The Following Documents Are Required Before Go-Live

Original Date:

Last Revised:

Concierge RCM Implementation

Practice Name: /

Specialty:

Documents

The following documents are required before Go-Live:

/ Implementation Forms:
Business Entity Setup Form
 Provider Setup Form
 Office Location Setup Form
 Additional POS Location Setup Form
 User Setup Form
Top 10 Payer List, plus a copy of a claim submitted to those payers and its corresponding EOB. (This will allow us to verify credentialing and prevent First-pass resolution denials)
Copy of Office Super billand Hospital Super bill/ rounding card or a list of your top billed procedure and diagnosis codes. (This will allow us to ensure that all ICD-10 requirements are being met.)
W-9 for each Office Location you are currently billing under
Login and passwords for payer web portals must be received or created before the ‘Go-Live’ date.

CLAIMS

PAYER REQUIREMENTS

1. Are there currently any unique requirements when billing claims to specific payers? For example:

A.Workers’ Compensation claims requiring authorizations and/or medical records. If so, please provide plan name and specific requirement(s).
B.Medicaid claims requiring consent forms for payment. If so, please indicate which payers, procedure codes, and specific requirement(s).
Please note: for any claim that requires additional documentation to be attached to the initial claim, you must upload it tothe patient file and select “paper claim”when entering charges so it can be printed along with the initial claim. It is the client’s responsibility to provide all information required for a ‘clean claim’ submission.
CAPITATION

1. Are there currently any capitation contracts affiliated with the provider(s)? If so, please provide copies of these contracts and respond below.Please specify if your capitation contract is one of the following:

1. Fee for Service
2. Flat Fee
3. Fee Arrangement

Please note: any capitation contract billed through CareCloud that is not properly defined via acopy of the contract or specific contract details regarding carve out codes will be adjusted per the EOB/ERA information the payer provides.
CREDENTIALING

1. Credentialing information will be verified via the Top Payer List provided. We will address any issues we encounter with you immediately. However, if known, please indicate the following:

1. Are there currently any existing credentialing issues? If so, please indicate which payers are involved.
2. Are you currently billing payers that you are not credentialed for? If so, please provide us with the names of those payers and any specific process required for reimbursement.
3. Are there currently any Tax ID issues (e.g., provider not being linked to payers billed, provider with more than one tax ID),? If so, please indicate which payers are involved and the current status of each issue.
4. If you have mid-level providers (PA’s, APRN), will they be billing under the group or as individuals?
5. If you have individual providers will they be billing under the group or as individuals?

Payer / Credentialed / Validation / Notes
Please note: any current or discovered credentialing issues will require CareCloud to place the payer or provider on hold to prevent denials. Charges entered into CareCloud Central for these payers or providers will be accepted, but will not be submitted to the payers until the credentialing issues are resolved.
CLIA CERTIFICATION

1. Are you currently providing and billing Laboratory Services of any kind within your practice? If so, please review below.

1. If you provide CLIA certification numbers via the “Office Location Setup Form” CareCloud will validate the current certification level. Please ensure that all services you are billing under those locations fall under your current CLIA level. Please review the following questions:

1. Are you currently billing any lab services that fall outside of your established certification level? If so, what are those services?
2. Are you currently undergoing a CLIA Level upgrade? If so, are you currently billing codes outside of your current CLIA status? If yes, what are those services? Has the payer agreed to retroactively pay for these services once the upgrade is complete?

Unless otherwise indicated above, any services performed outside of the certification level parameters will be adjusted per the EOB/ERA information the payer provides.
INJECTIONS/IMMUNIZATIONS

1. Are you currently administering any injections, medications, or immunizations within yourpractice? If so, please provide a list along with the corresponding NDC numbers to ensure that this information is uploaded in the system.

1. If you are currently having issues with any of these codes please let us know which ones and with which payer(s)so CareCloud can proactively prepare and assist in the matter.

Please note: any services of this nature, billed without a corresponding NDC will generate a denial and cause a delay in reimbursement or potentially loss of revenue in some circumstances. Please ensure that you communicate any changes to the list,including additional services, to your client manager for system update.

BILLING DETAILS

ALL CLIENTS:
Please note: it is the client’s responsibility to keep track of and correct all PAYER REJECTIONS. Any failure to do so in a timely manner could result in a delay of payment or loss of revenue due to payers’ timely filing limitations.
Any claim edits overridden by the client within the system which produces a denial must be reworked via a task to the client within 7 days or timely filing whichever occurs first.

COLLECTIONS

SPECIAL PROGRAMS/PAYER INCENTIVES

1. Are you currently enrolled in any special medical program, arrangement, or payer incentive program? Examples of these programs include:

Flat Fee Arrangements
Fee for Service
Contract Specific Timely Filing Requirements
PQRS and or E-Prescribing Incentives (Medicare)
Charity Care Agreements with Facilities such as Hospitals.
Carve Out Payers – Client does not want CareCloud to work claims for these payers. Client retains responsibility for working these claims. Claims pending > 12 months must be completed/adjusted to remove them from the collections inventory.
Other: ______

BLANKET AUTHORIZATIONS

1. Do you provide specific services that should be written off, such as Medicare Reporting Codes, surgical trays, specimen handling, small balances, denials for Medicaid Secondary when allowable is less than primary payer payment,etc.? If so, please provide us the specific codes.

CPT Code = XXXXX / Systemic Adjustment
Ex: Balances >$5.00 and < $10.00 / Adjust
TASKS (INTERNAL COMMUNICATIONS BETWEEN COLLECTIONS TEAM AND CLIENT)

1. When collection incidents require information from the practice, who should the contact person beat your practice?

Turnaround time for task completion by the client is 7 business days. Any task you do not respond to in a timely manner, resulting in a denial for timely filing, will be adjusted per the EOB.
Clients with a single location: please provide thename of the person who will be resolving and/or supervising all assigned tasks. Clients with multiple locations: please provide one name per location of the person who will be resolving and/or supervising all assigned tasksfor eachlocation.
INSURANCE INFORMATION

1. Will you be scanning insurance cards and/or photo ID into the CareCloud system?

Please note: any denials related to member eligibility that cannot be confirmed via a scanned ID card or information provided within the account demographics or documents will be transferred to the patient’s responsibility.
REGULATORY AND COMPLIANCE AUDITS

1. Havethere been any payer audits conducted in the past or are any in process currently? If so, please address questions below:

1. When was the last audit?
2. Which payer(s) were involved?
3. What were the results of this audit?
4. Do you currently still owe money to the payer related to this audit?
5. Please provide a copy of the release letter.

MEDICAL RECORDS
If your practice is notusing CareCloud Charts (EHR),all medical records for services billed under CareCloud must have signed records scanned into the system.In the event of a denial requiring medical records, any record not found will delay reimbursement. The Collector will task the office contact for records and will not be able to proceed withthe claim until the signed records areloaded into CareCloud.
UNBILLED CHARGES
First date of service billed through CareCloud: ______

REMITTANCE

LOCKBOX

1. Do you currently have a Lockbox? If so, please address the questions below. If not, please proceed to question 2.

1. Please provide us with a contact names and numbers for the bank and office.
2. Please provide us with name of the bank utilized.
3. Please provide us with the log in information.
4. Refer to Lockbox implementation requirements document.

REMITTANCE BATCHES SUBMISSION

1. Remittances should be scanned both front and back and batches should not exceed 100 pages, but should be inclusive of the entire remittance. Batches should include a list of payments being submitted by payer, check number, and amount, within 48 hours of receipt.

The full remittance must be provided when the remittance includes services prior to the CareCloud effective date. Missing remittance > 15 days from the cash date will by manually created and posted based on payer provided information.
The payer has indicated the claim has been adjudicated and the check/EFT was deposited: CareCloud will create a manual EOB when the payer provides remittance details and the EOB document cannot be retrieved through various collection attempts (e.g., payer portal, faxing duplicate EOB, mailing duplicate EOB).
CORRESPONDENCE

1. ALL correspondence the practice receives from the payers must be included in batch submissions within 48 hours of receipt. (See attached Addendum for examples).

*Please note: failure to upload correspondence timely may result in a delay of payment or denials for timely filing concerning appeal resolution or medical record request sent to you by the payer.
POSTING

1. All remittances will be posted and adjusted based on the charge level, group, and claim level reason codes.

Claims with remaining balances under $5 will be systemically adjusted by CareCloud.
PREVIOUS PAYMENT ADDRESS

1. Please provide us with the previous remittance address: ______

BATCH PROCESS
ERA’s:  Same day auto batch and post 7 day batch and post (For those clients who reconcile)
EOB: If your practice does not use a lockbox, you must upload these intothe CareCloud system within 2 business days.

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Client SignatureClient Name/ PositionDate

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Implementations SignatureName/ PositionDate

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Collections SignatureName/ PositionDate

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Client ManagerName/ PositionDate

Correspondence Type / Description
Medical Records Request / A request from payer for documentation to be provided before payer will consider adjudication
W-9 Forms / Request for tax document/W9
Appeals letters denied for timely filling / A letter provided by payer advising of an appeal being denied
Letter for pending further review / A letter provided by payer advising client that claim is pending review
Refund Request / A letter provided by payer requesting the client to refund a payment previously made to provider
Tax Related Documents / W2 and other tax related documents provided throughout the year
Voided Checks / A copy of an EOB with voided check
EOBs without checks / An EOB provided reflecting payments but no proof of payment
Credit Cards / Patient and/or insurance virtual cards provided
Credentialing Request/Letters / Paperwork provided by payer requesting physician or group insurance enrollment/credentialing information or a letter welcoming a provider as an enrolled provider for the insurance
Bankruptcy Letter / Legal paperwork provided by the courts advising of patient and or patient parent in bankruptcy
Patient Letters / A letter provided by the patient with insurance information
Patient Letter (2) / A letter provided by the patient with demographic information
EFT Payment EOB / An payment EOB reflecting a EFT payment
Letter notification of lost or none deposited check / A letter provided by the payer advising of a check reflected in their system as not cashed
Appeal or claims denied for original decision upheld / A letter provided by payer advising of an appeal or claim original decision being upheld
A claim/appeals request letter in process / A letter provided by payer advising claim and/or appeal is being processed
Authorization letter received / A letter provided by payer with total number of days authorized and authorization number
A payment issue to patient letter / Payment made to patient/insured/responsible party/employer
A reject claim letter / A letter provided by payer stating the payer is rejecting and/or not processing claims
COB-Coordination of Benefit Letter / An attachment/other documentation is required to adjudicate this claim/service
Provider Enrollment Letters / Mark as Other

ADDENDUM

Examples of Correspondence Types that Clients Must Batch

IMP RCM Document 0904151