1. Office purchases and installs SOAPware Clinical Suite and signs up for the following training sessions in exact order:

         A.  SOAPware Billing Setup

         B.  Transaction Entry and Workflow

         C.  Claims Processing

2. Office contacts Gateway EDI (GEDI) and signs a contract with Gateway.  (Note:  This can happen before installing SOAPware CS.)

3. Office completes SOAPware master setup and begins practicing with the software in preparation for live use.  (Note:  This step can be done in conjunction with the steps shown below.)

4. GEDI will contact the Office to complete a Provider Enrollment online.  GEDI will request provider ID numbers and Master Insurance List (MIL) from Office; provider enrollment process will begin within two days of signed contract.

5.  GEDI will generate the Enrollment packet, and the Office is given payer enrollment packet to complete.

6. Office returns enrollment packet originals to GEDI and production date is estimated based upon projected payer approval time frames.

Estimated average payer approval times, (by state), can be viewed on the attached spreadsheet.

The Office can begin sending commercial claims as each payer approval is granted, followed by governmental approvals.)

7. GEDI verifies accuracy and forwards payer enrollment agreements to Carriers.

8. GEDI contacts Carriers to obtain approval dates and records dates on addendum.

9. BCBS, Medicare, and Medicaid payer approvals are obtained.  The training packet, which includes a copy of the Providers Addendum (list of Provider ID numbers and payer approvals), training CD, and MIL is sent to the Office.

10. GEDI will contact the Office to schedule an "install appointment."  

IMPORTANT:  BEFORE scheduling install appointment with GEDI, the Office MUST have attended and completed the training sessions listed in #1 above AND have completed setup of SOAPware system.

HIGHLY RECOMMENDED:  When the Office is ready to send the first live claim file, (with real patient claims), SOAPware recommends that the office use a one-on-one training session to provide assistance from SOAPware PM experts for this first filing.  A SOAPware representative will inspect the setup of the system to ensure everything looks correct, and will also assist the Office with creating, scrubbing and troubleshooting the first claim file.  SOAPware will also help the office prepare for their setup call with GEDI.

11.  Office sends first file with live claims to GEDI; file is tested (two day turnaround) before GEDI production begins.

12.  Once the Office is installed and is sending claims, the Office will be contacted to schedule initial report training.

13. Report training is completed.

14.  Two weeks after production begins, a second report/web training is offered to the Office.

15.  Two week-stage web training is completed.

16.  Each office is assigned to a GEDI New Accounts Rep who will monitor their claims for first 30-60 day period in production to ensure that the claims acceptance rate is above 85%.

17.  Office may request additional phone training with GEDI and/or call/email with Support questions at any time.

18.  GEDI Customer Service will work with the Office to correct any errors on claims submitted. GEDI will always be available for any insurance questions, or other questions about the reports or errors.  Anything related to the generation of claims files or errors on the software side will be handled by SOAPware Tech Support via www.soapware.com/ticket

NOTE: For an estimate on the average amount of time it will take to get approvals with the payers in your state, please see the attached Excel spreadsheet.

PLEASE NOTE THAT THIS TIME ESTIMATE BEGINS AFTER GATEWAY HAS RECEIVED YOUR COMPLETED PROVIDER ENROLLMENT PAPERWORK.  

To help expedite the setup process, Office should submit completed GEDI enrollment forms as soon as possible.