GoodX Supervisor for Medical | Dental Practices

Glossary: EDI Settings

The EDI Manual will explain how and where to access and set up your Desktop EDI Settings. The EDI Settings is the switch that establishes communication to and from Medical Aids so that the Practice can properly administrate their claims. GoodX Switch allows the user to submit claims directly and in real-time into all major Medical Aid computer systems and to receive proof of submission and delivery of claims directly into GoodX. The EDI Settings must be set up correctly.

• The contents of this user manual will consist of the following information:
• The GoodX Switch
• eRA Tabs Overview

• Log in to the GoodX Desktop as the Supervisor.
  
• From the Navigator, Double Click on the Options Module. 
  

• The Authorisation/Password Necessary screen will open. 

• Select the User from the User Name drop-down menu.
• Enter the password in the Password field. 

• Click on the OK button to proceed.
  

 Please Note: Only users with Supervisor access will be allowed to access the System Options. 

• The main System Options screen will open.

• Click on the System Options button on the toolbar. 

• The System Options Entity Setup screen will open.

• Click on the EDI tab on the left side of the screen.

• The EDI Screen will open.

EDI Connection: GoodX Switch

The GoodX Switch allows the Practice to send information back and forth from the GoodX system to the Medical Aids.

• An explanation will be given for each field on the GoodX Switch tab:

• Doctor System URL: The Location address of the Quant Switch Portal for Medical Practices.

• Source ID: The switch URL (Uniform Resource Locators) used to send the claims to the Medical Aid. GoodX Admin department does this registration on the portal and will provide it to the user.
• Password: The switch password for the Practice. Also provided by the GoodX Admin department after registration. 
• Timeout: Total time the switch has to deliver the claim to the Medical Aid. If the claim is not delivered within this time frame the claim will time out and the user must resend the claim again. The suggested sufficient time will be 30 seconds but this can be increased should a Practice have larger accounts to be sent through. For Hospital claims, the preferred time will be 120 seconds.

 

• Get Registration Info: The button will send a request for an auto-register of the Entity for EDI purposes. If registration was successful the Source ID and Password will pull in automatically. 

• Note: Indicates applicable Switch option the button applies to, (the Note: will be removed in the future, only GoodX Switch is currently being done and not SwitchOn). 

• Use as Ref No. in Claims: Identification number that the Switch will send through to the Medical Aid to help identify the claim when a claim get switched. Medical Aid pays the account and sends the eRA using the same reference number.

• Select an option by clicking on the relevant radio button:
• DEB No: Unique number automatically generated by the system when a new file is opened.
• DEB File No: Manually entered number by the Practice. The number is normally associated with the accounts holder's hard copy file. 
• Patient No: Automatically generated system number on the Patient Input screen when a debtor is created on the program. 

Please Note: By default, the system will set this option to Debtor No.

• Current Ben. Check values (can be set by any user from the front end): When validation of the Patient is done, the current Ben. Check values setup will be used to do a benefits check on the Patient's Medical Aid to see if the Patient has funds available in the Medical Aid for the code selected by the Practice. 

• Click on the Code and/or Amount text field to enter the desired code and or amount.
• Code: The procedure/tariff code, for example, 0190 (New and established Patient).
• Amount: The total amount to check benefits for, for example, R500. 

• Auto Fetch if the Last Fetch is older than: The auto fetch function will attempt to obtain a new response, if the Auto Fetch response timer expires. The number of seconds completed here will be the number of seconds before the system tries again for a new response.

• Click on the selector buttons to indicate the number of seconds that the user would like for the system to try again. 

• Auto-shift Amounts as per Response: The function will allow the Practice to do a setup to inform the system what to do with claims depending on the switch response. 

• Select an option by clicking on the relevant radio button:
• Off: By selecting the Off option the system will not do anything and the user will have to shift the amounts manually. 
• Automatic: The option will automatically shift the amount of the invoices submitted to the Medical Aid as per the switch response. If the response indicates the Medical Aid has accepted the claim the amount will stay on Medical Aid liable, if the response indicates the fund rejected the claim the invoice will move to Patient liable. 

• Per status configuration (only GoodXSwitch): The per status configuration will open up a second setup option to be completed. Will allow the user to do their own EDI responses setup. 
• When the Per Status configuration radio button is selected, the Per Status Cfg button will become available.
• Click on the Per Status Cfg button to open the EDI response.

• The EDI response: System Journal Action Configuration screen will open.

• Mark status if the amount should NOT be shifted: Allows the user to do a global setup in which EDI Responds Status should not auto-shift the amount to the Patient liable. For more information regarding EDI responses, please refer to the user manual: Different EDI Response statuses.
• Select the EDI responses on the list that should not apply to the auto shift amount function. The options selected will not trigger the system to shift the claimed amount to the Patient's liable side. 

• Click on the Cancel button to close the EDI response: System Journal Action Configuration screen and discard any changes that were made.

• Click on the Save button to save all the changes that were made on the EDI response: System Journal Action Configuration screen.

• The EDI response: System Journal Action Configuration screen will close.

• Submit Medical Aid Amounts Only: The Submit Medical Aid Amounts Only tick will ensure that only the Medical Aid portion of an invoice will be submitted when using balanced billing.

• Claim 0023 and 0035/0036 separately: The Claim 0023 and 0035/0036 separately tick will be used for Medical Aids that request that these Anaesthetic modifier codes get claimed separately.

• Automatic Fixed Fee based on EDI Response: The Automatic Fixed Fee based on EDI Response tick will ensure that fixed fees will be used based on the EDI response from the Medical Aid.

• Allow Zero Switching on All Billing Code Types: The Allow Zero Switching on All Billing Code Types tick will include zero amount Billing codes to be switched to the Medical Aid.

eRA Tabs Overview

The eRA tabs will be used to perform specific configurations that will instruct the system on how to handle accounts when posting an eRA. Electronic Remittance Advice is a way of importing receipts captured by the medical aids against debtors or cases into GoodX in a structured way.

• An explanation will be given for each tab:
• eRA Setup: Allows the user to do the eRA account setup. For a comprehensive explanation of how the eRA Setup can be done, please refer to the user manual: eRA Setup.
• eRA Matching Options - General: Allows the user to specify how the eRA journals should be applied based on the options selected. For a comprehensive explanation of how the setup can be done, please refer to the user manual: eRA Matching Options - General.
• Editing eRA: Allows the user to automatically resolve payment when saving allocation and the unlinked amount left. For a comprehensive explanation of how the setup can be done, please refer to the user manual: Editing eRA. 
• Posting eRA: Allows the users to choose what type of eRA can automatically post depending on matching or batches preferences. For a comprehensive explanation of how the setup can be done, please refer to the user manual: Posting eRA.
• Payment Link eRA: Gives the user the ability to set up and send out payment links to the Patients to the Patient. For a comprehensive explanation of how the setup can be done, please refer to the user manual: Payment Link eRA.

• Click on the Print Options button to print the setup of all System Options Tabs.

• Click on the Save button to save the changes that have been made.

Please Note: The Save button will only appear if changes have been made to the settings.

• The Confirmation Changes screen will open. 

• Please specify a reason for the changes made:  To confirm and save why changes have been made. 

• Click on the free text field to start typing the reason.

• Click on the Cancel button to go back to the EDI screen, no changes will be saved. 

• Click on the OK button to save the changes made.

• Click on the Exit button to close the Entity Setup screen and return back to System Option main screen.