Record categories for data entry:

• Provider invoice
• Insurance Claim
• Payment
• Journal
• Patient
• Provider
• Insurance

When and how to enter data

There is no one way for entering data to MySMC, but we recommend entering a provider invoice, only after you get a document from your provider with the service invoice. This is because the provider invoice record in MySMC should reflect the provider's view of what it charged, how much you paid and what your outstanding balance is. A provider invoice record in MySMC should not be what you think these amounts are.

Similarly, enter an insurance claim after you get an explanation of benefit document from your insurance company. Again, the insurance claim record in MySMC should reflect the insurer's view of what the various amounts like billed, allowed, patient responsibility, etc. are. The insurance claim record in MySMC should not be what you think these amounts are.

Similarly, enter a payment record after you make a payment or receive a reimbursement. A payment record in MySMC should reflect your view of hot much you paid or were reimbursed for. It should not be what, for example, the provider thinks you paid. Make sure you enter a payment record each time you pay for a healthcare expense.

We suggest tagging the payment entries to mark their status for tax and pre-tax saving accounts. Examples:

• If the payment is not tax deductible, tag it “not-tax-deductible”. If you tag each payment that is not tax-deductible, there is no need to tag payments that are tax-deductible.
• Let say you have a Health Saving Account (HSA) from a bank called Citi and a payment is eligible to submit to Citi's HSA in year 2007. Mark the payment with a tag like “Citi HSA eligible 2007”. If you end up submitting this payment to this HSA, you can change its tag to “Citi HSA submitted for 2007”. You can later use advanced search to find and calculate the payments that qualify for tax deductions, etc.

Providers and insurers might send documents invoice or explanation of benefit multiple times for the same service. If this is the case, maintain only ONE invoice record in MySMC and only ONE claim record in MySMC, but update the amounts and status of these records, when they change. (Note that you can use SmartMedicalConsumer's MyDocs service to store the documents you receive to have a copy handy).

When you want to enter a claim record, it is easier first to find the corresponding invoice record in MySMC (if there is one) and enter the claim record using the post a corresponding claim link.

Sometimes providers do not send an invoice. If this is the case, just enter the claim record when you get the explanation of benefits for those services.

You do not need to enter provider, patient and insurance records separately. They are created, when you enter invoices and claims.

Use journal record to keep a medical journal, your symptoms, side effects, interesting things you learned from your doctor, etc.

Entering a Provider Invoice record

A provider may send you more than one document containing the same invoice, for example until the invoice is fully paid. Maintain only ONE provider invoice record in MySMC, even if you receive multiple copies from the provider. Each time you receive a copy, update the provider invoice record, if any amount is changed. In addition, you can upload each document you receive from the provider in MyDocs to keep track of documents you receive.

The following are the fields of he provider invoice record. Try to enter values as close as what you see in the invoice you get from your provider.

• Service date:
  If an invoice contains more than one service with different dates, you may type the last service date. Another option is the billing period ending date that the provider uses to group these services: a good example is the outpatient bills from hospitals, where the services are itemized with individual service dates, but the total amounts are reported under a billing ending period date.
• Patient
• Provider
• Invoice #
• Diagnosis:
  Try to use the diagnosis/medical necessity codes or formal terminology used by your provider. When possible, learn the diagnosis code from your provider.
• Services:
  If the provider invoice document you get has more than one services listed within an invoice, you have the choice of:
  • itemizing the services as you see on the document you get from the provider, or
  • enter the total with a service name you choose, e.g., “total”, “outpatient services”, “doctor visit”, “inpatient services”

  If you enter itemized services as is, SmartMedicalConsumer can offer you a better error detection coverage and analysis.

  Itemized case: Try to use the service codes and formal terminology used by your provider.

• Charge:
  If the provider broke down the amount the provider charges into itemized services, enter the amount provider charges towards that service.
  If the provider did not break down provider charges into the itemized services, start a separate service line with name “TOTAL”, and enter provider charge to the CHARGE field of this service line.
• Patient payment:
  If the provider broke down your payment into itemized services, enter the amount provider claims you paid towards that service.
  If the provider did not break down your payment into the itemized services, start a separate service line with name “TOTAL”, and enter the payment provider claims you made to the patient payment field of this service line.
• Patient balance:
  If the provider broke down patient balance into itemized services, enter the amount provider claims you owe towards that service.
  If the provider did not break down patient balance into the itemized services, start a separate service line with name “TOTAL”, and enter the amount provider claims you made to the patient payment field of this service line.
• Tags:
  tag a provider invoice record to classify it in ways it will be later on useful to you. Examples:
  • For drugs: “Rx”, “Prescription drug”
  • If you see a doctor in a given facility called MSKCC, tag the record with MSKCC.
  • For mistakes: “call provider”, “check”
• Notes

Entering an Insurance Claim/Explanation of Benefits record:

The following are the fields of the insurance claims record. Try to enter values as close as what you see in the explanation of benefits (EOB) you get from your insurance plan. If you received redundant EOBs for the same service, there is no reason to maintain redundant insurance claims in MySMC. You can store the redundant EOB documents you receive in MyDocs service of SmartMedicalConsumer.

• Service date:
  If the EOB contains more than one service with different dates, you may type the last service date.
• Patient
• Provider
• Insurer
• Claim #
• Services:
  If the EOB document you get has more than one services listed, you have the choice of:
  
  • itemizing the services as you see on the document you get from the insurance plan, or
  • entering the total with a service name you choose, e.g., "total", "outpatient services", "doctor visit", "inpatient services"
• Billed
• Allowed:
  Amount allowed by the insurance plan.
• Remark: If there is a remark code, enter the remark code; then enter the remark for that remark code into Notes section of the claim record.
• Deductible
• Copay
• Percent:
  Percent of the allowed amount that is paid by the insurance plan.
• Plan Payment
• Patient responsibility
• Tags:
  tag an insurance claim record to classify it in ways it will be later on useful to you. Example:
  
  • If you believe the insurance plan did cover the services appropriately: "call insurance", "mistake"
• Notes

Entering a Payment Record:

Each time you make a payment, or reimbursed enter a payment record to MySMC.

• Date
• Amount:
  for reimbursements you received, enter a negative amount. For example, if your provider, or insurance, or pre-tax saving account reimbursed you $1,000, enter “–1000”.
• Patient
• Payee:
  for reimbursements you received, enter the name of the provider, insurance, etc., who reimbursed you.
• Tags:
  tag a payment record to classify it in ways it will be later on useful to you. Examples:
  • “HSA 2007 eligible”
  • “Not tax deductible”
• Notes

Linking/grouping a claim record with the corresponding invoice record

If you entered a claim record through the post a corresponding claim link within an invoice record, or similarly, if you entered an invoice record, through the post a corresponding invoice link within a claim record, MySMC links/groups this invoice and claim together.

If you entered a claim record independent of its corresponding invoice record, you can always connect them later on: In the edit page of the claim record, click the Add Invoice Links link and select the corresponding invoice.

An invoice can be linked to one or more claims. This is important to take care of situations like:

• if insurance divided the services on one provider invoice into multiple explanation of benefits, or
• if you have more than one insurance that covers a certain healthcare service.

Be careful deleting of a claim which is linked/grouped with more than one invoice! Let's say claim A is grouped both with invoice B and invoice C. If you all want to do is, to ungroup/unlink claim A from invoice C, do NOT delete claim A, just delete the link to C in record A.

We purposely designed MySMC such that an invoice can be kept independent of a claim, or a claim can be kept independent of an invoice, so that if you wish to choose to enter either an invoice or the claim for given service, you can do so. This also simplifies automatic data entry we offer to some users and enables a clutter-free user interface.

Tags

A tag is any word or short phrase that can be used to freely characterize a provider invoice, insurer claim, patient payment or journal record. Each data record can have as many tags as you'd like. On the edit screen, separate the tags with commas. Leading and trailing spaces are ignored and, when searching records by tags, so is case.

Record categories for search

Besides the categories listed under record categories for data entry, the following categories exist to ease the search and calculations:

• Services:
  If this category is selected, both provider invoices and insurance claims are displayed. Each invoice is displayed grouped with the claims linked to this invoice. For example, let's assume claim B is linked to invoice A. If services category is selected, invoice A and claim B will be displayed in a way that visually indicates A and B are linked.
• All:
  This category contains categories: invoice, claim, payment, journal, patient, provider, insurer.

Simple Search and Display

Select the record category or categories in which you want to perform a search. Type the search phrase in the search box.

• If you don't type a search phrase, all the records with the selected category will be displayed
• To search within records with a given date: type “yyyy-mm-dd” (e.g. 2006-02-14) into the search box.
• To search for records within a given year: type “yyyy” (e.g., 2006) into the search box.

Click the Search button.

Advanced Search

In addition to simple searches and displays of category records, an Advanced Search is available that allows a a search of records by individual field values, or by combinations of those values. The result of an advanced search is a listing of records just the same as that of a simple search.

To begin an advanced search, click the link: Advanced Search that's positioned just below the Search button for simple searches. Another way to do an advanced search is to select one or more records from the current listing and clicking the Search Selected action button. This will lead to an advanced search of only the records selected from the previous search operation.

An advanced search begins with an intermediate screen allowing you to select one or more “filter clauses” based on category record field values:

• Patient
• Service Date
• Provider
• Insurer
• Notes
• Tags

An advanced search clause is said to be “activated” when the And checkbox that begins the clause is checked. Usually, this happens automatically when you enter a value into the corresponding field. A record must satisfy all activated clauses in order to be selected for the result. Unactivated search clauses are ignored.

The input clauses for Patient, Provider, Insurer and Tags, allow the entry of one or more values separated by commas. Each list of values may be either “included” or “excluded” from the search by choosing one of those options from the clause's drop-menu. Included means that a record will match that search clause if its value for the field is any one of the values entered. Exclude means that a record will match only if its value is not among the list entered.

Note: If the name of a provider or insurer that you wish to include or exclue from a search contains a comma, enclose that name in double quotes to prevent confusion. This is done automatically if the value is picked from the drop menu (patient names and tags are not allowed to contain commas.)

There are two fields for entering dates which makes it easier to specify a search of records that fall within a time range. Dates may be entered using any of the following formats:

• mm/dd/yyyy     (e.g. 2/14/2008)
• dd.mm.yyyy     (e.g. 14.2.2008)
• yyyy-mm-dd     (e.g. 2008-02-14)

A search on the Notes field will match a record if any note attached to that record contains the string value entered in the notes search clause. An alternate option allows you to find all notes that omit a given string. Searches on notes are case-insensitive.

Frequently done searches

There are a number of searches that are done frequently enough that it makes sense to pre-package them for ease of use. These searches appear in a drop-menu just under the input field for simple searches and display.

The following Frequently Dones Searches are available:

• Invoices with an outstanding balance
• Claims with positive patient responsibility
• Claims where allowed amount is less than billed
• Claims where there is an out-of-pocket amount
• Claims where provider accepts less than charged
• Claims with positive copay
• Claims with positive deductible
• Estimated in-network claims
• Estimated out-of-network claims
• Search services for unique dates

Choosing one of the above from the drop-menu will take you to an intermediate screen in which you can specify additional search clauses as you whould in an advanced search.

Summary vs Detail listing

The results of any search are displayed as a listing of records in date descending order. This listing can be viewed in either of two ways: summary or detailed. The summary view is more compact, showing the key fields of the record and the total amounts of the important fileds. A detailed view shows all the information available for that record and, in the case of provider invoices and insurance claims, all of the service items and their respective amounts.

The default for most searches is a summary listing (a few of the Frequently Done Searches default to the detailed view in order for the results to be verified.) To change the listing option, check or uncheck the box labeled: Show summaries only at the top of the result listing, just to the right of the action buttons. The option checkbox also appears above the search clauses on the advanced search screen.

To move back and forth between display modes, use the Select All and Display Select action buttons after checking or unchecking the option box. In summary display mode, you can view the detail of any single record by clicking on the View button under the totals for that record in the list.