CIF, Appeal & LTC (25-1) claim form templates (integrates with Medi-Cal website as well as RA database to ensure quality claim preparation). Eligibility Retrieval (pulls results directly from Medi-Cal website and store indefinitely)

TAR Retrieval (pulls results from Medical’s PTN and store indefinitely)

Claim & Appeal Status Retrieval (pulls results directly from Medi-Cal’s PTN and store indefinitely)

SAR Retrieval (pulls results directly from CSS/CMS and store indefinitely)
The Appeal (90-1) and LTC (25-1) forms are both proprietary claims within the Medi-Cal Program and do not exist in most system applications. BillPro on the other hand has specialized billing modules that facilitate the completion of these- forms. The claims are saved in our database indefinitely and can be easily accessed via several search criteria (Acct#, Doc#, ID#, etc.). Additionally, the Appeals Program is integrated with our Medi-Cal RADS database, and the LTC Program is integrated with our Eligibility Retrieval tool. This level of integration to multiple resources provides staff with greater accuracy during the claims- completion process.

The process of finding and printing a Medicare or Commercial RA can be very tedious depending on the application in which the data is stored. Storing electronic remits in BillPro has many advantages, some of which include: (a) very streamlined process of retrieving, storing and searching for records, (b) covers multiple years in the same searchable database, and (c) eliminates dependency on other applications (i.e. Patient Accounting Systems, Imaging Systems, PC Print) for certain reference info that’s needed in order to locate an RA, such as Batch#. For instance, finding an RA in BillPro involves going to the lookup screen, typing an Acct# or HIC#, hitting the ENTER key resulting in seeing all of the matching RA’s spanning multiple years display on the screen. An example of a less-efficient alternative search method involves (a) going into an Imaging System, (b) looking up an account number, (c) selecting Encounter and then clicking the item that contains the desired RA. If the RA isn’t found in Encounter then the user must look up the account in the Patient Accounting System, write down the Batch# and then go back into the Imaging System to find the specific batch. Once the batch is located then the user has to scan through the pages until the correct RA is found. If a Medicare RA cannot be found in the Imaging System then the user has to go into an archive drive, browse for the applicable 835 file and then use something like PC Print software to view & print the RA in the correct format.

The CIF program in BillPro (60-1 form) is integrated with the Medi-Cal RADS database. This is beneficial because users can type just the CCN# into our template and BillPro automatically fills the rest of the information in that charge- line/row of the CIF or Appeal form. Having these fields automatically populated and sourced from the actual RA page provides efficiencies and eliminates data- entry and transposition errors.

BillPro has a printable ‘hardcopy’ version of the Medi-Cal RA which can be used when filing CIFs, Appeals or disputes with the Correspondence Specialist Unit. Essentially this electronically-reproduced RA is equivalent to the scanned hardcopy/paper version, and requires fewer steps to find and print.