTEM” prefix added to the claim submission id
The claim submission ID was updated to include “GENTEM” in the prefix to improve ERA parsing between Gentem and SimplePactice.
When the ID is received internally from an external system, the ID is parsed to remove the prefix (“GENTEM-”) and only the claim submission ID is stored in Gentem systems.
The new submission id format shared with external systems is GENTEM-123456
Historical Claim Data Script
A historical claim data script was created to assist in analyzing historical claim data for customers being onboarded.
The new report will be provided to RCM after the historical sync runs. The report fields include the following:
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Rendering Provider Name
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Rendering Provider NPI
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Supervising Provider Name
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Supervising Provider NPI
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Billing Provider Name
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Billing Provider NPI
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Place of Service
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Date of Service
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Modifiers
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CPT codes
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Total Charges
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Claim Status (paid, denied, rejected, etc)
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Payer (Primary)
Added feature flag for processing Eligible ERAs
To support the new ERA sharing feature between SimplePractice and Gentem, a feature flag was added to enable or disable pulling ERAs and EOBs from Eligble using the SimplePractice API. The default value is set to false to disable importing.