Skip to main content

Cross Episode Financial Eligibility - PM

  1. Last updated
  2. Save as PDF

Create and maintain the guarantor record that is applied to all episodes for the selected client.

This form is used for clients that have guarantors and benefit plans where the coverage specifications and limits can be applied across all of the client episodes. Select the guarantors, connect them to benefit plans, and customize the benefit plan to meet the individual client requirements. Eligibility coverage and limitation entered in this form span all client episodes.

Note: If both Financial Eligibility and Cross Episode Financial Eligibility are used for the same patient, Financial Eligibility will be used for the associated episode.

The guarantor order is automatically populated in this form when the following conditions exist:

  • The Pre-Fill Financial Data (834/271) registry setting is enabled.
  • Guarantor order is set in the Pre-Filling Financial Eligibility Data (834/271) Setup form.
  • Guarantor information has been verified through a received 834 or 271 file.
  1. Go to: Avatar PM > Client Management > Account Management > Cross Episode Financial Eligibility.
  2. In the Select Client screen, enter the client name or ID, and select. Choose Select.
      Note: The Financial Investigation Medicaid Number and the Financial Investigation Medicare Number display the numbers entered in the Financial Investigation form.
  3. Select Clear Previous Guarantor Order to clear the current guarantor order.
  4. In the Guarantor fields, choose the guarantors in the order in which to distribute liability. Up to a maximum of 20 guarantors can be assigned to a client.
    Note: Guarantors must already be entered in the Guarantor Selection section to make them available to select.
  5. Select Financial Eligibility Report to generate a user-defined report (set up in the Import Report For Command Button Launch form in RADplus Utilities).
  6. Select Review Financial Eligibility to launch an eligibility information report. 
    Note: This button display is controlled with the Enable 270/271 Submission on Cross Episode Financial Eligibility registry setting (if 270/271 web services are available).
  7. Select Submit.
► Additional Sections
► SQL Tables
  • SYSTEM.billing_guar_data
  • SYSTEM.billing_guar_data_no_ep
  • SYSTEM.billing_guar_emp_data_no_ep
  • SYSTEM.billing_guar_order_no_emp
  • SYSTEM.billing_guar_subs_data_no_ep
  • SYSTEM.billing_plan_assigned_no_ep
► Registry Settings
  • Add Cross Episode Financial Eligibility
  • Add Detailed Client Name
  • Allow Additional Release Of Information HIPAA Codes (2300-CLM-09 and 2320-OI-06)
  • Allow Inquiry Program Override
  • Assignment of Benefits
  • Benefit Plan Start/Stop Date Defaults
  • Client Demographics - Additional Fields
  • Customize Plan Description
  • Default Benefit Plan Level
  • Default Subscriber Secondary ID
  • Enable 270/271 Submission on 834/820 Update
  • Enable 270/271 Submission on Cross Episode Financial Eligibility
  • Enable 270/271 Submission on Financial Eligibility
  • Enable 270/271 Transaction Sets
  • Enable Automatic Contractual Adjustment Based On Fee Table
  • Enable Contract Information
  • Enable Default Guarantor Assignment
  • Enable Medigap Support
  • Enable Percentage of Coverage Based on Gross Charge
  • Enable Real-Time 270/271 Submission
  • Enable Subscriber Additional Id (2100C)
  • Enable Subscriber Policy Number Override
  • Enable Variable Plan Limitations
  • Get Dictionary Items (Financial Eligibility)
  • Include Enhanced Limits
  • Include Notes
  • Include Per Diem Percentage Applies To
  • Include Subscriber Secondary ID Info
  • Include Title XX Information
  • Make 'Per Diem Rate' Not Required
  • Make 'Subscriber Social Security Number' field Not Required
  • Other Subscriber Secondary ID Suffix
  • Pre-Fill Financial Data (834/271)
  • Specify Insurance Plan Name Or Program Name At Client Level
  • Specify Patient Signature Source Code (2300-CLM-10 and 2320-01-04)
  • Specify Subscriber/Dependent Date (2100C/2100D-DTP and 2110C/2110D-DTP)
  • Subscriber Additional Identifier
  • Subscriber Information
  • Support Foreign Address
  • Support Foreign Address For Subscriber
  • Support Pseudo Social Security Numbers
  • Update Cross Episode Financial Eligibility
  • Update Financial Eligibility
► Test Scripts

For implementing new systems or new functionality, download the following standard test script for this feature. Please contact your Netsmart representative for more information about Test scripts.