0 comments on “AR/LA/MS On Board With Our New MAC!”

AR/LA/MS On Board With Our New MAC!

In the midst of all the EDI updates, transitioning to our new Part A/B MAC is right around the corner. Novitas, formerly known as Highmark , will begin this transition with AR/LA/MS Part A in August. DSM is asking all the right questions and informational updates will be posted here. We will help you “weed” through the overwhelming “blast” of information and highlight points of interest for our providers. Stay tuned for these and other updates…

Click here for more information about the JH Implementation.

0 comments on “It’s Got a Dashboard!”

It’s Got a Dashboard!

DSM’s new insurance programs include a dashboard.  We have dashboards in our cars, what’s a dashboard doing in an insurance system?  The term “dashboard” is commonly used now to describe what in the past might have been the “menu”, but that term just doesn’t quite cut it for the more modern applications.  An automobile’s dashboard organizes and presents information in a way that is easy to read and for that reason the term has been adapted to computer applications that try to do the same thing.   OK, now that’s out of the way, let’s look at how the new DSM “dashboard” organizes and presents  information in a way that is easy to read.

Just like the “oh” meters in your car, the left side of the dashboard has graphics to tell you things like, how many unfiled claims there are, how many have been filed, how many are unpaid etc. 

This dialog box which is part of the dashboard, let’s you choose what you want to see.

Once the user chooses, filed claims for example, then the user specifies what period to review, today, yesterday, a week etc.

If you don’t like pie charts, you can choose a bar chart:

The right side of the dashboard helps you keep up with the work flow, allowing the user the choice of viewing claims that have failed the scrubber, been denied, are unpaid as well as messages the system uses to inform the user of any important situations.

By double clicking on the patients displayed in the “failed scrubber” view, the claim can be reviewed with the results of the scrubbing.

These are just the options that we have added so far, additional options will be added, but we think it’s the way to go, hope you do too!

0 comments on “New Insurance Programs Designed for 5010”

New Insurance Programs Designed for 5010

The DSM programmers didn’t skimp on anything in designing the new programs for 5010. No, really, I mean they didn’t skimp on ANYTHING in 5010. ALL FIELD SIZES ARE TO 5010 MAXIMUM LENGTHS. This “design to the max” philosophy might have been considered a waste in the past, BUT due to new technologies which increase disk sizes, compress transmissions, and compress the backups, our programmers have taken the high road to system design.

Attrition of programs by regulation has always been the bane of healthcare programmers. The problem with regulation requirements is the simple fact that new fields, field lengths, types and how the data is captured cannot always be anticipated by program designers. Typically the regulations come from entities interested only in a particular end result. The assumption is that any obstacles created by their legislation will be overcome without any problem. And if problems do arise, it’s not THEIR problem. Luckily, the regulators are mostly right. The programmers do overcome the problems but the inability to foresee changes has resulted in solutions that would have benefited from “design” rather than “accommodation”. The lack of the ability to foresee requirements has been one of the most limiting factors in healthcare program design. In recent years standards have helped to mitigate this hindrance, but it has not eliminated it. The fact that 5010 is an upgrade within the X12 standard helps a lot, but without committing to a re-design can cause obstacles which cannot be appreciated by the end user.

Our new programs have benefited greatly in the area of supporting file design. After years of experience with submitter ids, taxpayer ids we have designed the supporting files to be able to accommodate changes in these areas that normally only programmers and support personnel have to deal with. This makes our staff better able to react to changes at the intermediary level.

Our Claredi Classic relationship for testing our claim transmissions way in advance of 5010 is another tool in the hands of our programmers. No longer do the programmers have to wait for testing from the intermediary. Instead, changes are tested immediately by mock transmissions to our partner for confirmation or identification of any problem in the format.

An example of the type of solution we are avoiding by re-design would be what I saw often in the year 2000 programming (Y2K) done by some of our competitors’ programmers. When working with their files we often would find a date minus the century, only to find the century for that date in another field in another record. These “accommodation” programming methods even had names, “re-partitioning” and “windowing”. Those were cool sounding names for what were really bad solutions born out of desperation. Believe it or not many of our competitors still have these poor database designs within their products. (Rest easy, all dates in the HDMS product were made to include the century, “re-sizing” is the cool name and it is the ultimate solution). One might say that the year 2000 should have been anticipated, it’s not like legacy programmers didn’t know it was coming. Yes, but most programmers thought they would never face it!

Experience is a dear teacher and we have applied our experience to predict where regulations are going and the programmers have made educated “guesses” with respect to what areas are going to be addressed next by regulation. The “Y2K” accommodations mentioned above might be necessary to transition ICD9 to ICD10 without re-design. The problems most software companies face is that there is no space for the additional characters, just like in the Y2K situation. The new 5010 addresses ICD10 which positions our new programs for ICD10 as well.

Our design decisions will mean the ability to accommodate field changes for years to come, without the need to do re-“partioning” or “windowing”, the euphemisms for legacy work-arounds. But our new design decisions will not cause the new product to run off and leave our legacy applications. Rather, the new browser based graphics make it easier to get to and use the legacy apps.
For example, note the tabs on the top of the insurance screens. Click the “image” tab for images captured in our eBOSS scanning module.
Click the “Eligibility” for eligibility information received from Passport. “Notes” for the account notes that show maintenance changes, FC changes etc.

The most important design difference is the legacy insurance system in use by our customers was designed around clerks building claims as accurately as possible before transmission and the new insurance system is designed around the computer programs building claims accurately for automatic transmission without clerical intervention. Only rejected claims will require attention by the insurance clerks to work the exceptions. That’s where our clearinghouse and claim scrubbing partners come in, to exploit the opportunity to get clean, paying claims through without intervention.

Keep us bookmarked, more information is coming.

0 comments on “Integrated Claim Scrubbing… YEI!”

Integrated Claim Scrubbing… YEI!

The new DSM insurance system takes advantage of the services of DSM’s third party scrubbing partner, Yost Engineering Inc. (YEI).
To scrub a claim the insurance clerk clicks “Next Step” which presents options in a dialogue box. The clerk then selects “Scrub Claim” which sends the claim info to YOST through secure Internet communications.
The clerk receives a report back that looks like the following (click on the image to enlarge):

The report above is also parsed out to the “scrub” window of the claim, which is on the same screen as the claim. It’s all on one screen for the insurance clerk. To mark an error as having been corrected, the clerk double clicks the error.


Errors are fully described (left). In this case, the error is medical necessity and the Policy Number from the CMS book is displayed along with the policy name. A policy hyperlink is provided which allows the clerk to click the link, opening a browser window with the appropriate bulletin in the “Medicare Coverage Database Archive”. How easy is that?

The edits are all up-to-date because the claims are scrubbed online with the latest updates. No downloading of voluminous files to edit against, just keep an Internet connection.

Both Yost and Ingenix are contracted through DSM, so no having to deal with a third party, just DSM.

Thanks for reading, keep checking, more articles coming!

0 comments on “The Ingenix and DSM Partnership”

The Ingenix and DSM Partnership

Our summer EMR conference was attended by Bill Rodakowski from Ingenix to kick off the new DSM and Ingenix partnership. The first thing that we discovered about our two companies is that we seem to be lacking golfing expertise. Bill and DSM programmer John Malone were in a foursome with Guy Geller and Emmett Hennessey of Beacham Memorial. I won’t say anything about the golfing skills of our customers, but as far as Bill and John, well….new grass should grow back fine, but the alligators and fish will be coughing up golf balls for months to come. Luckily our lack of golfing expertise doesn’t reflect on the ability of our companies to create a great new insurance system for DSM customers. Bill’s golfing prowess aside, we were glad he came to Mississippi to share information on Ingenix. This powerhouse of a company is one of the foremost leaders in claim processing in the U.S. Something one doesn’t hear mentioned by other clearinghouses is the fact that Ingenix is actually a company many CHs use to process their claims as well as for testing their programs. Ingenix is the owner of Claredi Classic, which was the first comprehensive HIPAA testing solution for testing and certification. DSM’s new product includes Claredi testing and certification. The testing infrastructure will be an integral part of the new system, allowing the programmers to get the jump on new regulatory mandates. This has been a great help in getting our programs ready for 5010 and also validating our legacy 4010 programs in use now.

The Claredi reports provide easy to read reports for both our technical and non-technical staff, making our staff that much more productive and DSM that much more confident in our new product.

In the words of Karen Griffin, “tried Claredi today, neat little tool!”

0 comments on “New Insurance Programs are on Schedule!”

New Insurance Programs are on Schedule!

DSM announced at it’s recent summer EMR conference a completely new set of programs for processing insurance claims. The new system has been designed to the latest 5010 format required by CMS. The 5010 format requirement will take effect sometime in 2012. With a brand new web interface, our new system positions DSM users for new regulatory changes such as 5010 and ICD10 while at the same time providing new clearinghouse and scrubbing services. In order to meet the ever increasing demands for claim information down to increasingly detailed levels, our programmers have taken the control structures down to the insurance company level (right) and insurance claim build profiles have been enhanced (below).

Menu structures are drop-down selections within the browser (right):

Using experience gained in working with other clearinghouse interfaces, the DSM solution will generate claims automatically, requiring little human intervention. If a claim does require maintenance for correction errors found in the scrubbing process, it will be corrected with screens in our new web interface. There are many great features and instead of trying to address each one, we will highlight certain features as we go along. For example, predictive text searches provide for fast lookups and more accurate input. The best way to explain predictive searches would be to demonstrate. For example, the following shows how our new programs do a city/state/zip lookup using predictive search:

On the left is the field for the patient’s city, state and zip. Of course, for insurance filing purposes, this field is mandatory and that condition is indicated by the red underlining of the field.

The user only has to begin keying the city, “spring” and the predictive matches appear in a box below the field:

As the user continues typing and gets to the state code for MS, the correct city, state and zip is displayed for the user to simply click and select.

Note that the user doesn’t have to type all of the city name. Typing “spring” and then putting a “,” and the first character of the state code, provides a list of cities to choose from in alphabetical order in states that begin with the letter “M”. Predictive text reduces keying and improves accuracy.

This first installment article on our new insurance system is just a glimpse. Look for future emails or just check this blog for more in-depth articles on the clearinghouse, claim scrubbing, certification and “deep dives” into the new system which will be available late September to early October.