August 2007 Newsletter

An Event to Remember: Part 3

By: EDI Client Support Center Supervisor

Beginning in Summer 2006, I devised a glossary of terms to assist EDI clients with the occasionally confusing language we use at Quadax and in the healthcare industry. The three-part series of articles resumed in Winter 2007 and concludes in this issue, with additional terms intended to clarify any continuing misunderstandings.

VFTP Folder

Essentially, the location where “pending files” are kept, waiting to download to a client. This includes Response files, Remit files, and Updates files.

Response file/RESPONSE.ZIP

File containing the response to the claims submitted, including Quadax accepted and rejected responses, as well as payer rejections and responses, if available from the payer. Sometimes this file will be received multiple times per day.

Wednesday Update/Codetable Update

New edit procedures and software updates compiled and released on prescribed days, usually Tuesdays nights. As a client, it will effectively be Wednesday that you see what changes have been made.

Software Release/New Version

Working in the same manner as the weekly updates, major updates to Xpeditor are created that include new or expanded features. This type of release is done quarterly instead of weekly.

Remit Manage Utility/RMU

Quadax programmers developed a tracking program that will list the remittances received and processed as part of our remittance scraping. In a nutshell, if Quadax support personnel are able to find your remittance in this tracking program, we have received and initially processed the remittance you are expecting.

837 Outgoing File

The “outgoing” file of claims that Quadax sends to payers.

Control Number

Quadax assigns a Control Number to the outgoing file as an internal tracking mechanism. While this number is actually given to the payer as part of the outgoing 837, this is only an internal distinction.

Print File/Dropping a Print File

The claims file in which you send claims into Xpeditor. The process of loading this Print File is referred to as “dropping.” Print Files can be in several different formats, the two most common of which are ANSI and Print Image.

ANSI Print File

A data format in a “universal” and compliant format. Due to the standardized nature of this file, there is no mapping to be done; the data will automatically load into Xpeditor when dropped.

Print-Image File

A print file that “looks” like a claim form; that is, the layout matches the claim form appearance. Getting this claim information into Xpeditor requires mapping the print-image file.

Mapping

In order to get the data in the print file into a claim in Xpeditor, your file is “mapped.” Only print-image files are mapped; ANSI files are not. It is very important that your print-image file remain consistent because the Map is looking at specific lines and columns in your file to find the data you are expecting to populate the claim. If a change has been made, your claim will likely not load the way you expect and must be remade.

Filter

One of many programs that run “behind the scenes” of Xpeditor. Its job is to take your print file and break it up into its individual claims. As Filter runs and processes a print file, your claims will begin to load into Xpeditor, but will remain unusable and “locked” until the Batch Process runs.

Batch Process

Once Filter is completed, the Batch Process will take over and conclude the processing of claims in the print file. During the Batch Process, Quadax and Custom Converts will run, followed by any XpressBiller rules or converts. The claims will first be edited for errors during the Batch Process.

Ufile/Holding/Dropoff

Folder locations that print files can or will be passed through as part of the dropping process. If Filter, Batch Process, or mapping functions fail, your print file will usually be found in one of these locations. Which location your file is in gives Quadax representatives an idea of why your print file hasn’t loaded into Xpeditor.

Dup/Duplicate (Print File)

Print files that you attempt to drop are checked against previously dropped files for duplication. If Xpeditor and its background programs recognize a duplicate file, the new print file will not be dropped, as the claims contained have already been loaded.

QAServ

The root, or base, folder location for all Xpeditor files and folders. For Xpeditor Online clients, this is hosted on our servers along with the rest of their Xpeditor database. Xpeditor Enterprise clients maintain this folder on their Director PC. It is important that access to this folder is secured as inadvertent changes to its contents will adversely affect Xpeditor.

Communicator

Another background program of Xpeditor. Its job is to send and receive your files to the Quadax servers. This does not include print files, but released claims that are uploading to our servers and receiving the Response, Remittance, and Update files to your Xpeditor.

Citrix Xpeditor

Online clients connect from their workstations to our servers through Citrix. Technically speaking, Citrix is the company that developed the software (Client Presentation Server) allowing this connection. Xpeditor Enterprise clients will not use a Citrix connection to communicate with Xpeditor or Quadax servers.

Remit/REMIT.ZIP

The file compiled by Quadax that contains the remittance data. Each payer will be listed separately, allowing Quadax staff to confirm the payer’s remittance information.

Quick/Provider Setup

Our interface to the computer mainframe that does further processing of the claims before being transmitted to the payers. A major function of Quick is the entry of Provider and NPI numbers to our database. Without these numbers in the database, your claims will not be released.