Manage User Settings: Billing Roles and Permissions

The following roles and features should be assigned in accordance with your organization’s billing and utilization review (U/R) workflows.

Click here for full instructions on adding a new user to the Kipu EMR. 

User Roles For Integrated Billing

Every system in the Kipu suite has a different method of identifying and classifying user roles and permissions. Before we dive into each role granularly, let's get a broad understanding of how each product structures these roles.

• The CRM assigns users roles based on the scope of their workflow. The Limited Admissions Worker role is required for users to create patient records, enter insurance information, and complete eligibility checks used for integrated billing. Click here for information on roles in CRM.
• User roles in the EMR are broken down into four categories: Admin, Medical, Clinical, and Billing. Since we are reviewing user profiles related to billing, we will focus only on the Admin and Billing roles.
• User roles in the RCM have two categories: Admins and Users. Admin-level roles allow users to configure settings at each system level (Managing Organization Admin, Organization Admin, and Practice Admin). User-level roles are highly customizable and provide better control over what users can and cannot do.
• Similar to the RCM, CMD user profiles are categorized as Admin or User. Additionally, CMD has a third category used by 3rd-party billers known as Authorized Representatives. Authorized Representatives have the same permissions as admins but can access multiple organizations. For more information on creating users and managing permissions in CMD, click here.

Required Billing Roles - EMR

A Super Admin has the highest level of access in the EMR. In addition to configuring settings at every level, Super Admins can inherently perform all workflows associated with integrated billing.  For other users, the following roles should be assigned to users based on their required workflow.

Workflow	Required Roles/Permissions
Create and Edit Patient Charts (including insurance information)	Super Admin, Record Admins, Admins
Create U/R Plans and Send Demographic Information to RCM	Super Admin, Utilization Review Internal
Access Billable Report and Transmit Charges	Super Admin, Biller
Delete Batches	Super Admin, Records Admin

Recommended Assignments

We recommend granting the Records Admin, Biller, and Utilization Review Internal roles to each user who will be billing. This allows them to correct information on the facesheet, such as authorizations and insurance, update essential items like schedules and contacts, and submit data to the desired billing solution.

Note: Adding the Biller role together with other internal roles will prevent users from deleting forms in the Open status (as they normally would) unless they are also Super Admins or Records Admins.

Required Billing Roles - RCM

A Managing Organization (MO) Admin holds the highest level of access within the RCM. Like in the EMR, MO Admins can set up all configurations and carry out all workflows, often managing multiple organizations. Organization and Practice Admins have similar capabilities but are limited to a single organization. Since most of the patient's journey takes place in the EMR, user profiles in the RCM require two permissions enabled to complete tasks related to integrated billing. For details on creating and managing users in the RCM, click here.

Workflow	Required Roles/Permissions
Enter Insurance Info, Check Eligibility, Complete VOB	Admin-level users need no additional configuration. User-level profiles will need the Patient Access permission set to Edit.
Create U/R Plans	Admin-level users need no additional configuration. User-level profiles will need the Create U/R Plans permission set to Edit.

Helpful Hints

Click below to review some commonly asked questions!

• Yes! Users with Integrated Billing permissions can set their default landing page to Reports and their default Reports tab to the Billing Audit Tool, streamlining the login experience.
• Adding the Rendering Provider role enables the user to be selected as the ancillary provider on the billable report. Note that you must enter their NPI to prevent transmission errors.
• Super Admins can create and manage payer rules. Billers can view payer rules but cannot make changes.