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Avatar PM 2022 Update 59

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Product Requirements / Recommendations

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Product Update Form Description

The following is included: 1) The registry setting 'Allow For Number Of Days Since Last Claim' is updated to support inhibiting self-pay services. 2) The registry setting 'Enable Progressive Self-Pay Dunning Messages' is added and allows the use of dunning messages based on the amount of self-pay claims created.

Included Updates

3, 55

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Allow For Number of Days Since Last Claim - Option added to Inhibit services
The registry setting 'Allow For Number of Days Since Last Claim' is updated with a new value to inhibit services. A new form for progressive dunning messages is added to the system.
A new form 'Progressive Self Pay Dunning Messages' is added for progressive dunning messages so that the message that goes out on self pay bills can change based on the number of bills that have gone out instead of just the number of days since the last claim which is how the system dunning messages work currently.
Value Added: The registry setting 'Allow For Number of Days Since Last Claim' is updated with a new value to inhibit services rather than just quit the billing process altogether.
Topics
• 837 Professional • Crystal Self Pay Bill • Inhibit Billing • NX • Registry Settings
 
Acceptance Tests
AV-79634 Summary | Details
Allow For Number of Days Since Last Claim - Option added to Inhibit 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
  • Crystal Report Viewer
  • Crystal Self Pay Bill
  • Default Guarantor Assignment
  • Dynamic Form - Admission - Client
  • Dynamic form- Social Security Number
  • Financial Eligibility
  • Guarantors/Payors
  • Inhibited Services For Billing Report
  • No Information Found
  • Registry Settings (PM)
  • Service Codes
  • App Dashboard
  • Diagnosis
  • Dynamic Form - Individual Cash Posting - Alert
  • Dynamic Form - Individual Cash Posting - Client
  • Dynamic Form - Individual Cash Posting - Information
  • Individual Cash Posting (PM)
  • Dynamic Form - File Service Inhibit Information
  • Dynamic Form - Un-Inhibit services - Please review your selections to Un-Inhibit service
  • Inhibit Billing By Service
  • Progressive Self Pay Dunning Messages
  • SQL Query/Reporting
  • Update Client Data
  • Admission
  • Dynamic Form - Edit Service Fee Definition
Scenario 1: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Registry Setting 'Allow For Number of Days Since Last Claim' = I
Specific Setup:
  • Registry Settings:
  • Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
  • Guarantors/Payor:
  • The self pay guarantor is identified. Note the guarantor code/value.
  • Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
  • Admission:
  • A new client is admitted. Note the client id, admission date and admission program.
  • Financial Eligibility:
  • A self pay guarantor is assigned to the client. Note the guarantor code.
  • Diagnosis:
  • The diagnosis record is created for the client.
  • Client Charge Input:
  • The service is rendered to the client. Note the service date and service code.
  • Client Ledger:
  • The service distributed to the self pay guarantor.
Steps
  1. Open the 'Crystal Self Pay Bill' form.
  2. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
  3. Select 'Yes' in the 'Create Claims Y/N' field.
  4. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  5. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  6. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  7. Click [Compile Self Pay Bill].
  8. Verify the 'Compile Complete' message displayed.
  9. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  10. Select value for 'Select By Client Or File' field.
  11. Select compiled bill file or client record for bill data display.
  12. Click [Print Self Pay Bill].
  13. Ensure that it displays the Self Pay Bill report/information.
  14. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
  15. Open the 'Client Charge Input' form.
  16. Render a service to the client. Note the date of the service.
  17. Verify the service distributed correctly to the self pay guarantor assigned to the client.
  18. Close charges.
  19. Open the 'Crystal Self Pay Bill' form.
  20. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date.
  21. Select 'Yes' in the 'Create Claims Y/N' field.
  22. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date.
  23. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  24. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  25. Click [Compile Self Pay Bill].
  26. Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed.
  27. Click [Close Report].
  28. Click [Discard].
  29. Open the 'Inhibited Services For Billing Report' form.
  30. Enter 'Start Date'.
  31. Enter 'End Date'.
  32. Select the client from the previous steps.
  33. Click [Process report].
  34. Verify the report contains all the services for the client for the episode inhibited from the billing.
  35. Close the report.
  36. Open the 'Crystal Self Pay Bill' form.
  37. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is after the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
  38. Select 'Yes' in the 'Create Claims Y/N' field.
  39. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  40. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  41. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  42. Click [Compile Self Pay Bill].
  43. Verify the 'Compile Complete' message displayed.
  44. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  45. Select value for 'Select By Client Or File' field.
  46. Select compiled bill file or client record for bill data display.
  47. Click [Print Self Pay Bill].
  48. Ensure that it displays the Self Pay Bill report/information.
  49. Verify the report displays the recently claimed service in the report.
  50. Close the report.
  51. Close the form.
Scenario 2: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Make payments so that the self pay balance for that client/episode is zero
Specific Setup:
  • Registry Settings:
  • Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
  • Guarantors/Payor:
  • The self pay guarantor is identified. Note the guarantor code/value.
  • Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
  • Admission:
  • A new client is admitted. Note the client id, admission date and admission program.
  • Financial Eligibility:
  • A self pay guarantor is assigned to the client. Note the guarantor code.
  • Diagnosis:
  • The diagnosis record is created for the client.
  • Client Charge Input:
  • The service is rendered to the client. Note the service date and service code.
  • Client Ledger:
  • The service distributed to the self pay guarantor.
Steps
  1. Open the 'Crystal Self Pay Bill' form.
  2. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
  3. Select 'Yes' in the 'Create Claims Y/N' field.
  4. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  5. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  6. Select the self pay guarantor assigned to the client.
  7. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  8. Click [Compile Self Pay Bill].
  9. Verify the 'Compile Complete' message displayed.
  10. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  11. Select value for 'Select By Client Or File' field.
  12. Select compiled bill file or client record for bill data display.
  13. Click [Print Self Pay Bill].
  14. Ensure that it displays the Self Pay Bill report/information.
  15. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
  16. Open the 'Client Charge Input' form.
  17. Render a service to the client. Note the date of the service.
  18. Verify the service distributed correctly to the self pay guarantor assigned to the client.
  19. Close charges.
  20. Open the 'Crystal Self Pay Bill' form.
  21. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date.
  22. Select 'Yes' in the 'Create Claims Y/N' field.
  23. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date.
  24. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  25. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  26. Click [Compile Self Pay Bill].
  27. Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed.
  28. Click [Close Report].
  29. Click [Discard].
  30. Open the 'Inhibited Services For Billing Report' form.
  31. Enter 'Start Date'.
  32. Enter 'End Date'.
  33. Select the client from the previous steps.
  34. Click [Process report].
  35. Verify the report contains all the services for the client for that episode inhibited from the billing.
  36. Close the report.
  37. Open the 'Individual Cash Posting' form.
  38. Enter the 'Client' identified in the setup section.
  39. Select desired value in 'Post By'.
  40. Review 'Start Date' and 'Stop Date'. Change the values if desired.
  41. Click [Select Item(s) to Post Against].
  42. Highlight the first two services.
  43. Click [OK]. Note the 'balance due'.
  44. Click [OK].
  45. Enter the 'Posting Date'.
  46. Enter the 'Date of Receipt'.
  47. Enter the 'balance due' in 'Dollar Amount To Be Posted'.
  48. Enter the 'Posting Code'.
  49. Click [Update Temporary File]'.
  50. Click [OK].
  51. Click [Submit].
  52. Click [Yes].
  53. Click [No].
  54. Open 'Client Ledger'.
  55. Enter the 'Client ID'.
  56. Select 'All Episodes' in 'Claim/Episode/All Episodes'.
  57. Select 'Simple' in 'Ledger Type'.
  58. Set the 'From Date' to the first date of service.
  59. Set the 'To Date' to the last date of service.
  60. Click [Process].
  61. Services one and two have been paid in full. The 'LINE BALANCE' is '0.00'.
  62. The balance for the 'Self Pay' guarantor is 0.00.
  63. Open the 'Crystal Self Pay Bill' form.
  64. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
  65. Select 'Yes' in the 'Create Claims Y/N' field.
  66. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  67. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  68. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  69. Click [Compile Self Pay Bill].
  70. Verify the 'Compile Complete' message displayed.
  71. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  72. Select value for 'Select By Client Or File' field.
  73. Select compiled bill file or client record for bill data display.
  74. Click [Print Self Pay Bill].
  75. Ensure that it displays the Self Pay Bill report/information.
  76. Verify the report displays the recently claimed service in the report.
  77. Close the report.
  78. Close the form.
Scenario 3: Compile Self Pay bill - Previous claim date does not fall within the 'Number Of Days Since Last Claim' - Validating registry setting 'Allow For Number of Days Since Last Claim'
Specific Setup:
  • Registry Settings:
  • Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
  • Guarantors/Payor:
  • The self pay guarantor is identified. Note the guarantor code/value.
  • Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
  • Admission:
  • A new client is admitted. Note the client id, admission date and admission program.
  • Financial Eligibility:
  • A self pay guarantor is assigned to the client. Note the guarantor code.
  • Diagnosis:
  • The diagnosis record is created for the client.
  • Client Charge Input:
  • The service is rendered to the client. Note the service date and service code.
  • Client Ledger:
  • The service distributed to the self pay guarantor.
  • Close Charges:
  • Services rendered to the client are closed.
Steps
  1. Open the 'Crystal Self Pay Bill' form.
  2. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
  3. Select 'Yes' in the 'Create Claims Y/N' field.
  4. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  5. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  6. Select the self pay guarantor assigned to the client.
  7. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  8. Click [Compile Self Pay Bill].
  9. Verify the 'Compile Complete' message displayed.
  10. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  11. Select value for 'Select By Client Or File' field.
  12. Select compiled bill file or client record for bill data display.
  13. Click [Print Self Pay Bill].
  14. Ensure that it displays the Self Pay Bill report/information.
  15. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
  16. Open the 'Client Charge Input' form.
  17. Render another service to the client. Note the date of the service.
  18. Verify the service distributed correctly to the self pay guarantor assigned to the client.
  19. Open the 'Close Charges' form.
  20. Close the service rendered to the client.
  21. Open the 'Crystal Self Pay Bill' form.
  22. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the last claim date. Note the date.
  23. Select 'Yes' in the 'Create Claims Y/N' field.
  24. Enter desired date to the 'Date Of Claim' field such that it is after the last claim date and 'Print Charges Thru' date.
  25. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  26. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  27. Click [Compile Self Pay Bill].
  28. Verify the 'No Information Found. Cancel OK No Information Was Found For Inclusion On The Bill.' message displayed.
  29. Click [Close Report].
  30. Click [Discard].
  31. Open the 'Inhibited Services For Billing Report' form.
  32. Enter 'Start Date'.
  33. Enter 'End Date'.
  34. Select the client from the previous steps.
  35. Click [Process report].
  36. Verify the report contains all the services for the client for that episode inhibited from the billing.
  37. Close the report.
  38. Open the 'Individual Cash Posting' form.
  39. Enter the 'Client' identified in the setup section.
  40. Select desired value in 'Post By'.
  41. Review 'Start Date' and 'Stop Date'. Change the values if desired.
  42. Click [Select Item(s) to Post Against].
  43. Highlight the first two services.
  44. Click [OK]. Note the 'balance due'.
  45. Click [OK].
  46. Enter the 'Posting Date'.
  47. Enter the 'Date of Receipt'.
  48. Enter the 'balance due' in 'Dollar Amount To Be Posted'.
  49. Enter the 'Posting Code'.
  50. Click [Update Temporary File]'.
  51. Click [OK].
  52. Click [Submit].
  53. Click [Yes].
  54. Click [No].
  55. Open 'Client Ledger'.
  56. Enter the 'Client ID'.
  57. Select 'All Episodes' in 'Claim/Episode/All Episodes'.
  58. Select 'Simple' in 'Ledger Type'.
  59. Set the 'From Date' to the first date of service.
  60. Set the 'To Date' to the last date of service.
  61. Click [Process].
  62. Services one and two have been paid in full. The 'LINE BALANCE' is '0.00'.
  63. The balance for the 'Self Pay' guarantor is 0.00.
  64. Open the 'Crystal Self Pay Bill' form.
  65. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
  66. Select 'Yes' in the 'Create Claims Y/N' field.
  67. Enter desired date to the 'Date Of Claim' field such that it is after the last claim date and 'Print Charges Thru' date. Note the claim date for further testing.
  68. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  69. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  70. Click [Compile Self Pay Bill].
  71. Verify the 'Compile Complete' message displayed.
  72. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  73. Select value for 'Select By Client Or File' field.
  74. Select compiled bill file or client record for bill data display.
  75. Click [Print Self Pay Bill].
  76. Ensure that it displays the Self Pay Bill report/information.
  77. Verify the report displays the recently claimed service in the report.
  78. Close the report.
  79. Close the form.
  80. Open the 'Registry Setting' form.
  81. Set the 'Allow For Number Of Days Since Last Claim' registry setting to 'Y'.
  82. Open the 'Admission (Outpatient)' form for the client.
  83. Add new episode to the client.
  84. Assign a self pay guarantor to the client.
  85. Open the 'Client Charge Input' form.
  86. Render a service to the client.
  87. Close the charges.
  88. Open the 'Crystal Self Pay Bill' form.
  89. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
  90. Select 'Yes' in the 'Create Claims Y/N' field.
  91. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  92. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  93. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  94. Click [Compile Self Pay Bill].
  95. Verify the services are not claimed and no information found message displayed.
  96. Open the 'Inhibited Services For Billing Report' form.
  97. Enter 'Start Date'.
  98. Enter 'End Date'.
  99. Select the client from the previous steps.
  100. Click [Process report].
  101. Verify the report does not contain all the services for the client for that episode inhibited from the billing.
  102. Close the report.
  103. Open the 'Registry Setting' form.
  104. Set the 'Allow For Number Of Days Since Last Claim' registry setting to 'I'.
  105. Open the 'Admission (Outpatient)' form for the client.
  106. Add new episode to the client.
  107. Assign a self pay guarantor to the client.
  108. Open the 'Client Charge Input' form.
  109. Render a service to the client.
  110. Close the charges.
  111. Open the 'Crystal Self Pay Bill' form.
  112. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
  113. Select 'Yes' in the 'Create Claims Y/N' field.
  114. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  115. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  116. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  117. Click [Compile Self Pay Bill].
  118. Verify the services are not claimed and no information found message displayed.
  119. Open the 'Inhibited Services For Billing Report' form.
  120. Enter 'Start Date'.
  121. Enter 'End Date'.
  122. Select the client from the previous steps.
  123. Click [Process report].
  124. Verify the report does contain all the services for the client for that episode inhibited from the billing.
  125. Close the report.
  126. Close the form.
Scenario 4: Progressive Self Pay Dunning Messages - Form validation - Validating registry setting 'Enable Progressive Self-Pay Dunning Messages'
Specific Setup:
  • Registry Settings:
  • The registry setting 'Enable Progressive Self-Pay Dunning Messages' is added.
  • The registry setting 'Enable Progressive Self-Pay Dunning Messages' is set to 'Y'.
  • The registry setting 'Allow For Number Of Days Since Last Claim' set to 'I'.
  • User Definition:
  • Verify the form 'Progressive Self Pay Dunning Messages' is added to the system.
  • Select the form and submit the user definition.
  • Form Search:
  • Verify the form 'Progressive Self Pay Dunning Messages' is available in the system.
  • Guarantors/Payor:
  • The self pay guarantor is identified. Note the guarantor code/value.
  • Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
  • Admission:
  • A new client is admitted. Note the client id, admission date and admission program.
  • Financial Eligibility:
  • A self pay guarantor is assigned to the client. Note the guarantor code.
  • Diagnosis:
  • The diagnosis record is created for the client.
  • Client Charge Input:
  • 6-7 services are rendered to the client. Note the service date and service code.
  • Client Ledger:
  • The services distributed to the self pay guarantor.
  • Close Charges:
  • Services are closed.
Steps
  1. Open the 'Progressive Self Pay Dunning Messages' form.
  2. Select the guarantor.
  3. Verify the first message field is enabled.
  4. Verify that each subsequent message field enables when the prior field has a value.
  5. File data for multiple guarantors.
  6. Print the information for the selected guarantor.
  7. Verify the report displays data for all the guarantors.
  8. Select a desired guarantor.
  9. Click [Print Only the selected guarantor].
  10. Verify the report includes data filed for the selected guarantor.Open the 'Crystal Report' or any other SQL Data Viewer.
  11. Query the SQL table SYSTEM.billing_prog_sp_dunn_msg.
  12. Verify the data files successfully and correctly as entered through the form.
  13. Select a desired guarantor.
  14. Click [Delete].
  15. Verify the data filed for the guarantor deleted.
  16. Open the 'Crystal Self Pay Bill' form.
  17. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
  18. Select 'Yes' in the 'Create Claims Y/N' field.
  19. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  20. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  21. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  22. Click [Compile Self Pay Bill].
  23. Verify the 'Compile Complete' message displayed.
  24. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  25. Select value for 'Select By Client Or File' field.
  26. Select compiled bill file or client record for bill data display.
  27. Click [Print Self Pay Bill].
  28. Ensure that it displays the first message defined in the form in the Self Pay Bill report/information.
  29. Run the bill for the second service.
  30. Ensure that it displays the second message defined in the form in the Self Pay Bill report/information.
  31. Run the bill for the second service.
  32. Ensure that it displays the third message defined in the form in the Self Pay Bill report/information.
  33. Run the bill for the second service.
  34. Ensure that it displays the fourth message defined in the form in the Self Pay Bill report/information.
  35. Run the bill for the second service.
  36. Ensure that it displays the fifth message defined in the form in the Self Pay Bill report/information.
  37. Close the report.
  38. Close the form.
Scenario 5: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Validating new billing cycle - Updating client's address using the 'Update Client Data' form - Inpatient client - Multiple guarantors
Specific Setup:
  • Registry Settings:
  • Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
  • Guarantors/Payor:
  • The self pay guarantor is identified to be assigned to the client as a secondary guarantor. Note the guarantor code/value.
  • Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
  • Any other existing guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value.
  • Admission:
  • A new client is admitted. Note the client id, admission date and admission program.
  • Financial Eligibility:
  • The guarantor identified above is assigned to the client as a primary guarantor.
  • A self pay guarantor is assigned to the client as a secondary guarantor. Note the guarantor code.
  • The 'Coverage Effective Date' of the primary guarantor is set to the date that comes after the 'Service Date' and the primary guarantor does not cover the services rendered to the client and they distributed to the next guarantor.
  • Diagnosis:
  • The diagnosis record is created for the client.
  • Client Charge Input:
  • The service is rendered to the client such that it comes prior to coverage effective date of the primary guarantor. Note the service date and service code.
  • Client Ledger:
  • The service distributed to the self pay guarantor.
  • Close Charges:
  • The services rendered to the client are closed.
Steps
  1. Open the 'Crystal Self Pay Bill' form.
  2. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
  3. Select 'Yes' in the 'Create Claims Y/N' field.
  4. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  5. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  6. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  7. Click [Compile Self Pay Bill].
  8. Verify the 'Compile Complete' message displayed.
  9. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  10. Select value for 'Select By Client Or File' field.
  11. Select compiled bill file or client record for bill data display.
  12. Click [Print Self Pay Bill].
  13. Ensure that it displays the Self Pay Bill report/information.
  14. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
  15. Open the 'Client Charge Input' form.
  16. Render a service to the client. Note the date of the service.
  17. Verify the service distributed correctly to the self pay guarantor assigned to the client.
  18. Close charges.
  19. Open the 'Crystal Self Pay Bill' form.
  20. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date.
  21. Select 'Yes' in the 'Create Claims Y/N' field.
  22. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date.
  23. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  24. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  25. Click [Compile Self Pay Bill].
  26. Verify the 'No Information Was Found For Inclusion On The Bill.' message displayed.
  27. Click [Close Report].
  28. Click [Discard].
  29. Open the 'Inhibited Services For Billing Report' form.
  30. Enter 'Start Date'.
  31. Enter 'End Date'.
  32. Select the client from the previous steps.
  33. Click [Process report].
  34. Verify the report contains all the services for the client for the episode inhibited from the billing.
  35. Close the report.
  36. Open the 'Update Client Data' form for the client.
  37. Navigate to 'Demographics' section of form.
  38. Change any of the Client's Address field.
  39. Click [Submit].
  40. Open the 'Crystal Self Pay Bill' form.
  41. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
  42. Select 'Yes' in the 'Create Claims Y/N' field.
  43. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  44. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  45. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  46. Click [Compile Self Pay Bill].
  47. Verify the 'Compile Complete' message displayed.
  48. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  49. Select value for 'Select By Client Or File' field.
  50. Select compiled bill file or client record for bill data display.
  51. Click [Print Self Pay Bill].
  52. Ensure that it displays the Self Pay Bill report/information.
  53. Verify the report displays the recently claimed service in the report.
  54. Close the report.
  55. Close the form.
Scenario 6: Crystal Self Pay Bill - Previous claim date within the 'Number Of Days Since Last Claim' - Validating services that are transferred to the Self-Pay guarantor
Specific Setup:
  • Registry Settings:
  • Set the 'Allow For Number Of Days Since Last Claim' set to 'I'.
  • Guarantors/Payor:
  • The self pay guarantor is identified to be assigned to the client as a secondary guarantor. Note the guarantor code/value.
  • Enter desired days in the 'Number Of Days Since Last Claim' field. Note the number of days.
  • Any other existing guarantor is identified to be assigned to the client as a primary guarantor. Note the guarantor code/value.
  • Admission:
  • A new client is admitted. Note the client id, admission date and admission program.
  • Financial Eligibility:
  • A self pay guarantor is assigned to the client as a secondary guarantor. Note the guarantor code.
  • The other guarantor identified above is assigned to the client as a primary guarantor.
  • Diagnosis:
  • The diagnosis record is created for the client.
  • Client Charge Input:
  • The service is rendered to the client. Note the service date and service code.
  • Client Ledger:
  • The service distributed to the primary guarantor.
Steps
  1. Open the 'Crystal Self Pay Bill' form.
  2. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client. Note the date.
  3. Select 'Yes' in the 'Create Claims Y/N' field.
  4. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  5. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  6. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  7. Click [Compile Self Pay Bill].
  8. Verify the 'Compile Complete' message displayed.
  9. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  10. Select value for 'Select By Client Or File' field.
  11. Select compiled bill file or client record for bill data display.
  12. Click [Print Self Pay Bill].
  13. Ensure that it displays the Self Pay Bill report/information.
  14. In the Self Pay Bill report/information display, ensure that the 'Current Charges' section includes claim/service information for all services meeting bill generation criteria selection, with service date/description/amount values, as well as charge total information.
  15. Open the 'Client Charge Input' form.
  16. Render a service to the client. Note the date of the service.
  17. Verify the service distributed correctly to the self pay guarantor assigned to the client.
  18. Close charges.
  19. Open the 'Crystal Self Pay Bill' form.
  20. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days since last claim defined in the 'Guarantors/Payor' from the claim date. Note the date.
  21. Select 'Yes' in the 'Create Claims Y/N' field.
  22. Enter desired date to the 'Date Of Claim' field such that it is after the previous claim date.
  23. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  24. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  25. Click [Compile Self Pay Bill].
  26. Verify the 'No Information Was Found For Inclusion On The Bill.' message displayed.
  27. Click [Close Report].
  28. Click [Discard].
  29. Open the 'Inhibited Services For Billing Report' form.
  30. Enter 'Start Date'.
  31. Enter 'End Date'.
  32. Select the client from the previous steps.
  33. Click [Process report].
  34. Verify the report contains all the services for the client for the episode inhibited from the billing.
  35. Close the report.
  36. Open the 'Update Client Data' form for the client.
  37. Navigate to 'Demographics' section of form.
  38. Change client's address field.
  39. Click [Submit].
  40. Open the 'Crystal Self Pay Bill' form.
  41. Enter/select values for 'Print Charges Thru' field such that it covers the service rendered to the client and it is within the number of days defined in the 'Number Of Days Since Last Claim' field in the 'Guarantors/Payors. Note the date.
  42. Select 'Yes' in the 'Create Claims Y/N' field.
  43. Enter desired date to the 'Date Of Claim' field such that it is after the service date. Note the claim date for further testing.
  44. Select 'No' in the 'Print for Interim Batch' field. Please note the 'Number Of Days Since Last Claim' functionality does not support batch.
  45. Select 'All Clients' in the 'Print For An Individual Or All Clients'.
  46. Click [Compile Self Pay Bill].
  47. Verify the 'Compile Complete' message displayed.
  48. Navigate to the 'Print Crystal Self Pay Bill' section of the form.
  49. Select value for 'Select By Client Or File' field.
  50. Select compiled bill file or client record for bill data display.
  51. Click [Print Self Pay Bill].
  52. Ensure that it displays the Self Pay Bill report/information.
  53. Verify the report displays the recently claimed service in the report.
  54. Close the report.
  55. Close the form.
Topics
• 837 Professional • Crystal Self Pay Bill • Inhibit Billing • NX • Registry Settings

 

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