As Connect Care rolls out across AHS facilities in Alberta, physicians now have the option to enter their billings directly in Connect Care. The feature allows physicians to save time by entering their billings directly in the hospital EMR, but still allows physicians to retain control over what codes they bill and which billing company they use.
Statgo is one of only 2 billing software providers in Alberta with a complete integration to Connect Care. This allows you to enter your billing charges in Connect Care and then have those claims sent to Statgo for processing. Statgo remains your billing agent and submitter, allowing you to follow all your claims in the Statgo software and have Statgo agents manage any rejections. If you’re interested in using Connect Care for billing, here’s what you need to know.
How does billing in Connect Care work?
Connect Care allows physicians to enter AHCIP and WCB billing codes in the hospital EMR at the same time they are updating the patient record. Connect Care calls this feature the Service Code Capture (SCC) tool. Once per day, your claims are sent to your billing company. Your billing company will then process and submit your claims.
Connect Care does not submit your claims directly to AHCIP or WCB for payment. Instead, it will record the claim information you enter and then send this information to your billing company for processing. You cannot use Connect Care to bill without a 3rd party billing company.
What are the advantages and disadvantages to using Connect Care for billing?
Using Connect is a great option for many physicians, but there are some restrictions to consider. Below is a list of the advantages and disadvantages to billing with Connect Care.
Advantages:
- Continued Statgo transparency and rejection management: Claims entered in Connect Care will still be fully managed within Statgo’s software. All the claim information is sent from Connect Care to Statgo and then processed by Statgo. You will be able to review all your claims in Statgo prior to submission and be able to track the claims as they are assessed and paid. All rejections will continue to be managed and resubmitted by Statgo agents.
- Save time: Connect Care provides all the required patient information to Statgo. If you currently enter your own claims, this saves any time spent transcribing claim information. This is particularly helpful for out-of-province claims where full demographics are required.
- Reduced transcription errors: When you submit thousands of claims with thousands of patient names and PHNs each year, transcription errors are bound to happen. Connect Care reduces these errors and helps prevent rejections. It also ensures the patient’s insurance information and type mirrors exactly what is recorded in the AHS Connect Care system.
- Reduced cost: Client’s using Connect Care for billing are placed on Statgo’s Self Entry pricing rates. If you current use Statgo’s Agent Entry service, billing with Connect Care may allow you to lower your billing costs without having to spend time entering all your claim information.
Disadvantages:
- Connect Care Billing Interface Limitations: The Connect Care billing module does have customization options but it is not yet optimized to manage all claim types. You may find billing for visits and repetitive procedures works well with the favourite code feature. However, complex surgical or anesthesia billings and time based billings are almost certainly easier to enter in the Statgo system directly. Convenience features like time vs procedure calculations or auto intelligent modifiers are also not enabled in connect care. In general, be aware that the Connect Care billing module is new and will likely evolve and improve over the coming years as more physicians use it.
- Diagnostic Codes: Connect Care uses ICD-10 and AHCIP uses ICD-9. There are occasional issues when the DI codes are converted from ICD-10 to ICD-9 for billing. Also, the connect care system will always flag codes that do not have a linked diagnostic code and the mobile charge capture module currently does not allow charges to be submitted without a DI code. This can cause an issue for anesthesia related billing which do not require a DI code. This issue is discussed further in this blog post.
Other items to consider:
- Your billing data: Billing in Connect Care does mean that there is a record of your charges in the Connect Care system. AHS has considered policies around access to this data that it records of what you intend to bill to AHCIP and WCB for the medical services you provided. You may wish to review these policies to fully understand how your billing information can be used.
How do I set up to bill in Connect Care?
To get started, you must fill out the Alberta Health Service Code Capture Request form. You can find this form here.
To complete the form, you will need the following:
CPSA License #
AHS Email Address
PRACID
SKILL CODE
BA Number
Once you’ve filled out the form, Alberta Health will confirm with you that they have processed the request and you are set up to bill. Select Statgo as your billing provider.
You can find all the resources for Connect Care billing here.
How do I enter claims in Connect Care?
Alberta Health has created training materials that walk through how to submit your claims in Connect Care using the Service Code Capture (SCC) tool. You can find these materials here. You will need to your AHS credentials to access these materials. The training materials include screenshots and explanations to help you get started.
Once I submit my claims in Connect Care, what happens next?
Connect Care sends the billings to your billing company each night. For example, claims you enter today will be sent to Statgo tonight (around 2AM) and be available in your billing software the next day. Claims entered in Connect Care will be created as claims in your ‘Unsubmitted’ tab. You can then review your claims, make any edits/corrections, and submit them.
Connect Care does not send encounters, so all claims for a given patient/day will be created on the same encounter. This can be modified within your billing software as required.
The Connect Care billing module is new, and there may still be some uncovered kinks. If you see claims that do not process correctly from Connect Care, please let us know!
My afterhours time premiums aren’t working correctly. What’s wrong?
Afterhours premiums can be a bit tricky (TEV, TNTP, TNTA, etc.). The modifier (not the calls input) indicates the number of units. For example, TEV4 should be entered in Connect Care as:
03.01AA [code] TEV04 [modifier] 1 [calls] – CORRECT
Note this is different than:
03.01AA [code] TEV [modifier] 4 [calls] – INCORRECT
The DI Code I entered in Connect Care is different from my billing. What happened?
Connect Care uses ICD-10 for diagnostic codes, but AHCIP requires billing codes to be submitted with ICD-9. To address this, Connect Care converts the DI codes from ICD-10 to ICD-9 before sending the claims to your billing company. This conversion works well most of the time, but we have seen cases where the DI code sent for billing does not match what the physician entered and may not be appropriate to have the claim paid. Also, the connect care system will always flag codes that do not have a linked diagnostic code and the mobile charge capture module currently does not allow charges to be submitted without a DI code. This can cause an issue for anesthesia related billing which do not require a DI code.
But don’t worry! You can review your claims in Statgo before they are submitted. And if a claim is refused for a DI code incompatibility, Statgo will review, fix and resubmit you claim to ensure you get paid.
Can I use multiple billing companies with Connect Care?
Some physicians are required to use 1 billing company as part of a group at one hospital, but need to use a different billing company when they work at a different facility. Unfortunately, Connect Care only allows you to setup with 1 billing company at this time. Once you setup with a billing company, all claims entered in Connect Care will go to this selected billing company.
Getting Started Billing in Connect Care
If you would like to start billing using Connect Care or have further questions about how to bill using Connect Care, contact us at support@statgo.ca . We’re happy to answer any questions and we can help you get setup to bill.