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					                             IDX SYSTEM SUPPORT & USAGE
                                   Policies & Procedures

                             IDX SYSTEM SUPPORT & USAGE
                                Policies & Procedures

                                   Table of Contents


I. Patient Scheduling

      A.   Scheduling an Appointment
      B.   Maintaining Provider Schedules
      C.   Patient Appointment Verification
      D.   Canceling an Appointment or Session

II. Pre-Registration

      A.   Referral Management
      B.   Pulling Charts
      C.   Printing Encounter Forms
      D.   Printing Facesheets

III. Registration/Insurance Management

      A.   Registration Interface
      B.   Identifying a Patient in IDX
      C.   Bad Addresses
      D.   Entering Insurance FSC Information
      E.   FSC Defaulting
      F.   Deactivating/Deleting FSCs

IV. Visit/Encounter

      Check In

      A. HIPAA Privacy Consent Forms
      B. Worker‟s Compensation/No Fault Patients
      C. Arriving Patients

      Check Out

      E.   Transaction Editing System (TES)/Ingenix Edits
      F.   Charge Entry
      G.   Charge Interface
      H.   Posting Payments



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V. Visit Reconciliation

      A. Identifying Missing Charges
      B. End of Day Reconciliation
      C. Downtime Preparation

VI. Claims Processing

      A. Production Schedule
      B. Edit Lists
      C. eCommerce Follow Up

VII. Electronic Remittances

      A. Automatic Payment Posting Batches
      B. Rejection Code Posting

VIII. Payment Batching, Posting & Reconciliation

      A. Reconciliation of IDX Payment Batches to Banking and FAS Records
      B. Control Accounts for Undistributed Deposits
      C. Payment Corrections & Adjustments

IX. A/R Follow Up & Collections

      A. Write Offs
      B. Outsourcing

X. Reporting

      A.   Daily Reports
      B.   Month End Financial Reports
      C.   Scheduling Reports
      D.   Managed Care Reports

XI. System Access & Security

XII. Requesting System Changes & Report Requests

      A. New IDX Installations
      B. Report Requests
      C. Updating Fee Schedules


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      D. Dictionary Changes

XIII. Reporting System Problems




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OVERVIEW

This manual is intended for IDX system departments to assist them in using the IDX
Practice Management System.

APPLICATIONS & TERMS

The IDX Practice Management System contains several applications and modules as
defined below:

BAR – Billing and Account Receivable, referred to in this manual as the Billing System.

SCHED & FRONT DESK – Scheduling and related front desk activities, referred to in
this manual as the Scheduling System.

TES – the Transaction Editing System, is a charge suspense system used to capture
complete or incomplete charge information that will eventually become an invoice on the
IDX Billing System.

Due to staffing variations across departments, for consistency, the following terms are
used to describe the level of system users:

Department Administrator – describes the highest administrative manager in the
department. This person is ultimately responsible for the department or practice.

Scheduling Manager – is the manager overseeing the scheduling and front desk
activities in the practice area.

Scheduling Supervisor – is the person responsible for day-to-day scheduling and front
desk functions.

Scheduler – is the person who schedules patient appointments.

Front Desk Person – is responsible for arriving patients and performing other related
front desk activities in the practice area.

Billing Manger – is the manager overseeing the billing functions in the department.

Billing Supervisor – is the person responsible for managing the day-to-day billing
operation and overseeing charge entry and payment posting functions.

Charge Entry Person – is responsible for entering charges into the billing system.




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Payment Poster – is the person posting payments, rejections and performing other
related insurance follow up.

SPSG – The Shared Practice System Group, is the systems group responsible for
supporting the IDX system.

RELATED LINKS

Throughout this manual there are several related links that will help you navigate other
related policies, forms or other training documents. They are indicated as follows:

Policy – will link you to another related policy.

Forms – will link you to a related form.

How2 – will link you to a related section in one of our training manuals for more detailed
information on how to execute a particular action on the IDX system.




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 I. A. Scheduling an Appointment                               Approved By:                    Approved By:
                                                               Kathleen O’Donnell              Michael O’Connor

                                                               Page 1 of 2                     Effective Date:
                                                                                               01/01/2005
                                                               Policy Number:                  Revision Date:

Draft of 9/10/2004; Revised 9/24/2004

Objective:

Use the following procedure when scheduling a patient appointment to ensure complete
and efficient data capture and enhance patient service.

Policy & Procedure:

Perform the following tasks to schedule a patient appointment.

1. Properly identify the patient using one of the system search options. Once the
   patient is appropriately identified, verify the registration information if the Minimum
   Data Set (MDS) field has not been updated in the past six months. Otherwise ask
   the patient if any of the information on file has changed. Update any changes to
   registration data on the IDX system. If the patient has not previously been
   registered in the IDX system, the user should refer to Registering a New Patient
   policy.

2. Select an appointment using the following criteria:

     a. Provider
     b. Appointment Type – New, Consult, etc.
     c. Date & Time preferences

3. Always use the “First Available” search option to easily identify the next available
   appointment matching your criteria.

4. Capture the following information on the Custom Appointment Information (CAI)
   screen when scheduling an appointment.

        a. Appointment reason
        b. Provider
        c. Appointment type – New, Consult, etc.
        d. Any free text comments you would like to print on the Provider Daily Schedule
           and be available from the ONTRAC Check-In Screen.
        e. Referring physician


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 I. A. Scheduling an Appointment                               Approved By:                    Approved By:
                                                               Kathleen O’Donnell              Michael O’Connor

                                                               Page 2 of 2                     Effective Date:
                                                                                               01/01/2005
                                                               Policy Number:                  Revision Date:

Draft of 9/10/2004; Revised 9/24/2004

        f. Referral information, such as referral number or prior authorization
        g. Par/Non Par Indicator
        h. Workers Comp/No Fault indicator, if applicable

5. File the appointment and relay the date, time and any special instructions to the
   patient.

For more detailed information on how to schedule appointment refer to How2 Schedule
an Appointment.




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 I. B. Maintaining Provider                         Approved By:                    Approved By:
                                                    Kathleen O’Donnell              Michael O’Connor
 Schedules
                                                    Page 1 of 2                     Effective Date:
                                                                                    01/01/2005
                                                    Policy Number:                  Revision Date:

Draft of 9/10/2004

Objective:

To ensure the integrity of provider master schedules and prevent errors that result in
patient inconvenience or underutilized provider time.

Policy & Procedure:

1. Completing Master Schedule training class is a required before access to editing
   master schedules is permitted.

2. Create a Master Schedule for each individual day of the week.

3. Distribute Master Schedules to create the daily schedules.

For more information on how to edit and maintain Master Schedules, please refer to
How2 Maintain Master Schedules.




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 I. C. Patient Appointment                            Approved By:                    Approved By:
                                                      Kathleen O’Donnell              Michael O’Connor
 Verification
                                                      Page 1 of 2                     Effective Date:
                                                                                      01/01/2005
                                                      Policy Number:                  Revision Date:

Draft of 9/10/2004

Objective:

To avoid underutilized physician time and undue patient inconvenience always verify
patient appointments prior to the visit date.

Policy & Procedure:

1. Front Desk staff will print a copy of the Provider Daily Schedule at least 24 – 48
   hours in advance of the appointment date for both AM and PM sessions.

2. Call patient to confirm their appointment and make them aware of any outstanding
   balances, required co-payments or referrals that need to be collected at the time of
   service.

3. If patient is unavailable, do not leave a message. Retry the call again within 24
   hours.

4. Pull the chart after the appointment has been confirmed. For more information see
   policy on Pulling Charts.




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 I. D. Canceling an Appointment or                              Approved By:                    Approved By:
                                                                Kathleen O’Donnell              Michael O’Connor
 Session
                                                                Page 1 of 1                     Effective Date:
                                                                                                01/01/2005
                                                                Policy Number:                  Revision Date:

Draft of 9/10/2004; Revised 9/24/2004

Objective:

Used to handle patient requests to cancel/reschedule appointments, or when bumping a
patient in the event of a change in a provider‟s availability.

Policy & Procedure:

Canceling an Appointment

1. Locate the patient‟s appointment in the system.

2. Update the appointment status from „Open‟ to „Cancel‟.

3. Enter a cancellation reason.

4. Reschedule the appointment for a different time, if appropriate.

Canceling a Session

1. In the event that a provider‟s availability changes, update the daily schedule to
   reflect the change.

2. Print a list of any patient appointments that were „Bumped‟ as a result of the change.

3. Reschedule all appointments, in order of date/time priority, using the Bump List.




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 II. A. Referral Management                                     Approved By:                   Approved By:
                                                                Kathleen O’Donnell             Michael O’Connor

                                                                Page 1 of 1                    Effective Date:
                                                                                               01/01/2005
                                                                Policy Number:                 Revision Date:

Draft of 9/10/2004; Revised 9/24/2004

Objective:

To associate and track referral information with corresponding visit(s), and cases where
multiple visits are being authorized, have the system automatically decrement them as
they are utilized.

Policy & Procedure:

1. Create the referral under the appropriate FSC and generate an IDX Referral
   Number.

2. Enter the Date Ordered (the date the referral was provided.)

3. Indicate the Referral Type.

4. Indicate where the patient was Referred From.

5. Indicate where the patient was Referred To.

6. Confirm the Referral Status (the system status will default to „Approved‟.)

7. Enter a Referral Reason.

8. Enter a Description.

9. Enter Valid From and Thru Dates.

10. Indicate the Number of Authorized Visits.

11. Attach the Referral to the Visit prior to Check Out.

12. As charges are entered, the system will decrement utilized visits against the total
    number authorized.

For more detail on how to enter a referral see How 2 Enter a Referral.


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 II. B. Pulling Charts                                 Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 2                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure for all patient charts that should be pulled and
prepared in advance of a scheduled patient appointment.

Policy & Procedure:

    1. Print Provider Daily Schedules the day before scheduled visits. See How 2 Print
       Provider Daily Schedules.

    2. Pull medical charts for follow up appointments.

    3. Create chart for new appointment scheduled.




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 II. C. Printing Encounter Forms                        Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor

                                                        Page 1 of 1                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To capture and bill all patient visits, all patient encounter form should be printed 24
hours prior to the appointment date.

Policy & Procedure:


    1. Print encounter forms, either individually or in bulk, 24 hours prior to scheduled
       visits. See How2 Print Encounter Forms.

    2. Place the encounter forms in the medical chart.

    3. For walk-in or unscheduled visits, print the encounter form at the time of arrival.




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 II. D. Printing Facesheets                           Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 1                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure for printing Facesheets to effectively capture and
update patient information necessary for patient registration, billing, and follow up.

Policy & Procedure:

1. Print Facesheets at the time of service for all new patients and any existing patient
   not seen within the past six months.

2. Identify the patient from the encounter manager list.

3. Select the patient and go to the Action menu, select Registration, select Registration
   document.

4. Select Facesheet and print. See How2 Print Facesheets.




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III. A. Registration Interface from                  Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor
NYPH
                                                     Page 1 of 1                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:



Objective:

To document the functioning rules of the registration interface for accepting new
demographic and insurance updates from the hospital system.

Policy & Procedure:

The registration interface between IDX and the hospital‟s Eagle system receives data
real-time and continuously. The Shared Practice Systems Group is responsible for
monitoring the interface throughout the day.

1. Any registration information that has not been updated by an end user will be
   overwritten by the next registration process.

2. Any registration information that has been updated by an end user will not be
   overwritten by the interface within 6 months.

3. Any registration information that has been updated by the interface is indicated in
   the registration screen with the user initials RTREG.




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 III. B. Registering a New Patient                      Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor

                                                        Page 1 of 1                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure new patient registration data is accurately captured to expedite clinical and
billing follow up and to prevent duplication of patient records.

Policy & Procedure:

1. Perform the following series of steps to properly verify if the patient is not already
   registered in the system before registering a new patient account:

             a. Use a partial spelling of the patients‟ last name and first name. When the
                search criteria specified provides more than one valid entry, verify the
                patient‟s date of birth, and address information.

             b. Use a unique identifier, such as medical record or social security number,
                if proper identification cannot be established from the information
                displayed.

             c. Obtain and enter registration and demographic information as specified in
                the Minimum Data Set policy and check off the Minimal Data Set field
                indicating that this has been done.

2. For more information see How2 Register a Patient.




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 III. C. Bad Addresses                                  Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor

                                                        Page 1 of 2                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004; 9/27/2004

Objective:

Use the following procedure to update incorrect patient address information to ensure
efficient patient billing and communicate any changes to other system users.

Policy & Procedure:

With Forwarding Address Information

1. Sort all returned patient mail to identify any returned mail with Forwarding Address
   Information.

2. Locate patient on the system and update their existing address information. See
   How2 Edit Registration.

3. Request a new patient statement. See How2 Demand A Patient Statement.

4. Indicate the change of address in the General Comments.                          See How2 Enter a
   General Comment.


Without Forwarding Address Information


1. Locate patient on the system and attempt to contact the patient using the home and
   business telephone numbers.

2. Request new address information from the patient upon contact and update the
   system accordingly.

3. If the patient telephone contact information is not valid, use the Online Eligibility
   system to verify the patient address.




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 III. C. Bad Addresses                                  Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor

                                                        Page 2 of 2                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004; 9/27/2004


4. Update the system with any new address information obtained from the Online
   Eligibility system.

5. Request a new patient statement.

6. Indicate the change of address in the General Comments.

No New Insurance Information Available

1. Change the FSC for all pending invoices on the account to FSC #7 Bad Address,
   only after all insurance companies have paid, the invoice balance is in a Self Pay
   FSC and all other methods of obtaining new address information have been
   exhausted.

2. Enter a comment indicating the bad address in the General Comments.




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 III. D. Entering Insurance FSC                        Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor
 Information
                                                       Page 1 of 2                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure that Insurance Financial Classes (FSCs) are entered and managed
consistently across all groups to ensure that patient insurance information is always
complete and current for efficient billing.

Policy & Procedure:

Financial Class Definitions

Insurance FSCs are high level insurance categories that direct patient billing processes
to particular insurers and allow us to segregate and track insurance activity for reporting
purposes.

Registration Level FSCs –

1. Registration FSCs are FSCs entered at the point of registration.

2. The list of FSCs stored at the registration level are accessed and shared across
   departments. For that reason, all registration FSC are non-assigned and do not
   assume any departmental elections to participate with a particular plan.

3. The registration FSC stores with it all of the FSC follow up information associated
   with that FSC, such as insurance company name and address or expiration dates.

Invoice Level-FSCs –

1. Invoice FSCs are applied at the time the charge information is being entered to
   create an invoice.

2. An invoice level FSC is correlated to a corresponding registration-level FSC to
   reference FSC follow up information.




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 III. D. Entering Insurance FSC                       Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor
 Information
                                                      Page 2 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

3. Based on rules set up in the FSC Default Table registration FSCs can be
   automatically transferred to a different more appropriate FSC based on certain
   elements of the invoice header such as group, provider, billing area, etc. The most
   common use of this set up feature is to automatically „flip‟ the FSC to an assigned
   FSC at the departmental level. For more details on this see the FSC Defaulting
   policy.

Entering FSC Information

Enter the following information when adding a new FSC to a patient registration on the
IDX system.

1. Insurance Name, Address and Phone Number

2. Certificate ID#, Group # and Plan information

3. The name of the Subscriber and Subscriber‟s Relationship to the Patient

4. The Effective Date of the insurance policy and/or future Expiration Date

5. Call the insurance company or use the Online Eligibility system to verify insurance
   eligibility.




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 III. E. FSC Defaulting                                Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 1                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

Provide a policy and procedure to govern the use of FSC Defaulting on IDX.

Policy & Procedure:

Based on rules set up in the FSC Default Table registration FSCs can be automatically
transferred to a different more appropriate FSC based on certain elements of the
invoice header such as group, provider, billing area, etc. The most common use of this
set up feature is to automatically „flip‟ the FSC to an assigned FSC at the departmental
level.

1. Only use group-level FSC defaults in cases where all providers in the group
   participate with a particular carrier.

2. Use other criteria such as Division, Billing Area, Location, etc to set up FSC Defaults
   by exception within a Department.

3. Print and review the FSC Default tables set up in your department quarterly.

4. Direct any requests to update the FSC Default table to SPSG. SPSG maintains the
   FSC Default table and is responsible for making all requested updates.




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 III. F. Deactivating/Deleting FSCs                    Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 1                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure all FSC information is consistently managed and obsolete insurance data is
retained or discarded as necessary to expedite billing.

Policy & Procedure:

1. Insurance FSCs and their detail should not be deleted from registration unless the
   registration FSC that was identified is inaccurate, and the error was identified on the
   same day it was registered. The ability to delete an insurance FSC is restricted to
   Managers and Supervisors.

2. Use the Expiration Date field to indicate that a patient‟s insurance policy has expired.
   The date entered should contain the true expiration date of the insurance contract.

3. When a registered insurance FSC is incorrectly identified, and no longer meets the
   criteria for deletion, then the effective and expiration date of 07/01/93 should be
   entered.

4. Use General Comments to document any changes in registration. Enter comments
   in chronological date order.

5. For complete instructions on this policy and procedure please refer to our How2
   Delete/Deactivate a FSC.




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 IV. A. HIPAA Privacy                                  Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 1                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

Educate patients about our HIPAA Privacy Policy and track this on the IDX system.

Policy & Procedure:

1. Provide each patient with a copy of the Notice of Patient Privacy (NOPP) if there
   is no indication that one is already on file.

2. Complete the NOPP field indicating whether or not the patient was given the
   document.

3. Indicate the date given.

4. Indicate “Y” if the patient acknowledged receipt of the notice.

5. Indicate if an original signed document was placed in the patient‟s medical record.

6. Enter the exact location of where the document can be retrieved along with your
   user initials.

7. Date and indicate any additional comments and file this information on the system.




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 IV. B. Workers Compensation & No                    Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor
 Fault Patients
                                                     Page 1 of 1                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure that the proper information is collected and filed on the system for services
covered by workers compensation and no fault arrangements to expedite billing and
payment.

Policy & Procedure:

1. Establish whether a patient‟s services are covered under a Workers Compensation
   or No Fault arrangement and indicate this on the CAI form when scheduling the
   appointment.

2. Obtain and enter the following insurance information for all workers compensation
   and no fault cases:

    a. Name/address of the insurance company responsible for an injury related case
    b. Claim, File or Policy Number
    c. Date of Injury (or Accident)
    d. State, if an Auto Accident
    e. Case Manager with Phone Number

3. Create a case in the IDX system and enter the following and enter the following
   insurance information for all workers compensation and no fault cases:

    a. Generate Case Number
    b. Select Case Type
    c. Enter a Case Description
    d. Indicate appropriate Worker‟s Compensation or No Fault FSC
    e. Enter any required authorizations




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 III. D. Arriving Patients                             Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 1                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure the proper disposition of patients to reconcile patient services and accurately
reflect visit statistics.

Policy & Procedure:

    1. Check patient in when they arrive for their appointment. The following tasks are
       performed during the check-in process:

    2. Verify registration information. Make any changes to demographic or insurance
       information on the system. Print a new Facesheet and place it in the chart.

    3. Verify the Pre-Appointment work-list is completed and that:

        a. The patient‟s insurance is verified and valid for the visit.
        b. Any referrals needed are on file and entered into the system for tracking.
        c. There is a HIPPA Privacy Notice on file for the patient.
        d. The Medicare Secondary Questionnaire and Advance Beneficiary Notices are
        completed, if necessary.
        e. Patient co-payments are collected.
        f. Outstanding patient balances are collected and posted to the system.

    4. Arrive the patient on the system.

    5. Print an encounter form.




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 IV. E. Transaction Editing System                      Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor
 (TES)/Ingenix Edits
                                                        Page 1 of 2                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure for using the Transaction Editing System (TES) and
Ingenix Coding Enhancement Modules to capture and edit charge information on IDX to
ensure prompt and accurate billing of claims. The TES system is a charge suspense
system that captures any available charge data to create a pre-invoice until all
necessary data elements for billing can be obtained. Ingenix edits „scrub‟ claims data
prior to submission to the carrier for coding compliance and other billing requirements.

Policy & Procedure:

TES Edits

1. Enter all charge capture information into the TES system.

NOTE: Effective October 1, 2004 all new groups are required to enter charges using TES
instead of the Charge Entry Function. All existing groups will be required to migrate to TES as
they participate in the Clinical Revenue Initiative.

2. All TES users are required to attend a training class before access to this module is
granted.

3. Department is responsible for designing their individual work files. SPSG will provide
sample criteria and recommendations during installation.

4. Department is responsible for establishing a procedure for workfile compilation.
SPSG will perform extractions nightly.

5. Department is responsible for reviewing workfiles and TES Management Reports
daily to ensure that edits are being cleared in a timely fashion.




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 IV. E. Transaction Editing System                   Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor
 (TES)/Ingenix Edits
                                                     Page 2 of 2                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004



Ingenix Edits

1. SPSG is responsible for managing the set up of Ingenix edits. Department input on
new edits should be directed to their SPSG Project Manager.

2. SPSG prints weekly information edits for the departments.

3. Departments are responsible for working these edit lists. All Ingenix edits are
information-only and will not prevent a claim for being submitted to the carrier.




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 IV. F. Charge Entry                                            Approved By:                   Approved By:
                                                                Kathleen O’Donnell             Michael O’Connor

                                                                Page 1 of 2                    Effective Date:
                                                                                               01/01/2005
                                                                Policy Number:                 Revision Date:

Draft of 9/10/2004; Revised 10/1/2004

Objective:

To ensure that charge capture information is entered into the system in a timely and
consistent fashion across departments to prevent delayed or lost opportunities for billing
these services.

Policy & Procedure:

1. Copy of the printed Encounter Form should contain a CPT code, and ICD-9 code
   and the physician‟s signature.

2. All pre- and time of service payments are batched with a control total, and posted in
   the system along with the charge.

TES Charges

1. Enter all charges into TES. Corrections may be made in TES to only those
   encounters, which have not yet extracted to BAR. Erroneous encounters need to be
   deleted prior to extraction.

2. Contact SPSG to force extraction of encounters with edits, but this function can only
   be performed by Managers.

3. Contact SPSG to delete TES batches without any extracted encounters.

BAR Charges

1. All clean encounters, regardless of the TES batches from which they originated,
   create a single BAR batch per group per extraction. Never delete a BAR batch
   which was created by TES.




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 IV. F. Charge Entry                                            Approved By:                   Approved By:
                                                                Kathleen O’Donnell             Michael O’Connor

                                                                Page 2 of 2                    Effective Date:
                                                                                               01/01/2005
                                                                Policy Number:                 Revision Date:

Draft of 9/10/2004; Revised 10/1/2004



2. Delete erroneous invoices from open BAR batches prior to night job processing.

3. Correct charge errors once the BAR batch has closed using Charge Correction. The
   rules for charge correction are as follows:

        a. Charge correction is an activity that creates a cancellation invoice for the old
           charge and a new corrected invoice. As part of the process, the system
           automatically places both the old invoice and the cancellation invoice into
           FSC 888 (Charge Correction). Users should never transfer either the
           canceled or the cancellation invoices out of FSC 888.
        b. Always provide a reason in the comment field when performing a charge
           correction and file the necessary documentation to justify the correction.
        c. Charge Corrections done prior to first claim form generation completely nullify
           the original invoice. There is no down-stream impact from this.
        d. Charge Corrections performed subsequent to claim form generation may
           create payment posting issues. To prevent this electronic remittance is
           programmed to edit for insufficient balance, which allows it to find the new
           invoice during the reconciliation process. Payments posted to the canceled
           invoice result in erroneous credit balances.
        e. If a charge must be corrected subsequent to payment posting, all payments
           must be first reversed using the same pay-code. After the charge correction,
           the payments must be reposted making the new invoice exactly reflective of
           what was done. If one of the paid lines has been removed, a credit balance
           will occur until a refund can be made.

4. For more information see How2 Enter Charges and How2 Charge Correct.




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 IV. G. Charge Interfaces                               Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor

                                                        Page 1 of 1                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure for managing automated charge interfaces between
the IDX system and other charge capture systems.

Policy & Procedure:

NOTE: Effective October 1, 2004 all new requests for charge interfaces are accommodated
with a TES Charge Interface which transmits all incoming data directly into the TES system.

SPSG loads any incoming files from outside systems on a daily basis and provides the
department with a daily error log.

The Department is responsible for:

1. Reviewing the error log daily.

2. Reconciling the error log with TES batches created on IDX to compare the number
   of all filed and non-filed records received from the sending system.

3. Manually entering any records not filed by interface because of a:

    A. Missing or duplicate MRN.
    B. Locked account being accessed by another system or user.

4. Notifying SPSG of any problems or discrepancies with the TES Charge Interface.




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 IV. H. Payment Posting                               Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure that all payments and rejections are posted into the IDX system properly, all
batching and balancing of payments received must be completed at the end of each
business day and reconciled to the IDX System.

Policy & Procedure:

Front End:

1. Post all Time of Service Payments in a timely manner with the proper Front Desk, or
   TOS Paycode.

2. Provide patient with a carbon receipt acknowledging payment.

3. Provide Self-Pay patients with any necessary claim forms or copies of encounters
   for personal claim filing/reimbursement.

4. Batch and balance payment using the same process described below for Back End
   payments.

Back End:

1. Enter all payments and/or insurance rejections in the system within 24 hours of
   receipt.

2. Create a control total prior to opening the batch, by added up the total of the checks
   to be posted. Enter this number into the batch to ensure that payments posted
   balance to the figure.

3. Create a batch with a corresponding bank deposit dates and control totals.

4. Identify payments and rejections with the appropriate payment code identified, for
   example lockbox vs. check). The invoice FSC must be in the FSC associated with



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 IV. H. Payment Posting                              Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor

                                                     Page 2 of 2                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004
    the paycode. When secondary payments arrive before primary payments the FSC
    must be flipped to the secondary and then back to the primary.

5. Post all transactions on the line item payment-posting screen, wherever possible.
   Payment reversals must also be done at the line level.

6. Prior to closing of the batch, single transactions or entire batches may be deleted.
   Subsequent to closing, all errors must be reversed using the same pay code as that
   originally used.

7. Identify the approved amount, deductible, coinsurance, copay, and payment amount
   in the corresponding fields.

8. Verify that the invoice balance is accurate, identifies the check number in which
   payment or rejection has been processed and that any remaining invoice balance is
   transferred to the next appropriate Insurance FSC in the patient‟s FSC list.

9. Process refunds for any credit balances resulting from an overpayment to an
   account.

10. For more information regarding Payment Posting see How2 Post Payments.




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 V. A. Identifying Missing Charges                   Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor

                                                     Page 1 of 1                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure to reconcile all visits in the IDX practice
management system to prevent lost or missing charges.

Policy & Procedure:

1. Print the Missing Charge List daily to track all unbilled appointments. The Missing
   Charge List contains all appointments that do not have corresponding charge record
   in the Billing System.

2. Locate encounter forms for all missing charges and enter a charge record into the
   billing system within 7 days of the appointment date.




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 V. B. End of Day Reconciliation                       Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 1                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure that visits for all scheduled and walk-in patients are processed appropriately
in the IDX system and that staff members accurately complete all required fields for all
patient visits by the end of each business day.

Policy & Procedure:

1. Status all patient visits in the system by the end of each business day as either
   Arrived, if they were seen or as No Show, if they never arrived.

2. All completed encounter forms should be reconciled with the list of Arrived patients.
   Locate any missing encounter forms to ensure timely charge entry.

3. Enter a Referring Physician Name, Prior Authorization Number and/or a Referral
   attached to “Arrived” appointment if these are required to bill for the service.

4. Create a corresponding charge/invoice for all Arrived appointments in the billing
   system for all services posted at the time of service.

5. Balance, print and close all batches that were created to prepare them for IDX night
   jobs processing.

6. Verify that there are no remaining appointments in Pending status on the system.




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 V. C. Downtime Preparation                            Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 2                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To continue efficient patient flow and reconciliation process in the event of an IDX
system or network downtime.

Policy & Procedure:

Downtime Preparation

1. Print Provider Daily Schedules for the next three business days and file them in a
   centrally accessible location. Refer to How2 Print Provider Daily Schedules.

2. Discard the existing Provider Daily Schedules on a daily basis and replace with
   updated schedules.

3. Print 100 blank encounter forms and store them in a centrally accessible location.


Downtime Procedures

Patient Encounters

1. Distribute Provider Daily Schedules and Encounter Forms to the appropriate staff in
   the practice areas.

2. Arrive patients and capture visit information using these documents until the system
   becomes available.

3. Manually complete the demographic portion of the Encounter Form for any new
   patients being seen for the first time and include the Appointment Number.

4. Enter any information captured on paper documents into the IDX system when the
   system becomes available.



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 V. C. Downtime Preparation                           Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 2 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Scheduling Appointments

1. Use the Registration Form to capture registration information.

2. Manually enter patient‟s name and appointment time on Provider Daily Schedule for
   any Walk In patients.

3. Make appointments for any patients that need to be seen within the next 3 business
   days using the Provider Schedule.

4. Inform patients that need to be seen after 3 business days, that the system is down
   and offer to contact them to schedule any future appointments.

5. Indicate patient appointment criteria on a blank form and contact them after the
   system has been brought up to schedule and confirm their appointment.

6. Input any new registration and appointment information and make sure that all
   appointments are in the correct status – e.g., Pending, Arrived, Canceled,
   Rescheduled or No-show once the system becomes available.




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 VI. A. Production Schedule                           Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 1                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To publish a production schedule of claims and statement production that allows for
timely creation and submission of these documents for billing and follow up.

Policy & Procedure:

1. Submission of all electronic claims submission is performed daily by SPSG.

2. Running paper claims daily and statements weekly is also an SPSG responsibility.

3. Printing paper forms and edit lists is done by the departments (unless other
arrangements are made for SPSG to print these documents).

4. Working claim form and statement edit lists is a departmental responsibility. For
more information on managing edit list see policies on Edit Lists and eCommerce Follow
Up.


For a detailed listing of production jobs run nightly, see Production Schedule.




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 VI. B. Edit Lists                                      Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor

                                                        Page 1 of 1                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure that all claim form edits are worked proactively to avoid delayed or non
submission of claims to payers or statements to patients.

Policy & Procedure:

Definition of an Edit

An edit is an error condition within the patient‟s account, which causes the account to
appear on a claim form or statement edit. There are two types of edits that appear on
the claim or statement edit lists:

       A “Fatal Edit” stops production of a claim form for an invoice or the production
        of a statement for an account
       A “Non-Fatal Edit” indicates that the claim or statement was produced but was
        missing some non-essential information.

Procedure for Working Edits

    1. Print edit lists weekly (or arrange for SPSG to print out these documents.)

    2. Resolve edits to ensure that all claims are cleared for submission within 7
       business days.

    3. Invoices with “fatal edits” that are cleared will be released in the next claim run. If
       a user needs to produce a claim prior to the next run, a claim can be demanded
       from IDX using the appropriate procedure.




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 VI. C. eCommerce Follow Up                           Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 1                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure that all claims passing through the eCommerce System are actively
managed by reviewing the status and performing necessary follow up daily.

Policy & Procedure:

Definition of eCommerce

eCommerce is a method of transmitting claims to certain insurance carriers. This
application also includes a web screen with edits available to the Departments
immediately after submission, allowing users to work rejections more proactively. This
application should be used in conjunction with IDX Edit Lists.

Daily Procedure
All Billing Managers and Billing Staff need to perform daily follow-up on all claims
submitted via eCommerce.

    1. Verify/validate status of claims by logging into the eCommerce system daily.

    2. Correct any discrepancies and/or problems.

    3. Work rejections within one business day.

    4. Monitor any potential discrepancies within the system and troubleshoot.

    5. Report any system high volume discrepancies to SPSG at (212) 342 – 0582.

For more details on how to use the eCommerce, see How2 eCommerce Guide.




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 VII. A. Automatic Payment Posting                    Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor
 Batches
                                                      Page 1 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a procedure for reconciling IDX receipts tapes processed with actual
payments received.

Policy & Procedure:

1. Print the Receipts Tape Edit List immediately after a payment tape has been
   processed. This report is a reconciliation of what was posted to the IDX system.

2. Reconcile all check received from Medicare and Medicaid with their corresponding
   Receipts Tape Edit Lists. Contact SPSG immediately if the checks or totals do not
   match.

3. Compare the totals from the summary report to the payment batch totals.

4. Verify that there is a corresponding check received from the payer and posted to the
   clinical fund for every receipts tape posted. If the check has not been received and
   the remittance has posted it is the responsibility of the department to follow up with
   the payer form receipt of the check.




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 VII. A. Automatic Payment Posting                      Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor
 Batches
                                                        Page 2 of 2                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004



5. Maintain a spreadsheet of all checks NOT received for which an electronic
   remittance has posted the payment.

6. Follow up with the payer if these checks have not been received within 30 business
   days. It is the responsibility of the Department to ensure all electronic checks are
   accounted for and received in the next fiscal period.

Processing Schedule

1. Medicaid Remittance Tape – arrive to SPSG on Friday or Monday depending on the
   schedule of United States Postal Service

2. Medicare Remittance Tape – arrive to SPSG on Wednesday via UPS.

NOTE: Depending on holidays and weather conditions, there will be delays on the delivery of
these tapes. If there is an extent delay, SPSG will notify the Departmental Billing Managers.




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 VII. B. Posting Rejection Codes                     Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor

                                                     Page 1 of 1                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

Record reasons for denials and/or rejections of transactions according to the carriers
EOB documentation. This allows accurate reporting of rejection trends and provides
more complete information for reimbursement analysis and rebilling.

Policy & Procedure:

Rejections should be posted daily using information from all EOB‟s and insurance
correspondence received from the carriers, as well as from A/R Follow-Up.

For more information on posting rejections into BAR Payment Posting, please refer to
the How2 Post Rejection Codes.




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 VIII. A. Reconciliation of IDX                         Approved By:                   Approved By:
                                                        Kathleen O’Donnell             Michael O’Connor
 Payment Batches to Banking and
 FAS Records                                            Page 1 of 1                    Effective Date:
                                                                                       01/01/2005
                                                        Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To provide a daily record of all payment postings to the IDX billing system in order to
reconcile the system with banking and FAS records.

Policy & Procedure:

1. Create a daily log of all posted activity in IDX and send it (electronically or via fax) to
   the appropriate department business manager.

2. The Billing Manager or Supervisor will reconcile billing system postings with bank
   activity and non-bank activity (such as IDIs, Global Payments, and refunds from
   other departments that do not go through the bank but are recorded in the financial
   accounting system).

3. Complete the reconciliation of these postings to the bank statement and FAS. Refer
   to this Posted Funds Log for evidence that a posting has occurred.

4. Enter the IDX batch numbers (or other billing system identifier) on a separate bank
   log.

5. Indicate when/whether they locate a posting among bank activity or FAS.

6. Use the “Business Manager Confirm Receipt” column for a physical checkmark by
   the business manager. If this is completed daily, it will create an easy reference for
   the business manager to identify which postings have/have not been received in the
   bank or in FAS.




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 VIII. B. Control Accounts for                        Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor
 Undistributed Deposits
                                                      Page 1 of 1                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To develop a policy and procedure to track Unidentified or Undistributed payments that
have been collected and deposited, but not yet linked to a service rendered by a
specific provider because of insufficient information or a delayed electronic remittance.

Policy & Procedure:

1. Deposit and post all unidentified monies received by departments into the IDX
   system.

2. Use the following account to track and report unidentified payments.

                        Patient Name: CU,UNIDENTIFIED PYMT
                                IDX MRN: IDX02369995

3. Create at least one invoice per month in each department to identify the receipt
   month of unidentified/undistributed payments.




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 VIII. C. Payment Corrections &                     Approved By:                   Approved By:
                                                    Kathleen O’Donnell             Michael O’Connor
 Adjustments
                                                    Page 1 of 1                    Effective Date:
                                                                                   01/01/2005
                                                    Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To ensure that a daily record is created for all payment corrections and adjustments
made to the IDX system as part of sound financial accounting practices.

Policy & Procedure:

1. Reverse all Payments and Adjustments using the same paycode(s) as the paycodes
   used in the original invoice.

2. If moving Payment to another account, repost the payment/adjustment to the
   appropriate invoice.

3. The IDX payment batch payment/adjustments should always equal to $0.00 when
   transferring from one invoice to another.

4. Attach proper documentation such as copies of checks and reason for
   reversal/transfer to the batch proofs.




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 IX. A. Write Offs                                     Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 1                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

Periodic Write Offs of aged accounts receivable and bad debt will be performed
routinely on the IDX System to ensure timely account follow up and more accurate
accounts receivable valuation.

Policy & Procedure:

1. Write off active accounts receivable at the time of collection placement.

2. SPSG will attach an IDX variable indicating that they have been outsourced for
   tracking these accounts.

3. Place any accounts withdrawn from the scheduled referral by the department in the
   FSC Accounts Pending Department Review (FSC#481).

4. This FSC will be monitored by the CRO for write off resolution by the departments.

5. Write off other small administrative write offs as determined by the Department
   Administrator, using appropriate IDX write off codes (e.g. late filing, small balance,
   missing authorization/referral, etc.)




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 IX. B. Outsourcing                                      Approved By:                   Approved By:
                                                         Kathleen O’Donnell             Michael O’Connor

                                                         Page 1 of 2                    Effective Date:
                                                                                        01/01/2005
                                                         Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To maximize reimbursement, Accounts Receivable must be followed up on proactively
and routinely referred to outside agencies when outside expertise or staffing is required
to assist in account adjudication.

Policy & Procedure:

Placement of Delinquent Insurance Balance

1. Delinquent accounts with insurance balances will be placed with an outsourcing
   agent based on the following criteria:

                 Accounts (assigned non-statement producing) must have a last submit
                 date greater than 90 days.
                 Invoice balance must be equal to or less than $500.

2. All invoices will be assigned an IDX variable for tracking activity.

3. Accounts being worked by an outsourcing agency must be re-billed on the IDX
   system to ensure utilization/correction of all enrollment data and claim form logic as
   new information becomes available. This prevents errors in billing and payment
   deposit arrangements in place with our third party payers.

4. The placement of accounts will be coordinated during the middle (15 th) of the month
   to avoid delays with the IDX month end processing.

5. Write off of the accounts will be coordinated at the request of the placement agency,
   and the department‟s approval.




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 X. B. Outsourcing                                     Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 2 of 2                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Placement of Delinquent Self Pay Balance

1. Delinquent accounts with Self Pay balances will be placed with an outsourcing
   agency based on the following criteria:

        The patient is at a minimum dunning level of two, and has received at least two
        previous statements and one a collection referral notification letter.
        Invoice must be in statement producing financial class with a balance of less than
        or equal to $700. (Radiology $500)

2. Accounts, including those with any unassigned statement producing FCSs, will be
   automatically flipped to a pre-collection financial class (FSC#480) after two dunning
   statements have been processed.

3. The invoice will be placed in a non statement producing status to cease statement
   production.

4. Accounts will remain in this FSC for 30 days at which time departments may review
   the accounts.

5. Accounts will be written off the active accounts receivable at the time of placement,
   following the above 30 day review period.

6. An IDX variable will be attached to these accounts for tracking.

7. Any payments posted after this point will recognized as a recovery from delinquent
   accounts.

8. Any accounts withdrawn from the scheduled referral by the department must be
   placed in the FSC Accounts Pending Department Review (FSC#481). This FSC will
   be monitored by the CRO for write off resolution by the departments.




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9. Two agencies will be used in accordance with Internal Audit recommendation. An
   alpha split (A-L and M-Z) between agencies will be coordinated to avoid patients
   being called by multiple agencies minimizing confusion.




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 X. A. Daily Reports                                  Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To provide a policy and procedure for managing the daily reporting tools available in
IDX.

Policy & Procedure:

Daily Report Definition

IDX Daily Reports summarize the activities that took place in the system on the previous
day. The reports enable the audit and balance of the transactions entered into the
system on a daily basis.

DAILY CHARGE LIST
Lists the charges entered on the previous day by order of patient name.

DAILY CASH LIST
Itemizes payments deposited for a range of bank deposit dates. Payments are listed by
patient and invoice number.

CURRENT PERIOD‟S TRANSACTION SUMMARY
Summarizes all transactions such as charges, payments, adjustments etc… for the
month up to the present date (does not include information about batches on hold).

DAILY BATCH SUMMARY
Summarizes all transactions for individual batches from the previous day.

DAILY CREDIT BALANCE REPORT
Lists invoices with credit balances, total number of credit invoices and total amount of
the invoices.

INVOICE MOVE REPORT
Lists all invoices that were moved between patient accounts on the previous day.




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 X. A. Daily Reports                                 Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor

                                                     Page 2 of 2                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004



CURRENT PERIOD‟S ATB
Summarizes transactions by FSC and invoice age for the month up to the present date
(does not include information on batches on hold)

Production and Use of Daily Reports

1. Compile and print Daily Reports as needed (unless other arrangements have been
   made for SPSG to this.) For more information on how to produce daily reports see
   How2 Run Daily Reports.

2. It is recommended that the Department review Daily Reports each day to effectively
   manage their A/R and identify any operational issues.

3. Contact SPSG with any problems compiling and printing Daily Reports.




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 X. B. Month End Financial Reports                    Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 4                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To provide a policy and procedure for using Month End Financial Reports to effectively
manage A/R.

Policy & Procedure:

Month End Report Definitions

AGED TRIAL BALANCE (By All FSCs)
This report alphabetically lists patients with outstanding balances. It displays one
balance for every Financial Status Classification (FSC) by age and is typically produced
only once on demand to check receivable details against other reports.

AGED TRIAL BALANCE SUMMARY REPORT
This report provides a summary of receivables by age. It lists transactions by FSC and
invoice age.

SINGLE FSC AGED TRIAL BALANCE REPORT
This report lists outstanding patient balances for a single FSC by invoice age to identify
old outstanding receivables for follow up.

MONTH TO DATE TRANSACTION SUMMARY REPORT
This report lists the charges, payments, and adjustments for the month-to-date and
current month end. This report has both a daily and a month end version. The monthly
report summarizes activity by payment code for the month, or a preceding month if
printed at the end of the month. It is a month-to date report if printed the daily.




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 X. B. Month End Financial Reports                     Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 2 of 4                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

MONTHLY PAYCODE SUMMARY
The Monthly Paycode Summary lists accounts by payment codes. This report can be
produced for all or selected codes. Managers and supervisors can use this report to
monitor transactions related to a specific payment code, such as refunds.

ACTIVITY REPORT BY PROVIDER
This report is sorted by Provider and contains a list of patients and all of their
transaction information for a particular month. This report only lists patients that have
current activity. The transaction information that appears includes all current charges,
payments and adjustments posted to an individual account.

ANALYSIS REPORTS

 Income Analysis Report
 The Income Analysis report lists revenue and income by various dictionary
 parameters such as Provider, Division, or Location. Income Analysis Sub-reports,
 which are client-defined subsets of the Main Income Analysis Report. This report
 includes line item and non-line item payments.

 Payment Analysis Report
 The Payment Analysis Report lists payments by paycode, payment category, and
 procedure code, or other parameters that IDX set up on the system. This report only
 includes payments posted to the line item.

 Use this report to:
          Compare how much is collected against the charges and approved amounts
          Determine reimbursement rates for specific procedures




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 X. B. Month End Financial Reports                     Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 3 of 4                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

 Service Analysis Report
 This report shows services (procedures) and charges by month, quarter, or year.

 Collection Analysis Report
 This report shows the previous 12 periods with the percentage of outstanding
 receivables for each payment category within that period. It summarizes the total
 charges for each BAR period for reconciliation with payments and adjustments.

 Ratio Analysis Report
 This report lists the receivables by age and Financial Class (FSC). The Ratio
 Analysis helps identify weak collection areas and the amounts by insurance carrier.

 There are two percentages represented in this report.

        The first percentage represents the percentage of all receivables in the FSC for
        the period compared to the other FSCs at the same age.
        The second percentage represents the percentage of the remaining receivables
        for that FSC compared to the other aging categories.

 Production and Use

    1. SPSG compiles Month End Reports immediately after books are closed each
       month.

    2. Departments are responsible for printing their Month End Reports, unless other
       arrangements are made to have SPSG print these reports. For more information
       on how to print Month End Reports see How2 Print Month End Reports.




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 X. B. Month End Financial Reports                   Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor

                                                     Page 4 of 4                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004

    3. Review Month End Reports to effectively manage trends in their Accounts
       Receivable.

    4. Contact SPSG with any problems printing or to request changes to the Month
       End Reports.




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 X. C. Scheduling Reports                             Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure to understand and review key scheduling reports.

Policy & Procedure:

Daily Scheduling Reports

MISSING CHARGE LIST
The Missing Charge List contains all kept appointments that do not have corresponding
charges entered in the IDX Billing and Accounts Receivable System (BAR). This report
helps to eliminate lost revenue by immediately identifying any lost charges.

Scheduling Managers use this report to track down unbilled appointments.

NO-SHOW LIST
The No-show List contains the names of patients who failed to show up for their
scheduled appointment.

Scheduling Managers use the information on this report to contact patients who have
missed their appointments. Providers use this report to track which of their patients do
not come in for appointments.

Monthly Scheduling Statistics Reports

APPOINTMENT STATUS SUMMARY REPORT
Appointment Status Summary Report counts the status of all appointments on the
system during the period that the report is compiled. An appointment has one of the
following statuses: Arrived (ARR), Bumped (BUM), Cancelled (CAN), Pending (PEN),
No-show (NOS), Reminder (REM), and Rescheduled (RES).




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 X. C. Scheduling Reports                             Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 2 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

The Appointment Status Summary Report shows Scheduling Managers how their show
rate compares to their no-show rate. It allows them to isolate these totals by session
and by year, to chart trends in their patient population.

PENDING AND ARRIVED COUNT REPORT
The Pending and Arrived Count Report lists the total number of appointments on the
system that have a status of Pending or Arrived (PEN or ARR). It lists the appointments
by department and provider with totals for each.

Scheduling Managers use this report to create staffing schedules. It is typically printed
once per week to once a month. This report also gives a manager the total number of
patients seen (status of ARR) for a given day.

Production and Use

1. Print Daily Scheduling reports on demand and actively review and work them daily.

2. SPSG compiles Monthly Scheduling Statistics Reports immediately after books are
   closed each month. They are assigned to print out to a device in the Scheduling
   Department. These reports should be referenced monthly to proactively monitor
   scheduling trends.




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 X. D. Managed Care Reports                            Approved By:                   Approved By:
                                                       Kathleen O’Donnell             Michael O’Connor

                                                       Page 1 of 1                    Effective Date:
                                                                                      01/01/2005
                                                       Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure to monitor Managed Care reimbursement trends,
such as compliance with timely filing.


Policy & Procedure:

Definition of Managed Care Reports

UNBILLED OXFORD CLAIMS 90 + DAYS OLD
This report identifies Oxford Invoices that are 90 days old or greater that have not had a
claim sent to the carrier yet.

OXFORD TES UNBILLED 90 + DAYS OLD
This report identifies Oxford encounters still pending in the TES system that are 90 days
old or greater that have not had a claim sent to the carrier yet.

Production and Use

    1. SPSG is responsible for compiling and printing this report weekly for all
       Departments.

    2. These reports are distributed via Email to Billing Managers.

    3. Billing Managers should review these reports weekly to proactively identify any
       claims in danger of missing the 180 Day filing deadline with Oxford.




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 XI. System Access & Security                         Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 1                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a policy and procedure that ensures accountability for granting and deleted
all system access to the IDX system.

Policy & Procedure:

1. Access to IDX systems and related databases is not authorized until the user is
   trained on the applications, demonstrates proficiency and has completed the
   institution‟s HIPAA and ICA compliance training requirements.

2. No new access or changes or deletions to existing access will be made without
   completion of the System Access Request Form including signature by an
   authorized Department Administrator or Billing Manager.

3. Fax completed forms to SPSG at either (212) 342-0576 or (212) 342-0584.

4. Changes will be made after Shared Practice reviews and confirms the
   appropriateness and authorization of the request. Department will receive an
   acknowledgement when the change has been made, typically within 24 hours.

5. All requests will be processed within 1 to 2 business days contingent on the volume
   of requests and the completeness of the information provided.

6. Notify SPSG of any employee terminations within 48 hours of their termination date,
   using the System Access Request Form. IDX related licensing fees are billed using
   these records.




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 XII. A. New IDX Installation                         Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 1                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a procedure for loading IDX onto a new or existing workstation.

Policy & Procedure:

1. Complete the IDX Workstation/Printer Set-up Request form and have it signed
   by the appropriate Department Administrator or Manager. On the request, identify
   the workstation‟s location, contact person, and the telephone number.

2. Send or fax (342-0576) the completed forms to Shared Practice. The requests will
   be given to the Security Manager for authorization and will assign the appropriate
   person to install the software onto the designated computer.

3. SPSG will notify the Department Manager or Supervisor when the request has been
   completed.




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 XII. B. Report Requests                             Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor

                                                     Page 1 of 1                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a procedure for requesting new or ad-hoc reports.

Policy & Procedure:

1. Complete the Report Request form and have it signed by the Department
   Administrator or Manager to have a new or ad-hoc report created. On the request,
   identify the contact person and telephone number.

2. Send or fax (342-0576) the completed forms to Shared Practice. The requests will
   be reviewed by a Project Manager. An acknowledgment will be provided within 48
   hours with a time frame for completion.

3. SPSG will notify the Department Manager or Supervisor when the request has been
   completed.




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 XIII. C. Updating Fee Schedules                      Approved By:                   Approved By:
                                                      Kathleen O’Donnell             Michael O’Connor

                                                      Page 1 of 2                    Effective Date:
                                                                                     01/01/2005
                                                      Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

To establish a procedure for maintaining fee schedules and updating them annually to
reflect prevailing fees.

Policy & Procedure:

The fee schedules on the IDX system are maintained by either the CPPN office for
contracted fee arrangements or the individual departments to set their own charge
amounts. IDX NY Medicare and NY Medicaid fees are updating annually by the Shared
Practice Systems Group.

CPPN Managed Fee Schedules

1. The CPPN Office is responsible for providing the Shared Practice Systems Groups
   (SPSG) with updated fees on a global basis for all services on all contracted fee
   arrangements on an annual basis. Four weeks lead time for annual global changes
   is anticipated.

2. The CPPN Office is responsible for submitting all ongoing fee schedule changes and
   updates to the Shared Practice Systems Group in a timely manner, preferably, at
   least five business days before the effective date.

3. Use the Fee Schedule form to request changes to the fee schedule. For multiple
   changes to fee schedules, attach an excel spreadsheet or other document to one
   change request form authorizing the update. SPSG will provide notification in writing
   to CPPN and all groups when any changes have been made to these fee schedules.

Department Fee Schedules

1. Departments are responsible for managing their fee schedule charge amount for all
   services provided.




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XIII. C. Updating Fee Schedules                     Approved By:                   Approved By:
                                                    Kathleen O’Donnell             Michael O’Connor

                                                    Page 2 of 2                    Effective Date:
                                                                                   01/01/2005
                                                    Policy Number:                 Revision Date:


2. Departments must update their fee schedules at least once on an annual basis.
   Four weeks lead time for annual global changes is anticipated at the beginning of
   the calendar year.

3. Use the Fee Schedule form to request any changes to the fee schedule. SPSG will
   notify individual departments in writing when fee schedule updates have been
   completed.




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 XIII. D. Dictionary Changes                         Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor

                                                     Page 1 of 1                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective

To establish a procedure for requesting IDX dictionary changes to ensure proper
authorization and tracking of all updates.

Policy & Procedure

Use the following procedure to request an addition, change or deactivation to any
IDX dictionary.

1. Complete the form which corresponds to the dictionary to be updated. See System
   Access & Request Forms for a copy of all forms. If the request is a change,
   indicate the current value as well as the change to be made.

2. Have the form approved by the appropriate supervisor.

3. Fax the request to the SPSG at fax number (212) 342-0576 or (212) 342-7732.

4. Changes will be made after Shared Practice reviews and confirms the
   appropriateness and authorization of the request. An acknowledgement will be
   received when the change has been made.

5. All requests will be processed within 24-48 hours (contingent on the volume of
   requests and the completeness of the information provided.)




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 XIII. Reporting System Problems/                           Approved By:                   Approved By:
                                                            Kathleen O’Donnell             Michael O’Connor
 Downtime
                                                            Page 1 of 2                    Effective Date:
                                                                                           01/01/2005
                                                            Policy Number:                 Revision Date:

Draft of 9/10/2004

Objective:

Establish a procedure for user reporting of all IDX system problems and outages.

Policy & Procedure:

    1. Please report any possible IDX software problems or issues to the departmental
       supervisor.

    2. If the supervisor confirms the problem or issue, it should be documented and
       reported to the Help Desk at 305-4357 (5-HELP). If 5-HELP cannot resolve the
       issue, their office will contact Shared Practice with the following information:

             a. IDX Application (BAR, PCS, or SCHED)
             b. Activity being performed
             c. User‟s group
             d. IP address of terminal(s)
             e. Error message on the screen
             f. Batch #, if applicable
             g. Invoice #, if applicable


    3. Shared Practice will document on the problem or issue on their Issues Log for
       review.

    4. The issue will be reviewed and if software vendor intervention is required, it will
       be reported to IDX for resolution.




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 XIII. Reporting System Problems/                    Approved By:                   Approved By:
                                                     Kathleen O’Donnell             Michael O’Connor
 Downtime
                                                     Page 2 of 2                    Effective Date:
                                                                                    01/01/2005
                                                     Policy Number:                 Revision Date:

Draft of 9/10/2004


    5. Once the problem is solved, the supervisor will be contacted and informed that
       the problem has been corrected.




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