Electronic Visits (evisits)-providers Corporate Office 16703 Mc Gillivray Blvd., Suite 200 Vancouver, WA 98683
Table of Contents General Information:...4 Patient evisit eligibility:...4 Fees for evisits:...4 Practice Mate set-up to accept evisits:...5 The evisit Process:...6 Responding to an evisit:...8 Billing your evisit:...12 Practice Mate billing software users with self-pay evisits...12 Practice Mate billing software users with covered visits (Blue Shield-CA patients):...13 Non-Practice Mate billing software users:...13 Checking Claim Status:...14 Accessing Download File Summary Reports:...14 Rejected Claims:...15 For Claim Fix in Practice Mate:...16 For Claim Fix in the Service Center:...16 2
Electronic Visits (evisits) evisits are an option for patients to receive diagnosis and health care consultation without visiting the provider s office, via the Patient Ally communication channel. An evisit prompts the patient to answer clinicallyderived questions based upon the general symptoms and/or conditions they may be experiencing. The evisit begins when an enrolled patient logs into his or her secure Patient Ally account and selects a non-urgent problem to report to their physician. A series of targeted questions survey the essential information, much as a physician would during a live office visit, and the patient s responses are sent securely to the physician s message center. The physician responds with a course of action or schedules an office appointment. 3
General Information: Provider must be enabled with Office Ally for Practice Mate, join Patient Ally, and select Allow EVisit as an option. The provider will be enabled for the evisit once the evisit User Agreement is received by Office Ally. Schedulers will call providers within 48 hours to schedule training. Patient evisit eligibility: Patient must be a Patient Ally user evisits may be: o Patient Covered (insurance does not pay, patient self-pays), or o Payer Covered (insurance is an OA payer which covers evisits) Fees for evisits: Patient Covered: o Provider sets the fee to the patient o Office Ally will collect the fee via credit card or electronic check, retain $1.00 per evisit, and remit funds to provider within 45 days. o If the provider uses credit card processing through TransEngen, the fee is reduced to $0.50, and funds are deposited directly to the provider bank account at time of processing (see TransEngen posting policy). o The fee is collected at the time the patient retrieves the reply from the provider. Payer Covered: o Payer specifies allowed amount to the provider and patient co-pay o Office Ally will collect the co-payment via credit card or electronic check, and remit funds to provider within 45 days. o If the provider uses credit card processing through TransEngen, the funds are deposited directly to the provider bank account at time of processing (see TransEngen posting policy). o Office Ally will generate and electronically transmit the claim automatically to the payer. 4
Practice Mate set-up to accept evisits: From Manage Office tab, select Patient Ally Settings. Edit the profile for each provider who will accept evisits. Enter your TransEngen Merchant number if applicable, and make any adjustments to your selections as needed. The email addresses may not be changed currently. 5
The evisit Process: The patient will request evisit, using the Healthcare Requests link in the Patient Ally website The patient will select the desired provider from their provider list by clicking Start Interview and be asked if they are a Blue Shield patient or Private Pay If the patient is a Blue Shield patient, Patient Ally will check eligibility to determine if evisits are covered in their plan The patient will accept the Terms of Agreement, which will disclose the fee, either the self-pay fee determined by the provider, or the Blue Shield co-pay The patient will select the reason for visit from a list or will type in a reason The patient will complete a series of questions from a pre-determined list based on the reason for visit. o The patient interview is an algorithm, developed by Prime Time Medical, and used by the Mayo Clinic and many EMR programs o The series of questions will change based on the patient s answers to previous questions o The patient will also be able to add narrative comments to the interview A sample question is below: 6
When the patient has completed the interview, they will review their answers and submit the report to the provider. 7
Responding to an evisit: The Provider will see an entry in the upper right portion of the Practice Mate screen (where the login message and Company appear) indicating New EVisit, and if the option is currently selected in the Patient Ally Settings, will also receive an email notification that a new evisit message has arrived. The email contains a link to the Office Ally website. Once in Practice Mate, the provider will access the Patient Portal and view the E- Visit list. Click the View link to access the evisit. 8
The Doctor Report will present the interview information from the patient, and the Self-assessment Scales. o The questions responded to positively will be in bold. o The questions skipped by the patient will be listed at the end of the Doctor Report, along with the narrative comments. The Doctor Report may be printed or saved outside of Practice Mate for attachment to a patient chart with the icon in the upper left corner. 9
Below the Doctor Report, the provider will enter ICD9. o User Defined list and System list are available in popup boxes The provider s narrative response is entered in the reply area. o Templates for common replies may be created in the Manage Office tab in Practice Mate, in the E-Visit Reply Template link The Reply button will send your narrative report to the patient. To view your report, the patient must pay your established fee or their co-pay for covered visits. The patient may then respond to the provider report if you have requested additional information. Visit correspondence is displayed in the evisit Message History area of each visit. By checking the Complete Electronic Visit box, you will prevent the patient from sending you a response. Click the Close evisit button if you wish to save the visit without replying to the patient, or would like to allow the patient to respond to your reply. 10
When you click the Reply button, and the patient is a Blue Shield CA covered patient, Practice Mate will search for the required information to take the next step, which is to bill your transaction. If you receive an error message upon clicking the Reply button, required elements are missing, and you will need to correct this prior to proceeding. See the next section for details. 11
Billing your evisit: Practice Mate billing software users with self-pay evisits: You will need to create a visit and a claim using your Practice Mate system. Use the link in the EVisit list to shortcut to the Patient Visits tab. Complete the Billing Info with all of the required information, using a Place of Service code of 99, and a CPT code of 99444, and inserting your fee for evisits. You may create a shortcut for entering the codes and fees in your User Defined CPT code base and/or Superbill in the Manage Office tab. 12
Practice Mate billing software users with covered visits (Blue Shield- CA patients): If you are a Practice Mate user and the evisit is a covered visit with a Blue Shield-CA patient, your visit and claim will be created automatically, and the claim will be submitted automatically. The visit and claim are created at the time you send your first Reply to the patient. If the required elements to create a visit and claim are missing from the patient profile, an error message will be generated, and you will need to update the patient profile in Practice Mate prior to generating your Reply Non-Practice Mate billing software users: For self-pay evisit patients, you will need to use your billing software to create a receivable for this patient, just as for any self-pay treatment. For covered patients (Blue Shield-CA patients that qualify), you will need to create a receivable for this patient in your software; however, Office Ally will create and submit a claim for you. If the required elements to complete a claim are missing, you will need to update the information in Practice Mate before proceeding. 13
Checking Claim Status: Accessing Download File Summary Reports: For all providers, to see the results of your claim you will need to access the Download File Summary to see your results. If you are already using Practice Mate as your billing software, these results will be in your normal Download File Summary, accessed through Practice Mate. If you are uploading claims to Office Ally from another software in a batch file, you will see these results in your normal Download File Summary in the Service Center. They will be identified as ONLINE ENTRY BATCH. If you are not currently sending claims through the Office Ally website, the directions to access your Download File Summary from Practice Mate are below. 14
Rejected Claims: If there are any claims rejected, or shown as failed in your reports, you will locate them either: o In Practice Mate, in the Claims Billing tab, Repairable Claims link, or o In your usual Claim Fix/Repairable Claims area of the Office Ally Service Center if you upload claims to us in a batch file. 15
For Claim Fix in Practice Mate: For Claim Fix in the Service Center: 16