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SolAce
FAQs |
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SolAce Frequently Asked Questions
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Is SolAce HIPAA compliant?
Yes. SolAce can produce claim data in the ANSI 837 Professional
and Institutional formats, and can process several other related
transactions. The ANSI 837 file format is technically referred
to as ASC X12N 837 (00401X098A1). Full specifications can
be found at the Washington Publishing Company's web site at
www.wpc-edi.com.
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Is SolAce compatible with our practice
management system?
Yes. SolAce integrates loosely with your existing practice
management system, extending it to give you the control you
need for today's complex insurance billing tasks. Our unique
tool lets your staff and practice management system do what
they are best at, and SolAce snaps in to bridge the HIPAA
transactions gap. We have not found a practice management
system yet that SolAce won't work with.
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What happens after I order SolAce?
We'll help you get started as you place your order by inquiring
as to what payers you need to submit to. If you need enrollment
for any of the payers we can point you to the correct forms
and advise you while you fill them out. We can also recommend
the optimum way to submit your claims with our combination
of direct plus clearinghouse features. Some customers choose
to submit all their claims to the clearinghouse and pay the
15 cents per claim for government claims. Most customers have
a lot of government claims and it is beneficial to get a Medicare
submitter ID plus a clearinghouse ID.
You will receive your software CD-ROM and User's Guide in
5-10 days. We can provide a download link if you want it sooner.
Once you have the software installed you can rely on our staff
via phone or e-mail to get you going. If you have e-mail access
at your office we can even configure SolAce at our end and
e-mail your configuration to you.
The enrollment and setup assistance is covered by your Setup
Fee for what we call our Basic Support plan. There will be no extra support charges during your setup
period unless you opt for an on-site installation and training
session.
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How easy is it to setup SolAce?
We have complete step by step instructions in our manual
to walk you through the setup process. We also provide computer-based
training tutorials on the CD-ROM to show you how it works
in an animated, visual way.
The overall setup process that you can expect is outlined
below.
- You will need to enroll with payers for submitter IDs
and add them into SolAce as mailboxes. We enroll you with
clearinghouses if you are using any.
- You need to generate claims from your practice management
system and import them into SolAce to test it out. The most
difficult part for new users is getting the print file mapped.
This is a visual, drag-and-drop interface, and is very easy
to work with once you understand how it works. It is the
most intuitive mapping interface we've seen out there.
- You need to add your provider ID numbers into SolAce,
by entering them manually or preparing a CSV import file
if you have hundreds of providers to add.
- If you will be transmitting to any payers via a direct
modem connection you will need to setup and test your modem
information.
We have an online Flash demo
you can watch that takes you through the setup process. This
is one of the components that we provide for documentation
and training purposes.
On top of being easy to use, we have a dedicated support
team at 602-439-2525
or support@ivertex.com that can take you through the steps
or configure SolAce for you. |
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How much memory do I need to run SolAce?
On newer operating systems like Windows XP and Mac OS X you
will need at least 128MB of memory because the operating system
consumes a lot of memory. We recommend 128MB on all computers.
Memory is very inexpensive and gives you the most bang for
your performance buck of any computer component, so please
make sure you have sufficient memory installed on your computer.
You should have at least 100MB of free disk space for the
software to install and for data storage of claims, transmit
files, and configuration settings.
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How do I print to a file?
Almost every practice management system has an added feature
that allows you to send the printed claims to a file, because
that is how you would submit to a regular clearinghouse. This
is the ideal situation because you can set the destination file
in your printing step. Most systems that have this feature will
save the setting for you too, so you can just set it and forget
it.
This technique works with some practice management systems
but is reliant on the underlying Windows print driver. If
your practice management system has a print to file feature,
we highly recommend using that instead of relying on the Windows
technique. We can't guarantee that this print driver will
produce consistent results, although we haven't had a problem
to date.
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To setup a printer that directs to a file in a Microsoft
Windows environment, click the Start button, click Settings
and then Printers. The Printers folder appears on your
screen. |
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Open (double-click) the Add Printer icon. A ?wizard?
appears on your screen. |
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Click the Next button, choose Local Printer and click
Next again. |
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On the next screen of the wizard, make sure the ?Use
the following port? option is selected, and click the
?FILE:? port in the list. Click the Next button. |
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The next screen of the wizard requires you to select
a print driver. Find ?Generic? in the Manufacturers list
and select it. Next click ?Generic / Text Only? in the
Printers list, and click the Next button to proceed. |
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On the next screen of the wizard you'll be prompted
to name this printer. We suggest naming it SolAce. You
probably don't want this to be your default printer, so
select the No option on that question. Click Next twice
to finish up the wizard. From now on you can just select
this printer in your practice management system. Windows
will prompt you to enter a filename after you start the
printing. You should choose something simple to enter
here each time, and make sure the SolAce Setup / System
Options window has the same filename in the Print File
field. Also note that each time you select this printer,
Windows will indicate that the file already exists and
will ask if you want to overwrite the file. You will need
to select ?Yes?. This feature works best if you batch
your claims into one file. Printing one claim at a time
will cause the previous file/claim to be overwritten.
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Is there an additional fee for the clearinghouse?
If you purchased SolAce EMC prior to December 10, 2003 there
is a $200 setup fee to add the commercial claims option. Sales
after that point included the commercial options option as
part of the base package.
Our preferred clearinghouse partner is THIN.
Their payer list includes access to around 1,000 payers at no
extra charge. You do have to sign a user agreement with
them, which we send to you after you order SolAce.
If you choose to go with another clearinghouse that we support there may be payers on their list that are called non-participating,
which means the payer accepts claims electronically but does
not participate with clearinghouses for their revenue model.
These payers are primarily the Medicare, Medicaid, and Blues
plans that SolAce can submit directly to for no charge. EDI Healthcare, for example,
charges 15 cents per claim for these payers, plus a $20 per
month per submitter ID fee and potentially a $15 charge per plan for enrollment. If there are multiple providers
within a group practice and they send all the paperwork in
together then it is treated like one enrollment. Also, you
may only need one BC/BS enrollment for the whole nation, depending
on your situation. If you use SolAce to send commercial claims to THIN and your government claims direct to those payers you will have the best of both worlds. |
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How do I read a Explanation of Medicare
Benefits (EOMB)?
There is an excellent link at
Noridian Medicare to help you through reading an EOB.
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What platforms will SolAce run on?
SolAce is available for Microsoft Windows(tm), Linux, Mac
OS X(tm), and any other platform that supports Java(tm) 1.4
or higher. We have tested SolAce on the following operating
systems.
- Microsoft Windows 95, 98, ME, XP
- Windows NT 4.0 Workstation and Server editions
- Windows 2000/2003 Professional and Server editions
- Novell Netware version 4 or higher networks
- RedHat(tm) Linux 7.x, 8.0 and 9.0, Gentoo Linux 2004+, Mandrake
Linux 8 or higher, Debian Linux 3.0r1
- Any Linux or Unix distribution that supports Java and
XWindows should work fine
- Mac OS X (version 10.2 with Java 1.4 installed, or version
10.3
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How soon can I submit live claims with
SolAce?
For direct links most payers have us certify as a vendor,
then you have to enroll to get a submitter ID and send a successful
test batch. The payer will move you to production status within
a few days of that transmission. Some of our direct links
allow you to go directly to production, although we still
advise sending a test to get familiar with their system and
ensure your reports come back good. It usually takes 2 weeks
to get your submitter IDs, assuming you enroll when you order
SolAce, so you can be sending live claims within about 3 weeks.
If you are using a clearinghouse
then we have to help you with enrollment and your submitter ID will initially
be in test mode. You should review the report that the clearinghouse
sends back after a transmission. It will indicate whether
each claim was accepted or rejected. For THIN and EDI Healthcare clearinghouses, when you are
comfortable that SolAce is submitting clean claims to the
clearinghouse you can switch your mailbox in SolAce to production
mode. They do not care when you go production, it is entirely
up to you to decide when you are ready. For some clearinghouses
we must submit a production request form for you. We'll do
this after you send a test batch and feel comfortable that
your reports look good.
We recommend reviewing all reports that come back from payers.
These reports show up in your Inbox on the Send/Receive screen
after a transmission. Some reports are fairly useless, and
others are very important to review to ensure your claims
are accepted by the payer's claims processing system.
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How does SolAce handle provider ID numbers?
SolAce supports multiple payers and communication channels,
and payers have differing requirements on the Provider ID
numbers (PINs) that need to be used on their claims. To accomodate
all the different requirements, SolAce has built-in support
for very complex provider setups. SolAce tries to present
this in a very user-friendly way so that providers with simple
setups aren't overwhelmed, but providers with complex setups
are not limited by the software.
For starters, SolAce requires setup of a provider list. There
are multiple reasons for this, most important among them to
be able to provide good edit checks for new electronic claim
billers, and to support the provider data requirements of
the HIPAA 837 transactions. The provider list can be setup
by typing it in, or by importing CSV, NSF, or 837 files. For
users using the print image import option there is currently
no auto-setup feature since paper claims are so unstructured
(relative to the HIPAA standards) in the way they use provider
numbers.
Provider Types
Each provider in the SolAce provider list has an entry
type that is easy to understand, but tells SolAce an important
piece of information about how the PINs for that provider
can be used. The table below shows the provider entry types
along with the information that SolAce gets from that entry
type.
| Provider Type |
Valid as a
Billing Provider |
Valid as a
Rendering Provider |
Notes |
| Solo Practice/Organization |
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| Group Practice |
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Will
have no UPIN or taxonomy code. Used for Facilities also. |
| Group Provider |
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Will
have no address, and will always reference a billing provider
(a Group Practice) for name, address and Tax ID. |
General PINs
Each provider in the SolAce provider list has a Tax ID
or SSN. Group Providers have an SSN but it is never transmitted
and is only used in rare cases for matching an SSN on a claim
form to an entry in the SolAce provider list.
Each provider also has a list of General PINs, which are
provider ID numbers based on a payer's Plan Type (also known
as "line of business"). Examples of General PINs
are Medicare PIN, Medicaid PIN, and BCBS PIN. Plan Type corresponds
to payers because each payer in the SolAce payer list has
a Plan Type. SolAce determines which PIN to use for an individual
claim by looking at the payer and provider number on that
claim. For a Medicaid claim it will try to locate a provider
with the Medicaid PIN on your claim. If there is no matching
PIN for the payer a match will be attempted based on Tax ID.
As an example of how this works, assume you have a claim
imported into SolAce with the payer identified as Virginia
Medicaid and a PIN in box 33 of 12345. Virginia Medicaid's
entry in the SolAce payer list indicates that the Plan Type
is Medicaid. In this example, SolAce will try to locate a
provider entry with a Medicaid PIN of 12345. Once located,
the provider entry tells SolAce everything it needs to know
for edit checks and transmission.
There are always exceptions, and for everything we have covered
up to this point there is a way to override the default behavior.
PIN Overrides
The PIN Overrides feature in SolAce is where the ultimate
in PIN flexibility resides. This feature lets you build a
list of payer-specific provider ID numbers. PIN Overrides
take precedence over the General PINs we just covered.
To add a PIN Override you select the payer and enter the
PIN that should be submitted for that payer. The PIN Overrides
list is checked before the General PINs or Tax ID, both during
editing and transmission. This allows you to print one PIN
on your claim form and set it up in the General PINs area,
but override it for electronic claims by adding an entry to
the PIN Overrides list.
In addition, you can override whether the PIN is valid for
use as a billing or rendering provider number. Remember what
we covered in the Provider Types section above about the different
provider types being valid for billing or rendering usage?
The PIN Overrides feature lets you override this default behavior
for individual payers to allow use of a PIN as billing or
rendering. SolAce also tries to default this sensibly, such
as allowing Group Practices to be used as Rendering providers
on commercial claims.
Scenarios
Some of the more complex scenarios are described below
with a description on how SolAce would be setup to handle
the situation. Keep in mind that each scenario might be payer-specific,
and SolAce can handle each scenario separately by payer. In
other words, you might have one scenario that applies to Medicare,
and another that applies to Medicaid. You would just combine
the different setup techniques described below to handle all
your payer's requirements.
| Scenario |
Provider Setup |
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Group number for the office and individual numbers
for each physician.
In
1500 form terms this would be your office name and group
PIN in box 33, and individual name and PIN in box 31
and 24K respectively.
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Add the office as a Group Practice, then
the individuals as Group Providers. Enter the Medicare
Group ID in the Group Practice's Medicare PIN field, and
the Medicare PINs in the individual providers' Medicare
PIN field. For Noridian submitters, use the PIN Overrides
feature to supply a different PIN for electronic claims
than you would typically use for paper claims. |
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Billing provider is a company, but the individual providers
don't have PINs and get billed using a company PIN for
all or most of the providers.
In 1500 form terms this would be your office name and
PIN in box 33, and an individual's name in box 31. This
is a common setup for commercial payers where the Tax
ID is used as the PIN.
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Add the company as a Group Practice. Go to the PIN
Overrides feature for the Group Practice and add a payer-specific
PIN with the Rendering checkbox marked to indicate the
group PIN can be used for the rendering provider ID.
Be certain to map the RENDERING-NAME field to box 31
or 33 in your map because SolAce will not be able to
pull the name from the provider list in this case.
If there are also individuals in the mix that have
specific PINs for themselves, then add those individuals
as Group Providers related to the Group Practice. Enter
general or payer-specific PINs for these individuals
and it will be used with the Group Practice PIN on the
claim.
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Billing provider is a company, but some individual
providers have PINs and should be billed as the billing
provider.
In 1500 form terms this would be the physician's name
and PIN in box 33, even though they are part of a larger
group of doctors.
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Add the company as a Group Practice, then
the individuals as Group Providers. Use the PIN Overrides
feature to enter the PINs on the Group Provider entries,
and mark the Billing checkbox to indicate the individual
PIN can be used for the billing provider ID. If you also
have a PIN at the Group Practice level it will only be
used for Group Providers that have PINs without the Billing
checkbox marked. The Group Practice information is still
used for Address, Contact Person, and Tax ID. |
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How does SolAce send claims to multiple
payers?
SolAce determines how to route each claim on an individual
basis. The payer on the claim has to first be resolved to
a payer in the SolAce payer list. This can be accomplished
in one of two ways:
- Use the same ID or Name that SolAce has on its payer list
for the claims that you import, or
- Add an alias for the payer the first time SolAce tells
you the payer doesn't match to one in the list. This is
done by clicking the Search button and picking the correct
payer, then answering Yes when prompted if you want to setup
an alias.
You can mix claims to different payers into a single batch
unless you have different billing requirements for the payers.
For example, some specialties have to bill Medicare differently
than they bill other payers, such as Chiropractic, Ambulance,
Podiatry, and PT/OT specialties. If this is the case for you
then you may need to separate your Medicare claims from all
the other payers before you import into SolAce.
Secondly, the billing provider on the claim has to be resolved
to a provider in the SolAce provider list.
Once the payer and provider are resolved, SolAce then finds
the best route for the claim using the mailboxes that you
have setup on the Setup/Mailboxes screen. Direct connections
are weighted as zero cost even though there may be long distance
or ISP charges involved. Clearinghouse connections can vary
in cost because clearinghouses charge different rates depending
on their contract with the payer or other clearinghouses.
SolAce estimates clearinghouse charges for you based on whatever
clearinghouse data it has loaded, and will display the estimate
on each claim and on the Send/Receive screen before you transmit
the claims.
You can see the route that SolAce selected for each claim
by checking the Mailbox field in the Claim Editor screen.
This field is present in both the claim form views and on
the Payers tab, located just below the payer field.
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SolAce
EMC Desktop Edition |
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