Revenue Cycle Management
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      Revenue Cycle Management

      Agencies that have signed up for the Billiyo revenue cycle management (RCM) program use this page to review and work with our RCM team.

      Table of Contents

      Accessing the Revenue Cycle Management Page
      Communicating With the RCM Team
      Page Headings
      Assigned Claims Table
      Claim Denial Analysis Table

      If you have not signed up for the revenue cycle management (RCM) program, and are interested in learning more about it, please reach out with your Customer Success Manager.

      Accessing the Revenue Cycle Management Page

      To access this page, in the left menu navigate to:

      Dashboards > Revenue Cycle Management

       

      Communicating With the RCM Team

      Communication with the RCM team is done though the that appears in the heading of the Assigned Claims table.


      After clicking on the , you will be asked to provide information and enter a note.

      Claim Number

      Enter the claim that needs to be reviewed/in question.
      Assign To Click the circle next to Billiyo.
      Enter Note

      Notate why the claim needs to be reviewed or any questions you have about it.

      Make sure to leave as much detail as possible so that the RCM team is able to easily understand what is going on!
      Click or Drop files to upload Attach any files you'd like to share, if applicable.


      After the fields mentioned above have been filled out, click on the button to send your message/create a task for the Billiyo RCM team to review.

      Once the Billiyo team has reviewed and responds, the task should be assigned back to your agency. Above the table, use the My Agency filter to find the tasks assigned to you.


      In the table, click on the icon to the right of a line to review a history notes that were left on the task or leave additional notes for the RCM team.

       

       

      Page Headings

      At the top of this page there will be several headings that appear.
      Denials

      Billiyo has not yet recovered payment or is needing information.

      This number represents the total of claims that are Waiting on Agency, Waiting to Rebill, and Pending to Be Paid.
      Waiting on Agency Information is needed for the Billiyo team to move forward.
      Waiting to Rebill Claims that have been reassigned to Billiyo to be rebilled after any necessary action has been taken.
      Pending to Be Paid Billiyo has rebilled these claims and they are pending processing at this point.
      Received Rebilled claim amounts that have been recovered.
      Write-Offs Claims that have been written off — i.e. patient liability, timely filing exceeded, etc — and funds will not be recouped.


      Each heading, except the Denials heading, can be clicked on to view additional information.

      Client The name of the client of whom the claim is for .
      Claim No# The number associated with the claim, along with the claim date range.
      Payer The name or abbreviation of the payer the claim was submitted to.
      Charge Amount The total amount that was billed for the claim.
      Paid Amount The total amount that was paid for the claim.
      Claim Note The last note that was left on the claim will display here.
      Show History A complete history of the claim will appear when clicking on the icon.
       

      An option to download a CSV file of the information will also appear.

       

      Assigned Claims Table

      Below the headings at the top of the page, a table for assigned claims will appear.

      Outside of using this table to communicate with our RCM team, you'll be able to review claims that are being worked on.

      Use the filter at the top to see what's assigned to you and what's assigned to Billiyo.

      Make sure to check what's assigned to you at least once per week, if not more, to ensure timely filing deadlines can be met! More on timely filing deadlines below.


      Each column in the table will display information about a claim that's being worked on.

      Claim # The number assigned to the claim.
      DOS The dates of service the claim is for.
      TF Days The number of days remaining for timely filing, more on this below.
      Payer The name of the payer to whom the claim was sent to.
      Procedure Code The procedure code + modifier that was worked.
      Summary The last claim note that was left in this page.
      Assigned Date The date the claim was assigned for review.
      Status The stage the claim is currently in.

      When clicked on, this displays the claim task history — including all conversation about the claim done through this page.

      Always leave detailed notes so the RCM team is aware of what you need or are expecting!


      Additional information about the TF Days column status colors.

      Black The timely filing period has passed, the Billiyo team is no longer able to continue trying to recuperate funds for it. 
      Red There are 1-15 days remaining in the timely filing period.
      Orange There are 16-30 days remaining in the timely filing period.
      Green There are more than 30 days remaining in the timely filing period.


      Timely filing days for payers

      Payer Timely Filing Days
      Minnesota Department of Human Services 365 days
      UCare 180 days
      Blue Cross Blue Shield 90 days
      Blue Cross Blue Shield Waiver 90 days
      Medica 180 days
      HealthPartners  180 days
      Medicare 365 days

       

       If the status of a claim needs to be changed, it can be by using the Status column.


      Information about status options.

      To Do The claim is awaiting review.
      In Progress The claim is currently being worked on.
      Done Work on the claim has been completed.


      Upon selecting the new status, a note will need to be left — make sure to leave detailed notes so that the RCM team is aware of what is happening!

      When changing status, the amounts in the headings at the top of the page will update accordingly to account for the status change that was made.

       

      Claim Denial Analysis Table

      Claims that have been denied will appear in the Claim Denial Analysis table at the bottom of the page for easy and quick review.

      The information that shows in this table pulls from the denial analysis report page.


      Within this table, click on the to the left of a claim line to review its denial information and even take action.
      Claim Notes

      Add a note to the claim and view past notes that were left.

      Doing this does not send a message/create a task.
      Archive Claim Archive the claim so that it is not worked on.
      Void Claim Void the claim so that it is not worked on.