Overview

Welcome to Barti RCM! We are thrilled to have you on board and look forward to providing revenue cycle management support.

This guide outlines our shared workflows, key best practices, and communication guidelines. Following these steps is the best way to ensure a smooth and successful partnership.

For all billing questions, please submit an RCM ticket

Contents

1. Communication Policy
2. System Setup
3. Your Team's Core Responsibilities
4. Payment Posting

1. Communication Policy: 

Emailing Barti RCM: To ensure your request is seen and handled in a timely manner, all billing-related communication must be sent to our shared inbox: rcm@barti.com. For urgent billing matters, please include “URGENT” in the subject line. 

• Please do not email individual RCM specialists directly. Using the shared inbox guarantees that your email is visible to our entire team, allowing for the fastest possible response and preventing delays if an individual specialist is out of the office.
• Barti RCM will confirm receipt of email within 1 business day. Inquiries that require further investigation may require 2 business days for a comprehensive response. 

Status Reports: You will receive monthly status reports from the RCM team.

Tasks in Barti: Any tasks from our team requiring additional details will be posted in Barti for your office to review and respond to.

Technical Support: For any technical issues or bugs with the Barti software, please submit a support ticket from the Help Center. 

Help Videos: We regularly update our help videos to reflect Barti’s monthly updates. View them at https://support.barti.com/.

2. System Setup

• Trizetto Implementation: 
  • Your Trizetto implementation rep will walk you through the process of setting up your enrollments in Trizetto. Please begin enrolling your insurance plans promptly. This step is critical for timely payments and ERA receipt. Regularly check your enrollment portal to stay on top of pending tasks. Enrollments are the responsibility of the practice.  
  • Trizetto will send automated emails alerting you of outstanding enrollment tasks. The subject line for these emails typically start with: Reminder: TriZetto Provider Solutions, LLC enrollment for ORG NAME
• Insurance Portals: If our team requires access to specific insurance portals for eligibility or appeals, we will inform you.
• Payer List: If you would like to restrict the payer ID dropdown in Barti to only the payers accepted by your practice, here is a helpful video walking through the setup.

3. Your Team's Core Responsibilities (Front Desk & Checkout)

A clean claim starts with a precise front-desk workflow. These steps are critical for us to process your claims quickly and accurately.

A. Insurance & Referral Verification (Before Every Visit) This is the most important step in preventing billing issues.

• Adding Patient Insurance to Patient Profile: We recommend searching by payer ID; it is the office's responsibility to ensure that the correct payer ID is chosen and the member ID is entered correctly. You may opt to restrict the payer ID list in your organization if you prefer. 
• Verify Coverage: Always obtain a new insurance card during each visit and verify the patient's coverage.
• Scan Both Sides: Please scan both the front and back of the insurance card and upload the image to the "Files" section of the patient's profile.
• Check Participation: Confirm that your practice is participating in the specific plan the patient holds.
• Determine Referral Needs: It is critical to determine the need for a referral before the patient’s visit. Insurance companies are unlikely to approve referral requests retroactively.
• Be Specific with Carriers: When calling an insurance company, clearly communicate the exact nature of the visit (e.g., medical exam vs. routine exam) and the provider they will be seeing.
• Understand Referral Documents: A valid referral is not just a note from the PCP; it is a formal authorization from the insurance carrier. It must include a reference number, the number of approved visits, and effective dates.
• Document Everything:
  • After confirming eligibility and referrals, scan the printout or documentation into the patient’s account.
  • When confirming by phone, always get a reference number and the name of the representative you spoke with.
• Final Responsibility: Please remember that the responsibility lies with your office to ensure compliance. Information from insurance reps is not a guarantee of payment. Thorough documentation is your best defense.

B. Creating Claims At Checkout To ensure all claims and payments are correctly linked to their services, you must create claims directly from the invoice.

• Always Create Claims from the Invoice: Do not create claims from the main "Claims" table.
• How it Works:
  1. On the patient's invoice, designate the "Insurance Responsibility." (By default, it will say "No amount owed by insurance.")
  2. Once insurance responsibility is set, a button to create the claim will appear directly on the invoice.
  3. If the patient has no insurance on file, Barti will prompt you to "Add Insurance." After adding it to their profile, you can return to the invoice to create the claim.

C. Vision Claim Submission: The Barti RCM team does not scrub and submit vision claims for exams or material claims. The Barti RCM team does not handle Accounts Receivable (AR) for vision payers. 

4. Claims Management (The RCM Handoff & Process)

This is how claims move from your team to ours for processing.

• "Draft" Status = Not Ready: Please note that claims in "Draft" status are considered incomplete and will not be reviewed or submitted by the RCM team.
• "Hold" Status = Ready for RCM: Once your team creates a claim from an invoice and marks its status as "Hold," it signals our RCM team to begin processing. Our Billing Specialists will then review, scrub, and file the claim.
  • Once a claim is in "Hold" status, it becomes our responsibility. Claims are typically processed within 2 business days of being placed on "Hold."
• Denials & Rejections: If a claim is denied or rejected, our RCM team is responsible for promptly addressing the issue. We review and work on all denials and rejections weekly, and all actions taken will be documented in the patient’s internal claim notes. If additional information is needed, our team will reach out to your office.
  • If additional information is required from the office, we will add a task for the primary RCM contact at the office. Tasks to Barti RCM will be addressed within 2 business days. 
  • If a claim has been resubmitted in Trizetto, we will add an internal note to the claim. Internal notes can be viewed from the claims table and from each specific claim. 

5. Payment Posting

• Paper Remits (EOBs & Checks): We have created a dummy patient in your system named "Bill Billings." Please scan and upload all paper documents (e.g., paper EOBs, patient checks, insurance correspondence) to the "Files" section of this profile. We check this file weekly, so there is no need to notify us.
• Electronic Remits (ERAs): Our billing team will post all electronic remits directly from the Trizetto Clearinghouse on a weekly basis.
• Patient Responsibility: After insurance payments are posted each week, any patient responsibilities (deductibles, coinsurance, etc.) will be applied. You can confirm this update by viewing the patient balance reflected on the invoice.
• Posting Grace Period: We allow a five-business-day grace period each month to finalize payment postings and address prior-month denials. (For example, January’s postings will be completed by February 5th).

Additional Notes:

• It is the responsibility of your office to respond to requests for additional information in a timely manner to prevent claim delays or denials.
• Communication regarding claim issues will be sent to the designated contact(s) provided by your office. Please ensure this contact is kept up to date.
• Barti is not liable for delays caused by third parties, including but not limited to insurance carriers, clearinghouses, or system outages.
• RCM is not a 24-hour service and will be available during normal business hours.
• Claims with Date of Service prior to RCM commencement date will be the sole responsibility of the practice

• RCM charges will be due upon commencement of your Barti Contract; RCM commencement and RCM Go-Live dates may differ

Thank you for choosing Barti RCM! We’re committed to supporting you every step of the way.