Skip to main content

Avatar PM 2022 Update 22

  1. Last updated
  2. Save as PDF

Product Requirements / Recommendations

Avatar PM required
RADplus required

Product Update Form Description

The following issues are resolved: 1) When billing a CCBHC guarantor on an 837 Professional bill, the "PPS service [service description] cannot be billed until all associated enumerated services are ready to bill." is erroneously reported on the bill. 2) When selecting "Include Services With and Without Diagnosis Entry" in the 'UB/837I Billing Options' field on the 'Electronic Billing' form, diagnosis associated with the service might not be included on the 837 Institutional bill. 3) When loading an Implementation Acknowledgment (999) file in the 'Functional or Implementation Acknowledgment (997/999)' form, the "Missing required segment. Unable to determine loop information. Please contact Netsmart. Loop: 0 Seg: ISA" error message might be reported. 4) Total Claim Charge Amount (2300-CLM-02) might not be correct on an 837 Institutional CCBHC bill if the Component/Enumerated service is edited after it has an associated PPS charge rendered via the 'CCBHC PPS Compile' form. Additionally, the 837 electronic billing is updated to support secondary billing to CCBHC guarantors with claim grouping.

Included Updates

None

Required Updates

Avatar PM 2021 Update 136
Details
NEW1 CHANGED0 FIXED4
New (1)
CCBHC Billing – Transferring services to a secondary guarantor
The 837 electronic billing logic is updated to support secondary billing to CCBHC guarantors with claim grouping. KB0069814 v0.01
Value Added: An 837 billing logic is updated to support CCBHC secondary billing.
Topics
• 837 Professional • NX
 
Fixed (4)
837 Professional - Billing CCBHC Enumerated service
Resolves an issue to ensure that the current billing logic is updated to not enforce the presence of the component/enumerated services in the same bill as associated PPS charge when the 'CCBHC Claim Grouping' is set to "Separate Claims: Hold PPS Charges for Remittances from Private Insurance and Include Component Services on Separate Claims". KB0068082 v0.01
Topics
• 837 Professional • NX
 
837 Institutional - Service diagnosis when the 'Include Services with and Without Diagnosis Entry' option is selected
Resolves an issue to ensure that the 837 Institutional bill includes the diagnosis associated with the service when selecting the 'Include Services With and Without Diagnosis Entry' in the 'UB/837I Billing Options' field on the 'Electronic Billing' form. KB0068763 v0.01
Topics
• 837 Institutional • 837 Professional • NX
 
Functional or Implementation Acknowledgment (997/999) - loading an Implementation Acknowledgment (999) file
Resolves an issue to ensure that an Implementation Acknowledgment (999) file loads successfully in the 'Functional or Implementation Acknowledgment (997/999)' form. KB0068996 v0.01
Topics
• Functional or Implementation Acknowledgement (997/999) • NX
 
837 Institutional - CCBHC Bill for the updated Component/Enumerated service
Resolves an issue to ensure that an 837 Institutional CCBHC bill displays correct total claim charge amount if the enumerated service is updated after the 'CCBHC PPS Compile' process. KB0068764 v0.01
Topics
• 837 Institutional • NX
 
Acceptance Tests
AV-71370 Summary | Details
837 Professional - Billing CCBHC Enumerated service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • App Dashboard
  • CCBHC PPS Compile
  • Client Charge Input
  • Client Ledger
  • Crystal Report Viewer
  • Diagnosis
  • Dictionary Update (PM)
  • Dynamic Form - Admission - Client
  • Dynamic Form - Edit Service Fee Definition
  • Dynamic Form - Individual Cash Posting - Alert
  • Dynamic Form - Individual Cash Posting - Client
  • Dynamic Form - Individual Cash Posting - Information
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Individual Cash Posting (PM)
  • Service Codes
  • Dynamic form- Social Security Number
Scenario 1: CCBHC Billing - 837 Professional for the secondary guarantor when the enumerated and partial service transferred to secondary guarantor - CCBHC Claim grouping =Same
Specific Setup:
  • CCBHC setup has been completed.
  • Dictionary Update:
  • Two new covered charge categories are created in Client File - Data Element # 10021.
  • Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Guarantors/Payors 1:
  • Is a CCBHC Guarantor. Note the guarantor's code/name/financial class of the guarantor.
  • The Financial Class does not equal Self-Pay.
  • Allow Customization of Guarantor Plan = Yes.
  • Select Category 1 in the 'Categories Available For Reviews'.
  • Guarantors/Payors 2: Note the guarantor's code/name/financial class of the guarantor.
  • Is a CCBHC Guarantor.
  • The Financial Class does not equal Self-Pay and is the same financial class of Guarantor 1.
  • Allow Customization of Guarantor Plan = Yes.
  • Select Category 2 in the 'Categories Available For Reviews'.
  • Admission:
  • A client is enrolled in an outpatient program. Note the program.
  • Diagnosis:
  • Client has an active diagnosis record. Note the diagnosis code.
  • Financial Eligibility: The financial eligibility record is:
  • ‘Guarantor 1 is set up as a primary guarantor.
  • The 'Customize Guarantor Plan' has a value of 'Yes'.
  • In the 'Customize Plan' section the Category 1 is selected in the 'Covered Charge Categories'.
  • ‘Guarantor 2 is set up as a secondary guarantor.
  • The 'Customize Guarantor Plan' has a value of 'Yes'.
  • In the 'Customize Plan' section the Category 2 is selected in the 'Covered Charge Categories'.
  • Service Code 1:
  • Is a CCBHC enumerated service code. Select Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Service Code 2:
  • Is a CCBHC non-enumerated service code. Select Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Client Charge Input:
  • A service for Service Code 1 is rendered to the client.
  • Client Ledger:
  • Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount.
  • Use 'Close Charges' to close the charges.
  • CCBHC PPS Definition:
  • The CCBHC PPS service definition is created for the CCBHC PPS non-enumerated service code.
  • Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors.
  • Client Ledger:
  • The CCBHC PPS service for the client is distributed to the secondary guarantor. Do not close that charge.
  • 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client:
  • CCBHC Claim Grouping = None
  • Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank
  • Create an interim billing batch to include services for the financial class defined for the guarantors assigned to the client.
Steps
  1. Open 'Electronic Billing'.
  2. Compile the 837 Professional bill for the financial class without claiming.
  3. Set the 'All Or Individual Guarantor' field to 'All'.
  4. Select the interim billing batch.
  5. Set the 'Include CCBHC Services' to 'Yes'.
  6. Compile the bill.
  7. Verify the bill compiles successfully.
  8. Select 'Run Report' in 'Billing Options'.
  9. Select 'Print' in Print Or Delete Report'.
  10. Select the 'File'.
  11. Click [Print 837 Report].
  12. Verify that the correct primary guarantor is included for the CCBHC Enumerated service.
  13. Click [X].
  14. Click [X].
Scenario 2: 837 Professional - Bill CCBHC Enumerated service and PPS service separately - CCBHC Claim grouping = Separate Claim
Specific Setup:
  • CCBHC setup has been completed.
  • Dictionary Update:
  • Two new covered charge categories are created in Client File - Data Element # 10021.
  • Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Guarantors/Payors:
  • A new CCBHC Guarantor is added. Note the guarantor’s code/name/financial class of the guarantor.
  • The Financial Class does not equal Self-Pay.
  • Allow Customization of Guarantor Plan = Yes.
  • Select Categories 1 and 2 in the 'Categories Available For Reviews'.
  • Admission:
  • A client is enrolled in an outpatient program. Note the program.
  • Diagnosis:
  • Client has an active diagnosis record. Note the diagnosis code.
  • Financial Eligibility: The financial eligibility record is:
  • An identified guarantor is set up as a primary guarantor.
  • The 'Customize Guarantor Plan' has a value of 'Yes'.
  • In the 'Customize Plan' section the Categories 1 and 2 are selected in the 'Covered Charge Categories'.
  • Service Code 1:
  • Is a CCBHC enumerated service code. Select the Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Service Code 2:
  • Is a CCBHC non-enumerated service code. Select the Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Client Charge Input:
  • A service for Service Code 1 is rendered to the client.
  • Client Ledger:
  • Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount.
  • Use 'Close Charges' to close the charges.
  • CCBHC PPS Definition:
  • The CCBHC PPS service definition is created for the client and CCBHC PPS service code.
  • Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors.
  • Client Ledger:
  • The CCBHC PPS service for the client is distributed to the primary guarantor. Leave the PPS charges open.
  • 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client 1:
  • CCBHC Claim Grouping = Separate Claim
  • Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank
Steps
  1. Open 'Electronic Billing' form.
  2. Compile the 837 Professional bill for the financial class without claiming.
  3. Set the 'All Or Individual Guarantor' field to 'All'.
  4. Select the interim billing batch.
  5. Set the 'Include CCBHC Services' to 'Yes'.
  6. Compile the bill.
  7. Verify the bill compiles successfully.
  8. Select 'Run Report' in 'Billing Options'.
  9. Select 'Print' in Print Or Delete Report'.
  10. Select the 'File'.
  11. Click [Print 837 Report].
  12. Verify that the CCBHC Enumerated service is compiled successfully.
  13. Click [X].
  14. Click [X].
  15. Close the CCBHC PPS service.
  16. Open 'Electronic Billing' form.
  17. Compile the 837 Professional bill for the financial class without claiming.
  18. Set the 'All Or Individual Guarantor' field to 'All'.
  19. Select the interim billing batch.
  20. Set the 'Include CCBHC Services' to 'Yes'.
  21. Compile the bill.
  22. Verify the bill compiles successfully.
  23. Select 'Run Report' in 'Billing Options'.
  24. Select 'Print' in Print Or Delete Report'.
  25. Select the 'File'.
  26. Click [Print 837 Report].
  27. Verify that the CCBHC PPS service is compiled successfully without any error.
  28. Click [X].
  29. Click [X].
Topics
• 837 Professional • NX
AV-72373 Summary | Details
837 Institutional - Service diagnosis when the 'Include Services with and Without Diagnosis Entry' option is selected
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Ledger
  • Diagnosis
  • Dictionary Update (PM)
  • Dynamic Form - Admission - Client
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Program Maintenance
  • Recurring Client Charge Input (Diagnosis Entry)
  • Client Charge Input With Diagnosis Entry
  • Crystal Report Viewer
  • Dynamic Form - Edit Service Fee Definition
  • Dynamic form- Social Security Number
  • Service Codes
Scenario 1: 837 Professional - HCFA-1500/837-P Billing Options - Outpatient client
Specific Setup:
  • Client 1:
  • Is admitted to an outpatient program. Note the program.
  • Has an active ‘Financial Eligibility’ record. Note the ‘Guarantor’ and ‘Financial Class’ for the guarantor.
  • Has an active ‘Diagnosis’ record. Note the diagnosis code.
  • Two charges, in the same month, have been entered in ‘Client Charge Input’. Note the last service date.
  • Two charges, in the same month as above, have been entered in ‘Client Charge Input With Diagnosis Entry. Enter a code in ‘Diagnosis 1’ that is not the same diagnosis code as in the ‘Diagnosis’ record. The last date of service is before the last date of service entered in ‘Client Charge Input’.
  • Client 2:
  • Is admitted the same outpatient program. Note the program.
  • Has an active ‘Financial Eligibility’ record for the same guarantor.
  • Has an active ‘Diagnosis’ record. Note the diagnosis code.
  • Two charges, in the same month, have been entered in ‘Client Charge Input’. Note the last service date.
  • Two charges, in the same month as above, have been entered in ‘Client Charge Input With Diagnosis Entry. Enter a code in ‘Diagnosis 1’ that is not the same diagnosis code as in the ‘Diagnosis’ record. The last date of service is after the last date of service entered in ‘Client Charge Input’.
  • Use ‘Close Charges’ to close the charges.
  • The 'Guarantor/Program Billing Defaults' template for the guarantor and program combination has a value of '1' in '837 Professional', 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)'.
  • 'Form Designer' has been used to revert the 'Electronic Billing' section of the 'Electronic Billing' for to 'Netsmart Produced Changes'.
Steps
  1. Open 'Electronic Billing'.
  2. Select '837-Professional' in 'Billing Form'.
  3. Select 'Include Services With and Without Diagnosis Entry' in 'UB/837-I Billing Options'.
  4. Select 'Diagnosis Entry' in 'HCFA-1500/837-P Billing Options'.
  5. Verify that an 'Error' message is received stating: The 'Diagnosis Entry' and 'Include Services With and Without Diagnosis Entry' billing options cannot be used together.
  6. Click [OK].
  7. Verify that 'Include Services With and Without Diagnosis Entry' is still selected in 'HCFA-1500/837-P Billing Options'.
  8. Select the guarantor 'Financial Class' in 'Type' of Bill'.
  9. Select 'Individual' in 'Individual Or All Guarantors'.
  10. Select the desired 'Guarantor'.
  11. Select 'Outpatient' in 'Billing Type'.
  12. Select 'Sort File' in 'Billing Options'.
  13. Enter the desired 'File Description'.
  14. Select 'All Clients' in 'All Clients Or Interim Billing Batch'.
  15. Select the desired 'Program'.
  16. Select 'No' in 'Create Claims'.
  17. Enter the 'First Date of Service To Include'.
  18. Enter the 'Last Date of Service To Include'.
  19. Click [Process].
  20. Click [OK].
  21. Select 'Dump File' in 'Billing Options'.
  22. Select 'Print' in 'Print Or Delete Report'.
  23. Select the desired 'File'.
  24. Validate that four services are output for Client 1.
  25. Validate that for the two services created in 'Client Charge Input', that the 'HI* segments include only the diagnosis code from the 'Diagnosis' record.
  26. Validate that for the two services created in 'Client Charge Input With Diagnosis Entry', that the 'HI' segments include the diagnosis entered in 'Client Charge Input With Diagnosis Entry'.
  27. Validate that four services are output for Client 2.
  28. Validate that for the two services created in 'Client Charge Input', that the 'HI* segments include only the diagnosis code from the 'Diagnosis' record.
  29. Validate that for the two services created in 'Client Charge Input With Diagnosis Entry', that the 'HI' segments include the diagnosis entered in 'Client Charge Input With Diagnosis Entry'.
  30. Close the report.
  31. Close the form.
Scenario 2: Electronic Billing - UB/837-I Billing Options - Inpatient bill for an outpatient client
Specific Setup:
  • Admission:
  • A new client is admitted to an outpatient program. Note the program.
  • Financial Eligibility:
  • The client has an active ‘Financial Eligibility’ record. Note the ‘Guarantor’ and ‘Financial Class’ for the guarantor.
  • Diagnosis:
  • The client has an active ‘Diagnosis’ record with three diagnosis codes. (i.e. 1st row - F10.10 (Primary), 2nd row - F19.10 (Secondary), 3rd row - F70). Note the diagnosis codes.
  • Client Charge Input With Diagnosis Entry:
  • A service is rendered to the client. Enter a code in ‘Diagnosis 1’ that is not the same diagnosis code as in the ‘Diagnosis’ record. Note the date of service.
  • Close Charges:
  • Close the charges.
  • The 'Guarantor/Program Billing Defaults' template for the guarantor and program combination has a value of '1' in '837 Institutional', 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)'.
Steps
  1. Open 'Electronic Billing'.
  2. Select '837-Institutional' in 'Billing Form'.
  3. Select 'Include Services With and Without Diagnosis Entry' in 'UB/837-I Billing Options'.
  4. Verify that an 'Error' message is received stating: The 'Diagnosis Entry' and 'Include Services With and Without Diagnosis Entry' billing options cannot be used together.
  5. Select the guarantor 'Financial Class' in 'Type' of Bill'.
  6. Select 'Individual' in 'Individual Or All Guarantors'.
  7. Select the desired 'Guarantor'.
  8. Select 'Outpatient' in 'Billing Type'.
  9. Select 'Sort File' in 'Billing Options'.
  10. Enter the desired 'File Description'.
  11. Select 'All Clients' in 'All Clients Or Interim Billing Batch'.
  12. Select the desired 'Program'.
  13. Select 'No' in 'Create Claims'.
  14. Enter the 'First Date of Service To Include'.
  15. Enter the 'Last Date of Service To Include'.
  16. Click [Process].
  17. Click [OK].
  18. Select 'Dump File' in 'Billing Options'.
  19. Select 'Print' in 'Print Or Delete Report'.
  20. Select the desired 'File'.
  21. Validate that for the service created in the 'Client Charge Input With Diagnosis Entry', that the 'HI*ABF' segment includes the diagnosis entered in 'Client Charge Input With Diagnosis Entry'.
  22. Close the report.
  23. Close the form
Topics
• 837 Institutional • 837 Professional • NX
AV-77655 Summary | Details
Functional or Implementation Acknowledgment (997/999) - loading an Implementation Acknowledgment (999) file
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Functional or Implementation Acknowledgement (997/999)
Scenario 1: Functional or Implementation Acknowledgment (997/999) - Load / Compile an Implementation Acknowledgment (999) file
Specific Setup:
  • This scenario needs to be tested in the system that has multiple root system codes (not sub-system codes).
  • Create a 999 file to load/compile. Note the File name/ Path of the 999 file.
Steps
  1. Open the 'Functional or Implementation Acknowledgement (997/999)' form.
  2. Load the 999 file.
  3. Verify the file loads successfully.
  4. Compile the recently loaded file.
  5. Verify that there is no hard error found during compile the file.
  6. Close the report.
  7. Close the form.
Topics
• Functional or Implementation Acknowledgement (997/999) • NX
AV-78652 Summary | Details
837 Institutional - CCBHC Bill for the updated Component/Enumerated service
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • CCBHC PPS Compile
  • CCBHC PPS Service Definition
  • Client Charge Input
  • Client Ledger
  • Crystal Report Viewer
  • Diagnosis
  • Dictionary Update (PM)
  • Dynamic Form - Admission - Client
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Service Codes
  • Admission (Outpatient)
  • Dynamic Form - Edit Service Fee Definition
  • Dynamic Form - Edit Service Information - Select Service(s) to Edit
  • Dynamic form- Social Security Number
  • Open Closed Charges
Scenario 1: CCBHC Enumerated services - Validate 837 Institutional billing for the CCBHC services when CCBHC Claim Grouping = Same
Specific Setup:
  • All CCBHC setup is complete.
  • Service Codes:
  • Service Code 1 has a value of 'Yes' in 'Is this a CCBHC Service' and a value of 'Yes' in 'CCBHC Enumerated Services'. Note the 'Insurance Charge Category'.
  • Service Code 2 has a value of 'Yes' in 'Is this a CCBHC Service' and a value of 'Yes' in 'CCBHC Enumerated Services'. The 'Insurance Charge Category' must be any value other than the value selected for Service Code 1.
  • Guarantor 1 is a CCBHC guarantor. Allow Customization Of Guarantor Plan' has a value of 'Yes'. Note the 'Financial Class'.
  • Admission:
  • A client is enrolled in an outpatient program. Note the program.
  • Client has an active diagnosis record. Note the diagnosis code.
  • The financial eligibility record is:
  • ‘Guarantor # 1’ = Guarantor 1.
  • The 'Customize Guarantor Plan' has a value of 'Yes'. In the 'Customize Plan' section all 'Covered Charge Categories' are selected.
  • Client Charge Input:
  • A service for Service Code 1 and Service Code 2 are rendered to the client on the same date.
  • Use 'Client Ledger' to verify that these services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount.
  • Use 'Close Charges' to close the charges.
  • Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors.
  • Use the 'Client Ledger' to verify that the enumerated charge for Service Code 1 was created and liability distributed to Guarantor 1. Note the 'Date'. Note the 'CHG' amount.
  • 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client 1:
  • CCBHC Claim Grouping = Same.
  • Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank
  • Close the charges.
Steps
  1. Open 'Electronic Billing'.
  2. Create an '837 Institutional' for the 'CCBHC services, selecting 'Yes' in 'Include CCBHC Services'.
  3. Select 'Dump File' in 'Billing Options'.
  4. Select 'Print' in Print Or Delete Report'.
  5. Select the 'File'.
  6. Click [Process].
  7. Verify the PPS compile service and enumerated services are included on the same claim.
  8. Click [X].
  9. Click [X].
Scenario 2: 837 Institutional CCBHC bill - Editing Component/Enumerated after it has an associated PPS charge - Claim Grouping =Same Claim
Specific Setup:
  • CCBHC setup has been completed.
  • Dictionary Update:
  • Two new covered charge categories are created in Client File - Data Element # 10021.
  • Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used as a CCBHC Guarantor. Note the guarantor's code/name/financial class of the guarantor.
  • The Financial Class does not equal Self-Pay.
  • Allow Customization of Guarantor Plan = Yes.
  • Select Category 1 and 2 in the 'Categories Available For Reviews'.
  • Admission:
  • A client is enrolled in an outpatient program. Note the program.
  • Diagnosis:
  • Client has an active diagnosis record. Note the diagnosis code.
  • Financial Eligibility: The financial eligibility record is:
  • A guarantor identified above is set up as a primary guarantor.
  • The 'Customize Guarantor Plan' has a value of 'Yes'.
  • In the 'Customize Plan' section the Category 1 and Category 2 are selected in the 'Covered Charge Categories'.
  • Service Code 1:
  • Is a CCBHC enumerated service code. Select Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Service Code 2:
  • Is a CCBHC non-enumerated service code. Select Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Client Charge Input:
  • A service for Service Code 1 is rendered to the client.
  • Client Ledger:
  • Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount.
  • Use 'Close Charges' to close the charges.
  • CCBHC PPS Definition:
  • The CCBHC PPS service definition is created for the CCBHC PPS non-enumerated service code.
  • Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors.
  • Client Ledger:
  • The CCBHC PPS service for the client is distributed to the secondary guarantor. Do not close that charge.
  • 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client:
  • CCBHC Claim Grouping = Same
  • Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank
  • Create an interim billing batch to include services for the financial class defined for the guarantors assigned to the client.
Steps
  1. Open 'Electronic Billing'.
  2. Compile the 837 Institutional bill for the financial class without claiming.
  3. Set the 'All Or Individual Guarantor' field to 'All'.
  4. Select the interim billing batch.
  5. Set the 'Include CCBHC Services' to 'Yes'.
  6. Compile the bill.
  7. Verify the bill compiles successfully.
  8. Claim the service.
  9. Verify the bill compiles successfully.
  10. Select 'Run Report' in 'Billing Options'.
  11. Select 'Print' in Print Or Delete Report'.
  12. Select the 'File'.
  13. Click [Print 837 Report].
  14. Verify that the correct primary guarantor is included for the CCBHC Enumerated service.
  15. Select 'Dump File' in 'Billing Options'.
  16. Select 'Print' in Print Or Delete Report'.
  17. Select the 'File'.
  18. Click [Process].
  19. Verify that the PPS and Enumerated services are in same claim and also the claim total displayed in the 2300-CLM-02 segment is correct.
  20. Click [X].
  21. Click [X].
Topics
• 837 Institutional • NX
AV-80348 Summary | Details
CCBHC Billing – Transferring services to a secondary guarantor
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • App Dashboard
  • CCBHC PPS Compile
  • Client Charge Input
  • Client Ledger
  • Crystal Report Viewer
  • Diagnosis
  • Dictionary Update (PM)
  • Dynamic Form - Admission - Client
  • Dynamic Form - Edit Service Fee Definition
  • Dynamic Form - Individual Cash Posting - Alert
  • Dynamic Form - Individual Cash Posting - Client
  • Dynamic Form - Individual Cash Posting - Information
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Individual Cash Posting (PM)
  • Service Codes
Scenario 1: CCBHC Billing - 837 Professional for the secondary guarantor when the enumerated and partial service transferred to secondary guarantor - CCBHC Claim grouping =Same
Specific Setup:
  • CCBHC setup has been completed.
  • Dictionary Update:
  • Two new covered charge categories are created in Client File - Data Element # 10021.
  • Category 1: Is to be used for the CCBHC-Enumerated service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Category 2: Is to be used for the CCBHC-PPS service. Give it the desired name. Set Type Of Billing Category attribute to 'Ancillary/Outpatient/Other'.
  • Guarantors/Payors 1:
  • Is a CCBHC Guarantor. Note the guarantor's code/name/financial class of the guarantor.
  • The Financial Class does not equal Self-Pay.
  • Allow Customization of Guarantor Plan = Yes.
  • Select Category 1 in the 'Categories Available For Reviews'.
  • Guarantors/Payors 2: Note the guarantor's code/name/financial class of the guarantor.
  • Is a CCBHC Guarantor.
  • The Financial Class does not equal Self-Pay and is the same financial class of Guarantor 1.
  • Allow Customization of Guarantor Plan = Yes.
  • Select Category 2 in the 'Categories Available For Reviews'.
  • Admission:
  • A client is enrolled in an outpatient program. Note the program.
  • Diagnosis:
  • Client has an active diagnosis record. Note the diagnosis code.
  • Financial Eligibility: The financial eligibility record is:
  • ‘Guarantor 1 is set up as a primary guarantor.
  • The 'Customize Guarantor Plan' has a value of 'Yes'.
  • In the 'Customize Plan' section the Category 1 is selected in the 'Covered Charge Categories'.
  • ‘Guarantor 2 is set up as a secondary guarantor.
  • The 'Customize Guarantor Plan' has a value of 'Yes'.
  • In the 'Customize Plan' section the Category 2 is selected in the 'Covered Charge Categories'.
  • Service Code 1:
  • Is a CCBHC enumerated service code. Select Category 1 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Service Code 2:
  • Is a CCBHC non-enumerated service code. Select Category 2 in the 'Covered Charge Category.' field. Note the Covered Charge Category.
  • Has a fee definition in Service Fee/Cross Reference Maintenance.
  • Client Charge Input:
  • A service for Service Code 1 is rendered to the client.
  • Client Ledger:
  • Services have liability distributed to Guarantor 1. Note the service dates. Note the 'CHG' amount.
  • Use 'Close Charges' to close the charges.
  • CCBHC PPS Definition:
  • The CCBHC PPS service definition is created for the CCBHC PPS non-enumerated service code.
  • Create the 'CCBHC PPS Compile' for the client/the dates of service. Review the report to verify that the client is included with no errors.
  • Client Ledger:
  • The CCBHC PPS service for the client is distributed to the secondary guarantor. Do not close that charge.
  • 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client:
  • CCBHC Claim Grouping = None
  • Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank
  • Create an interim billing batch to include services for the financial class defined for the guarantors assigned to the client.
Steps
  1. Open 'Electronic Billing'.
  2. Compile the 837 Professional bill for the financial class without claiming.
  3. Set the 'All Or Individual Guarantor' field to 'All'.
  4. Select the interim billing batch.
  5. Set the 'Include CCBHC Services' to 'Yes'.
  6. Compile the bill.
  7. Verify the bill compiles successfully.
  8. Select 'Run Report' in 'Billing Options'.
  9. Select 'Print' in Print Or Delete Report'.
  10. Select the 'File'.
  11. Click [Print 837 Report].
  12. Verify that the correct primary guarantor is included for the CCBHC Enumerated service.
  13. Click [X].
  14. Click [X].
Topics
• 837 Professional • NX