Claim Processing Blackout
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Admission (Outpatient)
- Authorization Listing
- Batch Creation
- Batch Creation - Assign ID
- Claim Processing (CMS 1500)
- Claim Processing Blackout
- Close Batch
- Service Authorization
Scenario 1: Claim Processing Blackout
Specific Setup:
- Client: Identify a client that has a valid Service Authorization record.
- Note the Client, Provider, Funding Source, and Authorization Number.
- Claim Processing Blackout:
- Add a blackout entry, noting the value selected in the following fields (if used):
- Blackout Start Date, Blackout End Date, Client, Provider, Funding Source, and Authorization.
- Batch Creation is used to create a new batch, Note the number.
- Claim Processing (CMS 1500) or Claim Processing (UB-04) is used to create a date of service that is within the Blackout Start Date and Blackout End Date. Validate that the claim is denied due to the blackout.
- Close Batch is used to close the batch.
Steps
- Open ‘Claim Processing Blackout’.
- Select ‘Add’ in ‘Add/Edit/Delete’.
- Create an entry that will overlap the entry created in setup.
- Validate that following message is displayed: Blackout cannot be filed because it overlaps with an existing blackout record for the same entities.
- Click [OK].
- Change the entries so that there is no overlap.
- Click [Submit].
- Click [Yes] to remain in the form.
- Select ‘Edit’ in ‘Add/Edit/Delete’.
- Select the ‘Blackout Record’ that was just created.
- Edit any field.
- Click [Submit].
- Click [Yes] to remain in the form.
- Select ‘Edit’ in ‘Add/Edit/Delete’.
- Select the ‘Blackout Record’ that was just edited.
- Validate that the data that was changed was retained.
- Select ‘Delete’ in ‘Add/Edit/Delete’.
- Select the ‘Blackout Record’ that was created in setup.
- Validate that the claim that was denied displays in ‘Previously Denied Services For Retro Adjudication’. Select the claim.
- Select the desired ‘Adjustment Code’.
- Click [Submit].
- Validate that following message is displayed: There are services selected for retro adjudication. Are you sure you want to continue?
- Click [Yes].
- Click [Yes] to remain in the form.
- Select ‘Edit’ in ‘Add/Edit/Delete’.
- Validate that the deleted ‘Blackout Record’ is no longer displayed in the ‘Blackout Record’ field.
- Close the form.
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Topics
• Claims Processing
• NX
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