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Benefits

• Electronic claims eliminate paper CMS1500 and UB04 forms.
• Patient database eliminates re-entering information.
• Increase revenues over manual systems by recapturing lost, denied and ineligible claims.
• Improved turn around time for claim reimbursement, typically ten days to direct deposit.
• Improved cash flow.
• Fewer denials with computer generated claims.
• Reduced labor requirements.
• Reduces billing time from hours to minutes.
• Reduced paper handling.
• No postal expenses.
• Increased accuracy of claims processing.
• Bill directly to Medicaid or other payers, no third party clearing houses or fees.

System Features

• Generates HIPAA compliant electronic claims.
• Electronic Billing & Claim Submission, 24 hours a day, 7 days a week.
• Client Authorizations detects over-billing with pop up warnings and reports.
• Integrated Accounts Receivable.
• Unlimited Payers
• Client database, unlimited number of clients and claims.
• Case Worker Production Reporting.
• Bill Mainecare and New Hampshire Medicaid electronically
• Bill any payer on paper.
• Other electronic payers coming soon.
• Export to Quickbooks and other accounting software.
• Multiple / remote Site Support.
• Network / multi-user ready.
• Microsoft SQL server support for large databases
• On-site training.

Reference Tables

• Diagnosis Codes – stores ICD9,  ICD10, DSM IV diagnosis codes.
• Procedure Codes –CPT-4 and HCPCS medical procedure codes.
• Programs – Authorized Medicaid programs and associated PIN numbers.
• Workers – Caseworker and related skills information.
• Teams – Organizational groups of Workers.
• Sites – physical location identifying codes.
• County – service area county list.
• Supports – third parties who provide professional or support services to clients.
• Claim Status and Adjustment reason codes - expands the codes on your remittances to their full explanation

Client Database

• Unlimited online client history.
• Personal, Medicaid billing, demographic, medical, referral, intake, case management, hospitalization, emergency, minor and guardian information.
• Automatic numbered or manual alphanumeric (20 characters) Client ID’s.
• Prior Authorizations - records PA numbers, authorized units, accrued units for unlimited periods. Rebilling old claims will always select the appropriate PA for the date of service.
• Client External Supports  – outside professionals providing services to client.
• Client Program Participation – list of 1 or more Medicaid programs client is approved for.
• Minor Supplementary pages – 30 fields of additional information specific to clients under 18 years old.
• Client Authorizations – approved hours by program and dates, with alert system when exceeded.
• Client Pricing – for defining negotiated prices by procedure, on a client-by-client basis, if needed.
• Skill level (acuity) pricing.

Billing Features

• Bills CMS1500, UB04, 837-96, 837-98, Service Encounter Data (SED) and “Paper Invoice” claims.
• Services are billed using 5-digit Service Code, which identifies a unique Procedure Code and pricing combination.
• Unit of measure conversion - services may be billed in hours, days, weeks, months, per incident and flat rate. SSP automatically converts to Medicaid service units.
• Select claims for billing by status (i.e. “Never Billed”), batch, client, age and selectively flagged for rebilling.
• Fast rebilling of rejected claims.
• Authorizations system tracks and monitors approved units versus billed units. Pop up warnings and reports of unit over-runs.

Easy Data Entry

• Batch Entry – random entry of services from any worker for any client
• Reference tables for easy and accurate lookup of all codes, programs and client information.
• Duplicate claim detection with pop-up warning.
• Missing mandatory Medicaid information is highlighted in yellow for easy correction.
• User definable default values for most repetitive fields (state, etc.)
• Extensive data validation reduces errors including:
• Invalid dates of service
• Future dates
• Duplicate Date of Service
• Service period year mismatch
• Excessive hours
• Exceeding approved hours
• Services too old for reimbursement
• Bad or missing Medicaid numbers or birth dates
• Bad or missing Prior Authorization
• Bill in hours, days, weeks, units and per-incident – conversion to Medicaid service units is automatic.
• Batch Copy reduces data entry by creating new claims, by copying existing ones and automatically adjusting dates.
• Invoice viewer for browsing and printing (optional) completed invoices.
• Color-coded field backgrounds identify potential problems.
• “Tool tips” display field description and usage when mouse is paused on field.

Prior Authorizations

• Prior Authorization database records PA #, Effecitve Dates, Authorized Units Accrued units for unlimited periods.
• Pop warnings on exceeding authorized units, expired authorizations, or no authorization on file.
• Units authorized versus actual reports.
• Color coded fields on forms and reports indicate units exceeded
• PA warnings and requirements are program selectable

Pricing

• Service Code – user defined code maps CPT procedure code to a rate specified in billing units (typically quarter hour increments).
• Flat Rate – one fixed amount per incident regardless of hours or units.
• Client Level – unique pricing by service code to an individual client. Allows for rates negotiated by client.
• Mixed Mode – uses Client Level pricing if one has been specified, else uses price from Service Codes table.
• Client Level / Flat Rate – client level prices may also be flat rate.
• Skill Level – up to 10 skill (acuity) level prices for approved caseworkers.

Accounts Receivable

• Monitor open claims.
• Open Invoice Aging reports.
• Payments from multiple payers.
• Any point in time agings.
• Integrated 835 Electronic Remittance reader (optional).
• Reconcile claims as paid in full, partial payment, denied or re-bill with user defined payment codes (full, write off, non-reimbursable, denied, etc.)
• Denied claim tracking and reporting.
• Export invoices, payments and credits to accounting software.

Case Worker Tools

• Worker production reporting.
• Track non-billable services, collect payroll and expense information.
• Worker production summary of billable and non-billable hours, paid and unpaid dollar amounts.

Reports

SSP provides dozens of reports, including:

1. Never Billed – services performed but never submitted for billing.
2. Never Paid – summary of eligible claims billed but remaining unpaid.
3. Never Served  - list of clients eligible for Medicaid but have never received services.
4. Worker Production – monthly summary of billable and non-billable hours, paid and unpaid dollar amounts
5. Pending Clients – list of clients with billable services that are pending Medicaid approval.
6. Billing: Actual units and dollars Versus Authorized units and dollars.
7. Billing History by Program– summary or detailed historical billing by program.
8. Billing History by Client – summary or detailed billing history by client.
9. Billing History by Service – summary or detailed billing history by service.
10. Billing History by General Ledger Account – summary or detailed billing history by GL account number.
11. Billing Detail – client file and journal copies of submitted claims.
12. Billing Summary – transactional summary of billing sessions.
13. Remittance Journal – list of reconciliation activity by Pay Order Number.
14. Green Sheet Print – prints prepared green sheets for submission.
15. Client Level Pricing – list of client custom pricing.
16. Client List – summary client listing.
17. Client List by Program – clients by their program participation.
18. Client List by Diagnosis code - clients listed according to their primary diagnosis code.
19. Client History – billing transactions by client.
20. Client Overview – all client billing, demographic, support and related information.
21. Pending Clients – clients with billable services but awaiting Medicaid approval.
22. Case Load – active and pending clients by caseworker.
23. Program Members – clients by program participation
24. Billing Log –  summary history of  billing activity.
25. Weekly Billable Units – actual billable units per client by fiscal week, with approved hours vs. actual.
26. Monthly Billable Units - billable units for each client totaled by month, with quarterly subtotals.
27. Open Invoice Aging – outstanding invoices listed, sorted and summarized by age in 30-day periods.
28. Open Invoice Aging by Program, Summary – outstanding invoice totals for each program, in 30-day periods.
29. Open Invoice Aging by Program, Detailed – outstanding invoices, sorted and summarized by program.
30. Denial Analysis – overview of denied claims, by denial reason with totals.
31. Worker History – detailed list of case workers activity, by day. Totals for billable and non-billable units, billing charges.
32. Activity Log – detailed logging of all user activity, including viewing, data modification, report execution and billing. Includes user name, time and date of action taken.
33. System Status – comprehensive overview of billing totals and client counts by program, payment and client status.
34. Program, Procedure Code, Diagnosis Code, Service Code, Region, Team and Supports Lists – prints the contents of these system tables.
35. Rebilled Claims – history of claims billed more than once.
36. Claims flagged for Rebilling - claims marked to be rebilled.
37. Case Management – In home or Case Management Status; Waiting List
38. Actual versus Authorized client unit billing - Alerts you to over billing.

All reports include extensive range and filter criteria.

Accounting Software Interface

Export Invoices, Payments and Credits to third party accounting software.

Currently supported:

• Quickbooks
• Business Works
• MIP
• MAS90
• AccPac

Label Generator

• File folder labels.
• Mailing labels.
• Shipping labels.

HIPAA Compliant

• SSP generates HIPAA compliant X12 electronic claims, including 837-98 Professional (CMS-1500) and the 837-96 Institutional (UB04).
• Activity Log records all access to client information, billing activity and report processing. User name, time/date and detailed information about changes or viewing of any client information are logged. 
• Certified by EDIFecs, the countries most popular third party HIPAA certification service

Microsoft Office Compatible

Built in integration with Microsoft Word, Excel and Access.

One click easily emails reports and forms. (Required Microsoft Outlook).

Technical Support

One year unlimited technical support by phone, email and on-site (as required) included in sales price. Includes all software updates, new reports and features. At least one manual update per year.