EPS Help and Reference for Providers

Note: EPS features contained within these Help topics may not be applicable to all Payers.

Electronic Payments & Statements (EPS) is a tool designed to make your claim payment reconciliation process quicker and more efficient by eliminating paper checks and receiving electronic payments and remittance advices online.

EPS provides multiple levels of payment and remittance analysis:

1. View Payment: See a list of all payments made to your organization in the last 30, 60 or 90 days. Choose to download the corresponding HIPAA compliant 835 file (requires auto posting capability).
2. View/Save/Print Remittance(s): Select a payment and view, save or print the claims for that payment along with any service level or payment level adjustments.
3. View Claim: View details for a single claim to see how the claim was adjudicated and paid.
4. Search Remittance: Choose from eight different ways to search for the payment and remittance information.
  Provider Service

From the ‘Resources’ menu, select ‘Contact Us’ for EPS Support information.   EPS Welcome (Home) Page

From the EPS Welcome page you can:

• View Payments
• Search Remittance
• Maintain Enrollment
• View Proprietary Payer EOBs
• Search the News Section for current news and events

To return to the EPS Welcome page, click on the ’Home’ link on the top navigation bar.

  Update Your EPS Account

Changes to your Organization’s Contact Information (address, phone numbers, adding new contacts, email updates, etc.) can be made online. From the Welcome Page, click on ‘Maintain Enrollment’ in the top navigation bar to begin this process.

Changes to banking and NPI information must be submitted in writing. To make any of the following changes to your EPS selections, from the ‘Resources’ menu, select ‘Contact Us’ for EPS Support information.

• Organization Bank Account
• NPI Bank Account(s)
• Payer Bank Account(s)
  View and Print Documents

Many of the documents available on this Web site are in PDF format. You will need the Adobe® Reader® software to view and print PDFs. To download Adobe® Reader®,
visit www.adobe.com/products/acrobat/readermain.html, or click the ‘Get Adobe Reader’ icon at the bottom of the EPS screens.   View Individual EOB (Claim/Remittance Advice)

From the ‘View Payments‘ tab select the payment number to view all the claims contained in the consolidated payment. To view and print the EOB/Remittance Advice:

1. From the View Payments, Payment Summary page, select a payment by clicking on the Payment Number.
2. The Remittance Details page will display. To print the EPRA,click ‘Print Request’ or ‘Print Request’.
3. To view a single claim, locate the desired claim and click on the Claim Number.
4. The Claim Detail page displays. To print the EOB, click ‘Print Claim Detail’.
5. To return to the remittance information, click ‘Return to Remittance Detail’.

You can also search for an individual EOB by using the Search Remittance tool.   Print or Save Remittance, EPRA & Claim

EPS allows you to print the information you need to post your payment. We have three printing options available, depending upon the type of information you need.
Note: Once Adobe® Reader® launches, you can save this file using the ‘Save’ option.

1. From the Payment Summary page, you can choose to print a list of payments made in the last 30 days by clicking ‘Print Payment Summary’.
   • For payments received in the last 30 days, you can immediately print the EPRA from the Payment Summary page by clicking ‘Print Available’ in the Print EPRA column.
   • For payments that are older than 30 days, click on the ‘Quick Search’ drop-down menu and choose Last 60 Days or Last 90 Days. Select the desired payment and click on the ‘Print Request’ link in the Print EPRA column. EPS gathers this data and alerts you when the information is available to print. In most instances, if you click on the ‘View Payments’ link to refresh the page, you will see the link change to ‘Print Available’. Click on ‘Print Available’ to print a copy of the EPRA. If the link does not change, you may need to wait a bit longer, depending on the size of the EPRA file.
2. From the Remittance Details page, click ‘Print Available’ for a printer-friendly version of the remittance.
3. From the Claim Detail page, click ‘Print Claim Detail’ for a printer-friendly version of that particular claim.

Note: You can use your browser’s ‘Print’ command at any time to print the current screen.   Tax Identification Number (TIN)

EPS allows you to review claim payments for up to 10 TINs. To begin reviewing payments and claims for a different TIN click on the TIN drop-down menu and select a different TIN.   Payment Number

The Payment Number is a unique number assigned by the Payer to identify a consolidated payment for a group of claims. Use this number to reconcile the electronic payment with the remittance. You can find this number on the ACH payment file that you receive from your bank.   Account Number

The Account Number is a unique number assigned to a patient by the hospital or clinic where the patient received care.   Codes

EPS presents claim data using a nationally recognized standardized list of ‘denial’, ‘adjustment’, and ‘payment’ codes. This list is maintained by the Claim Adjustment Status Code Maintenance Committee and is updated three times a year. For more information about the codes and how they are maintained:

1. Go to the WPC Web site (www.wpc-edi.com).
2. Select ‘HIPAA’ from the left navigation.
3. Select Code Lists. Click each code for its definition or click on the column heading for a complete printable code list.
  Adjustment Reason Code

An Adjustment Reason Code provides the reason for an adjustment and why a claim or service line was not paid as billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.   Remark Code

The Remark Code conveys information about remittance processing or provides a supplemental explanation for an adjustment already described by an Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message.   Search Claims

EPS can search for claims paid electronically on or after your EPS enrollment becomes effective.

Currently, you can search for claims based on:

• Date of Service
• Subscriber ID
• Payment Number
• Payment Date
• Patient Name
• NPI
• Zero Payment Claims
• Claim Number (exact match)

To begin the search process:

1. From the EPS Welcome page, click ‘Search Remittance’.
2. Select the type of search you would like to use. Click the ratio button next to the search selection and type the search criteria in the box that displays below the search options.
   Note: For search criteria definitions, click the ‘Here’ link.
3. Click ‘Search Remittance’.

You can review your results online or print them.   Search Zero Payment Claims

A Zero Payment Claim results in no payment to your organization. This happens for many different reasons, but you still need to reconcile the claim payment to the claim that was billed from your practice management system.

You can search for claims that resulted in a zero payment (services rendered where zero dollars were paid) on EPS by:

1. From the Search Remittance page, click ‘Zero Payment Claims’ radio button.
2. Type the search criteria in the space provided.
3. Click ‘Search Remittance’.

You can review your results online or print them.   Download 835 File

Note: This feature requires that your organization auto posts payments to your practice management system. If you cannot perform this activity, do not use the Download 835 feature.

You can download a copy of the HIPAA 835 remittance file directly to a desktop network computer from EPS by performing the following:

1. From the View Payments page, click ‘Download’ in the Download 835 column.
2. Select ‘File’ and then ‘Save As’.
3. Save this page to a location on your desktop or network computer.

Consult with your Network Administrator for assistance with uploading the file to your practice management/billing system.   Reconciliation

You can access electronic payments and their respective EOBs using EPS. From the ‘View Payments’ link, your organization can retrieve payment and remittance information online for the past 90 day period (you can also search for payment and remittance information for up to 13 months–depending how long your organization has been enrolled in EPS–via the ‘Search Remittance‘ link).

To complete the reconciliation process:

1. Click ‘View Payments’.
2. Find the payment that you need to reconcile to your practice management system.
3. Select the payment by clicking the Payment Number.
4. The ‘Remittance Details’ page displays all the claims, service lines, and adjustment data included in the payment.
5. You may work directly from the ‘Remittance Details’ page or print the EPRA.
6. To view a single claim, locate the desired claim and click the Claim Number.
7. The ‘Claim Detail’ page displays with additional adjustment information (if applicable).
8. Print the claim by clicking ‘Print Claim Detail’.
9. To return to the EPRA that contains the claim, click ‘Return to view Remittance Detail’.
10. To quickly locate a particular claim, EPRA , or payment, select ‘Search Remittance’. Use the search option to find what you need.

Note: If you need to view a claim that was paid electronically prior to your EPS effective date or if you need further assistance with reconciliation, call the Customer Support number listed under Resources, Contact Us.   Help on Other Topics

Not finding what you need? Check the EPS Frequently Asked Questions (FAQs) or the User Guide under Resources in the EPS header (you can find these links in the top navigation). The User Guide provides step-by-step instructions on everything EPS.   Enrollment

The EPS Online Enrollment Form displays if the currently selected Tax Identification Number (TIN) is not yet enrolled in EPS. Complete the enrollment form. Your EPS enrollment is typically active within 2-3 business days.   Enrollment Maintenance

Click ‘Maintain Enrollment’ to make changes to your existing EPS information. You can make online changes to your organization information. Changes to organization bank accounts, NPI, and NPI bank accounts require written authorization. Call the Customer Service Support number listed under Resources, Contact Us, to obtain an EPS Enrollment/Change form. Be sure to indicate whether the form is being submitted for a new enrollment or to update an existing enrollment. Complete your changes and fax it to the number on the form.   National Provider Identifier (NPI) Bank Accounts

If your organization uses more than one business checking account and would like to direct specific payments to these accounts by NPI number, EPS can assist you to manage multiple bank account functionality. During the initial enrollment, your organization will have the opportunity to set up NPI banking information for as many NPIs as your organization needs. If you want to add additional NPI bank accounts in the future, we have an NPI addendum form that must be used. After completing the form, you will need to fax (preferred) or mail the form to EPS along with a copy of a voided check or bank letter.   Helpful information to know prior to establishing an NPI level bank account:

Payers create payments that are grouped by either Tax ID (TIN) or by National Provider ID (NPI). When the payer generates the Electronic Remittance Advice/835, they will assign either the TIN or NPI as the Payee ID. This may be determined by the billing provider ID submitted on the claim or agreed to in contractual arrangements between the payer and the provider.

EPS will deposit the payment dollars to the account assigned to the Payee ID in the ERA/835, which was generated by the payer and sent to EPS for processing the Electronic Funds Transfer/direct deposit (EFT). If the bank account assigned to the TIN should also be used for the NPI, no further NPI bank account enrollment is required with EPS.   Payers

To enroll in EPS and establish separate depository accounts at the Payer level, contact an EPS Enrollment Specialist at EPS Customer Support for assistance.