Service Detail Section

Enter service details.

1. In the Claim Service Detail History table, click Add. The Procedure Code Type field populates with CPT Code.

2. In the Type Of Service field, select Inpatient or Outpatient as appropriate.

3. In the Date Of Service field, enter the service date.

4. In the Procedure Code field, enter the procedure code.

5. In the Diagnosis Reference field, select the service diagnosis. This field is disabled if no diagnosis is associated with the member.

6. If a diagnosis is associated with the member, the Diagnosis field displays the diagnosis.

7. In the Total Charge field, enter the service charge.

8. In the Service Units field, enter the number of service units.

9. In the Does This Service Represent An Admission field:

• Select Yes record the service as an admission.
• Select No to record the service as a unit of service.

10. Click Display Valid Authorizations to display the Authorization Listing screen.

• Select the authorization, click Ok.
• The authorization number populates the Authorization Number field.

11. In the Authorization Number field, enter an authorization number, if appropriate.

12. In the Performing Provider field, select the performing provider. Performing providers are setup in the Performing Provider Registration form, then associated to a contracting provider (Contracting Provider Registration form).

13. In the Performing Provider Type field, select the provider type. Provider types associated with the Performing Provider field are available.

14. In the Level Of Care field, select the level of care.

15. In the Location field, select the location.

16. The Total Fee Table Amount field displays the total service charge.

• This value is the addition of the service fee amount, times the number of units for each procedure code in the claim.
• If there is no associated amount, 0.00 displays.
• The maximum value is limited to the total available units contained in the service authorization, times the Fee Table amount.
• The following four fields display values when a service is approved.
• If there is no associated amount, 0.00 displays.

17. The Expected Disbursement field displays the Total Fee Table Amount minus the member deductible, or member co-pay amounts.

18. The Approved Units field displays the number of units.

19. The Member Deductible field displays the deductible amount for out of network providers (Plan Definition form).

20. The Member Co-Pay field displays the co-pay for out of network providers (Plan Definition form).

21. The Co-Pay Counts Towards Deductible field displays the value in the Do Co-Pay Ceilings Count Towards Deductible field (Plan Definition form).

22. In the Third Party Amount Paid field, enter the reimbursement amount paid by a third party payer (if appropriate).

23. The Explanation Of Coverage field displays service denial information (if appropriate).

• When service information is entered, this field displays information required to have the service approved.
• If this field is blank the service has been approved.

24. The Member Enrolled On Date Of Service displays whether the member was enrolled on the service date.

25. The Eligible Provider field displays whether the provider was enrolled in the funding source.

26. The Authorization Valid field displays the status of the service authorization.

27. The Claim Status field displays the claim's status.

28. In the Claim Status Reason field, select claim status reason.

29. In the HCPCS Code field, enter the HCPCS code.

30. Click Launch Report to generate the Authorizations Hardcopy report, which displays authorization information.

When the parent product is Cal-PM, and the Enable MHSA/DIG Data Collection Fields registry setting is enabled, the Evidence-Based Practices / Service Strategies (CSI) field displays.