GoRev Integration with WaveHDC
As of GoRev 2024.04.23 GoRev now supports an integration with WaveHDC to support automated insurance discovery. The WaveHDC system can be utilized to discover coverage for patients where you may not have obtained any coverage at time of service.
Automated routines can be configured to check for coverage on historical patient sets.
As needed runs can be executed via the eligibility screen within GoRev.
More can be read about WaveHDC here: https://www.experian.com/blogs/healthcare/experian-health-brings-waves-ai-claims-technology-to-more-hospitals/
Note: You will need to submit a ticket to GoRev to request activation of this integration.
Granting Permissions To WaveHDC
In order for your users to access the Find Coverage button they will need to be granted the WaveHDC permission. This will grant a user the ability to perform individual coverage detections.
NOTE: Grant this to specific users as each Find Coverage run may incur costs with WaveHDC
Single Account Coverage Discovery
This process can be run as needed and will not be blocked by any other configurations in place for the WaveHDC integration.
Important: Users must be assigned the permission WaveHDC in order to access the Find Coverage button specified in the process below.
From Patient Overview click on Eligibility
Click Find Coverage
GoRev will then initiate the request via API to WaveHDC. Processing time can take between 5 seconds and 20 seconds.
If coverage is found you will be presented with a Found Coverages popup with a list of all coverages found. The type of coverage is specified at the top of the form (Primary, Secondary, Tertiary). By default clicking Apply Selections will import all insurance coverages found and make them active on the visit in GoRev.
Deselect specific coverages you do not want to import prior to clicking Apply Selections.
The Eligibility Status will change Green when Active insurance coverage is found. Proceed with normal Collaborative Insurance Group Management (CIGM) & Real Time Eligibility processes.
If no coverage is found you will be presented with the following UI.
Automated Coverage Discovery
Automated coverage discovery can execute the WaveHDC process on selected insurance carriers and ranges of claims by dates of service.
From Insurance Carrier Management select the Carrier you want to activate Auto Coverage Discovery on, scroll down on the left, and toggle the box as shown below.
The following settings will be configured during your implementation with WaveHDC
Setting | Default | Purpose |
WaveHDC_ClientMnemonic | Required WaveHDC credentials to connect. Provided by WaveHDC during onboarding. | |
WaveHDC_Password | Required WaveHDC credentials to connect. Provided by WaveHDC during onboarding. | |
WaveHDC_Password | Required WaveHDC credentials to connect. Provided by WaveHDC during onboarding. | |
AutoCoverageDiscovery | False | True will activate WaveHDC to automatically check for insurance coverage on qualifying accounts. |
AutoCoverageDiscoveryIncludeNoPayerVisit | False | Set True if you want the WaveHDC system to attempt coverage discovery on patients marked self pay within GoRev. |
AutoCoverageDiscoveryMaxAge | 30 | Restricts how far back the WaveHDC automatic insurance discovery process can run by admit date |
AutoCoverageDiscoveryMaxAttempts | 20 | Sets how many accounts the WaveHDC automatic insurance coverage detection system can run on per maintenance run. Used to control API request volume. |
WaveHDC_TestMode | True | True indicates the WaveHDC system is in test mode and will return test mode patient details on each run. Must be set to False in order to turn the system on into Production mode. |
WaveHDC_SetFollowUpStatus | Coverage Review | WaveHDC sets this followup status when coverage is found. Use this key to specify a different follow up status to apply. |
When Coverage is found via the automated discovery process the GoRev system will apply a follow up status equal to what is configured in WaveHDC_SetFollowUpStatus. It will also set a follow up date of today. This work queue can then be used by your billing team to review all accounts where coverage was found.
Note: ALL coverages found during automated discovery will be automatically applied to the patient's account
Reports Bulk Actions can be used to file new claims in bulk directly from this report by sending them to Coding Review. Or you can set each individually to Coding Approved as needed after your review of coverage found.
GoRev Support Team
If you have any questions, concerns, or problems regarding this GoRev Tutorial, please contact the GoRev Support Team by submitting an IT Support Ticket, by phone at 1-(317)-794-3900, and/or by email at ask@gorev.com.
Note: If possible, always submit an IT Support Ticket detailing any problem that you are experiencing within GoRev. This will give GoRev Support Agents access to additional information that will help expedite the resolution of your issue. If you are unsure how to submit an IT Support Ticket in GoRev, please see theIT Support Ticket Creation for assistance.