How to setup Revenue Management for Lytec and Change Healthcare

PREREQUISITS

1. On any workstation (including the server) that will use Revenue Management, adjust the following settings. You can search for the following settings via the Task Bar:

2. DEP (Data Execution Prevention); Should be set to “Turn on DEP for essential Windows programs and services only”. You can find this setting by searching Windows for “Advanced System Settings”.

3. UAC (User Account Control); Should be set to the lowest setting, “Never Notify”.

*Note: You may need to login as “Administrator” to adjust this setting.

This setting may be modified via the registry, however this is only recommended for Advanced Users, if you are unfamiliar with modifying the registry, please call support for help.

HKLM\SOFTWARE\Microsoft\Windows\CurrentVersion\Policies\System
Set “EnableLUA” = “0”

PRACTICE MANAGEMENT SETUP

1. Make sure all Lytec users have been setup with their own login as Revenue Management requires a login.

2. Verify information needed to bill claims (like Practice information, Providers, IDs, etc.) is setup.

3. Go to Lists, then Standard Lists, then EDI Receivers. Enter CHNG as the code.

4. Go to Lists, then Insurance Companies, on the Claims tab enter the appropriate 4-digit Payer ID (use “CHC Payer ID). The Change Healthcare’s payer search can currently be found at: https://connectcenter.changehealthcare.com/#/site/payers

*Optionally: If you’ve also signed up for Eligibility Verification, now would be a good time to enter that ID (use “Eligibility ID”) as well.

*Note: The “9999” is just an example, use the appropriate ID from Change Healthcare’s Payer List. Some payers may require additional paperwork (Payer Agreement), see above link.

SERVER SETUP

1. On the Lytec server, create a folder called “RMData” in the Lytec Data Folder. Share the “RMData” folder if Revenue Management will be used at any other workstations.

2. In the Windows Start-menu, go to “Programs” or “All Programs”, then “Revenue Management”. Select “Check for Updates”. If the PMS is still open and updates are found, close the PMS. Complete the update process if updates are found, or click Close if none are found.

3. Go to Billing, then Revenue Management, then Revenue Management

4. Click Create, then browse to and select the “RMData” folder, then click OK.

5. If the “DB List Upgrade” window appears, click OK, otherwise continue on to the next step.

6. If the “Revenue Management Update” window appears, click Next then Close (since the updater was run in “Step 2”, no updates should be found).

7. On the “Add Practice” window, select the practice you’re trying to setup, then click OK.

8. On the “Database Upgrade” window, click OK.

9. On the “Configure?” window, click OK.

10. On the “Connection Wizard” window, click Next.

11. Enter your Lytec Login Name and Password.

12. Select a “Connection” that begins with “ChangeHealthcare…” and ends with the value that best describes the type of claims you send: General (used in most cases), or… Ambulance, DME, ESRD, Rehab, Rural.

13. Click Next to continue.

14. Select the receiver setup for Change Healthcare (Practice Management Setup; “Step 3”).

15. Click Next to continue.

16. On the “New Receivers” window, no selections should be necessary, click Next to continue.

17. Complete the following fields on the “Additional Receiver Information” window (it is not necessary to complete the “Secondary Contact Information”).

Group Practice: Select/check if this is a Group Practice (one that has a Group/Practice NPI). Primary Contact; Name: Enter a first and last name.
Primary Contact; Type: Select “TE/Telephone”.
Primary Contact; Number: Enter the contact telephone number
ISA/GS Submitter ID: Enter your Change Healthcare assigned ID (“p” + “Submitter ID”) 1000A Submitter Name: This will default to the practice name, change if desi
1000A Submitter ID: Enter the “Billing ID” + “Submitter ID”
Taxonomy: Leave Blank
User ID: Enter your Change Healthcare assigned ID (“p” + “Submitter ID”).
Password: Enter your Change Healthcare assigned password.
Communication Session: Leave default; “CHCL”.

18. Click Next, then click Next on the following screen (“Configuring Receivers”).

19. On the “Edit Receivers” window, find the line for the EDI Receiver being setup, and make changes to the fields as necessary (click outside the fields to return to the main grid):

Group Practice: Check for “Group Practice”, un-check for “Individual/Non-group
UseBillingService: Check if this a Billing Service submitter, billing for a practice.
ClaimNumberFormat: Select desired option (click in field for options)
SupressLegacy: It is recommended to check this option (this prevents non-NPI/EIN IDs)
SendDrugLoop: If NDC information may be transmitted, select this option.
EntityType: Select appropriate option… 1/Individual, 2/Group.
Comm Session: Leave default; “CHCL”.

20. Click in the “Transaction Sets” field and navigate to IGuide pull down menu.

21. For Professional Claims select Outbound Claims(837P LY2020 5010 Claim – Standard)

For Institutional Claims select Outbound Claims(837I LY2020 5010 Claim – General UB04)

22. Click outside the current window, to return to the main grid, then click Next, then Finish.

23. Back at the “Revenue Management Practice List”, highlight the desired practice, then click Select.

24. The Revenue Management main window should open. If the “Claim Editor Database Update” window also appears, close Revenue Management, then click Next on the update window. Click Next, then Start. When the update finishes, click Finish. Open Revenue Management again.

25. If the “Install?” window appears, verify no one else is in Revenue Management, then click Yes, then OK, to continue. When “The Claims Editor update has been installed”, click OK. Open Revenue Management again.

26. At the main Revenue Management screen, go to Configure, then Preferences.

27. Select the “Revenue Management” tab, then select the “Remit Posting Options” sub-tab. Set values for the fields listed below, under the “Default Posting Code” section. Enter Primary Payment, Secondary Payment, Adjustment, and Charge Back codes.

28. Select the Claims Editor tab.

29. Click Next, then select any state(s) where services are performed.

30. Click Next, then select any Payers to which claims may be sent. If none of the listed payers apply, you do still have to select at least one.

31. Click Next, then select any services the practice performs. Optionally; Select to Suppress Dx Warnings.

32. Click Next, then choose a CCI Edit Type and Global Periods Option (see notes to the right).

33. Click Next, then Finish, then Save.

34. Go back to Configure, then Preferences.

35. Next, select the Assign Posting Codes tab.

36. Set your desired “Insurance Adjustment” code under the CHCL column (and under any other EDI receivers if you maybe posting remittance for those insurances), next to “42” and “45”. These correspond to “CO42” and “CO45”.

*Note: These are just examples, your claim types, insurance carriers, and code preferences will determine what codes should be set, and the code is your preference…

37. Optionally; Set any other adjustment reason code numbers to the desired “Insurance Adjustment” Code, under the appropriate receiver column. For example, if you need to post an “OA23”, set the desired “Insurance Adjustment” code, next to “23”, under the CHCL column:

If you have multiple “EDI Receivers” (setup for different insurances), you can set them to use a different “Insurance Adjustment” codes:

If you have multiple “EDI Receivers” (setup for different insurances), and you want one or more of them to use a different “Insurance Adjustment” code, that can be setup as well: