Table of Contents

Release Highlights

Administrative Enhancements

Reactivation and Editing of Inactive Providers

What's New: The Providers list now includes a 'Provider Status' dropdown for admins to view and manage inactive providers. This allows for easy reactivation and editing of providers without re-entering their information.

Why It Matters: This update simplifies the process when an inactive provider's details affect system operations or when rehiring previously departed providers.

Who It's For: This feature assists admins in managing provider information efficiently, saving time and ensuring data consistency.

How to Use: Select 'Inactive' from the 'Provider Status' dropdown to edit or reactivate providers as needed.

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RCM Enhancements

RCM Control Enhanced: Introducing Manual EOB Holds

What's New: Our RCM now includes the ability to manually hold EOBs, granting users the power to meticulously review and manage Insurance EOBs that differ from expected rates.

Why It Matters: This development is pivotal for optimizing both the collection process and financial reporting. By allowing targeted holds on EOBs, users can ensure cash allocation is accurately reflected, directly influencing the effectiveness of collections and the precision of financial reports.

Who It's For: This tool is crafted for RCM users who demand detailed oversight of EOBs, particularly when there is a need for extensive follow-up with payers and when reporting must indicate that payment is not recognized as final.

How to Use:

• Access Billing → Manage EOBs

• Click the Columns filter at the top right and select “On Hold” ensuring the check mark is visible.

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• Notice with the Claims section of an EOB the new checkbox for holding EOBs.

• Visually identify held EOBs through color differentiation.

   

• Utilize the new filter function to view EOBs by their hold status, streamlining your management tasks.

Debut of Net Claim Balance on Ad-hoc: A Transformative Step in Financial Reporting

What's New: Ad-Hoc Reports now include a Net Claim Balance calculation. This feature dynamically adjusts the receivables based on the status (Hold) of EOBs and payments received.

Why It Matters: This enhancement provides an alternative perspective on Account Receivables, adapting to a range of payment and EOB situations influenced by our EOB Hold flag.

Who It's For: Designed for Billers and Financial Users who need a nuanced and accurate reflection of financial standings, especially in managing receivables and understanding the impact of pending payments or EOB holds.

How to Use: Access the updated Net Claim Balance in Billing → Ad-Hoc Report

Auto EOB Holds: A New Dimension to EOB Management.

Auto-EOB-Hold based on Threshold & Auto-EOB-Hold based on Remits

What's New: We've just launched the EOB Hold Management System. This system presents a set of functionalities tailored to improve the handling of Explanation of Benefits (EOBs):

1. Auto-Hold EOBs based on Threshold — This automated process identifies and holds EOBs that deviate from expected rates.

2. ERAs Auto-Hold for Multiple Remits — Another automation, this function holds claim adjustments that come following the 1st remit, ensuring the seamless handling of EOBs.

Why It Matters: Effective EOB management is the backbone of precise payment allocations, RCM reconciliations, and financial reporting. This new system empowers users to swiftly pinpoint discrepancies, streamlining workflows and enhancing financial data integrity.

Who It's For: RCM users, billing departments, and financial analysts who prioritize efficiency and accuracy in their EOB management.

How to Use:

• Accessing the EOB Interface: Go to the "Manage EOBs" screen.

• Engage with Manual/Auto Holds: Utilize the provided UI components to activate or deactivate manual holds. Stay informed that certain holds will be applied automatically, based on pre-defined criteria.

• Spotting Held EOBs: Distinct color differentiation makes it easy to identify EOBs that are on hold.

• Review and Modify: You have full control to manually inspect and make changes to held EOBs, ensuring consistent accuracy.

• Using New Features: Take advantage of the “Remits” column when dealing with multiple remits. Adjust realm flags to finetune your EOB management, setting specifics for automated processes or manual oversight.

New "EOB Hold" Field in Claims and Payments Reports

What's New: We've added an "EOB Hold" field to both the Ad-Hoc and Payments Reports, enhancing the capability to filter claim lines and payments based on their EOB Hold status.

Why It Matters: This new filtering option allows billing analysts to easily segregate and analyze payments that are currently on hold, streamlining the management and review process.

Who It's For: A valuable tool for billing analysts and RCM users who need to focus on payments, especially those that are on hold, for detailed analysis and reporting.

How to Use:

• Access the "EOB Hold" field under the Dimensions section in the Claims Ad-Hoc Report via Billing > Ad-hoc Reports.

• Drag the "EOB Hold" field into the Filters section to apply as a filter.

• In the Payments Report under Billing > Payments Report, utilize the dropdown next to the "EOB Hold" field to filter by "True" (on hold) or "False" (not on hold) statuses.

Aging Report Upgrades: Flipping Between "Charged" and "Expected" Views for Comprehensive Financial Analysis

What's New:

Why It Matters: Financial analysis in medical billing is seldom black and white. By facilitating a toggle between "Charged Amount" and "Net Amount", we provide users the ability to dissect their data from various financial vantage points.

Who It's For: Billers, Financial Analysts, and RCM users, who yearn for a deeper dive into their financial data, desiring the ability to switch perspectives for a full-circle view of their outstanding balances.

How to Use:

1. Open the Aging Report.

2. Use the "Amount Based on" dropdown to select between "Charged Rate" or "Expected Rate".

3. Based on the selected "Aging Type", the report will adjust its calculations using either the standard claim balance or the newly introduced Net Insurance/Patient Balances.

Enhanced EOB Management Interface

What's New: We've rolled out significant UI enhancements in the EOB Management section under Billing → Manage EOBs. Key updates include the introduction of new columns related to EOB Hold and real-time payment tracking by Claim Line ID. Additionally, essential columns have been renamed for greater clarity and efficiency in managing accounts receivable.

Why It Matters: These updates are tailored to make EOB management more intuitive and effective. The new "Open NET Claim Balance" and "Close NET Claim Balance" columns offer insights based on Expected Amounts, providing a valuable alternative to the traditional Claim Balance calculations based on Charged Amounts. This is particularly beneficial for organizations seeking different approaches to A/R calculation and management.

Who It's For: This update is crucial for Billing Users who require an intuitive and informative interface to efficiently manage EOBs and navigate the complexities of RCM.

How to Use:

• Column Display Control: Access new EOB management columns via a dropdown menu. These columns are hidden by default for a cleaner UI.

• Open NET Claim Balance Column: Located next to the "Open Balance" column, this new field reflects the pre-payment allocation status.

• Manual EOB Hold Column: Find this column immediately after the "Open NET Claim Balance" column to view the hold status.

• Close NET Claim Balance Column: Positioned next to the "Close Balance" column, it shows real-time allocation based on the specific formula.

• Renaming 'Patient Responsibility' Column: Now renamed to "Close Balance" for better accuracy in representation.

• Fixing Open Balance Calculation Bug: Corrected for more reliable open/close balance calculations.

Enhanced Reporting with Service Facility Nickname

What's New: We've added Service Facility Nickname to the Billable Report.

Why It Matters: By incorporating Service Facility Nicknames into reports, analysts and billers can now distinguish between reports more efficiently, especially in scenarios where service facilities share similar names.

Who It's For: This update is particularly beneficial for Billers and Analysts who manage reporting across different service facilities within an organization.

How to Use: To leverage this new feature, simply access the Census > Billable Report. You'll find theService Facility Nickname in the export.

Enhanced Billing Facility Selection in Managed Services

What's New: We have upgraded the 'Edit Service' section under Managed Services. Now, the 'Bill Under Legal Entity' dropdown will display each billing facility as 'Name (Nickname)'. This change uses data from Practice Setup > Billing Facilities, offering clearer identification of billing facilities.

Why It Matters: For our implementation team as well as billing users, selecting the correct billing facility is crucial. This enhancement simplifies this process by combining the billing facilities' names with their nicknames in the dropdown list. It addresses challenges in identification, ensuring billers can easily and accurately select the desired facility.

Who It's For: This update is tailored for billers who navigate through multiple billing facilities. It's particularly useful in scenarios where distinguishing between facilities is complex due to similar names or large numbers of facilities.

How to Use: When editing a service in the Managed Services, use the newly renamed 'Bill Under Legal Entity (Billing Facility)' dropdown. You'll find each billing facility listed as 'Name (Nickname)', like 'ABC Clinic Inc (Case Management)'. This format enhances clarity and ensures the correct billing facility is selected every time.

CRM Enhancements

Added Referral Source Contact Info to Facesheet

What's New: The Sunwave facesheet has been enhanced to optionally display the patients referral source contact information.

Why It Matters: Presenting the referral source contact information on the face sheet allows quicker communication from EMR users if they need to provide updates or contact the referring entity for any reason.

Who It's For: This enhancement is for case managers, therapists, administrators or techs who may need to contact the referral source of a patient.

How to Use: When creating a facesheet, add the “Referral Sources” component in form build. Click the edit button to be presented with the flag controlling if Referral Contact information is shown or hidden.

All Tickets in Release

• SUN-3512 Average Length of Stay Report Resolution

• SUN-3506 Copy existing user feature update

• SUN-3493 Referral Performance Report

• SUN-3485 Update Transaction ID Field Name to “Credit Card Transaction ID” in Payments report

• SUN-3481 RCM Reports - Add Service Facility Nickname

• SUN-3475 Treatment Plan Objectives/Interventions rendering via Pt Engagement

• SUN-3473 EMR - Export Form of Revoked Consents

• SUN-3443 CRM - Deleted Referral Sources removed from Reporting

• SUN-3415 Implement Insurance Member ID Inclusion Flag in Header for Export Folder

• SUN-3335 Manage Service - Integrate Billing Facility Nickname to Bill Under Legal Entity list of values

• SUN-3282 Providers - Implement 'Show Deleted Providers' Feature in Practice Setup

• SUN-3269 CRM - Add Caller Relationship to Lead entity

• SUN-3187 PE - Prevent Appointment Invitations on Cancelled Forms Allow Cal Scheduling

• SUN-3146 Initial UI Enhancements for Managing EOBs

• SUN-3109 Reports - Service Audit - Freeze header pane

• SUN-3030 EMR - Group Sessions - Remediate Patient's Journey Copy Feature

• SUN-2986 RCM - Aging Report - Introduce Net Balance Calculations to the Aging Report Filtering

• SUN-2865 Users - Labs - Allow Users to View Pending Signatures & Labs

• SUN-2275 Calendar - Generate and Send Appointment Invitation when pt books through PE

• SUN-1447 CRM/EMR - Leads/Opportunities/Face Sheet - Add Referral Source Contact component

• SUN-1186 EMR - Sync Queues and Chart Locking/Unlocking Forms

• SUN-3518 Authorizations Report Discharge Date Filter Resolution

• SUN-2590 CRM - Copy Forms from Prior Admission During Intake Process in a Child Realm