A guide to how the two software systems interact, how you can use it, and how it can help improve your billing workflow
AngelTrack integrates with NSure / PayorLogic / AR Boost to offer the following products within AngelTrack:
- Demographics Verifier
- Eligibility Checker
- Insurance Finder
Nsure allows you to automatically locate missing insurance plans, MBI numbers, SSNs, DOBs, addresses, and more within seconds by scrubbing credit bureaus and thousands of government and commercial payors. AngelTrack offers one-click access to NSure's products, as shown in this walkthrough of all three being used in sequence.
Nsure’s average customer locates 37% of self-pay with active billable insurance and streamlines the process of tracking down missing documentation with a click of a button.
NSure Signup and Configuration Checklist
To use AngelTrack's NSure integration, complete this checklist:
Download your self-pay data
When you contact NSure to sign up, they are going to ask you for the last six or twelve months' worth of self-pay data for analysis. You can easily retrieve this from AngelTrack; visit the Settings page, click on the "NSure Configuration" item, and then click the "Download self-pay data" links. AngelTrack will send you data for all completed billable trips occurring in the selected time frame, in which the patient's insurance was unknown or self-pay.
Contact NSure and sign up
Once you've got your self-pay data in hand, contact NSure and go through their signup process. As an AngelTrack customer, you may use this direct contact:
Vice President of Sales
Send email to email@example.com, or schedule a meeting instantly.
If you plan to use a single NSure account while providing billing services for multiple AngelTrack customers, then let NSure know. You will then perform an additional configuration step inside AngelTrack, explained below.
Input your NSure API key into AngelTrack
Once you've provisioned your NSure account, visit AngelTrack's Settings page, click on the "NSure Configuration" item, and input your NSure API key. Click "Verify the access key" to make sure that the key works and that it reports access to the aforementioned NSure products.
After all that is completed, AngelTrack will begin showing an NSure icon in various places where you might wish to query the NSure products. For example, the Patient Edit page will show the icon to allow queries against NSure's demographic verifier and insurance finder.
Set the NPI option
If you are using a single NSure API key to perform billing services for multiple AngelTrack customers, then you must tell AngelTrack to send the provider's NPI inside each NSure query, so that NSure can separate out the costs by agency.
To do this, select the "Include NPI" option that matches what is configured in your NSure account. It's likely that you will use each agency's rendering provider NPI for this purpose.
Otherwise, set the NPI option to "None".
Decide whether to allow NSure queries from the PCR
On the NSure Configuration page there is a checkbox that controls whether the PCR will allow crews to initiate NSure queries. You must decide whether to allow this, versus restricting NSure queries to dispatchers and billers.
NSure queries cost money, but are also useful to crews in the field... and yet, crews may begin to use the NSure queries rather than typing in patient identity and insurance policy data even when they have it in front of them.
Configure AngelTrack's CMS Payor ID Cross-Reference
When NSure discovers that a patient has Medicare part A or B, it returns a provider name of "CMS" and a generic payor-code 00472, which is the generic code for Medicare. This payor-code is not a payor ID suitable for the filing of insurance claims, so AngelTrack will try to automatically look up the appropriate state-by-state MA/MB payor ID.
...but this feature requires you to first configure AngelTrack's cross-reference table of payor ID values for MA/MB, by visiting the NSure CMS Payor ID Cross-Reference page, accessible by link from the NSure Configuration page. See below for details.
Configure AngelTrack's Payor-Code Cross Reference
NSure usually does not return a payor ID usable for claims; what it returns instead, is an NSure-internal "Payor-Code" that is only usable for NSure eligibility checks.
AngelTrack will store the payor-code for that purpose, and then it will try to cross-reference it to a payor ID using its Payor-Code Cross-Reference table.
...but this feature requires you to first configure that table of payor-code cross-references, which you can reach from the link on the NSure Configuration page. When you visit the page, AngelTrack will fetch from NSure the list of all payor-codes in their system. You can then configure each one with its matching payor ID. See below for details.
We strongly advise that you do not skip this step. Over time AngelTrack will auto-populate your payor-code cross-reference for you, but this will create incorrect entries in cases where billers accidentally lock an incorrect payor ID. Better to fill out the cross-reference table ahead of time, with every match you can think of.
The Demographic Verifier product is available from the Patient Edit page, and from the pop-over patient mini-editor, and by crews on the PCR Patient page (if AngelTrack is configured to allow NSure queries from the PCR). Clicking the NSure icon will perform a Demographic Verifier query, and if a match is returned, the corrected demographic data will be populated into the fields on the page, but not committed to the AngelTrack database until the user accepts the changes and clicks the save button.
Note that under your contract with NSure, in which AngelTrack LLC is not a party, you will be billed by NSure for each query to the Insurance Discovery product.
Running the verifier
All patient demographic information pages -- including in the PCR if so enabled -- will display an NSure icon on the right-hand side. Click the icon to launch a demographic verifier query, using whatever patient demographic information is already on-file.
NSure will use the information on-hand to try to fill in all the blanks, or perhaps contradict the partial identity. The results will be displayed in AngelTrack, with all updated fields outlined in blue.
NSure always returns the best match of possibly many matching people, and it is possible that the best match is not actually the correct match; therefore you must carefully check the results before saving them.
After the query completes, AngelTrack changes the NSure icon to indicate the result:
No corrections are necessary to the information already on-file in AngelTrack
One or more demographic corrections were made, and should now be saved to the patient record
No such person could be identified, or other error
Like the Demographic Verifier, the Insurance Discovery product is available from the Patient Edit page, and from the pop-over patient mini-editor, and by crews on the PCR Billing page (if AngelTrack is configured to allow NSure queries from the PCR). Clicking the NSure icon will perform an Insurance Discovery query, and if a match is returned, the insurance policy data will be populated into the fields on the page, but not committed to the AngelTrack database until the user accepts the changes and clicks the save button.
Under your contract with NSure, in which AngelTrack LLC is not a party, you will be billed by NSure -- separate from your AngelTrack license -- for each query to the Insurance Discovery product.
Running the discovery
All patient billing information pages -- including in the PCR if so enabled -- will display an NSure icon on the right-hand side. Click the icon to launch an insurance discovery query, using the patient demographic information already on-file. If some of the patient demographic information is missing, then run a Demographic Verifier query beforehand.
NSure will use the demographic information to locate the patient's insurance policies. The results will be displayed in AngelTrack, with all updated fields outlined in blue.
Sometimes the information is incomplete; AngelTrack will do the best it can with the data it receives. Oftentimes the carrier type and policy type data are missing, and in that case AngelTrack will leave those fields un-set and un-locked, to allow you to input the answers.
Remember that AngelTrack's patient records are checkpointed, such that all trips during a week utilize the same checkpoint, i.e. the same insurance data.
When you save the NSure discovery data, you must reflect on the checkpoint controls which appear just beneath the insurance fields, and decide whether or not to apply the results forward and/or backward in time, across multiple checkpoints.
Payor-code versus payor ID
During insurance discovery, NSure almost never returns a payor ID usable at your clearinghouse. Instead, NSure returns a payor-code, which is an NSure-internal ID number that represents an insurance carrier known to NSure.
This payor-code is required when later firing an eligibility check to NSure, but it is not useful beyond this. As such, the biller must still choose and lock the patient's payor ID in the usual way, for the purpose of submitting claims.
When you do lock a patient's payor ID, if that patient's NSure payor-code is also on file, then AngelTrack will add an entry to its cross-references table, connecting the payor-code to the payor ID. That way, when your future queries to NSure return the same payor-code, AngelTrack will already know the matching payor ID, and will auto-lock it for you.
This is accomplished by means of two cross-reference tables, outlined below.
CMS payor ID cross-reference table
When NSure discovers that a patient has Medicare part A or B, it returns a provider name of "CMS" and a payor-code of "00472", which is the generic code for Medicare. This payor-code is not a payor ID suitable for the filing of insurance claims, so AngelTrack will try to automatically look up the appropriate state-by-state MA/MB payor ID, and if found, automatically lock it into the patient's record.'
...but this feature requires you to first configure AngelTrack's cross-reference table of payor ID values for MA/MB in each of the fifty states, by visiting the NSure CMS Payor ID Cross-Reference page accessible by link from the NSure Configuration page.
You must review your clearinghouse's list of payor IDs for the various MACs, and input the respective payor IDs for (at least) your home state and all adjacent states. Once those payor IDs are in place, AngelTrack will then automatically set the correct payor IDs during an NSure insurance discovery, so that your coder will not have to re-lookup the payor IDs for your Medicare patients.
(Incidentally, AngelTrack does not have these lookup IDs already built-in, because they sometimes differ from clearinghouse to clearinghouse. You must set them up yourself... but you only need to do the states in and around your service area.)
If there are regional MACs in your state, such that there are multiple payor IDs to choose from, then do not configure any of them in AngelTrack. Instead, when NSure returns payor-code 00472 for a patient, you must manually choose the correct regional payor ID.
Incidentally, the CMS payor ID cross-reference allows you to specify the payor ID for each state's Medicaid adjudicator too, although this will probably not be needed, because NSure usually returns a specific payor-code for each of the 50 state Medicaid carriers, which AngelTrack can then auto-convert to a payor ID using the NSure Payor Code Cross-Reference discussed immediately below. AngelTrack will use the CMS cross-reference only if NSure returns payor-code 00472 for a Medicaid patient.
Payor-code cross-reference table
As discussed above, NSure usually does not return a payor ID usable for claims; what it returns instead, is an NSure-internal "payor-code" that is only usable for NSure eligibility checks.
AngelTrack will store the payor-code for that purpose, and then it will try to cross-reference it to a real payor ID using its NSure Payor-Code Cross-Reference table, accessible by link from the NSure Configuration page.
...but this feature requires you to first configure that table of cross-references. When you visit the aforementioned page, AngelTrack will fetch from NSure the list of all payor-codes in their system. You can then configure each one with a specific payor ID. Once that's done, AngelTrack will be able to auto-lock the payor ID whenever a cross-referenced payor-code comes back from NSure.
The cross-reference will also attempt to auto-populate itself. If you perform an NSure insurance discovery query and a payor-code comes back, and if you immediately look-up and lock a payor ID to match it, AngelTrack will add that cross-reference to the table, so that it will happen automatically the next time.
You must periodically review your payor-code cross-reference table, and make corrections as necessary, because AngelTrack automatically creates cross-reference entries whenever it sees a biller lock a payor ID subsequent to an NSure discovery query, and so an incorrect cross-reference might be created if the biller accidentally locks the wrong payor ID. For this reason it is best to fill out the payor-code cross-reference table in advance, with all the matches you know, rather than relying on the auto-populate feature.
Limitation: Multiple payor IDs mapped to one payor code
You might have two separate payor IDs which map to a single payor code in NSure. For example, you could have separate payor IDs for UHC and Wellcare, yet both of them are payor code 00675 in the NSure system.
In this situation, configure AngelTrack's payor-code cross-reference to map the single NSure payor code to one of the two payor IDs. To extend the example, you would map NSure payor code 00675 to the payor ID for UHC. The following limitations will then apply for any patient whose insurance is Wellcare:
1. For the NSure Insurance Discovery production, any query which returns (per this example) a payor code of 00675, meaning "UHC or Wellcare", will cause AngelTrack to auto-set the patient's payor ID to UHC, even if the patient actually has Wellcare. Therefore if you see AngelTrack auto-set the UHC payor ID, you must double-check whether the patient actually has Wellcare, and if so, switch the payor ID.
2. For the NSure Eligibility product, any patient whose primary policy is the additional payor ID (Wellcare in this example) must specify the NSure payor code (00675 in this example). That field cannot be left blank, because AngelTrack will not be able to auto-lookup the NSure payor code since the other payor ID (UHC in this example) already occupies that cross-reference.
Non-billable carriers / Replacement policies
Sometimes, NSure will return a response like this:
|Payor Order||Active Policy|
|Secondary (2)||Molina Healthcare (for example)|
A response like this means that although NSure has found the third policy (traditional Medicaid in this example), the third policy is not billable, because the secondary policy has replaced it. These "Medicare Replacement" and "Medicaid Replacement" plans are very common, and they are responsible for processing all claims on behalf of the underlying policy that they are replacing.
AngelTrack understands NSure responses like this, and will apply the data accordingly to AngelTrack's billing records. (While NSure uses the term "payor order" to describe the ranking in this situation, AngelTrack uses the term "cardinal.")
The eligibility checker appears as an NSure icon next to the popup patient editor, like this:
...but only if AngelTrack is configured to use NSure, and only if the patient's primary insurance has got an NSure payor-code on-file. Eligibility checks always require an NSure payor-code, which is separate from the payor ID. To learn about the difference between a payor ID and an NSure payor-code, see the discussion above.
Furthermore, eligibility checks can be run only from the dispatch/billing side of AngelTrack, never from the PCR.
The eligibility check is always required for the date of service of the associated dispatch, even if this date is in the past (when viewing a closed dispatch) or in the future (when booking a new dispatch).
The results of the eligibility check are displayed in the page, and the NSure icon changes to indicate the answer from the carrier:
|Coverage is active|
|Coverage is expired or pending (not yet active)|
|The carrier did not recognize the patient, or returned some other error|
All deductibles will be listed for coverage types 30 (general benefits), 56 (medical transportation), and 86 (emergency services). You will also be presented with a link by which you may view the complete X12.271 response from the carrier.
Explanation of incorrect "not found" eligibility result
If you run an eligibility check and it returns "not found", and you suspect this is incorrect, look closely at the result popup to see which payor provided the response. If the payor doesn't seem to match the patient's primary policy, then it might be caused by an incorrect payor-code. Remember that the NSure payor-code is different from the locked payor ID. Billers can set the payor-code in the patient's file and might set it incorrectly; as well, AngelTrack can auto-lookup the payor-code using its cross-references table, but the cross-references table might have an incorrect entry.
Therefore, if you get a "not found" eligibility result that doesn't make sense, or which seems to be coming from the wrong carrier, then check the payor-code in the patient's file, and also check the payor ID cross-references table (under Settings | NSure Configuration) to make sure that everything matches.
Crew Usage from the PCR
Under the NSure Configuration page, you can choose whether crews have use of NSure from the PCR.
NSure queries cost money, and can become a crutch for crews because they eliminate the need to keypunch all the data from face sheets. And yet, used carefully, NSure queries can help crews quickly fix missing or incorrect data.
If you do allow the crews to use it, they will see an NSure icon on the PCR Patient and PCR Billing pages, exposing the Demographic Verifier and Insurance Discovery products, respectively. The Eligibility Checker product is not exposed in the PCR.
Note that the PCR Billing page always saves its insurance data to the current checkpoint plus all future checkpoints, on the understanding that the PCR is used to modify recent trips where the same insurance data is applicable to the current and near-future dates of service. For this reason, the PCR Billing page is not suitable for use in recording an older insurance policy that has since been superseded. That is to say: The PCR assumes that crews will finish their reports and get them sent onward to billing within one week, or at most two, before a patient's insurance policy is likely to change.
If you wish to audit your employees' usage of the NSure API, which is cost-per-click, you must contact NSure, as AngelTrack does not keep records of such requests.
That said, every AngelTrack request can be traced back to the employee who initiated it, because the employee's login-name is included within the transaction IDs that AngelTrack submits to NSure. By looking at these transaction IDs, you can see which employees are are initiating the requests, and when.