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ARCHER INSURANCE MANAGEMENT SYSTEM

ARCHER INSURANCE MANAGEMENT SYSTEM. Phase I Training. Immediate Benefits of Archer Claims Phase I. Replaces the need for spread sheets (Mail Logs, Employee Production tracking, etc.)

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ARCHER INSURANCE MANAGEMENT SYSTEM

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  1. ARCHER INSURANCE MANAGEMENT SYSTEM Phase I Training

  2. Immediate Benefits of Archer Claims Phase I • Replaces the need for spread sheets (Mail Logs, Employee Production tracking, etc.) • Allows for full and complete inventory of claims and non-claims documents which substantially increases quality and control. • Provides for more efficient management of workflow. Easier to view, manage and report. • No longer required to manually attach images. Now an automated process. • Streamlines the claim import process. • Full data reporting capabilities. Filters, reports, exports, etc.

  3. Archer PhasesArcher Training Video’s (Phase I)

  4. Archer Overview

  5. Document Sources A document is a claim or a non-claim or combination of both. (Claims, Medical Reports, Forms, etc.) We have 4 different document sources as listed below. • Batch – This is used for large volumes of claims that should be assigned as a batch. Batches can be managed as a batch (Deleted, Assigned, etc.). • Scan - Paper Claims that are scanned to your pre-designated server location. • e-Mail – Claims received via e-mail and then placed into eclaims@gbg.com. • Web – Online claim submission at www.gbg.com (The easiest and most secure way to submit claims).

  6. Document Repository • It is a collection of all documents from different sources like Batch, Scan and e-Mail sources. An image repository and complete inventory of all received items. • There are multiple status’s of documents in the document repository: • Unprocessed • Incomplete • Processed • Voided • Voided Partially

  7. Claim A Claim is a document which is submitted by member or provider for reimbursement or adjustment to a previous payment. In Archer, There are 6 form types classified as follows:  HCFA  UB  Members  Providers (Directs)  Dental  Others Each Archer Claim has a status. The status’s are as follows: • New • Registered • In Process • Pended • Processed

  8. Claims Repository Documents (or Document Pages) that are linked as claims are stored in the Claims Repository. From the Claims Repository, Managers/Team Leads can allocate/assign claims to users (Examiners) based on company/group/aging/dollar-amountor any other assignment needed as the manager deems appropriate. By using filters we can generate daily production reports, individual production reports, aging reports. All information in Archer can be sorted and exported as needed.

  9. Non-Claim A Non Claim document which is related to a claim(s) or any member/provider or related to a group. Non Claim Categories are as follows:  Appeals  Pre- Authorization  Contract Agreement / Price List  Itemized Bill  MHS  EOB  Residence Verification Form  Questionnaire  Medical Records  Collection Letter  W9 Form  Banking Information  Other

  10. Non Claims Repository Documents (or Document Pages) that are linked as non claims are stored in Non-Claims Repository. From Non- Claims Repository, Managers/TL’s can allocate non-claims to users (Examiners) based on the category of non-claim. By using filters we can generate daily production reports, individual production reports, pending reports,.. We can track pending non-claims and take action based upon follow-up dates. Non Claim Status’s are as follows, • New • Pended • Processed

  11. Training Support/Technical Support • For support on Archer Claims please contact claims@gbg.com • Please provide screenshots for any issues you are experiencing. (This is done by selecting the PrtScn button on your keyboard and pasting the screen print into your e-mail. • We look forward to your feedback, comments and suggestions.

  12. Special Notes for Phase I • Effective from the release of Archer Phase I, ALL images, claims and non-claims items MUST be processed in Archer. • Splitting claims. Multiple reasons to split claims in Archer. This will be discussed later in the training video’s. • Claims are registered in Archer and Adjudication and all other processes continue in Bemas. Once the check has been generated or the claim has been processed, you must follow the adjustment process, which will be explained later.

  13. The role you play! • All users should validate the data that is being sent from Bemas to Archer and then again back from Archer to Bemas. • Claim Managers must review the training, create a training program for your team which includes testing in Archer Test and Bemas Test. The process described in this video may not fit your needs in their entirety. It will require the claims manager to adjust the process to meet the needs of the requirement. • Claims Managers must prepare to deploy and manage the utilization of Archer claims. • Claims Managers should create filters to validate the entry in Archer claims is being done correctly. Daily audits/reports should be reviewed for accuracy and to check for errors in the process.

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