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Avatar Cal-PM 2024 Update 45

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Product Requirements and Recommendations

Avatar Cal-PM required
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Recommended Update Level

Avatar Cal-PM 2024 Monthly Release 2024.01.00
RADplus 2024 Monthly Release 2024.01.00

Product Update Description

An issue is resolved where 837 billing may incorrectly display the error 'A parent service can only be billed if all the co-practitioner services are also on the bill.'

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Title: 837 Billing - Co-Practitioner Services
Issue is resolved where 837 billing may incorrectly display the error 'A parent service can only be billed if all the co-practitioner services are also on the bill.'
Topics
• 837 Institutional • 837 Professional • Client Charge Input • Progress Notes
 
Acceptance Tests
AV-95898 Summary | Details
Title: 837 Billing - Co-Practitioner Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Ambulatory Progress Notes
  • Client Charge Input
  • Electronic Billing
Scenario 1: Cal-PM - 837 Professional - Validate processing when progress note has a practitioner and a co-practitioner
Specific Setup:
  • Registry Setting: ‘Enable Co-Practitioner Services From Progress Notes’ has a value of ‘Y’.
  • Service Code A:
  • Service can be billed on the 837 Professional and has a fee defined in ‘Service Fee/Cross Reference Maintenance. Note the fee.
  • Client A:
  • Note the client’s admission date and program.
  • Financial Eligibility is assigned to a Med-Cal guarantor that allows customization of the plan. The plan is customized to set the ‘Insurance Dollar Limit Per Day’ to the amount of the fee noted above. The client has no other guarantors assigned.
  • A progress note has been created for Client A, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
  • Client Ledger has been used to verify that the practitioner service distributed to the Med-Cal guarantor and that the co- practitioner service distributed to the default guarantor (99999).
  • Close Charges has been used to close the charge.
  • Create Interim Billing Batch File has been used to create a batch for the service. Note the batch number.
  • Client B & Client C will be merged through 'Client Merge'.
  • Client B:
  • Note the client’s admission date and program.
  • Add diagnosis and financial eligibility records using the desired guarantor.
  • A progress note has been created for Client B, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
  • Client Ledger has been used to verify that the practitioner service distributed to the guarantor.
  • Client C:
  • Note the client’s admission date and program. Ensure that the program will allow the program for Client B to merge into the program for Client C.
  • Add diagnosis and financial eligibility records using the same guarantor.
  • Client Charge Input is used to create a service for Service Code A, on the same least one more service, using desired service code, on the same date of service, with a co-practitioner, and a co-practitioner duration.
  • Client Ledger has been used to verify that the practitioner service distributed to the guarantor.
  • Client Merge: Merge Client B (source client), into Client C (target client).
  • Edit Service Information:
  • Edit the co-practitioner duration for Service A, originally for Client B, on the primary service, not the co-practitioner service. Validate that the duration change was retained.
  • Edit the co-practitioner duration for Service A, for Client C, on the primary service, not the co-practitioner service. Validate that the duration change was retained.
  • Create Interim Billing Batch File: Create a batch for the services for Client C.
  • Close Charges: Close the charges in the interim batch.
Steps
  1. Open ‘Electronic Billing’.
  2. Select ‘837-Professional’ in ‘Billing Form’.
  3. Select ‘Medi-Cal’ in ‘Type Of Bill’.
  4. Select ‘All’ in ‘Individual Or All Guarantors’.
  5. Select ‘Outpatient’ in ‘Billing Type’.
  6. Select ‘Sort File’ in ‘Billing Options’.
  7. Set ‘File Description/Name’ to desired value’.
  8. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  9. Select the desired ‘Interim Batch Number’ that contains the services for Client A.
  10. Select desired value in ‘Create Claims’.
  11. Enter the desired values in required date fields.
  12. Select desired value in ‘Include Primary and/or Secondary Billing’.
  13. Click Process.
  14. Validate that an error message is received stating: ‘No Valid Information Found. Please Check The Error Report’.
  15. Select ‘Run Report’ in ‘Billing Options’.
  16. Select ‘Print’ in ‘Print Or Delete Report’.
  17. Select the ‘File Description/Name’ from above in ‘File’.
  18. Click [Print 837 Report].
  19. Click the ‘Required Data Missing: Patient Service Data’ link.
  20. Validate that the error message states: ‘ A parent service can only be billed if all the co-practitioner services are also on the bill’ and provides the service date and service code.
  21. Close the report.
  22. Close the form.
  23. Open ‘Electronic Billing’.
  24. Select ‘837-Professional’ in ‘Billing Form’.
  25. Select desired value in ‘Type Of Bill’.
  26. Select ‘All’ in ‘Individual Or All Guarantors’.
  27. Select ‘Outpatient’ in ‘Billing Type’.
  28. Select ‘Sort File’ in ‘Billing Options’.
  29. Set ‘File Description/Name’ to desired value’.
  30. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  31. Select the desired ‘Interim Batch Number’ that contains the services for Client A.
  32. Select desired value in ‘Create Claims’.
  33. Enter the desired values in required date fields.
  34. Select desired value in ‘Include Primary and/or Secondary Billing’.
  35. Click Process.
  36. Validate that no error is received.
  37. Select 'Dump File' in 'Billing Options'.
  38. Select 'Print' in 'Print or Delete Report'.
  39. Select the desired 'File'.
  40. Click [Process].
  41. Review the file to validate that the CLM and SV1 segments are correct.
  42. Close the form.
Scenario 2: Cal-PM - 837 Institutional - Validate processing when progress note has a practitioner and a co-practitioner
Specific Setup:
  • Registry Setting: ‘Enable Co-Practitioner Services From Progress Notes’ has a value of ‘Y’.
  • Service Code A:
  • Service can be billed on the 837 Institutional and has a fee defined in ‘Service Fee/Cross Reference Maintenance. Note the fee.
  • Client A:
  • Note the client’s admission date and program.
  • Financial Eligibility is assigned to a Med-Cal guarantor that allows customization of the plan. The plan is customized to set the ‘Insurance Dollar Limit Per Day’ to the amount of the fee noted above. The client has no other guarantors assigned.,
  • A progress note has been created for Client A, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
  • Client Ledger has been used to verify that the practitioner service distributed to the Med-Cal guarantor and that the co- practitioner service distributed to the default guarantor (99999).
  • Close Charges has been used to close the charge.
  • Create Interim Billing Batch File has been used to create a batch for the service. Note the batch number.
  • Client B & Client C will be merged through 'Client Merge'.
  • Client B:
  • Note the client’s admission date and program.
  • Add diagnosis and financial eligibility records using the desired guarantor.
  • A progress note has been created for Client B, Service Code A, has a duration, a practitioner, a co-practitioner, and a co-practitioner duration. Note the date of service.
  • Client Ledger has been used to verify that the practitioner service distributed to the guarantor.
  • Client C:
  • Note the client’s admission date and program. Ensure that the program will allow the program for Client B to merge into the program for Client C.
  • Add diagnosis and financial eligibility records using the same guarantor.
  • Client Charge Input is used to create a service for Service Code A, on the same least one more service, using desired service code, on the same date of service, with a co-practitioner, and a co-practitioner duration.
  • Client Ledger has been used to verify that the practitioner service distributed to the guarantor.
  • Client Merge: Merge Client B (source client), into Client C (target client).
  • Edit Service Information:
  • Edit the co-practitioner duration for Service A, originally for Client B, on the primary service, not the co-practitioner service. Validate that the duration change was retained.
  • Edit the co-practitioner duration for Service A, for Client C, on the primary service, not the co-practitioner service. Validate that the duration change was retained.
  • Create Interim Billing Batch File: Create a batch for the services for Client C.
  • Close Charges: Close the charges in the interim batch.
Steps
  1. Open ‘Electronic Billing’.
  2. Select ‘837-Institutional’ in ‘Billing Form’.
  3. Select ‘Medi-Cal’ in ‘Type Of Bill’.
  4. Select ‘All’ in ‘Individual Or All Guarantors’.
  5. Select ‘Outpatient’ in ‘Billing Type’.
  6. Select ‘Sort File’ in ‘Billing Options’.
  7. Set ‘File Description/Name’ to desired value’.
  8. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  9. Select the desired ‘Interim Batch Number’.
  10. Select desired value in ‘Create Claims’.
  11. Enter the desired values in required date fields.
  12. Select desired value in ‘Include Primary and/or Secondary Billing’.
  13. Click Process.
  14. Validate that an error message is received stating: ‘No Valid Information Found. Please Check The Error Report’.
  15. Select ‘Run Report’ in ‘Billing Options’.
  16. Select ‘Print’ in ‘Print Or Delete Report’.
  17. Select the ‘File Description/Name’ from above in ‘File’.
  18. Click [Print 837 Report].
  19. Click the ‘Required Data Missing: Patient Service Data’ link.
  20. Validate that the error message states: ‘ A parent service can only be billed if all the co-practitioner services are also on the bill’ and provides the service date and service code.
  21. Close the report.
  22. Close the form.
  23. Open ‘Electronic Billing’.
  24. Select ‘837-Institutional’ in ‘Billing Form’.
  25. Select desired value in ‘Type Of Bill’.
  26. Select ‘All’ in ‘Individual Or All Guarantors’.
  27. Select ‘Inpatient’ in ‘Billing Type’.
  28. Select ‘Sort File’ in ‘Billing Options’.
  29. Set ‘File Description/Name’ to desired value’.
  30. Select ‘Interim Batch’ in ‘All Clients Or Interim Billing Batch’.
  31. Select the desired ‘Interim Batch Number’ that contains the services for Client A.
  32. Select desired value in ‘Create Claims’.
  33. Enter the desired values in required date fields.
  34. Select desired value in ‘Include Primary and/or Secondary Billing’.
  35. Click Process.
  36. Validate that no error is received.
  37. Select 'Dump File' in 'Billing Options'.
  38. Select 'Print' in 'Print or Delete Report'.
  39. Select the desired 'File'.
  40. Click [Process].
  41. Review the file to validate that the CLM and SV1 segments are correct.
  42. Close the form.
Topics
• 837 Institutional • 837 Professional • Client Charge Input • Progress Notes