EXPERITY Waystar Enrollment Workflow Guide User Guide
- August 29, 2024
- EXPERITY
Table of Contents
**EXPERITY Waystar Enrollment Workflow Guide User Guide
**
Waystar Webinar FAQs
Enrollments
How do I know if a payer requires enrollment?
See page 4 of the Enrollment Workflow Guide.
How do I know if I enroll as a provider or facility?
See page 6 of the Enrollment Workflow Guide. Keep in mind that the provider you are using for enrollments is your billing provider information. This is the NPI/TIN that you use while submitting claims to the payers. You do NOT need to add each individual facility or provider into this screen. Add only unique NPI/TIN combinations as a new billing provider.
How can we get TriWest run in RTE in Experity?
Look up the appropriate payer ID for TriWest that you are setting up. This can be done by navigating to Patient Tools > Eligibility > Payers. You will need to look up the payer by name or payer ID – some payers do not have an RTE connection and will not be shown during your search. Once the payer ID is identified, you can use the attached document titled: Payer Set Up in Experity PM to complete the set up. Don’t forget to validate whether an enrollment is required.
What if a new insurance is not showing up in Waystar?
Waystar offers three payer IDs for this situation. These payer IDs allow the claim to go to the clearinghouse electronically and are then dropped to paper and sent to the insurance company.
- Commercial Insurance – 98999
- Auto Insurance – J9899A
- Work Comp – J9899W
Are all payer enrollments required to download the enrollment forms and send them back through opening a case in Waystar support?
Not all of them require this. Please see page 11 of the Enrollment Workflow Guide.
For the payers that have another payer ID for attachments, do we have to submit a separate enrollment request for the ones that require it?
Yes, if that payer requires enrollments, a separate one would need to be submitted for the claim’s attachment payer ID.
Can you please explain the Request remittances tab?
See page 51 of the Enrollment User Guide.
How do you correct inaccurate information on and enrollment form.
Cancel the enrollment with the incorrect information and kick off a new enrollment with your necessary corrections. Keep in mind the corrections sometimes need to be completed in the provider screen or they will continue to get the wrong information. For example: wrong NPI/TIN or legal name.
What are we doing with Tricare East claims since they aren’t currently accepting enrollment?
Per Waystar’s Enrollment Team Director, Tricare East still is not allowing new enrollments. Waystar is trying to convince them to develop a new process so that they will allow for enrollments. She also stated that she feels that if providers call in with that request it could help move the needle.
Where do we enter the payer ID numbers in Experity?
We have three different sections that require payer IDs be populated.
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Insurance Company Screen – This holds two of the three payer IDs (Claim payer ID and RTE payer ID).
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Utility ERA Screen. This holds the Remit payer ID
Reminder: This payer ID could be the same for all three enrollments or it could be different. Refer to Waystar’s payer screens to validate the appropriate payer IDs.
Claims/Rejections
Workers Comp does not have a Subscriber ID number and the WC claims that can go electronically are rejecting for Subscriber ID. What should we do to get them to move forward?
We recommend using this best practice: Use the patients SSN or the policy number from the work comp carrier
What does the rejection “Held by Waystar – Payer Impacted by Change Healthcare Outage” mean?
See Waystar Impacted Payers CHC Outage Fact Sheet and note impacted payers at Waystar due to the Change Healthcare (CHC) outage. Please review and decide if you want to continue to hold the claims or have Waystar send them to the payers on paper for processing.
How do you close/remove the rejection after working it?
If you work the rejections directly out of the Waystar platform, the rejection will be removed as soon as you resubmit the claim successfully. If you decide to work your rejections out of the Experity platform, resend/rebill the corrected claim from Experity and go back into Waystar to archive the originally rejected claims.
How can a claim be dropped to paper?
Update the payer ID tied to that invoice to the paper payer ID. Waystar has three paper payer IDs.
- Commercial Insurance – 98999
- Auto Insurance – J9899A
- Work Comp – J9899W
What’s the next step after the enrollment is approved by the payer?
Make sure that your enrollment is showing as completed/waiting for first remit. If the enrollment is activated in Waystar, you will need to resubmit all held claims to the payer.
Do this by going into Waystar to Claims Processing > Professional Claims > Claims and click on the rejected claims dashboard link.
It will bring up the rejected claims grouped by rejection message. Find your rejection linked to your enrollment. Click resubmit to send them all.
I do not have a work group. Do I need one?
You don’t need workgroups to work through rejected claims in Waystar; however, it does help get through like rejections faster. See Creating Workgroups Quick Start Guide for guidance setting up workgroups.
Am I understanding correctly that it’s best practice to work rejections through Waystar, but to work a corrected claim directly from Experity?
Yes. Best practice workflow recommendation is to work your rejected claims directly in the Waystar portal. Please keep in mind that you should always make updates to the Experity platform if the changes being made will affect your future claim submissions.
Could I get some training on the Attachment sections for workers comp?
See Claim Attachments User Guide_V12 outlining the details on Workers Comp (WC) attachments to review for necessary action. It is important that you review this guide as records MUST be manually linked at this time for submission via Waystar.
Remits
When will ERAs drop for auto-posting?
Once you ready an ERA batch it could take anywhere from three to six hours to auto-post into the Experity platform
Will payments still flow thru the ERA in Practice Velocity, or will we have to come into Waystar and get that information manually to post?
As soon as your ERA enrollments are approved and activated within the Waystar platform, you will begin receiving those remits in Waystar and subsequently uploaded into Experity for posting. We are not aware of any intention to resend remits, so we are advising clients to go out to payer websites to obtain these remits and have them hand posted.
How are these ERA’s going to come over? Right now in Experity we have the CPID as a payer ID in the utilities section for ERAs. Does this need to change?
The Waystar integration doesn’t rely on the Utility ERA screen as heavily as the Change Healthcare integration did. We would encourage clients to update these payer IDs over time to ensure consistent payer IDs throughout the Experity practice.
Is Waystar going to be able to capture all the remits that got held up at Change Healthcare right before the shut down?
Per Waystar, this is TBD. Until they have clearer insight from Change/Optum, they can’t provide a definite answer at this time.
Contact Information:
Experity Support Contact Information
Phone: 866-995-9863
Email:
customersupport@experityhealth.com
Waystar Contact Information
Phone: 844-392-9782
*This should only be used for enrollment-related questions. If you have system-related issues, reach out to Experity Support first.
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