British Columbia Alternate Payment Billing

Date of Tech Note: 23 April 2001
MediFile Version: 2.x
Author: Norine Bevan
Enhancement: N/A
Bug Fix: N/A

Instructions for Sending Files

1. Go to the Administration Corner.
2. From the Generate Billing Popup select ‘Alternate Billing’.

3. You will be presented with the MediFile search editor. Enter the information in the search editor to have MediFile find the billing records you want to send in the file.

4. Click on the OK button to have MediFile do the search.

5. You will then be asked to set the name and location of the file. This occurs via the standard dialog of your computer system.

6. MediFile will show you the progress of the file creation.

7. When the file is generated for you a dialog will inform you of what was accomplished in the file generation.

Example:

The report will tell you the total dollar value of the submissions and the number of billings that were reported in the file.

MediFile will check each billing record for the items listed below before sending them in and, if there is a problem, you will be presented with the following alerts. To send these billings in you will need to find these billings, fix the problem and change the status from APBHold to Created.

Item Checked Message

If the Date of Service is blank, "Date of Service Missing" will appear.

If the HSC is blank, "HSC not Entered" will appear.

If the ICD is blank, "ICD not Entered" will appear.

If the Agency is blank, "Agency not Entered" will appear.

If the Start Time is blank, "Service Time Blank, Appt not found" will appear.
If the Servoce time is blank, "Service Time Blank, Appt not found" will appear.

Patient record No MediFile # for Patient
No MediFile # for Patient
No PHN
DOB Missing

If the Bill Account is blank, "Area Missing MSP#" will appear.
AreaAcct Not Found

BC Billings

While in MediFile, when you are ready to send an electronic file to MSP, click on the generate e-bill button. The MediFile program will find all your claims that have a status of "created" in the billing file and will write them to your hard drive in a file named MSPClaims.DAT. This name is the same every week, since the Teleplan software cannot accept anything other than one name. It is then up to you to change the name of the file to the date you sent it each time the sending to MSP is successful. This way every file is not overwritten each time you click the generate e-bill button. Having renamed the file, the Medifile program will automatically place it in your PC MAC Share folder so that it can be seen on the PC side when you launch Virtual PC and Teleplan.

The Teleplan software will look for the file to be sent in with its program in the PC MAC Share folder; however, it will not put the file it brings back (remittance file) in this folder, since the Teleplan program would not allow it. This means the remittance files that come back from Teleplan will have to be moved to your PC MAC Share folder so they can be seen by the Mac side and reconciled by the Medifile program. Right now the Teleplan software puts the file in the simpc folder (C:\Simpc), to both of which a shortcut exists on the desktop of the virtual PC program. You will have to go in to the simpc folder and cut the MSPRemit.DAT file out of that folder and double click on the PC MAC Share icon and paste it in that folder. This Remittance file is also has the same name each time you call up Teleplan to receive your files, which means that it will be overwritten if left there the next time you call up Teleplan. The name of the MSPRemit.DAT file should be changed to the date you pulled the file back ( eg. 11/16/99 Remit). Each file should have a different name so that the Medifile program does not tell you that you have already reconciled the file by that name. You can only receive one file from Teleplan each time you sign on.

This differs from the OSLER system in that you only needed to work with two operating systems — Windows for the program and DOS for the Teleplan software. The program is also able to write an Autoexec.bat file that can do all your reconciling automatically, since files already reside on the one system. You must consider that your Mac computer is like 2 different computers with 3 different operating systems on it — Windows, DOS for Teleplan, and Mac for the Medifile program. The folder that puts a bridge between these two different computers is the PC MAC Share folder. It is being shared between the two different computers. If OSLER was working with as many different operating systems as we are, they could not make it any less steps than we are now, because they were all on the Windows/DOS platform they could make your transmission process a little more automatic for you. The Teleplan software is the same for OSLER as it is for us but it is what happens before and after the transmission that is different.

How to send Billings

1. In medifile click the generate e-bill button (file is generated and stored in the PC Mac Share folder.)
2. Quit or hide Medifile
3. Go to the apple menu > Medifile stuff > and select Virtual PC
(before starting virtual PC make sure the Remote access answer call is turned off and the modem setting is set to the internal iMac modem.)
4. Once Virtual PC is started you are now on a windows computer. go to the start menu-->Programs--> and select the MSDOSPrompt
5. Now you are in DOS where you can access the Teleplan software. Type “CD C:\SIMPC” and return. You are now in the Simpc directory. Type “Teleplan”. This should now launch the teleplan software.
6. Use option 1 which allows you to send and receive files from MSP at the same time. follow the normal transmission procedures to send.
7. After transmission is complete, you can view the log files to find out any errors or information that comes back from the transmission.
8. When finished with the Teleplan software, use F9 to exit and click in the close box to shut the DOS Prompt down.
9. While still in the Virtual PC(Windows) program, go to the simpc folder (double click to open it up) click once on the MSPRemit.DAT file. Go to the edit menu and select cut.
10. Double click on the PC MAC Share folder, go to the edit menu and paste.
11. You are finished with the Windows program, so go to the Start menu in the task bar and select the shut down option
12. This last step, on the Mac side of your computer, is important. In your PC Mac Share folder, you have a file called MSPClaim.DAT and a file called MSPRemit.DAT.
Click in the name portion of the MSPClaim.Dat file and the name should be highlighted. If you start typing, you will be able to rename this file. I recommend “11/16/99 Claims” as a format. The date lets you know on what date you generated the file, and the claims section tells you this was the billings sent in file.
Click in the name portion of the MSPRemit.Dat file. The name should be highlighted so that, by typing, you can rename this file. I recommend “11/16/99 Remit” as a format. This will let you know that this is the date on which you recieved your remittance and the word Remit lets you know that this is a remittance file.
13. On your Mac desktop are 3 shortcut folders — PC Mac share, Transmitted, and Received. (If the PC Mac Share folder is not open, double-click it). Drag the file named "Claims" (by clicking and holding the mouse down) to the Transmitted folder and drag the file named Remit to the Received folder.

How to Reconcile an MSP Remittance file

1. In the medifile program, go to the first-page admin corner. Click the Reconcile Payment button. Your Mac Directory should open up to the Received folder automatically. If it does not, you will have to find this folder, following a path of Reception-->Medifile ƒ-->Sync-->Received. In the received folder should be the “11/16/99 Remit” file. Click it to open.
2 Medifile is now reading in each line of the remittance file, finding the billing record in the billing file and updating the amount paid and the status, creating a billing history entry and if paid in full and going to the payment file to create a payment record. It will then give you a report of what it found. If you choose not to print out this report, it can be found in the Alert file for later viewing or printing out.
3. Your file is now reconciled in the medifle program. The report tells you which claims are refused.

Do not try to reconcile files that say "claims" as these are not remittance files, and would be in the wrong format. The program should give you this message in addition to telling you that it is aborting the process.

To Fix or resend in claims

1. You can find all billings reconciled today by clicking the find button and filling "Last reconciled" with today's date. You can sort your claims by status and all the paid, payless, refused, held, etc will be together.
2. You can only find all billings reconciled today with a refused status by clicking on the find button and filling "Last Reconciled" with today's date and setting the Status as "Refused."
3. You modify each claim so that it can be resent to MSP. The code out area should tell you what is wrong with the claim and you can target that area to fix it. Your billing history button, on the second page of the claim, may tell you more information about the claim as well. There is a chapter in the manual on fixing claims. It is important to remember that once you have fixed a claim and you want it to get sent in next time, you must change the status back to "created." The created status is how the program knows this record is to be sent in the MSP.