1)  How much does it cost to use i-Plexus’s clearinghouse?

2)  Will I receiving training when I start to use the i-Plexus system?

3)  Am I locked into sending all my payers to i-Plexus?

4)  Can I get out of the contract with the i-Plexus Clearinghouse?

5)  Are there any hidden fees in the i-Plexus Clearinghouse Contract?

6)  How long does it take to get started?

7)  What does a Par Claim mean?

8)  Does i-Plexus handle DME (Durable Medical Equipment) claims?

9)  How will my practice benefit by using the I-Plexus Clearinghouse?

10)  In your system of classification, what customer group would I fall into?

11)  Will I need any special equipment and/or software?

12)  Can I submit my claims online, right through the internet?

13)  Our office is behind in computers, software and technology, can we still use i-Plexus’ system?

14)  We have never sent claims electronically, what will we need to get started?

15)  What exactly is EDI?

16)  There are several formats and styles of claims, what type does i-Plexus accept?

17)  How can I tell you that a claim should be printed and mailed?

18)  Is it necessary to designate in the payer name to which state my government claims are sent?

19)  If I am sending a print image file, do I need to test before I sign a contract?

20)  How can I make sure that the print image file I send to you has all the data in the right places?

21)  When I print the claim through my software, it prints just fine, but the print image file you received from me prints differently. How is that possible?

1) How much does it cost to use i-Plexus’s clearinghouse?

Please click the sub-tab called Pricing under the Getting Stated Tab of the i-Plexus web site. All of our pricing plans are clearly outlined in this section.

2) Will I receiving training when I start to use the i-Plexus system?

Yes you will receive training when you start using the i-Plexus system. We will cover all the major areas of our system and monitor your initial set of claim files until we feel confident that there are no major items that need to be addressed.

3) Am I locked into sending all my payers to i-Plexus?

No, you can pick and choose which payers you want to send to i-Plexus.

4) Can I get out of the contract with the i-Plexus Clearinghouse?

Yes, you are not contractually committed to use i-Plexus and you can leave at any point and there is no fee to discontinue.

5) Are there any hidden fees in the i-Plexus Clearinghouse Contract?

So long as your claim file does not change from submission to submission, and so long as you know how to generate an electronic claim file out of your practice management system, there are no other extra charges other than those charges published on the pricing sub-tab found under the Getting Started tab.

6) How long does it take to get started?

We typically can have you submitting claims in two business days so long as there are no issues with your claim file. Government payers such as Medicare and Medicaid can take any where from two to four weeks to get approved to submit claims electronically through our clearinghouse.

7) What does a Par Claim mean?

Par typically means that a provider is registered and credentialed with a particular health plan or payer. In the clearinghouse industry, the term Par can mean that the clearinghouse gets reimbursed a small amount of money per claim from the payer. So if you are signing up for our “free plan”, you can only submit claims that i-Plexus receives payer reimbursement from.

8) Does i-Plexus handle DME (Durable Medical Equipment) claims?

Yes we do.

9) How will my practice benefit by using the I-Plexus Clearinghouse?

You may send all claims, including paper claims, in just one file. There are no charges for rejected claims. All claims are filtered for payer and your practice edits which minimize rejected claims. You will ultimately increase cash flow and reduce your accounts receivable through the use of the various features and functions of the i-Plexus clearinghouse. For example you can search by patient name on any claim at any point in time to see where your claim is in the over all process of getting it paid.

10) In your system of classification, what customer group would I fall into?

This is very simple. The first group we call a Provider, which includes practices, groups, hospitals, and clinics -- those directly providing care and treatment to patients. Next is the category of Software Vendors, Consultants and Billing Services. Depending on their scope of business, Software Vendors, Consultants and Billing Services supply a wide range of value added services and products to Providers. Next are the Payers, which include IPAs (Independent Physician Associations), MSOs (Management Service Organizations) and Insurance Companies. The remaining category is Clearinghouses, which include those organizations who receive claims from their clients which include Software Vendors, Consultants, Billing Services, Providers and other Clearinghouses. Once the clearinghouse receives the claims, they edit, parse, normalize the data and send it on to the payers. i-Plexus is a clearinghouse processing millions of claims a year and i-Plexus also operates a billing serv ice which submits claims to the i-Plexus clearinghouse. No matter the size of your operation, or type of your operation, i-Plexus will accommodate your needs either as a clearinghouse or as a billing service.

11) Will I need any special equipment and/or software?

Provided you already have a computer with simple internet access, and you have practice management software or other software can create an electronic claim file, you are ready to start. If you need practice management software, i-Plexus can help there as well by suggesting from the various vendors that we have worked with over the years.

12) Can I submit my claims online, right through the internet?

Absolutely and you can be up and running in a couple of business days from when we receive your executed contract.

13) Our office is behind in computers, software and technology, can we still use i-Plexus’ system?

There is still hope. If your systems have limited electronic claim capability, but you can print claims to a printer, then there is a good chance that you can generate a file that contains your printed claims. After receiving the print image file, i-Plexus will translate the data into a format that the payers understand. i-Plexus will help you figure this out.

14) We have never sent claims electronically, what will we need to get started?

You must be able to create a claim file and have Internet access. If you need a connection to a government plan (Medicare, Medicaid, Blue Cross Blue Shield or Champus) i-Plexus takes care of providing EDI contracts and connections for all states and regions.

15) What exactly is EDI?

Electronic Data Interchange (EDI) is the computer-to-computer exchange of business documents between companies, using a public standard format. Rather than preparing paper and sending it through the mail, or using other communications methods such as telex or facsimile, EDI users exchange business data directly between their respective computer systems. Two common EDI formats are the NSF and the HIPAA 837 Health Care Claims transaction formats.

The most tangible benefit of EDI is that it saves money for the provider and the payer. In fact, there are no paper forms, no envelopes and no stamps. I-Plexus provides a seamless transition from your Patient Management Software to outgoing claim forms. We minimize or eliminate the need to re-key or type claim forms.

16) There are several formats and styles of claims, what type does i-Plexus accept?

Most claim formats are supported through I-Plexus . Most practice management systems generate EDI formats or simple print image files which can be transmitted to i-Plexus. i-Plexus translates your claim file into the formats required by the insurance payers, including the HIPAA 837 Health Care Claims transaction format.

If your system has limited electronic claim capability, but it can print claims to a printer, then there is a good chance that you can generate a file that contains your printed claims. After receiving the print image file, i-Plexus will translate the data into a format that the payers understand.

17) How can I tell you that a claim should be printed and mailed?

If the payer name on the claim is not listed on the i-Plexus Payer List, then the claim will automatically be printed and mailed

18) Is it necessary to designate in the payer name to which state my government claims are sent?

No, it is not necessary but we would prefer if you following the payer naming convention found on our payer listing.

19) If I am sending a print image file, do I need to test before I sign a contract?

This simple answer is no. But to ensure that all data from your claim maps correctly in our system, we encourage all new submitters to test their print image claims with us. If the claim data sent in the print image fits inside the boxes on the claim form, your claims may be mapped with little or no changes required. If you make changes to your print image files after our mapping is completed, re-testing is often required. To make sure that your claim data can be mapped successfully, see the instructions included within the next question.

20) How can I make sure that the print image file I send to you has all the data in the right places?

Load plain paper into your printer. Using the copy command, at the prompt, type "copy(space)\(subdirectory)\filename.ext(space)lpt1:" Replace the "subdirectory" with the file folder name that contains your file and use the spacebar where you see the "space". Your command line will look something like this:

windows>"copy(space)\PMsoftware\claims.prt(space)lpt1:"

Do not print the claims through your practice management software's normal print functions. Your practice management software may force line feeds and other imbedded coding into the printing process that could give you a false picture of what you will be sending to I-Plexus . After printing the claims on plain paper and using the method described above, place a blank claim form over the data. If your claim data fits squarely inside the boxes, your claims should not encounter any problem during the mapping process. This is the key to an accurate mapping. If, for example, the date of birth is shifted a character to the left or right causing it to fall outside the date of birth area on the claim, then the claim will need specialized mapping. It is imperative that all fits inside the boxes. If your mapping fails, a representative from our mapping department will contact you to help you fix any problems and send another claim file. If the problem cannot be fixed from the practice management software, then we can work with you on producing a special map on our end to process your non-standard print image.

21) When I print the claim through my software, it prints just fine, but the print image file you received from me prints differently. How is that possible?

Many practice management software packages include coding that affects the positioning of the data as it is printing in the claim form. This is normally the cause for the difference in the printed output and the reason we suggest the test described above.