BBH Setup - PM

BBH defaults

This section of the BBH Setup form is where you specify the guarantor(s) that need to be configured for the certification modifiers. Program or service code exclusions are configured here. If the modifiers have to be output in a certain order, they are defined in this section.

• Avatar Guarantors for BBH - Required. This is a multi-select field. Select all guarantors that need to be configured for these NH certification modifiers. For example, Amerihealth, Beacon, NH Healthy Families.
• Service Codes to Exclude - This is a multi-select field. If there are service codes that do not require the NH state modifiers, select those service codes.
• Programs to Exclude - This is a multi-select field. If there are programs that do not require the NH state modifiers, select those programs here. For example, if the TMS program and SUD programs do not need the certification modifiers, they would be selected in this field.
• First Position Modifiers - Modifiers must be listed in order and separated by an ampersand (&). When modifiers are listed here, the system places those modifiers first on an 837P or HCFA-1500 bill, regardless of where the modifier comes from (BBH Setup, Service Fee/Cross Reference Maintenance, Modifiers by Practitioner Category, or the various Client Charge Input forms). The system places the modifiers in the specified order and outputs the first four modifiers on the claim in order to comply with EDI guidelines.

Example: 'AB&CD&EF' is listed in the 'First Position Modifiers' field, the BBH form has the 'CD' modifier defined, and Service Fee/Cross Reference Maintenance has 'EF,GH,AB' defined. The claim output will be AB,CD,EF,GH.

Note: The same modifiers cannot exist in both the 'First Position Modifiers' and 'Last Position Modifiers' fields.

• Last Position Modifiers - Modifiers must be listed in order and separated by an ampersand (&). When modifiers are listed here, the system places those modifiers last on an 837P or HCFA-1500 bill, regardless of where the modifier comes from (Service Fee/Cross Reference Maintenance, Modifiers by Practitioner Category, or the various Client Charge Input forms).

Certification category setup

This section of the BBH Setup form is where you define the modifiers for each certification category. The modifiers defined here are output on an 837P or HCFA-1500 bill along with the other modifiers defined elsewhere in myAvatar (Service Fee/Cross Reference Maintenance, Modifiers by Practitioner Category, or the various Client Charge Input forms). This is also where certain service codes can be restricted by certification categories.

• Certification Category - Required. This is a single-select field. Select the Certification Category to configure.

Note: This is a user-defined dictionary. If the state of NH changes their values, the agency can update this dictionary as needed. The dictionary can be found under 'Client' – Certification Category (44005).

• Effective Date - This is the start or effective date of the certification category. It has to be before the Lapse Date.
• Lapse Date - This is the lapse or end date of the certification category. It cannot be before the Effective Date.

Note: The dates of these entries cannot overlap for a given certification category. For example, you cannot have two entries for Low Utilizer (U) that overlap each other.

• Modifier 1 - Required. This is a single-select, user-defined field. Select the modifier used to configure the certification category. Use the Dictionary Update form to define new values as needed. This dictionary is found under ‘Other Tabled Files’ – Modifier 1 (19103).
• Modifier 2 - This is a single-select, user-defined field.  Select the modifier used to configure the certification category. Use the Dictionary Update form to define new values as needed. This dictionary is found under 'Other Tabled Files' – Modifier 2 (19104).
• Select service code(s) that progress notes cannot be entered for with this category - This is a multi-select field. If there are service code(s) that cannot be rendered for a particular certification category, select those service codes here. This produces a hard-stop for the provider, who will see the message ‘This client has an invalid certification category. Entry of this Progress Note is not permitted.’

Example: The case management service code is defined as a service code that cannot be entered for the Not Eligible certification category. When a provider tries to file a progress note for a client and the case management service code is designated as ‘Not Eligible’, the provider is prevented from selecting the code. The provider can either select an alternate service code or enter a new assessment in order to get a certification before proceeding with the desired service code.

 

► See also

• Certification Category - Dictionary Value
• Enable BBH Service Modifiers - Registry Setting
• Modifier 1 - Dictionary Value
• Modifier 2 - Dictionary Value

► SQL tables

• BBH Setup > BBH Defaults - SYSTEM.bbh_defaults
• BBH Setup > Certification Category Setup - SYSTEM.bbh_certification_cat