CA2401956A1 - Interactive electronic bill payment system - Google Patents

Description

1 Interactive Electronic Bill Payment System

2

3 BACKGROUND OF THE INVENTION

4 FIELD OF THE INVENTION
6 The present invention relates to electronic bill submission and processing, and in 7 particular to insurance claims corresponding to providers of insurance services.

According to the present invention there is provided an electronic bill processing system 11 for coordinating the submission and processing of an electronic bill corresponding to a provider 12 of insurance services, the system comprising;
13 a) a provider interface;
14 b) an integrated database coupled to the provider interface for storing bill information pertaining to the electronic bill;
16 c) a workflow engine coupled to the integrated database for coordinating the processing 17 of the electronic bill and for updating the bill information in response to the bill 18 processing; and 19 d) a management system coupled to the integrated database for monitoring the contents of the integrated database accessible by the provider interface;
21 wherein the provider can coordinate real-time retrieval of submission and status details 22 for bill information contained in the integrated database.

These and other features of the preferred embodiments of the invention will become more 26 apparent in the following detailed description in which reference is made to the appended 27 drawings wherein:
28 Figure 1 is an electronic bill processing and management system;
29 Figure 2 is a component model of the system of Figure 1;

1 Figure 3 is a component model for a provider bill submission interface for the system of 2 Figure 1;
3 Figure 4 is an example screen of the submission interface of Figure 3; and 4 Figure 5 is a further example screen of the interface of Figure 3.

7 Refernng to Figure l, an insurance bill electronic processing and management system 10 8 has user interfaces 12, 14 for communicating over a network 16, such as the Internet, information 9 18 related to insurance bill submission and processing corresponding to insurance claims. The user interface 14, such as but not limited to a web browser, facilitates electronic submission of 11 the bill information 18 between providers 20 and an integrated database 26.
The providers 20 12 provide insurance related services to workers 22 making the insurance claims. Management of 13 the insurance services, provided by the providers 20, is overseen by a labour management agency 14 24. The agency 24 uses the user interface 12 to manage the type and content of the bill information 18 contained within the database 26, as well as coordinating overall processing and 16 access of the bill information 18. It is recognised that the workers 22 could also submit 17 electronic bills through the interface 14 with limited functionality.

19 The system 10 supplements the bill information 18 with general data parameters 28 obtained from an insurance claim database 30, a provider identification database 32, and an 21 employers/workers database 34. The data parameters 28 are typically not specific to any one bill 22 represented in the bill information 18, such as but not limited to worker addresses, provider 23 names and services, and insurance claim particulars. A workflow engine 36 (see Figure 2) 24 manages the transfer of the bill information 18 and the data parameters 28 between an adjudication engine 38 and a payment engine 40. The adjudication engine 38 processes any 26 bills, related to the claims, resident in the integrated database 26 to determine what portion of the 27 bills, if any, should be paid out. The adjudication engine 38 therefore receives bills from the 28 providers 20, adjudicates the provider bills according to business rules (including utilisation 29 rules), generates adjudication results for valid "complete" bills, and generates exception records 1 for invalid "exception" bills. The payment engine 40 then directs payment of the adjudicated 2 bills to a financial institution 42 for subsequent payment to the providers 20 and/or workers 22.

4 Accordingly, the bill information 18 includes details related to bill status, such as pending or approved, related claim data, and bill payment particulars. The providers 20 have real-time 6 access through the interface 14 to selected bill information 18 contained within the integrated 7 database 26, corresponding to pre and post processing of the insurance claims and the related 8 bills. The management agency 24 determines the degree of access by the providers 20 to the bill 9 information 18 through the provider procedures 44 (see Figure 2), which defines the functionality of the provider interface 14. Real-time accessibility of the bill information 18 11 resident on the integrated database 26 facilitates self management, by the providers 20, of the bill 12 processing history once the bills are submitted through the interface 14 to the integrated database 13 26. Therefore, the integrated database 26 acts as a repository of bill information 18 and 14 payment information related thereto.
16 Refernng to Figure 1, the management agency 24 can use a support system 1 for 17 monitoring and setting up the electronic processing and management system 10. The support 18 system 1 can include a processor 2 coupled to the interface 12. The processor 2 is coupled to a 19 display 3 for displaying the interface 12 and to user input devices 4, such as a keyboard, mouse, or other suitable devices. If the display 3 is touch sensitive, then the display 3 itself can be 21 employed as the user input device 4. A computer readable storage medium 5 is coupled to the 22 processor 2 for providing instructions to the processor 2 to instruct and/or configure the various 23 components of the system 10, such as but not limited to the interfaces 12,14, and the processes 24 related to operation of the workflow engine 36 and interfaces 12,14. These instructions can be used to help setup and define the protocols and other procedures related to the operation of the 26 system 10. The computer readable medium 5 can include hardware and/or software such as, by 27 way of example only, magnetic disks, magnetic tape, optically readable medium such as CD
28 ROM's, and semi-conductor memory such as PCMCIA cards. In each case, the medium 5 may 29 take the form of a portable item such as a small disk, floppy diskette, cassette, or it may take the form of a relatively large or immobile item such as hard disk drive, solid state memory card, or 1 RAM provided in the support system 1. It should be noted that the above listed example 2 mediums 5 can be used either alone or in combination.

4 Refernng to Figure 2, the functionality of the provider interface 14 is controlled by the S provider procedures 44, which are predefined by the management procedures 46 according to the 6 desired degree of accessibility to the bill information 18 resident on the integrated database 26.
7 The procedures 44 permit the providers 20 through the interface 14 to select bills, update bills, 8 delete bills, and determine bill status once submitted to the integrated database 26. Sub-9 databases of the integrated database 26, directly accessible by the providers 20 in real-time, are a bill adjudication queue database 48 and a bill status database 50. The queue database 48 lists bill 11 information 18 including all bills (and corresponding bill details) awaiting adjudication, which 12 preferably are both read and write accessible by the providers 20. The status database 50 lists 13 bill information 18 including a pending status (bills undergoing adjudication), a result status (bill 14 adjudication results), and/or a payment status (bill payment decision), which are preferably only read accessible by the providers 20. Real-time inquiry of these bill statuses and queue are 16 accessible (defined by the provider procedures 44) by the providers 20 through the interface 14, 17 with detailed breakdowns of the adjudication and payment decisions determined by the 18 adjudication engine 38 and the payment engine 40.

Further referring to Figure 2, the management user interface 12 allows the management 21 agency 24 to make decisions on the operation of the system 10, as well as select, delete, update, 22 and inquire on selected bills submitted by the providers 20 and/or workers 22. The interface 12 23 has a set of sub-interfaces of a predictive payment interface 54, labour market re-entry (LMR) 24 interface 56, a consultation payment interface 58, and an inquiry interface 60, which are controlled by the management procedures 46 as defined by the management agency 24. The 26 management agency 24 can also use the interfaces 54, 56, 58, 60 to update the provider 27 procedures 44 and management procedures 46. The management agency 24 can use the 28 predictive interface 54 and the LMR interface 56 to define and create individual adjudication 29 rules (utilisation rules UR), related to specific codes (for example LMR
codes), for insertion into the business rule set of the adjudication engine 38.

2 Referring again to Figure 2, the management procedures 46 provide both read and write 3 interaction of the interfaces 54, 56, 58, 60 with the integrated database 26. Interaction between 4 the interfaces 54, 56, 58, 60 is indicated by arrows 66, which allows for the sharing of billing S data and review functionality between the interfaces 54, 56, 58, 60, including such as but not 6 limited to prepopulation of data fields. The interfaces 54, 56, 58, 60 have access to the 7 adjudication queue database 48 and the status database SO as described above, with further 8 capabilities such as but not limited to editing the operation of the bill queue and amending the 9 bill statuses. The interfaces 54, 56, 58, 60 also have access to sub-databases of a bill scheduling database 62 and an adjudication rules database 64. The scheduling database 62 contains data 11 pertaining to bills removed from the queue database 48 by the workflow engine 36 for future 12 processing, and/or data pertaining to predictive bills that are periodically inserted into the queue 13 database 48 by the workflow engine 36 for processing by the adjudication engine 38 and 14 payment engine 40. The adjudication rule database 64 contains adjudication rules created by the interfaces 54 and 56 in response to periodic bill parameters for predictive and LMR insurance 16 claims as controlled by the workflow engine 36. It is recognised that data for bills related to 17 LMR insurance claims could also be stored in the scheduling database 62.
The degree of access 18 for the read and write interaction of the database 48, 50, 62, 64 contents could also be limited to 19 various access levels for individuals of the management agency 24, depending upon the individuals' priority. The access to the integrated database 26 from the interfaces 12, 14 can be 21 determined by role based features for individual providers 20 and employees of the management 22 agency 24, as well as state based features used as lock out features to permit sequential rather 23 than parallel editing of the bill information 18 and data parameters 28.

Refernng again to Figure 2, the workflow engine 36 monitors the data content of the sub-26 databases 48, 50, 62, 64 according to the management procedures 46, as well as amendment of 27 the rule set of the adjudication engine 38 by the contents of the rules database 64. The data 28 content of the databases 48, 50, 62, 64 consists of the bill information 18 and the data parameters 29 28, which are supplied by the management agency 24, the providers 20, and the workers 22.
Adjudication and payment details, generated by the adjudication engine 38 and payment engine

-5-1 40 respectively, are also coordinated by the workflow engine 36 into and out of the integrated 2 database 26, as required. It is recognised that access of the interfaces 12, 14 to the contents of 3 the integrated database 26 is preferably in real-time. Further, access to the integrated database 4 26 by the workflow engine 36 is preferably in periodic or batch mode to facilitate processing efficiencies, such as but not limited to lump sum payments to particular providers 20 related to a

6 plurality of adjudicated bills. However, real-time access of the workflow engine 36 to the

7 integrated database 26, for adjudication and payment results, could also be done if desired.

8

9 Referring to Figure 2, the workflow engine 36 coordinates, through a defined gather/insert process 66 by the management procedures 46, the gathering of all adjudication rules 11 from the rule database 64 for insertion into the adjudication engine 38.
The workflow engine 36 12 also coordinates a scheduling process 68 for creating bills from the scheduling database 62 13 contents, which are scheduled for insertion into the queue database 48 and the processed by the 14 adjudication engine 38 and/or payment engine 40 at specified periodic intervals. The process 68 queries a scheduled bill table of the database 62 to confirm which bills should be processed on a 16 periodic cycle, such as but not limited to a daily cycle, and build any confirmed bills using 17 minimum bill data requirements for the bill queue of the queue database 48.
Accordingly, the 18 process 68 extracts scheduling data from the database 62, and then decides whether to hold the 19 bills pertaining to the scheduling data for future action or to populate the bill queue of the queue database 48 with the extracted scheduling data. This population of the queue table permits 21 adjudication of the associated bills in sequence through a query process 70 as described below.

23 The workflow engine 36 coordinates the query process 70, which queries all bills in the 24 database 48 ready for adjudication, both direct and predictive based. For example, the process 70 will create an 837 flat file containing all bills obtained from the database 48, and then transfer 26 the 837 file to the adjudication engine 36 for processing. The adjudication engine 36 creates an 27 adjudication results file, such as an acknowledgement 997 flat file, which is then reviewed by an 28 update process 72 to determine the degree of success/failure of each bill adjudication. The 29 update process 72 also transfers the success/failure details of the 997 file to the status database S0, for subsequent review through the interfaces 12, 14. Further, the update process 72 would _6_ 1 also insert and payment details from the payment engine 40, related to the success/failure details 2 of the 997 file. The workflow engine 36 also coordinates a purge process 74 to purge bills from 3 the queue database 48 and the scheduling database 62 if needed. For example, the process 74 4 will purge all successfully processed bills from the queue database 48 and all bill schedules from the schedule database 62 that have passed their end date. It should be noted that the bill tables of 6 the queue database 48 and the scheduling database 62, along with the query process 70 and the 7 schedule process 68 provides an extraction and processing loop for bills of a predictive nature as 8 entered into the integrated database 26 through the predictive interface and/or the LMR interface 9 56.
11 Referring to Figure 3, the provider interface 14 has four sub-interfaces, namely an initiate 12 LMR bill interface 76, an initiate bill interface 78, a bill submission search interface 80, and a 13 void bill interface 82. The interfaces 76, 78, 80, 82 allow the providers 20 (see Figure 2) to 14 directly manage electronically their bill submission and results relating to insurance claims of the 1 S workers 22. The interface 76 allows the providers 20 to submit bills for payment processing 16 using an electronic version of an LMR provider invoice, such as an electronic version that 17 conforms to an EDI claim import (ASCX12N 837) format. The interface 78 allows the providers 18 20 to submit bills for payment processing using the electronic version of a provider payment 19 request, such as for example the electronic version conforming to the claim import (ASCX 12N
837) format. The interface 80 allows the providers 20 to execute enquiries on their bill 21 submissions and draft bills resident on the integrated database 26. These enquiries can include 22 bill detail, bill history, as well as the status of bill payment submissions. Preferably for 23 processing efficiency, real time confirmation of submissions and payment status information 24 may not be supported, and payment detail may only be available as per a check run schedule implemented by the payment engine 40. The interface 82 allows the providers 20 to manage 26 their bill submissions through void bill actions. For example, in the case of batch mode 27 operation of the adjudication engine 38 and/or the payment engine 40, the interface 82 will 28 support same day avoidance submissions only. Capability could also be included in the system 29 10 to cancel previously submitted bills once they have been removed from the bill queue in the queue database 48 for adjudication by the adjudication engine 38. Accordingly, the interfaces 1 76, 78, 80, 82 allow the providers 20 to capture bill detail, save draft bills, export bill detail to the 2 adjudication engine 38, void bill submissions, and query bill detail and payment status.

4 Referring to Figure 3, the interface 78 has functionality defined by the provider procedures 44. In particular, the interface 78 has a bill details function 84 of the procedure 44, 6 which allows the providers 20 to initiate payment requests that axe subject to invalid data, create 7 payment requests and save submissions, create payment requests and exit submissions, create 8 and submit payment requests subject to an incompletion, and successfully create and submit 9 payment requests. It is understood that the bills are submitted in response to the providers 20 performing or otherwise providing service, treatment, or products to the workers 22. It is 11 understood that the workers 22 claims are established with the management agency 24 prior to 12 submitting the bills, and the worker/claim entitlement information has been previously loaded 13 into the adjudication engine 38 and the integrated database 26. The result of the details function 14 84 is either a payment request saved as a draft for future submission or a payment request that is 1 S submitted for processing through the interface 14 to the integrated database 26. Further, the 16 providers 20 can use a combination of claim/worker data to submit the bill requests. It is 17 recognised that the details function 84, and other functions as described below, could be 18 represented as software modules for use by the support system 1.

A first operation of the function 84 is to indicate that a combination of claims/worker 21 data 89, 91 in the payment request inputted by the provider 20 is invalid.
Referring to Figures 4 22 and 5, the function 84 provides a submit bill menu 86 to the provider 20, whereby the provider 23 20 enters a claim number in conjunction with worker/patient 22 profile data 91(see Figure S), 24 such as but not limited to date of accident, surname, given name, and date of birth, when completed for submission to initiate the payment request. Other claim data 88 includes service 26 codes, modifiers, ICD-9 codes, date of service, place of service, units, and dollar amounts. In 27 this instance, the profile or claim data 88 is determined to be invalid by the provider procedures 28 44 and the provider 20 is notified the claim/patient information is invalid. Accordingly, the error 29 could be the result of the combination of data 88, 89, 91 is invalid (e.g.
wrong claim/worker combination), the claim number (record) does not exist in the integrated database 26 (i.e. the _g_ 1 claim has not yet been approved/fed into the appropriate components of the system 10), and/or a 2 typographical error on the part of the provider 20 when keying in the requisite validation 3 information included in the data 88, 89, 91. Accordingly, the invalidation process of the 4 provider procedures 44 provides a validation mechanism in order for the provider 20 to proceed with the payment request submission. The provider 20 is given choices to continue with the 6 request session on the interface 14.

8 Another operation of the function 84 is to create the payment request and then save the 9 submission in draft for future editing/submission. Initially, the provider 20 navigates on the interface 14 to the bill submission component of the menu 86 and selects the submit payment 11 request submenu option. The provider 20 then enters the data 88, 89, 91 and submits to initiate 12 the payment request. The provider 20 then confirms patient 22/provider 20 profile information 13 87, 91 and defines the bill line item information 88, such as date of service, service code and 14 charge. The provider 20 then saves the payment request without submitting the bill to the integrated database 26. For example, a warning message could be displayed on the interface 78 16 advising the provider 20 that the payment request is being saved without submitting the bill to 17 the integrated database 26. Accordingly, the provider 20 can then retrieve and submit the bill 18 related to the saved payment request at a later date, or can delete the draft bill via the void bill 19 interface 82 as further explained below. It should be noted, referring to Figure 5, that the providers 20 have the ability to input a provider specific invoice as a payment request to the 21 integrated database 26. The data 88 can contain multiple bill line items on a per claim basis 22 which indicates the specific dates of service for each line and applicable modifiers (for 23 equipment) of the requests. The provider is given further choices to proceed with the request 24 session on the interface 14.
26 A further operation of the bill detail function 84 is for the provider 20 to create and exit 27 without saving or submitting the payment request. Accordingly, the provider 20 navigates on the 28 interface 14 to the bill submission component of the menu 86 and selects the submit payment 29 request submenu option. The provider then enters a claim number in conjunction with patient profile data 91 and submits to initiate the payment requests. The provider 20 also confirms the 1 patient 22/provider 20 profile information 87, 91 and defines the bill line item information 88, 2 however, then proceeds to exit the request without saving or submitting the bill. Accordingly, 3 the function 84 displays a warning message advising the provider 20 that the request is being 4 exited without saving or submitted. The provider is given further choices to proceed with the request session on the interface 14.

7 A further operation of the function 84 is to interact with the provider 20 when creating 8 the payment request, where some of the required data 87, 88, 89, 91 is incomplete. Accordingly, 9 the provider 20 selects the submit payment request from the menu 86 provided by the interface 14, enters the claim number in conjunction with the patient profile data 91 and submits to initiate 11 the payment request. The provider also confirms the patient 22/provider 20 profile information 12 87, 91 and defines the bill line item information 88. The provider 20 then proceeds to submit the 13 payment request, however, a warning prompt appears informing the provider 20 that the required 14 information is incomplete and that the payment request will not be dispatched for the current 1 S claim. The provider is given further choices to proceed with the request session on the interface 16 14.

18 Another operation of the function 84 is for a provider 20 to create and submit a complete 19 payment request. Once the provider 20 has entered the claim number in conjunction with the patient profile data 91, and confirmed the patient 22/provider 20 profile information 87, 91 and 21 bill line item information 88, the provider procedures 44 check that all of the required 22 information is correct and then provides the provider 20 with a confirmation prompt informing 23 that the bill will be dispatched to the integrated database 26 for payment processing.
24 Accordingly, the provider 20 can select OK and the bill will be submitted for processing, can select CANCEL and then edit or otherwise discard the payment request, or if the payment 26 request has been submitted the provider 20 can retrieve from the integrated database 26 the 27 particular payment request and void the related bill. Itis also recognised that a popup search box 28 for the selection of primary service provides (POS), representing a list of providers 20 enrolled 29 for use of the system 10, is accessible by the function 84 for completing the payment request.

-10-2 Referring to Figure 3, LMR bill interface 76 of the general provider interface 14 enables 3 LMR providers 20 to submit LMR invoices to the management agency 24 for payment via 4 electronic submission provided by the system 10. The LMR bills are for service, treatment, or products provided/performed by the provider 20 according to an approved LMR
plan as 6 accommodated for in the integrated database 26 and the adjudication engine 38. It is recognised 7 that the utilisation rules (UR) of the rules database 64 have been loaded by the work flow engine 8 36 into the adjudication engine 38 prior to submission of the LMR invoice.
The provider 9 procedures 44 contain an LMR bill detail function 92 for co-ordinating the creation and submission of LMR invoices (payment requests). It is noted that the LMR
providers 20 can

11 identify the combination of claim/patient profile information 89, 91 to proceed with a payment

12 request submission through the validation mechanism, as described above in relation to the

13 function 84. Further, the LMR providers 20 can submit multiple lines of service as bill line

14 items 88 on a per claim basis and can identify an SSP for each of the lines of service. Further, the LMR providers 20 also indicate specific dates of service for each line of service included in 16 the data 88 as well as indicating applicable modifiers (for equipment) in the LMR invoices. In 17 addition to that described above for the function 84, the function 92 also allows the LMR
18 provider 20 to identify the secondary service provider (SSP) for which the bill line items 88 19 apply. Preferably, only one SSP is identified per bill and all line items 88 are associated accordingly. Further, the function 92 also operates with a search popup page 94, which is 21 supplied to the provider 20 through the interface 76. The popup page 94 allows the provider 20 22 to search and select appropriate SSPs. In addition, further popup pages of an expense code 96 23 and an ICD-9 98 can be provided by the function 92 to the interface 76 to allow the provider 20 24 to clarify and confirm portions of the data 88 corresponding to expenses and ICD-9 information.
Accordingly, similar to the function 84, the function 92 also allows the provider to select OK for 26 submitting the LMR invoice for processing, selecting CANCEL and/or EDIT
discard features for 27 the LMR invoice, and if the invoice has been previously submitted the provider 20 can retrieve 28 and void the invoice. Further, more than one SSP can be selected through the popup page 94 29 tobe included in the LMR invoice.

1 Referring to Figure 3, the sub-interface 82 of the general provider interface 14 enables 2 the providers 20, both payment requests and LMR invoices, to cancel bill submissions and/or 3 draft bills. It should be noted, for batch mode operation of work flow engine 36 the voiding of 4 bills may only be available for same day cancellations, or any other period specified for the batch mode. It is assumed that prior to accessing the VOID bill page interface 82, the provider 20 has 6 already submitted the bill payment request, saved as a draft the bill payment request, and/or has 7 decided to proceed with a same day (or other period) review/cancellation process. Accordingly, 8 the provider procedures 44 allow the provider 20 to navigate to the VOID
bill submission 9 interface 82, whereby the provider 20 selects the draft or submitted bill to be cancelled via a check box (for example, "Void bill ?") and the submit a VOID request (for example by a "Void 11 selected" button). See scenarios below discussed users guide and example screens for the 12 interfaces 14, 76, 78, 80, 82. It should be noted that multiple bills can be voided simultaneously 13 through the VOID interface 82. Once the VOID request has been received by the integrated 14 database 26, a confirmation message is displayed on the interface 82 to the provider 20 thereby informing the provider 20 that the selected bills will be cancelled. The provider 20 is given the 16 option to select OK for the bills to be cancelled or to select cancel so that the VOID selections 17 will be cleared and therefore not voided from the integrated database 26, through operation of the 18 process 74 implemented by the work engine 36.

Referring to Figure 3, the bill submission search interface 80 of the general provider 21 interface 14 enables the providers 20, for both payment requests and LMR
invoices, to 22 investigate the adjudication and payment status of bills submitted to the integrated database 26.
23 For batch mode operation of the work flow engine 36, real-time confirmation of submissions and 24 payment status information may not be supported. Moreover, payment detail may only be available as per a check run schedule as implemented by the payment engine 40.
The interface 26 80 has a bill submission search results function 100 as part of the provider procedures 44. The 27 function 100 allows the provider 20 to retrieve bills/payment details from the databases 48, SO of 28 the integrated database 26 by a variety of search parameters, such as but not limited to claim-29 invalid, claim number-valid, date range-invalid, data range-valid, status-invalid, status-valid, claim number and date range, and status and claim number. It is further recognised that other 1 combinations of search parameters, including or excepting those above, can also be used for 2 treating the bill/payment details from the integrated database 26. It is noted that SDT inquiry 3 functionality and design can be leveraged for the provider 20 inquiry implemented by the 4 interface 80. The search function 100 co-ordinates the display of either a bill details page 102 or a payment details page 104 on the search interface 80.
6 Operation of the function 100 is initiated when the provider 20 navigates to the bill 7 payment inquiry component of the menu 86 of the general interface 14 (see Figure 4). The 8 provider 20 enters a claim number to filter the claims by and then submits.
However, in one case 9 the claim number entered may be invalid, and therefore an error message is displayed on the interface 80 by the search function 100 informing the provider 20 that no bill exists for that 11 claim. The provider 20 can then select different claim numbers or parameters and then re-12 submit. Accordingly, the provider 20 can investigate adjudication results and payment details 13 for submitted bills. An alternative to the above operation is when the provider 20 enters the 14 claim number to filter the claims by, which contains a valid claim number, and therefore a list of bills is provided by the function 100 for the appropriate claim number for display on the 16 interface 80. The interface 80 can display the inquiry results as the bill detail page 102, the 17 payment detail page 104, or a combination of both. Further, upon the inquiry for a valid claim 18 number, the provider 20 can narrow the search by the finding/modifying additional criteria. As 19 well, the provider 20 can select a particular bill (such as a link pertaining to a particular bill ID) to be viewed in greater detail. Accordingly, the function 100 interacts with the bill detail 21 function 84 or the LMR bill detail function 92 to retrieve the requested bill detail. Alternatively, 22 the provider 20 can select a paid amount (such as a link for a particular payment) to be viewed in 23 detail. The function 100 can then interact with the bill detail function 84 or the LMR bill detail 24 function 92 to retrieve required details for display on the bill detail page 102 or the payment detail page 104 on the interface 80.

27 A further operation of the search function 100 allows the provider 20 to retrieve 28 bills/payment detail information by date range. The provider 20 enters a start/end date range or 29 uses a calendar control to select a date to refine the search results by, and submits through the interface 80. The search function 100 then checks the date range against the bill details stored in 1 the databases 48, 50, and for example can return with an invalid date range entered by displaying 2 an error message on the interface 80 informing the provider 20 that no bills exist in the integrated 3 database 26 for the date range selected. The provider 20 can then select a different date range or 4 parameter and re-submit on the interface 80 through the search function 100.
An alternative to the above is when the date range entered by the provider 20 is considered valid by the search 6 function 100. In this case, a list of bills previously submitted by the provider 20 for the date 7 range parameters selected is displayed on the interface 80. Accordingly, the provider 20 can 8 narrow the search by defining/modifying additional criteria and can select either a particular bill 9 and/or a particular paid amount to be viewed in greater detail. It should be recognised that multiple bill/payment details can be accessed through the general interface 14 simultaneously, as 11 long as they correspond to the selected search criteria submitted through the interface 80 to the 12 search function 100.

14 A further operation of the search function 100 is retrieving bill/payment detail information by status. The provider 20 selects the status range to filter submitted/draft bills by 16 and then submits this to the search function 100. The search function 100 then proceeds to 17 review the contents of the databases 48, 50. If the status selected is invalid, then an error 18 message is displayed on the interface 80 informing the provider 20 that no bills exist for the 19 status selected. The provider 20 can then select a different status or other parameter and re-submit the new search criteria to the search function 100. An alternative to the above is when 21 the status criteria is considered valid by the search function 100. In this case, the status selected 22 produces a list of bills matching the selected status, subsequently displayed on the search 23 interface 80. As note above, the provider 20 can then narrow the search by defining/modifying 24 addition search criteria and/or can select particular bills and/or paid amounts to be viewed in greater detail.

27 A further operation of the search function 100 is to retrieve bill/payment detail 28 information from the databases 48, 50 by claim number and date range.
Accordingly, the 29 provider 20 enters a start/end date range to refine the search results and then enters a claim number to filter the claims by and then submits the search request to the search function 100.

1 The search function i00 then searches through the databases 48, 50, and if valid, provides a list 2 of bills previously submitted by the provider 20 for a given claim during the date range 3 parameters specified for display on the interface 80. As noted above, the provider 20 can narrow 4 the search further by defining/modifying additional criteria. Another operation is that the provider 20 can retrieve bills/payment detail information by specifying status and date range.
6 Accordingly, the provider 20 enters into the interface 80 a start/end date range to refine the 7 search results, then selects a status range to filter submitted/draft bills by, and then submits the 8 search request to the search function 100. The search function 100 retrieves the matching bills, if 9 valid, from the databases 48, 50 with a selected status during the date range parameters for display on the interface 80. The provider 20 can then narrow the search by defining/modifying 11 additional criteria as noted above. A further operation of the search function 100 is to retrieve 12 bill/payment detail information by status and claim number. The provider 20 enters a claim 13 number to filter claims by and submits and selects a status range to filter submitted/draft bills by 14 and submits. For a valid combination the claim number/status criteria is searched by the search function 100 in the databases 48, 50 to provide a list of bills usually submitted by the provider 16 for a given claim during the given status for display on the interface 80.
As noted above, the 17 provider 20 can narrow the search by defining/modifying additional criteria.

19 A further operation of the search function 100 is to retrieve a saved payment request, modify the bill detail, and the submit to the integrated database 26 for payment processing 21 through the work flow engine 36. This operation can be done by the provider 20 when bills have 22 been created and saved for future processing. Accordingly, the provider 20 navigates to the 23 bill/payment enquiry component of the menu 86 and then proceeds to enter a combination of 24 search parameters to retrieve a list of bills (both active and pending).
The parameters can include claim number, bill status, data range, and provider information. The provider 20 can 26 then select from the list displayed on the interface 80 a particular bill with a status of pending.
27 The details of the pending bill are displayed on the interface 80 and the provider 20 can make 28 any necessary changes/additions of the draft bill. The provider 20 is then given the opportunity 29 to submit the payment request, if the bill request is now complete, and then a confirmation prompt can appear on the interface 80 informing the provider 20 that the bill will be dispatched

-15-1 to the management agency 24 for payment processing. The provider 20 can select OK and the 2 bill will be submitted to the integrated database 26 for processing, can select CANCEL and 3 thereby edits/disguard the bill, or if the bill has been submitted previously the provider 20 can 4 retrieve and void the bill using the void interface 82.
6 The following outlines example interface 14, 76, 80, and 82 screens for a first scenario of 7 submitting the payment request, a second scenario of submitting an LMR
invoice, a third 8 scenario of bill payment status enquiry, and a fourth scenario of voiding a bill. Further to that 9 already described above, the scenarios l, 2, 3, and 4 demonstrate the ability to provide multiple bill line items per claim for display on the appropriate interface 14, 76, 78, 80, 82, and the 11 interaction of popup boxes for service code searches, date of service selections, LMR expense 12 codes, and provider searches. Further, the enquiry and void scenarios allow the retrieval and 13 subsequent selection of multiple bills per page, as displayed on the appropriate interface 80, 82, 14 to facilitate easy of selection by the provider 20.
Further, an application user guide is provided for the LMR submission interface 76, the

16 bill submission search interface 80 and void interface 82, appropriate either to LMR and/or bill

17 payment requests. It should be noted, that the user guide explains further functionality of the

18 system 10 such as printing a screen with bill information 18 contained thereon, and system 10

19 login for providers 20 part of a provider database having access to the system 10. It should be noted that registry opportunities for an unregistered provider 20 is also presented on the general 21 provider interface 14. It should be noted that the user guide should be considered as one 22 example of system 10 application to a specific management agency 24.
Accordingly, some of 23 the required criteria for entry into the data fields as displayed on the interfaces 14, 76, 80 may be 24 other than those shown.
26 Also provided in this disclosure is an example implementation of the system 10 for 27 provider bill submission UI web specification and error/warning messages.
The web 28 specification gives examples of the controls listed in the tab sequence of the menu 86 and sub-29 menus thereto, as well as the actions or events required on the various pages displayed on the interfaces 14, 76, 78, 80, 82 to initiate the corresponding listed responses.
Further, the web 2 specification also includes example data elements and data validation parameters.

4 Although the invention has been described with reference to certain specific embodiments, various modifications thereof will be apparent to those skilled in the art without 6 departing from the spirit and scope of the invention as outlined in the claims appended hereto.

FJ'r?E~'1'~IS
PBAS-Provider Interface [Bill Submission]
WEB SPECIFICATION
( I N-PROGRESS) Editor: Stephen Yendall BCE Emergis Inc.
eHealth Solutions Group Prepared on: 14 March 2002 Last Revised on: 20 August 2002 Copyright ~ 2001 BCE Emergis Inc.
eHealth Solutions Group All rights reserved. No part of this document may be used or reproduced in any manner whatsoever without permission in writing.
Material contained in this document should be considered CONFIDENTIAL
according to the BCE Emergis Inc., eHealth Solutions Group confidentiality policy and agreements This document contains information proprietary to BCE Emergis Inc., eHealth Solutions Group. No part of this document shall be duplicated, transmitted, used, or otherwise disclosed to anyone other than the organization or specific individuals to which this document is delivered, and then only for the purpose of the management of the specific BCE Emergis Inc., eHealth Solutions Group product to which it applies and is subject to the confidentiality covenant undertaken by the recipient in the agreements between the parties. BCE Emergis Inc., eHealth Solutions Group reserves the right to have the recipient return all copies of this document at any time.

BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
Document Change History VersionDate Editor Comments V1.0 14/0312002Stephen YendallInitial Population V1.1 28/04/2002Stephen YendallChanges based on review with Bob Ransom V1.2 03/05/2002Dennis DeWolf Added in validation tables \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/3/2002 2:36 PM
Page i Design\PBAS Provider UI Web Specification Build 1 vl.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
Contents 1 Introduction ...............................................................................
............................3 1.1 Document Purpose ...............................................................................
........................................

1.2 Structure......................................................................
..................................................................4 1.3 Scope ...............................................................................
.............................................................

Sitemap........................................................................
..........................................5 2.1 Purpose........................................................................
.................................................................5 2.2 PBAS Provider Bill Submission Interface............................................................
Site Map.......... 5 3 Provider Bill Submission UI Web Specification.................................................6 3.1 Initiate Bill...........................................................................
...........................................................

3.2 Bill Detail (Option 1 ) ...............................................................................
.......................................

3.3 Bill Detail (Option 2) ...............................................................................
.....................................

3.4 Date of Service Pop-Up ...............................................................................
...............................

3.5 Initiate LMR Payment Request........................................................................
...........................

3.6 LMR Bill Detaii (Option 1 ) ...............................................................................
............................

3.7 Service/Expense Code Pop-up.............................................................................
......................

3.8 SSP Search Pop-up.............................................................................
.......................................

3.9 ICD-9 Search Pop-up.............................................................................
.....................................

3.10 Bill Submission Confirmation Page ..........................................................
................................ 35 3.11 Statement of Services Page...........................................................................
..........................

3.12 Void Bills..........................................................................
.........................................................

3.13 BiII/Payment Search ...............................................................................
..................................

3.14 BiIIIPayment Search Results........................................................................
............................

3.15 Bill Detail.........................................................................
..........................................................

3.16 Payment Detail ...............................................................................
..........................................

3.17 Diagnosis/Modifier Pop-up ...............................................................................
........................

4 ErrorIlNarning Messages.......................................................................
.............61 4.1 Warning: Submit (Complete).....................................................................
.................................

4.2 Warning: Submit (Incomplete) ...............................................................................
....................

4.3 Warning: Void Bills..........................................................................
...........................................

4.4 Warning:
Exit...........................................................................
...................................................64 \\198.133.47.221\BCE Emergis\Web Development\Provider U112. 6/3/2002 2:36 PM
Page ii Design\PBAS_Provider UI Web Specification Build 1 v1.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PEAS-Provider Bill Submission Interface: Web Specification DRAFT
1 Introduction 1.1 Document Purpose Storyboarding is a process utilized within the requirements phase to illustrate how an application might implement the functionality required. It serves to validate logical processluse-case flow and to verify that all required functionality has been captured and associated in a valid sequence.
Storyboarding also serves the purpose of initial usability validation and as a model for later design and development efforts.
The Web specification represents the detailed design of the web pages including the page layout, page definition and documentation of the control/action/responses on the pages.
Solution.
Development Process Step Sign-Description Date Off?

Gather and document what the ?
users need eusl~es5 the system to do j Reqmrements Y Confirm scopeltiming of functionality i Documents ~iow the system will ?
meet the demands of the business Design Y . Detailed use-cases outlining precise functionality Lo-Fi screen designs and navigation Detailed component designs ?

~ Construction of Ullinterfacesldatabase/
~

Em N architecture e~~~d~rest . System integration testing i System configuration and end-user?

acceptance testing WSIB Y
Test \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/3/2002 2:36 PM

Design\PBAS Provider UI Web Specification Build 1 v1.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
1.2 Structure This document is broken into two distinct components: the sitemap and the Web Specification (screen) illustrations. Moreover, the control action response (CAR) table has been completed per screen to demonstrate the interaction and commands available/required.
1.3 Scope The scope of this document is limited to the Provider Bill Submission Interface functions and capabilities as expressed in the business requirements document. More specifically, this document outlines the functionality/capabilities to be enabled in the initial release of the Provider Interface.
\\198.133.47.221\BCE Emergis\Web Development\Provider 0112. 613/2002 2:36 PM

Design\PBAS Provider UI Web Specification Build 1 vl.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
2 Sitemap 2.1 Purpose The site map outlines all screens required within the application and the flow amongst those screens. Each block within the map represents one screen illustration in the Web Specification.
The entire flow of the Provider Bill Submission Interface and its hooks into other components is illustrated below. This map is a smaller section of what will be a complete PBAS Web Interface sitemap that will illustrate how all the components and of PgAS interacts.
2.2 PBAS Provider Bill Submission Interface Site Map Popup I
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Design\PBAS_Provider UI Web Specification Build 1 v1.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3 Provider Bill Submission UI Web Specification 3.1 Initiate BiII
Page Def'fnition Page Name Initiate Bill Description This page is used to initiate the composition of bill and validate that provider is submitting a bill for a.) an established claim, and, b.) the accurate claim. The method for preventing random bill submissions is to validate claim #Ibirth date.

Preliminary PagA !_ayout PEAS Home BIII Submission BIIUPayment Inquiry t " ", 4 fnltP I1t Wit ;i\_ r-.-"..--, W"" a ~.e,.v......z ,f'><..
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Submit Payment Request For:
Claim Number: r????....... ..... .............
Dete Of Birth: ????? , ___ Submit ' \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/3/2002 2:36 PM

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3.2 Bill Detail (Option 1) Page Definition Page Name gill Detail (Option 1 ) Description This page captures the details of the bill submission.
Details include provider invoice reference number (optional) as well as all line item (tee, DOS, service) information.

No validation (apart from required fields) will be performed on the data.

Preliminary Page Layout PBAS Home BIII Submission BIIIfPeyment Inquiry ~ ,,. a ..a,,..w k",. ,,>.
ubmit Payment . ' t RequesiY A~ 4tee -. ~ . ~: ~~', : ~ Subrolt ~".
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Claim Number ~'i~'' Date of Birth: i'~kXX%1"~UK7i v s PatientSumame:$h.~'-~'~=v t .~""
f~CX?i",; Date of Accident: ~(~U( ... Y x ~:~9::
Patient Given Name:

_.__..-.-__. _..-..-.___~..-_- . ~._.~.-_-3. BIII Llne Items _ No ServiceCodeModifierICD-9 Date of POS TypeUnitsCharges Service z (~xx~x-'~~ w~rr~~ xxxxx~c ~ ~ ~ asasas .. ' 2..xxxxxx ~~~~~ (i~c~c (xxxxx~c ~ ~ ~ asassa~"
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z??77? ~ :~i;i~ ~ ~ XXX 8888888 '' ~xxXX ~ ,' XXXX~'.~ ~ ~ XXX.888888 ~t~?a97v .

x~ ~ xxx asasssq~o~j 4. SubmftforPayment -.. - -_______-__.-.__-_.._-..-..__-__,__.-..___._._._._..__._._-__ It is an offense to de0berataty make false statements to Workplace Satery and Insurance Total Charges: ,f;~~~ g Board. I hereby certify that the information being submitted is We, correct and complete. 6.. r'r,~:
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U m m a BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3.3 Bill Detail (Option 2) Page Definition Page Name Bill Detail (Option 2) Description This page captures the details of the bill submission.
Details include provider invoice reference number (optional) as well as all line item (fee, DOS, service) information.

No validation (apart from required fields) will be performed on the data.

Preliminary Page Layout PBAS Home 8111 Submission BIIIIPayment Inquiry -'.._. Provider - __- --.
Information Provider Number: Invoice Reference ~(XXXX 'i ~(7(X~ ~ #: i T. Claim htfortnation ' i Clam Number 7(X7( Date of Birth ~KXX~(XX
J(X '_ ~ , .~..~, -.....m.~.N..,".~.a~..~w. ~.~.~.".

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~.

i Patient Gmen XXX
Name- yXX

3_.-- BtIILIne.--. . ....---_-._ _-- _. -... . ___-___.-Items - - _.._._.._...__._.___ --- !.

No SerutceCodeModifierICD-9 Date of ServicePOS TypeUnitsCharges ~ .. I 'x ~ 7777r ~cxx~ ?~~ l ~ ~ ~ 8sass8a .;

'77777 ~ ~ XXXXXX ~~ ~ ~ X~ 8888888 ~

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6 , ... XXXXXX~ 777777~ -~~,.XXXX)cX -.~,~~ XXX ~ 8888888 : - I

4.Submit forPayment-.- ----- _-It is an offense Total $S$$$$$
to deliberately Charges: :
make false statements to Workplace Safety and Insurance Board- I herebyt the submittedis .....~.a~,:.
certify tha mtortnaUOn We, being correct and complete.

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3.4 Date of Service Pop-Up Page Definition Page Name Date of Service Pop-Up Description This page (Pop-up Window) displays the line item details of submitted bills. The purpose of this facility is to view a facsimile of a provider's bill submission.

Preliminary Page Layout Dates of Service (select all that apply):
~ rr~m: rrrrrrrrrrrtr rrrrrr~rrrrrrrr ~~rrrrrr~rrrrrrrrrrr~rrrrrrrrrrrr Fee: $$$$$$$ ICD-9: $$$$$$$ ~"
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3.5 Initiate LMR Payment Request Page Definition Page Name Initiate LMR Request Description This page is used to initiate the composition of bill and validate that provider is submitting a bill for a.) an established claim, and, b.) the accurate claim. The method for preventing random bill submissions is to validate claim #/birth date.

Preliminary Page Layout PBAS Home BIII Submission BIIUPayment Inquiry f , s. w''~. _~;.~r , m ~ ,< ' a~.a . . SubmtlPa eMAR uea! ~ . ~ Submll LMR Pa ye ~ ~ : .~ y ~~p ~ F.. ~.~3~ w...:.,w.r ,P l~AtMA!! (~ eil..~.~.: :; . ~:~.~.' . , R ~ W ~ ~., Submit I.MR Payment Request For:
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v Compose Bill i \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/312002 2:36 PM

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c ' m a BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3.6 LMR Bill Detail Page Definition Page Name LMR Bill Detail Description This page captures the details of the LMR bill submission.
Details include provider invoice reference number (optional) as well as all line item (fee, DOS, service) information. No validation (apart from required fields) will be performed on the data.

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It is an offense to deliberately make false statements to Workplace Safety and Insurance Board. I hereby certify that the information being submitted ~s true, corecl and complete. Total Charges ~iSiSSi =
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v' BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3.7 SerwicelExpense Code Pop-up Page Definition Page Name Service/Expense Code Search Pop-up Description This pop-up displays a list of valid service codes that can be selected/ submitted for a payment request.

Preliminary Page Layout Service Code Search Tre~tment!keyword;: ????? .
Service Code: ?????
I Search Reset Services Service Code Description ~s . ~ ~~, ~ a ~.~ a~~
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m a D D s cn BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PEAS-Provider Bill Submission Interface: Web Specification DRAFT
3.8 SSP Search Pop-up Page Definition Page Name SSP Search Pop-up Description This pop-up provides a facility to search, identify and select an accurate Secondary Service Provider (SSP).

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BCE Emergis Ins., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3.9 ICD-9 Search Pop-up Page Definition Page Name ICD-9 Search Pop-up Description This pop-up provides a facility to search, identify and select an accurate Diagnosis, ICD-9 Code.

Preliminary Page Layout ICD-9 Search Diagnosis I!~eyv~~ord): ?????
Diagnosis Code: ?????
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m a BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3.10 Bill Submission Confirmation Page Page Definition Page Name Bill Submission Confirmation Page Description This page displays a non-editable, confirmation summary page of all the bill line item detail.

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4. Submit for Payment It is an offense to deliberately make false statements to Workplace Safety and Insurance Board. I hereby certify that the infdrtnation bamg submitted is We, correct and complete. Total Charges:
Submit 1 ~ Baok J
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m a BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3.11 Statement of Services Page Page Definition Page Name Statement of Services Page Description This page displays a non-editable, printable summary page of all the bill line item detail.

Preliminary Page Layout PEAS Home BIII Submlsafon BIIIIPayment Inquiry ._,...a~;:,u.~..a ,;o t~'.~~~ ~
~Submlt Payment Request z Subml~ tMR , Fe st rye trosf; _ 1 ' . . . _ . .e x ~ .W"."-. _ . ..
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m a BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PEAS-Provider Bill Submission Interface: Web Specification DRAFT
3.12 Void Bills Page Definition Page Name Void Bllls Description This page enables a provider to cancel a bill (same day voids only).

Preliminary Page Layout PBAS Home Bilt Submission BIIIfPayment Inquiry ''~'~°"'~ ' ~, '~,.:.,~~ ~ .fit xy~:... ~ 'w.u ~~-.
Submtt Payment Raqueat Submit LMR Pa~ront .. _ uwR ~'y: ' °~old P ' uttilt' ~''' Void Bills Only same day bills can be cancelled. Contact Workplace Safety 8 Insurance Board to void previous submissions.
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BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specificafion DRAFT
3.13 BiII/Payment Search Page Definition Page Name gill/Payment Search Description This page enables a provider to inquire on bills and their associated adjuc~icationlpayment status.

Preliminary Page Layout PBAS Home BIII SubmIsalon BIIIIPayment Inquiry _ ,- ~~.~,a3.. ~, . , ~ , v ,~ x ': '' 3 ~ b x~,. ' BtlllPaYm~t Status, ~~, r ~ ~ ~ ~~~' r' . ms. ~~'S~,~. ~ ~~ ~'~~~x , ~: 3~ ~
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Claim Number Effective Date Range Note: Results do not inUude current day's bill submissions. Updates are posted daily.
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w a w w o a a a a m a BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS-Provider Bill Submission Interface: Web Specification DRAFT
3.14 BiII/Payment Search Results Page Definition Page Name BiII/Payment Search Results Description This page displays the results of provider bill searchlinquiry.

Preliminary Page Layout _ , i PBAS Home BIII Submission BIIIIPayment 'i Inquiry a BilUPaymsrlt Statue far ~,. ,~~Y ~ ;as , .

Retrieve Bills Claim Number Effective Date Range Note: Results do not inGude current day's bill submissions. Updates are posted daily.

Claim # Bill ID Submitted Date Sub ChargesStatus ChequelEFT #
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3.15 Bill Detail Page Definition Page Name gill Detail Description This page (Pop-up Window) displays the line item details of submitted bills. The purpose of this facility is to view a facsimile of a provider's bill submission.

Preliminary Page Layout Claim Number Total Charges &~~~~~~:i Bill Number: 7~YIC~.~,..~s~ teas Total Allowances t,.!"~,t~~ x z~
Douumew Data: ~ p'sx~'~'"
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3.16 Payment Detail Page Definition Page Name Payment Detail Description This page (Pop-up Window) displays the actual payment details for bill. Users can select (link) to view payment details.

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3.17 Diagnosis/Modifier Pop-up Page Definition Page Name Diagnosis/Modifier Pop-up Description These pages (Pop-up Window) display the actual payment details for bill. Users can select (link) to view payment details.

Preliminary Page Layout :r eoR De.~rwvon Moe~ero..~nvbon W
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4 ErrorIWarning Messages 4.1 Warning: Submit (Complete) Page Definition Dialog Name Warning: Submit (Complete) Description This pop-up dialog is displayed upon submission (submit button) of a bill and all required fields are complete.

Preliminary Page Layout \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/3/2002 2:36 PM

Design\PBAS Provider UI Web Specification Build 1 vl.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS- Provider Bill Submission Interface: Web Specification DRAFT
4.2 Warning: Submit (Incomplete) Page Definition Dialog Name Warning: Submit (Incomplete) Description This pop-up dialog is displayed upon submission (submit button) of a bill and all required fields are not complete.

Preliminary Page Layout \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/3/2002 2:36 PM

Design\PBAS Provider UI Web Specification Build 1 vl.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS- Provider Bill Submission Interface: ~Veb Specification DRAFT
4.3 Warning: Void Bills Page Definition Dialog Name Warning: Void Bills Description This pop-up dialog is displayed upon submission of a bill cancellation request.

Preliminary Page Layout \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/3/2002 2:36 PM

Design\PBAS_Provider UI Web Specification Build 1 v1.2.doc BCE Emergis Inc., eHealth Solutions Group Proprietary and Confidential PBAS- Provider Bill Submission Interface: Web Specification DRAFT
4.4 Warning: Exit Page Definition Dialog Name Warning: Exit Description This o a dialo is dis la ed a on exitin exit button the bill confirmation a e.
P P- F 9 P Y P 9C ) P 9 Preliminary Page Layout \\198.133.47.221\BCE Emergis\Web Development\Provider UI\2. 6/312002 2:36 PM

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eHealth Solutions Group LMR Bill Submission Interface Application User Guide (Last Revised July 29, 2002) LMRbillsub v2 usrgd finalt BCE Emergis Inc., eHealth Solutions Group, 5090 Explorer Drive, Mississauga, Ont. L4W 4X6 Tel: 905-602-7350 BCE Emergis Inc., eHealth Solutions Group Proprietary Notice Page: ii LMR Bill Submission Interface Rev. Date: July 29, 2002 Proprietary Notice Copyright ~ 2002, BCE Emergis Inc., eHealth Solutions Group.
Telephone: (905) 602-7350 All rights reserved. Information provided in this publication is proprietary and confidential. No part of this publication may be distributed, reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, recording, or otherwise, without the expressed written permission of BCE Emergis Inc., eHealth Solutions Group.
Microsoft and Windows are registered trademarks of Microsoft Corporation. All other products or services mentioned in this document are trademarks or registered trademarks of their respective companies.
Disclaimer This publication, as well as the software described in it, is furnished under license and may only be used or copied in accordance with the terms of such license. BCE Emergis Inc., eHealth Solutions Group makes no representation or warranties with respect to the contents of this publication, and specifically disclaims any express or limited warranties that may result from misuse of the software and failure to comply with the procedures and/or operating instructions provided herein.
Further, BCE Emergis Inc., eHealth Solutions Group reserves the right to make changes to the software and any or parts of this publication at any time, without obligation to notify any person or entity of such changes.
Revisions The Information contained in this publication is subject to change without notice and does not represent a commitment on the part of BCE Emergis Inc., eHealth Solutions Group. Changes to this publication will be made, as required, to ensure the data contained reflects the latest configuration of the software, procedures and/or operating instructions. These changes may be the result of design improvements and/or customer requests.
Every effort will be made to inform users of these changes as soon as possible, provided the changes affect the performance and operation of the software.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Preface Page: iii LMR Bill Submission Interface Rev. Date: July 29, 2002 Preface Welcome to the Provider Bill Submission System Welcome to the BCE Emergis (Emergis) Provider Bill Submission web site that allows LMR
providers to submit their Workplace Safety and Insurance Board (WSIB) bill securely online.
The Emergis Provider Bill Submission site allows you to submit all of your WSIB claims electronically. To do this you will need to register with Emergis and provide us with your banking information. You will receive a registration kit that includes your user id and password.
Please note, electronic submission will only be paid electronically into your bank account. No cheques will be issued for electronic submission.
For access to the Provider Bill Submission site and to receive a registration package, please contact the Emergis Provider Services department at:
Phone: (866) 240-7492 Email: provider. registry@emergis.com About this Guide Information provided in this manual will guide you through starting and using the system. Using your PC, the Internet and a click of the mouse, you can perform tasks such as submitting, viewing and deleting bills. Illustrations of the menus and dialog boxes are provided to facilitate your tasks.
This guide is organized into 6 chapters as follows.
Chapter 1 System Overview Chapter 2 Getting Started Chapter 3 Submitting LMR Bills Chapter 4 Voiding LMR Bills Chapter 5 Inquiring on LMR BiIIs/Payment Chapter 6 Glossary of Terms Working with the System To get you started with the system, this guide provides step-by-step instructions with menus and description of commands appearing in the drop-down menus. Once you become familiar with the system, you may only need to refer to this guide for more help or specific details about a task you may not have performed for some time. Your routine tasks such as starting the application and performing basic functions are described in the Getting Started chapter.
Intended Audiences for this User Guide LMR providers and their staff are the primary audience of this user guide.
This guide assumes that you have a basic familiarity with Windows operation and terminology.
The most commonly used features of Windows that you will be using are described in the Getting Started chapter of this guide. If you need more details on working with Windows, refer to your Microsoft Windows documentation.
Using this Guide Effectively Your user guide is an effective and helpful tool; it has answers to many of your questions and pertinent information that will help you get most out of the system. It has been written with you, the user in mind.

BCE Emergis Inc., eHealth Solutions Group Contents Page: iv LMR Bill Submission Interface Rev. Date: July 29, 2002 Contents 1 System Overview ...............................................................................
...........................1-1 1.1 The LMR Provider Bill Submission Process ........................1-1 ...........................................

2 Getting Started ...............................................................................
...............................2-1 2.1 Moving Around the Provider Bill Submission ........................2-1 System.............................

2.1.1About the Navigation Bars ...............................................................................
...............2-1 2.1.2Navigation Bar Commands ...............................................................................
.............2-1 2.1.3Working with the Mouse..........................................................................
........................2-2 2.1.4Entering and Deleting Data...........................................................................
..................2-2 2.1.5Minimizing, Resizing or Closing an Application........................2-3 Window ........................

2.1.6Using the Date Calendar Pop Up Window......................................................................2-2.1.7Printing a Screen.........................................................................
....................................2-3 2.2 Hardware and Software Requirements...................................................................
........2-4 2.3 Starting the Provider Bill Submission System.................................................................2-4 2.4 System Login ...............................................................................
...................................2-5 3 Submitting LMR
Bills..........................................................................
..........................3-1 3.1 Submitting a Bill ...............................................................................
...............................3-1 3.1.1Entering and Viewing Provider Information ........................3-2 ............................................

3.1.2Viewing Claim Information ...............................................................................
...............3-2 3.1.3Entering Bill Line Items ...............................................................................
....................3-2 3.1.4Using the Expense Code Search Functionality ........................3-3 ......................................

3.1.5Using the Secondary Service Provider Search ........................3-6 Functionality .................

3.1.6Confirming LMR Payment Requests.......................................................................
........3-9 3.1.7Printing Statement of Services.......................................................................
...............3-11 4 Voiding LMR
Bills..........................................................................
................................4-1 4.1 Voiding a Bill ...............................................................................
....................................4-1 Inquiring on LMR
BiIIsIPayments.................................................................
...............5-1 5.1 Retrieving Bills ...............................................................................
.................................5-1 5.2 Displaying and Printing Bill Details ...............................................................................
..5-3 5.2.1Displaying Bill Detail.........................................................................
...............................5-3 5.2.2Printing a Bill ...............................................................................
....................................5-5 5.2.3Viewing Service Details........................................................................
...........................5-5 5.2.4Viewing EOB/EOR Details ...............................................................................
...............5-6 5.3 Viewing and Printing LMR Payment Details ........................5-6 ...........................................

5.3.1Viewing LMR Payment Details........................................................................
................5-7 5.3.2Printing Payment Details........................................................................
.........................5-8 BCE Emergis Inc., eHealth Solutions Group Contents Page: v LMR Bill Submission Interface Rev. Date: July 29, 2002 6 Glossary of Terms..........................................................................
...............................6-1 Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Contents Page: vi LMR Bill Submission Interface Rev. Date: July 29, 2002 Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 1: System Overview Page: 1-1 LMR Bill Submission Interface Rev. Date: July 29, 2002 1 System Overview LMR providers currently submit paper invoices to payers for reconciliation and payment. These bills are in turn re-keyed into the payer's application for adjudication and payment. BCE Emergis has created a web-based bill submission interface that links directly to the payer's application to eliminate the need for managing and re-keying paper bill submissions. The elimination of the re-keying of paper bill submissions subsequently speeds up the time in which an LMR provider will receive an explanation of benefits and payment for their bill submission.
Who Should Read this Chapter?
Read this chapter to familiarize yourself with the Provider Bill Submission system and the functions you can perform using the system. This chapter should be read by those who intend to use the system.
1.1 The LMR Provider Bill Submission Process The Provider Bill Submission system allows LMR providers to complete three basic business processes. These processes include:
~ Submit electronic LMR bills to the system.
~ Void submitted LMR bills.
~ Inquire on LMR bills and payment.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 2: Getting Started Page: 2-1 LMR Bill Submission Interface Rev. Date: July 29, 2002 2 Getting Started Welcome to the Provider Bill Submission system. This web-based interface allows the user to quickly move from screen to screen with the click of a mouse, easily accessing the screens required to create, void and view bills.
In this chapter, you will learn how to quickly get started with the system.
The information provided includes instructions for logging on to the system, descriptions of the navigation bars, and how to use them. Information regarding the minimum hardware and software requirements are also presented.
Who Should Read this Chapter?
Read this chapter to familiarize yourself with the Provider Bill Submission System and the basic information for moving around the system. All users of the Provider Bill Submission System should read this chapter.
2.1 Moving Around the Provider Bill Submission System The information provided in this chapter will guide you through the basics of moving around in the Provider Bill Submission system. A brief description of Windows menus/screens with instructions for entering, changing or deleting data is included.
2.1.1 About the Navigation Bars The Provider Bill Submission system has two navigation bars that are visible on every page of the Provider Bill Submission application. A detailed description of each option follows.
Navigation Bar Navigation Bar 2.1.2 Navigation Bar Commands Before going any further, you should learn about the commands available on the navigation bar and the tasks you can perform using them.
Submit LMR Payment or Bill Submission Buttons These buttons take the user to the Submit LMR Payment Request screen. It is from this screen that bills are submitted to the system.
Void Payment Button In order to void a bill, the Void Payment button is selected. This button will take the user to the Void LMR Bills screw-.
Note: The Provider Bill Submission application will support same day voids only. LMR providers will need to contact WSIB directly to cancel previously submitted bills.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 2: Getting Started Page: 2-2 LMR Bill Submission Interface Rev. Date: July 29, 2002 BiII/Payment Status or BiIIIPayment Inquiry Buttons These buttons take the user to the LMR BiIIIPayment Search screen where they can submit inquiries on their bill submissions. This includes bill detail, bill history as well as the status of bill payment submissions.
Note: Real time confirmation of the submission and payment status information is not supported.
There will be a 24-hour delay before LMR providers can inquire on the submitted bill. Payment detail will be available as per the EFT schedule.
2.1.3 Working with the Mouse Moving the mouse moves the mouse pointer around the screen. Nothing else happens unless you press the mouse button.
You can do four things with the mouse button:
1. Click - Press down on the mouse button and quickly release it any where on the screen.
This moves the mouse cursor to a new position.
2. Double-click - Press down on the mouse button twice in a row. This is usually a quick way to perform two steps in one - select and execute a command.
3. Press - Hold t'~e mouse button down, keeping the mouse stationary. This performs the select function only if you click on an object.
4. Drag and Drop - Hold the mouse button down, move the mouse, and then release the mouse button. If you click on an object (select it) while holding the mouse button down, then move the mouse to another location on the screen and release it, the object will be dragged with the mouse to a new location on the screen.
2.1.4 Entering and Deleting Data The areas in a screen where data, or information is entered or specified are known as fields.
Fields exist in a number of different formats with various methods of entering data.
For example:
~ A field may be a text box that you type directly into.
~ A small box that is checked r when clicked.
~ An option button that is filled in black when selected.
OR
~ A box filled by choosing an option from a drop-down list produced by clicking a down arrow in a text box.
To Enter Data:
1. To enter data in a screen, click once in the appropriate box with your left mouse button.
2. Enter the data.
To Delete Data:
~ Highlight the data with the mouse (click and drag), and then press the DELETE key.
OR
~ Highlight the data and type over with the correct data.
OR
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 2: Getting Started Page: 2-3 LMR Bill Submission Interface Rev. Date: July 29, 2002 ~ Backspace to erase the entry one character at a time.
Note:Clicking the Cancel button will close the dialog box or screen without saving the data entered. This is followed by a confirmation dialog box asking you to confirm or cancel your action.
2.1.5 Minimizing, Resizing or Closing an Application Window Any window that can be closed has a control bar ~~ on the top right corner of the window with Minimize, Resize and Close buttons.
To Minimize, Resize or Close a window:
~ Click on J to minimize the window.
~ Click on .~ to resize the window.
~ Click on ~x to close the window. You may be prompted to save the work you have done.
If you are prompted to save your work, click the Yes button to save your work or No to exit without saving or Cancel to cancel your last action.
2.1.6 Using the Date Calendar Pop Up Window All the date fields ~n the system have a pop up window that allows the user to view a calendar to help with the selection of dates. This functionality can be accessed by clicking on the ~ icon beside the date box.
To select a date, do the following:
~ Click on the down arrow in the Month drop-down box. Use the scroll buttons and click on the correct month to select the month. Or, use the -wf ) and ~ ~~~ buttons to move back and forth one month at a time.
~ Click in the Year box and type the correct year. Or, use the Y~~ and ~~
buttons to move back and forth one year at a time.
If the current date should have been selected, click on the 'Tflday button to return to the current month and year.
~ Click on the specific day and the date will be entered in the date box on the previous screen.
2.1.7 Printing a Screen If you wish to print a screen in Windows, follow the steps given below:
To Print a Screen:
1. Using your keyboard, press Alt + Print Scrn keys. This copies the screen to the clipboard.
2. Go to Start, Programs, Accessories and select Paint from the pop-up menu.
The Paint Program opens.
3. Choose Paste from the Edit menu. The screen displays the captured screen.
4. From the File menu, choose Print.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 2: Getting Started Page: 2-4 LMR Bill Submission Interface Rev. Date: July 29, 2002 2.2 Hardware and Software Requirements The following hardware and software is required to run the Provider Bill Submission system Hardware ~ Desktop Computer with Pentium III processor ~ 128 Meg memory ~ Graphics adapter with 8 Meg memory Software ~ Windows NT4.0, Service Pack 6/Windows 95198/2000 operating system ~ Internet Explorer 4.0 or Netscape 4.08 - capable of 128 bit encryption ~ A valid user ID and password Internet Access ~ Dial up access or high speed for faster access 2.3 Starting the Provider Bill Submission System 1. From the desktoF~, open the Internet browser. (Internet Explorer, Netscape) 2. In the address box, type the URL https:l/provider.emergis.com and press Enter.
Tip: To save this address as a favourite instead of typing the address in the future, do the following:
1. Click on Favourites in the main menu.
2. Select Add To Favourites from the drop-down menu.
3. Click on OK to save the address.
The system displays the Login screen.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 2: Getting Started Page: 2-5 LMR Bill Submission Interface Rev. Date: July 29, 2002 Login Screen 2.4 System Login To login, do the following:
1. Enter your User ID in the User ID box. This field is not case sensitive.
2. Enter your password in the Password box. This field is case sensitive and the password must be a minimum of 6 alphanumeric characters.
3. Press the ENTER button to login.
Note: If you forget your login User ID or password, please contact the Emergis Provider Services department at (866) 240-7492.
After you press the ENTER button, the system displays the Submit LMR Payment Request screen. It is from this screen that you can start to enter bills. It is also possible to easily click and move to screens where bill and payment information can be displayed or bills can be voided.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 2: Getting Started Page: 2-6 LMR Bill Submission Interface Rev. Date: July 29, 2002 Proprietary and Confidential Submit LMR Paymert Raquest Screen BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-1 LMR Bill Submission Interface Rev Date: July 29, 2002 3 Submitting LMR Bills The Provider Bill Submission system allows LMR providers to determine the best time for them to submit their bills. Because the site is always available, LMR providers can fit their billing submissions to WSIB into their own schedules and processes.
Who Should Read this Chapter?
Read this chapter if you are involved in submitting and viewing bills.
3.1 Submitting a Bill To submit a bill, do the following:
1. Ensure that the Submit LMR Payment Request screen is currently displayed.
This is the default screen after logging in. If this screen is not displayed, click the SUBMIT LMR
PAYMENT or BILL SUBMISSION buttons in either of the navigation bars.
2. Type the claim number in the Claim Number box.
3. Type the birth date of the patient in the Date of Birth box in the format dd/mm/yyyy or select the date by clicking on the pop up calendar.
Note: The Date of Birth field is not mandatory.
4. Click on the Search button to ensure that the claim record exists for the data entered.
The system displays the LMR Bill Detail screen.
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_ i3 ~4 r Q ~- L s LMR Bill Detail Screen Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-2 LMR Bill Submission Interface Rev Date: July 29, 2002 This screen has four sections as follows:
Provider Information ~ Claim Information Bill Line Items ~ Command Buttons (Submit or Exit).
3.1.1 Entering and Viewing Provider Information This section of the screen is used to display the billing LMR provider's provider id and allow for entry of the LMR provider's own Invoice Reference number. The Provider Number is a read-only field and cannot be modified. The Invoice Reference number is a field where LMR providers can enter their own number to help track the submitted charges in their own accounting system when the EOB is received.
To add an Invoice Reference number, do the following:
1. Type the referance rmmber in the Invoice Reference # box. The number can be alphanumeric and up to 15 characters in length.
3.1.2 Viewing Claim Information This section displays information about the claim that was selected. This information is read-only and cannot be modified.
Field Name Description Claim Number The claim number that the LMR provider is submitting a bill against.
Patient Surname The Surname of the Patient/Worker associated to the Claim and bill.
Patient Given The Given Name of the PatientlWorker associated to the Claim number and Name bill.
Date of Birth The Date of Birth for the Patient/Worker associated to the Claim number.
This field is displayed in MMM-DD-YYYY format.
Date of Accident The Date of Accident for the PatientlWorker associated to the Claim number. This field is displayed in MMM-DD-YYYY format.
3.1.3 Entering Bill Line Items This section is where the LMR provider enters the details of the bill submission. The LMR
provider is required to enter the mandatory fields for at least one line item in order to continue with the bill submission process.
Note: Up to 31 line items can be submitted in one bill. If there are more than 31 line items, a separate bill must be submitted.
To add bill items, information should be entered in the following fields:
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-3 LMR Bill Submission Interface Rev Date: July 29, 2002 Field Name Description Required?

Expense Code used to describe the expenses Yes Code being submitted.

The user can type in the code or use the expense code search functionality to populate the field. NOT case sensitive.

PSP Primary Service Provider. Populates No the secondary service provider with the ID of the billing provider.

Secondary The provider code of the secondary Yes provider. Will Provider default to the primary provider if the PSP box is checked.

Date of The user may type in the date or use Yes Service the calendar pop up functionality to select the date.

Charges This field records the dollar amount Yes to be submitted. If a whole number is entered, the system will automatically insert 2 decimal points.
The field is displayed as dollar value once the user moves off the field and clicks anywhere else on the screen. The value may be up to 8 characters.

Total ChargesThis field automatically sums the NIA
total of all charges entered for each of the line items.
This field cannot be edited.

3.1.4 Using the Expense Code Search Functionality If the user is uncertain of the correct code, the search functionality can be used to view a list of valid codes that can be selected and submitted.
To use the Expense Code Search functionality, complete the following:
1. Beside the Expense Code field, click the 0. icon.
The Service Code Search screen will open.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-4 LMR Bill Submission Interface Rev Date: July 29, 2002 The user has two methods of searching for the correct code - typing the exact expense code in the Service Code box or typing a partial description in the Treatment (keyword) box. The best results are attained when the user enters only one keyword.
2. Type text in the keyword box or type a code in the Service Code box. E.g.
"100" in the Service Code box or "tuition" in the keyword box 3. Click the Search button.
The system will search for one or many matches and display the results to the user. The displayed results will include the code and the corresponding description. The results are ordered by Code in ascending alphabetical order. For example, if 100 is typed in the Service Code box, one result will be displayed. (100 "LMR - University - Tuition and related") If tuition is typed in the keyword box, two services will be displayed. (100 "LMR - University - Tuition and related" and 110 "LMR - College - Tuition and related").
Proprietary and Confidential Expense Code Search Screen BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-5 LMR Bill Submission Interface Rev Date: July 29, 2002 4. Select the correct code by clicking on the code hypertext link.
The selected code will populate the code field on the LMR Bill Details screen.
If no search criteria were entered, the following message will be displayed:
You must enter one of the foUo~vin~, If no match was found for the search, the following message will be displayed:
Proprietary and Confidential Expense Code Search Results Screen Display when no service code or keyword is entered Click OK and type a service code or keyword.

BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-6 LMR Bill Submission Interface Rev Date: July 29, 2002 If the correct results were not returned or no results were found, click the RESET button and enter information for a new search.
3.1.5 Using the Secondary Service Provider Search Functionality If the user is uncertain of the Secondary Service Provider's ID, the search functionality can be used to view a list of providers that can be selected and submitted.
To use the Secondary Service Provider Search functionality, complete the following:
1. Beside the Secondary Service Provider field, click the a icon.
The Secondary Provider Search screen will open.
Proprietary and Confidential Display when no search results were found BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-7 LMR Bill Submission Interface Rev Date: July 29, 2002 ;.-, ~;. ~ x ,~ . ~~ ~ ~~..
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Secondary Service Provider Search Screen The user has two methods of searching for the correct provider - typing the exact provider ID in the Provider ID box or typing a partial description in the Provider Name (keyword) box. The best results are attained when the user enters only one keyword.
2. Type text in the keyword box or type an ID in the Provider Name box. E.g.
"123456789" in the Provider ID box or "Smith" in the keyword box 3. Click the Search button.
The system will search for one or many matches and display the results to the user. The displayed results will include the Provider ID, Name and Address of the Secondary Service Provider. The results are ordered by ID in ascending order. For example, if 123456789 is typed in the Provider ID box, one result will be displayed. (123456789, Dr. John Smith, 123 King St, Toronto, Ontario") If Smith is typed in the keyword box, many providers could be displayed.
(123456789 Dr. John Smith 123 King St, Toronto, Ontario, and 999999999, Dr.
William Smith 444 Main St., Toronto, Ontario).
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-8 LMR Bill Submission Interface Rev Date: July 29, 2002 Secondary Provider Search' ~> d ~ ~' ~~x Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-9 LMR Bill Submission Interface Rev Date: July 29, 2002 If no match was found for the search, the following message will be displayed:
If the correct results were not returned or no results were found, click the RESET button and enter information for a new search.
3.1.6 Confirming LMR Payment Requests Once the information for the invoice reference number and the line items has been completed, the user can review and confirm the information before submitting the bill.
If the user wants to cancel the information that was entered and return to the Submit LMR
Payment Request screen, do the following:
1. Click the EXIT button.
The user will be returned to the Submit LMR Payment Request screen where they can add a new bill or complete an entirely new task by clicking on the Navigation buttons.
Proprietary and Confidential Display when no search results were found BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-10 LMR Bill Submission Interface Rev Date: July 29, 2002 However, if the user wants to continue with the bill and confirm the details of the bill submission, do the following:
2. Click the SUBMIT button.
The LMR Payment Request Confirmation screen will be displayed.
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~.,_,.3,~'.,a.~"..,..,s..,....".,.:.~, .ax a~.~,~. ~,ay'..~..".,a.~'' ' LMR Payment Request Confirmation Screen The details will include the provider invoice reference number (optional) and all line item (Expense code, Secondary Provider, DOS, and charges) information.
Note: Clicking on the EXIT button will cancel the entire bill and the user will be prompted that they will lose information. Clicking on OK in this screen will cancel the bill and return the user to the Initiate LMR Bill screen.
( ? You may lose some information o~ the current page Contnue?' OK N CarKel ; ..' . - -Display message when EXIT button is selected If the user wants to edit this information, do the following - otherwise, go to step 4:
3. Click the EDIT button and the system will return to the LMR Bill Detail screen where the information can be modified and the bill can be resubmitted.
4. Click the SUBMIT button.
The following message will be displayed.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-11 LMR Bill Submission Interface Rev Date: July 29, 2002 Display when SUBMIT button clicked 5. Click Cancel if the bill should not be submitted to WSIB. The screen will return to the LMR
Payment Request Confirmation screen. If the bill should be submitted, click OK.
The user will be taken to the Statements of Service screen when the bill has been submitted.
3.1.7 Printing Statement of Services Once the bill has been submitted, the LMR provider can take the opportunity to print the information that they have submitted for this bill. The details include provider invoice reference number (optional) as well as the provider information, claim information, all line item (Expense Code, Secondary Provider, Date of Service and charges) information and the total charges.
There is also a line: for patient signature if necessary. LMR providers may wish to keep a copy of this printed page for their office files.
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To print the Statement of Services, do the following:
Click on the PRINT button.
The user will be prompted to select the appropriate printer from a screen similar to the following:
Proprietary and Confidential Statement of Services screen BCE Emergis Inc., eHealth Solutions Group Chapter 3: Submitting Healthcare Bills Page: 3-12 LMR Bill Submission Interface Rev Date: July 29, 2002 ~.
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Print screen 2. Select the printer, and click the Print button.
3. Click the CLOSE button to close the Statement of Services screen and return to the Initiate Bill Submission screen.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 4: Voiding Healthcare Bills Page: 4-1 Interface ~ ~ Rev Date: July 29, 2002 4 Voiding LMR Bills Voiding a bill allows the user to cancel a bill that was transmitted to WSIB
in the bill submission process. It is important to note that bills can only be voided on the same day they are created. If the bill has not been created on the same day, WSIB must be contacted to cancel the bill.
For time saving purposes, it is also possible to cancel more than one bill at the same time.
Who Should Read this Chapter?
Read this chapter if you will be voiding LMR bills.
4.1 Voiding a Bill To void a bill, do the following:
1. From any screen, click the VOID PAYMENT button in the Navigation Bar.
The Void Bills screen will appear and all same day bills will be displayed on the screen.
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a .a.. . .:: .. ". T , . '. , _ _a Void Bills Screen For each bill, the Claim #, Patient Name, Submitted Date and Sub Charges fields will be displayed. These fields are read-only and cannot be modified.
2. Select the bills to be voided by clicking on the Void check box beside the appropriate bill(s).
To unselect a bill that was selected in error, click the box again.
3. Click the VOID SELECTED button.
A window will pop up to confirm that the bills should be voided.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 4: Voiding Healthcare Bills Page: 4-2 mission Interface ~ ~ Rev Date: July 29, 2002 Confirm voiding of bills screen To cancel the voiding of the bills, do the following - otherwise, proceed to step 5:
4. Click the Cancel button. The user will be returned to the Void Bills screen.
5. To confirm the voiding of the bills, click the OK button.
A message will be displayed once the system has successfully voided the bills(s).
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Display when bill is voided.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare BiIIs/Payments Page: 5-1 -.I~AA~-B~3r~+ssian Interface ~ ~ Rev Date: July 29, 2002 Inpuiring on LMR BiIIsIPayments An LMR provider may want to inquire on the status of a bill that they have submitted to the WSIB.
Each LMR provider will only have access to view the bills that they have submitted. Bills submitted to WSIB are processed in an overnight batch run and are available for viewing the day following submission.
Who Should Read this Chapter?
Read this chapter if you will be inquiring on LMR bills and payments.
5.1 Retrieving Bills To retrieve bills and view their information, do the following:
1. From any screen, click either the BILUPAYMENT STATUS or BILUPAYMENT INQUIRY
buttons from the Navigation bars.
The Retrieve Bills screen will appear.
Retrieve Bills Screen 2. Type the Claim number in the Claim Number box. This is a required field and the number must be typed exactly.
In order to narrow the search of the bills for a claim, the Start and End date fields can be used, but these fields are optional.
3. In the Start date field, type the beginning date of the range desired or use the calendar pop up window to select the date.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare BiIIs/Payments Page: 5-2 L~aa Rill bmiSsion Interface ~~ Rev Date: July 29, 2002 4. In the End date field, type the ending date of the range desired or use the calendar pop up window to select the date.
5. Click the Search button to look for all bills for the selected claim in the date range (if applicable).
If there are bills for that claim in the date range (if selected) the LMR
BiII/Payment Search Results screen will be displayed.
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LMR BilllPayment Search Results Screen If the Search button was clicked and no claim number had been entered, the following screen will appear:
ii, , , You must enter the Following: Claim Number.
Display when no claim number entered To try again, do the following 1. Click OK and repeat steps 2 to 5 in the above section.
If there were no bills that match the criteria, the following screen will appear:
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare BiIIs/Payments Page: 5-3 LMR Bill a nterface ~~ Rev Date: July 29, 2002 No record4s were found.
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Display when no bills match criteria If there was only one date entered, the following screen will appear:
To try again, do the following:
1. Click OK and repeat steps 3 to 5 in the above section being sure to enter the missing date.
If the date was not entered correctly, the following screen will appear:
To try again, do the following:
1. Click OK and repeat steps 3 to 5 in the above section being sure to correctly enter the dates.
5.2 Displaying and Printing Bill Details Once the LMR BiII/Payment Search results screen has been displayed, each bill can be displayed in detail. The LMR provider also has the option to print the window if they would like a hard copy for their files.
5.2.1 Displaying Bill Detail To view a bill, do the following:
1. Click on the Bill ID field of the bill to be displayed.
The Bill Detail screen will be displayed.
Proprietary and Confidential Display when missing on date field Display when date entered incorrectly BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare BiIIs/Payments Page: 5-4 ss n-Interface ~ ~ Rev Date: July 29, 2002 Claim Number The 8 character claim number the user is enquiring about.
Bill Number The Bill ID generated by the WSIB adjudication system.

Invoice Ref The Invoice Reference # entered by the LMR provider at the time of the bill submission. This field may not always be displayed as it is not mandatory.

Document The date that the bill was submitted by the Date LMR provider through the Provider Billing Submission system.

Individual The name of the individual provider.

Provider Group ProviderThe name of the group provider.

Total ChargesThe total dollar amount that was submitted by the provider for that bill.

Total AllowancesThe amount that is eligible for payment as per the WSIB guidelines.

Worker Name The name of the worker who is associated with the claim and the bill.

Proprietary and Confidential Detail Screen The following fields will be displayed on the screen:
Field Name Description BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare BiIIs/Payments Page: 5-5 ill a Interface ~ 6 Rev Date: July 29, 2002 Field Name Description Date of Accident Date of the worker's accident which is associated with the claim and the bill.
Line No The numeric counter value for the bill line item.
Date of Service The date of service for the bill line item.
(DOS) Service Code The service code for the line item. Clicking on the service code will display a pop up window showing the description associated with that service code.
Sub Charges The submitted charge for the bill line item.
Allowance The amount eligible for payment as per the WSIB guidelines for the bill line Amount item.
FOR The numeric code value for an explanation of review (also known as an explanation of benefits). Clicking on the FOR code will display a pop up window that displays the description associated with that FOR code. This field will not be displayed if the line item has not been paid.
5.2.2 Printing a dill Once the bill has been displayed, it can be printed.
To print a bill, do the following:
1. Click on the PRINT button.
The user will be prompted to select the appropriate printer from a screen similar to the following:
Print screen 2. Select the printer, and click the Print button.
3. Click the CLOSE button to close the Bill Detail screen and return to the LMR Bill Payment Search Results screen.
5.2.3 Viewing Service Details To view the Service Code Description, do the following:
1. From the Bill Detail screen, click on the desired service code and the Service Code Description screen will appear.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare BiIIs/Payments Page: 5-6 l~laR-B+I~~hmiscic~In~erface ~~ Rev Date: July 29, 2002 Service Code Description Screen 2. Click the CLOSE button to close the screen and return to the Bill Detail screen.
5.2.4 Viewing EOBIEOR Details To view the Explanation of Benefits or Explanation of Review description, do the following:
1. From the Bill Detail screen, click on the desired EOB/EOR code and the Explanation of Benefits Description screen will appear.
5.3 Viewing and Printing LMR Payment Details From the Provider BiIIIPayment Search Results screen, it is possible to view the EFT payment information. This information is available to the LMR provider the day following bill submission.
The Payment Details screen will indicate which bills were paid, the amount of the payment and Proprietary and Confidential Explanation of Benefits Description Screen 2. Click the CLOSE button to close the screen and return to the Bill Detail screen.

BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare Bills/Payments Page: 5-7 ~a~+ssi'vn Interface Rev Date: July 29, 2002 the EOB information. The LMR provider also has the option to print the window if they would like a hard copy for their files.
5.3.1 Viewing LMR Payment Details To view payment details for a bill, there must be an entry in the Cheque/EFT
field for this bill on the Provider BiII/Payment Search Results screen. If there is an entry, do the following:
1. Click the number in the Cheque/EFT # field for the correct bill.
The Payment Details screen will open for this bill.
Field Name Description Payee The name of the provider or organization to which the deposit was made.
Payment Amount The total dollar amount for that EFT deposit.
Cheque/EFT The date that the EFT was deposited.
Date Cheque/EFT The EFT transaction number.
Number Bill ID The Bill ID generated by the WSIB adjudication system.
Document Date The date that the bill was submitted by the LMR provider through the Proprietary and Confidential Payment Details Screen The following fields will be displayed on the screen:

BCE Emergis Inc., eHealth Solutions Group Chapter 5: Inquiring on Healthcare BiIIs/Payments Page: 5-8 fission Interface ~ ~ Rev Date: July 29, 2002 Field Name Description provider web application to WSIB
Sub Amount The total dollar amount that was submitted by the LMR provider for that bill.
Allowed Amount The amount that is eligible for payment as per WSIB guidelines for that bill.
5.3.2 Printing Payment Details Once the payment details have been displayed, they can be printed.
To print the payment details, do the following:
1. Click on the PRINT button.
The user will be prompted to select the appropriate printer from a screen similar to the following:
Print screen 2. Select the printer, and click the Print button.
3. Click the CLOSE button to close the Payment Detail screen and return to the LMR Bill Payment Search Results screen.
Proprietary and Confidential BCE Emergis Inc., eHealth Solutions Group Chapter 6: Glossary of Terms Page: 6-1 LMR Bill Submission Interface Rev Date: July 29, 2002 6 Glossary of Terms This section includes a description/definition of term used in this application.
Term DescriptionlDefinition BILL NUMBER The ID number generated for the bill by the WSIB
adjudication engine.

CHARGES Dollar amount submitted by the LMR provider for the services.

CLAIM NUMBER A unique number assigned to the claim. This number is 8 digits in length.

DATE OF Date the accident occurred for the patient/worker.
ACCIDENT

DATE OF BIRTH Date of birth of the patient/worker.

DOCUMENT DATE The date the bill was submitted to the WSIB by the LMR provider.

END DATE I The maximum date criteria (based on Bill date) used to define a period to extract a set of transactions.

EFT Electronic Funds Transfer. The method of payment to the LMR providers using this system.

EOB Explanation Of Benefits FOR Explanation Of Review EXPENSE CODE A unique identifier for a service or product.

GIVEN NAME Patient/Worker given name or~~st name.

INVOICE i Number assigned by the LMR provider for a bill that REFERENCE is submitted to WSIB. Used NUMBER for tracking purposes.

NAME LMR provider name.

POS Place of service.

PPS Primary Service Provider PROVIDER The individual or group providing the service or product.

PROVIDER A unique number assigned to each LMR provider.
NUMBER

SSP Secondary Service Provider START DATE The minimum date criteria (based on Bill date) used to define a period to extract a set of transactions.

STATEMENT OF Describes the details of the bill that has been SERVICES submitted to the WSIB. Includes provider, claim and billing line item information.

SURNAME Patient/Worker surname or last name.

UNIT Quantity of services or product.

USER ID The ID used by the provider to login to the system.

Proprietary and Confidential

Claims