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Avatar Cal-PM 2023 Update 24

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Product Requirements / Recommendations

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Product Update Form Description

The 837 bills are modified to always include primary and associated add-on services in the same claim.

Included Updates

None

Required Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
837 Billing - Primary / Add-On Services
The 837 bills are modified to always include primary and associated add-on services in the same claim. KB0071948 v0.01
Topics
• 837 Institutional • 837 Professional • NX
 
Acceptance Tests
AV-85256 Summary | Details
837 Billing - Primary / Add-On Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Diagnosis
  • Dictionary Update (PM)
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Individual Cash Posting (PM)
  • Program Maintenance
  • Registry Settings (PM)
  • Service Fee/Cross Reference Maintenance
  • Admission
Scenario 1: Cal-PM - Electronic Billing - 837 Professional - Include primary and associated add-on services in the same claim
Specific Setup:
  • System is set up to allow ‘Add-On’ services to the primary services.
  • Service Codes:
  • Use ‘Service Code Category’ to note the ‘Primary Code’. Note the associated add-on codes.
  • Guarantors/Payors:
  • Guarantor 1: Note the ‘Financial Class’. This will be the client’s primary guarantor.
  • Guarantor 2: Note the ‘Financial Class’. This will be the client’s secondary guarantor.
  • Guarantor/Program Billing Defaults:
  • The ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = 1.
  • Clients:
  • Client 1:
  • Is enrolled in an outpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with the above guarantors.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
  • Client 2:
  • Is enrolled in an inpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with a primary and secondary guarantor.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
Steps
  1. Open ‘Electronic Billing’.
  2. Select ‘837-Professional’ in ‘Billing Form’.
  3. Select the primary guarantor ‘Financial Class in ‘Type Of Bill’.
  4. Select ‘Individual’ in ‘Individual Or All Guarantors’.
  5. Select the primary guarantor in ‘Guarantor’.
  6. Select ‘Outpatient’ in ‘Billing Type’.
  7. Select ‘Sort File’ in ‘Billing Options’.
  8. Enter the desired value in ‘File Description/Name’.
  9. Select ‘All Clients’ in ‘All Clients Or Interim Billing Batch’.
  10. Select desired value in ‘Program(s)’.
  11. Select ‘No’ in ‘Create Claims’.
  12. Enter the desired value in ‘First Date Of Service To Include’.
  13. Enter the desired value in ‘Last Date Of Service To Include’.
  14. Select ‘All in ‘Include Primary and/or Secondary Billing.
  15. Click [Process].
  16. Validate the ‘Processing Report’ message contains ‘Compile Complete’.
  17. Click [OK].
  18. Select ‘Dump File’ in ‘Billing Options’.
  19. Select ‘Print’ in ‘Print Or Delete Report’.
  20. Select the desired report in ‘File’.
  21. Click [Process].
  22. Validate that there is one ‘CLM’ segment per service,
  23. Close the report.
  24. Close the form.
  25. If desired, use 'Individual Cash Posting' to transfer the services to the secondary guarantor, transferring an add-on code before the transferring the primary code.
  26. If the transfer was performed, process the ‘837-Professional’ again to validate that only one claim is created for the service.
Scenario 2: Cal-PM - Electronic Billing - 837 Institutional - Include primary and associated add-on services in the same claim
Specific Setup:
  • System is set up to allow ‘Add-On’ services to the primary services.
  • Service Codes:
  • Use ‘Service Code Category’ to note the ‘Primary Code’. Note the associated add-on codes.
  • Guarantors/Payors:
  • Guarantor 1: Note the ‘Financial Class’. This will be the client’s primary guarantor.
  • Guarantor 2: Note the ‘Financial Class’. This will be the client’s secondary guarantor.
  • Guarantor/Program Billing Defaults:
  • The ‘Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = 1.
  • Clients:
  • Client 1:
  • Is enrolled in an outpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with the above guarantors.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
  • Client 2:
  • Is enrolled in an inpatient program. Note the program.
  • Client has an active diagnosis record.
  • Client has an active financial eligibility record with a primary and secondary guarantor.
  • Services have been provided for the above ‘Primary Code’ that include add-on codes.
  • Close Charges was used to close the charges.
  • Client Ledger has been used to verify that the liability distributed to the primary guarantor, and note the dates of service for closed, unclaimed services for the above service codes.
Steps
  1. Open ‘Electronic Billing’.
  2. Select ‘837-Institutional’ in ‘Billing Form’.
  3. Select the primary guarantor ‘Financial Class in ‘Type Of Bill’.
  4. Select ‘Individual’ in ‘Individual Or All Guarantors’.
  5. Select the primary guarantor in ‘Guarantor’.
  6. Select ‘Inpatient’ in ‘Billing Type’.
  7. Select ‘Sort File’ in ‘Billing Options’.
  8. Enter the desired value in ‘File Description/Name’.
  9. Select ‘All Clients’ in ‘All Clients Or Interim Billing Batch’.
  10. Select desired value in ‘Program(s)’.
  11. Select ‘No’ in ‘Create Claims’.
  12. Enter the desired value in ‘First Date Of Service To Include’.
  13. Enter the desired value in ‘Last Date Of Service To Include’.
  14. Select ‘All in ‘Include Primary and/or Secondary Billing.
  15. Click [Process].
  16. Validate the ‘Processing Report’ message contains ‘Compile Complete’.
  17. Click [OK].
  18. Select ‘Dump File’ in ‘Billing Options’.
  19. Select ‘Print’ in ‘Print Or Delete Report’.
  20. Select the desired report in ‘File’.
  21. Click [Process].
  22. Validate that there is one ‘CLM’ segment per service,
  23. Close the report.
  24. Close the form.
  25. If desired, use 'Individual Cash Posting' to transfer the services to the secondary guarantor, transferring an add-on code before the transferring the primary code.
  26. If the transfer was performed, process the ‘837-Institutional’ again to validate that only one claim is created for the service.
Topics
• 837 Institutional • 837 Professional • NX