Working with a Detached Biller

A detached biller is an outside contractor who performs insurance claims work on behalf of your company. The detached biller accepts run reports, and sends back EOBs.

AngelTrack was designed to support this arrangement, so that you can convert your operation to mobile/paperless/cloud without perturbing the relationship you already have with your billing contractor.

Your outside biller, if desired, can integrate with AngelTrack's cloud server for no additional cost, and there are significant benefits.


Detached Billers and Data Storage

When all of your receivables are in different billing software, your reporting capability is limited to the reports generated by the biller. Some billers offer free access to their software for real-time viewing and analytics, others offer only monthly cashflow reports.

One option to improve your reporting is by entering all EOBs into AngelTrack. You can request them in electronic format (as X12.835 EDI documents) for quick import into AngelTrack. (If the phrase "X12.835 EDI document" is unfamiliar to you, read the EDI primer.)

Alternatives

Instead of using detached billers, you may request that they perform your billing in AngelTrack. Remember, they can access the system from their office, or from home, or from anywhere. You can freely create user accounts for your biller's employees to use. It is all included in your AngelTrack license.

Sending Reports Out to the Biller

There are two data offload points in AngelTrack, from which your outside biller can pull data for billable calls.

AngelTrack recommends against the offload of billing data for calls that have not yet graduated from QA, as the QA review process can alter the service level that was provided.

Both of the data offload points below assume that you will use AngelTrack for QA review, and therefore will not be offloading calls until after they've reached  Billing office . They also assume that you will not be offloading data for calls that were delegated to an affiliate who is marked ☑ Independent billing, nor calls that were marked non-billable; both of the aforementioned will go straight to  Finished  after graduating or skipping QA.

Offloading data using the workflow API

AngelTrack has a webservice by which your biller can automatically pull data for trips that are ready for billing, and in the process, advance them to  Awaiting payment  or  Finished .

To learn more, read the API Reference for AngelTrack's PostprocessWorkflow webservice.

Offloading data using AngelTrack's user-interface / Master Billing Queue

AngelTrack's user-interface has a data-offloading facility in the Master Billing Queue, accessible from the Billing Home page.

You will use the queue with its default filter settings, in order to show only those trips which are at  Billing office . The queue will pick up all billable trips that have passed QA, without waiting for someone to perform insurance reviews.

The queue has a bulk exporter that can bundle up run reports in a .ZIP file. Each run report can be exported as a NEMSIS version 3 XML file (if your outside biller's software can import NEMSIS 3) or as a PDF file. Both formats include all attached documents, signatures, ECG strips, etc, and so either format is fully suitable for sending to an outside biller. Let the outside biller decide which format he or she prefers.

The queue can process 100 items at a time. After exporting the items and verifying that the data downloaded correctly, click the "Advance to 'Finished'" button to push the marked trips to  Finished . Those trips will then drop out of the queue, allowing you to select the next 100 trips.

Data loss during offloading of sub-BLS trips

EMS billing data is formatted according to the NEMSIS specification, and AngelTrack is certified compliant with it. Unfortunately, the NEMSIS specification does not support the following service levels:

The NEMSIS field "ePayment.50" contains the HCPCS code, but only BLS+ codes are allowed in that field, and so it will contain "[Not applicable]" in the case of the aforementioned services. Likewise the field "eResponse.15" does not support service levels below EMS First Responder, and so AngelTrack has no way to represent wheelchair vans, gurney vans, car service, fire responses, and the like.

To work around this problem, AngelTrack emits the billable service code (the words shown in square brackets above) in a NEMSIS custom field. To see all of AngelTrack's NEMSIS custom fields that will be useful for billing, refer to the State Uploads / NEMSIS guide.


Offloading From the Insurance Filing Queue

It is possible to use the Insurance Filing Queue as your offload point to your detached biller, with the intention of sending them only your insurable calls. However, there are drawbacks to this approach which you must consider.

Consider this diagram of the workflow of trips from dispatch to the billing office:

Insurance workflow

The diagram illustrates the problems that will occur when using the Insurance Filing Queue as your data offload point:

  1. There are three places where a trip can be marked "not insurable", and thus entirely skip the Insurance Review Queue and the downstream Insurance Filing Queue. Such calls will never appear in the Insurance Filing Queue for download to your detached biller, instead they will accumulate in AngelTrack's invoicer, waiting to be invoiced.
  2. The detached biller will be generating invoices for denials and copays, sometimes sending them to the very same counterparties as AngelTrack's invocing system is doing.
  3. If the detached biller needs to fail a trip back to QA for want of sufficient documentation, it must be done manually, then re-exported after it re-graduates.
  4. AngelTrack's workflow API is not useful, because it always pulls everything from  Billing office ; it cannot filter to the subset of calls waiting in the Insurance Filing Queue.

It is possible to work around problems 1 and 2 by instructing all dispatchers and QA reviewers to forcibly mark every trip as "insurable", thus causing all trips to appear in the Insurance Review Queue... but this requires ongoing manual intervention, sometimes in opposition to AngelTrack's otherwise helpful automatic systems.


Monitoring the Performance of a Detached Biller

It is inherently difficult to monitor a detached biller's activities and performance.

AngelTrack can provide assistance -- but only if someone in-house is uploading into AngelTrack all of the EOBs that come back from the biller, as well as all invoice payments. Only then can the software help you track your revenues and denials, verify no receivables were overlooked, and prove (yay or nay) that your biller is doing their job right.



Help Index - AngelTrack EMS Billing Software