Epic Implementation Guide

This guide explains the general process for setting up an MDsave payor code in Epic, and how to configure patient accounts to enable a smooth process for payment reconciliation. This configuration may not work exactly as described the same for every Epic installation, but it can be used as a general guide to establish a workflow similar to the one below, which will make reconciling payments from MDsave very simple.

Create an MDsave Insurance Plan in Epic

Create a commercial insurance plan for MDsave that can be added to patient accounts to identify them as MDsave patients for those services rendered on that account.

Enroll in MDsave Claims and ERA programs

Configure the insurance plan created in Epic to generate claims and connect the plan to the destination that is configured to go to MDsave.

MDsave uses Optum's iEDI as a clearinghouse to receive claims and send ERAs. See the guide below on how to enroll directly with the programs in CHC. However, any clearinghouse that has a connection to CHC can be used.

Optum Intelligent Electronic Data Interchange (iEDI)

Claims Online Portal

MDsave Payer ID - “MDSAV” (professional/institutional claims and ERA)

Institutional CPID - 3046

Professional CPID - 8295

Configuring a New Patient Account

When a patient that has purchased an MDsave Voucher for their procedure is scheduled and the patient account is created in Epic, the following steps will ensure that claims are generated for the services rendered while suppressing statements from being sent to the patient.

1. Verify that the patient’s MDsave voucher is for the correct procedure and was purchased.
2. In Epic, when creating the patient account, add the patient as guarantor,
3. Set the guarantor type to “Other”.
4. Add coverage to guarantor (select MDsave insurance).
5. Set coverage dates to date of service.
6. (Optional) Enter in the Voucher/Order # in the Member ID field.

Using the guarantor type “Other” will ensure that statements are not generated and sent to the patient automatically.

Reconciling MDsave payments

MDsave will send an ERA in the form of an 835 file for each payment that will contain details about each patient account that we received a claim for with the voucher and payment information.

For covered services, MDsave will use the CO 45 adjustment code with the amount being the difference between the original charges on the claim and the total payment from the voucher that was covered.

For uncovered services (no voucher purchased), MDsave will use the PR 96 adjustment code.

Handling Claim Denials from MDsave

When a claim is sent to MDsave for a patient’s services that are not covered by a voucher, MDsave will first process the claim and determine if there is a purchasing mistake that can be fixed by our support staff (e.g. the wrong procedure was purchased, or was purchased for the wrong facility). If there is nothing that can be addressed by MDsave support, such as for example, we have no record of that patient, we will send the information from the claim back in an 835 response using the PR 96 adjustment code as a denial.

We recommend creating a work queue in Epic to handle patient responsibility denials so that staff can determine if the patient or patient’s insurance needs to be billed if relevant.