Skip to main content

Avatar PM 2023 Update 100

  1. Last updated
  2. Save as PDF

Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.03.00
RADplus 2023 Monthly Release 2023.03.00

Product Update Description

An issue is resolved where CCBHC PPS charges were being claimed even when there were enumerated services still waiting for remittance from other insurance. This could occur when the 'CCBHC Claim Grouping' field on the 'Guarantor/Program Billing Defaults' form is set to 'Separate Claims' and 'Quick Billing' is used to generate the claims.

Required Updates

None

Included Updates

33, 58

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Quick Billing - CCBHC Claim Grouping
Functionality for Quick Billing has been modified to ensure that the value of the 'CCBHC Claim Grouping' field on the 'Guarantor/Program Billing Defaults' form is respected.
Topics
• 837 Institutional • 837 Professional • CCBHC • Quick Billing
 
Acceptance Tests
AV-90511 Summary | Details
Quick Billing - CCBHC Claim Grouping
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
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Diagnosis
  • Dictionary Update (PM)
  • Electronic Billing
  • Financial Eligibility
  • Guarantors/Payors
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • Program Maintenance
  • Quick Billing
  • Quick Billing Rule Definition
  • Admission (Outpatient)
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 compiled service and enumerated services are included on the same claim.
  8. Close the report.
  9. Close the form.
Scenario 2: Quick Billing - 837 Institutional - CCBHC Claim Grouping - Separate Claim
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 'No' 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'.
  • Guarantor 2 is a Non CCBHC guarantor. Allow Customization Of Guarantor Plan' has a value of 'Yes'. Note the 'Financial Class'.
  • Admission:
  • A client is enrolled in an In-patient program. Note the program.
  • The client has an active diagnosis record. Note the diagnosis code.
  • The financial eligibility record is:
  • ‘Guarantor # 1’ = Guarantor 2.
  • ‘Guarantor # 2’ = 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:
  • Service for Service Code 1 is rendered to the client.
  • Use 'Client Ledger' to verify that these Enumerated services have liability distributed to Non-CCBHC 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 CCBHC Guarantor 2. Note the 'Date'. Note the 'CHG' amount.
  • 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client 1:
  • CCBHC Claim Grouping = Separate.
  • 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 guarantor, selecting 'Yes' in 'Include CCBHC Services'.
  3. Select 'Sort File' in 'Billing Options'.
  4. Choose the Program/ Dates and all other mandatory fields and select Process.
  5. Observe that we see the error popup says "No Valid info found and there are Errors".
  6. Select 'Run Report' in 'Billing Options'.
  7. Select 'Print' in Print Or Delete Report'.
  8. Select the 'File'.
  9. Click [Print 837 Report].
  10. Verify that the PPS charge is correctly held for billing due to the enumerated service still awaiting remittance from private insurance. The PPS charge is not included in the bill.
  11. Click [X].
  12. Click [X].
Scenario 3: Quick Billing - 837 Professional - CCBHC Claim Grouping - Separate Claim
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 'No' 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'.
  • Guarantor 2 is a Non 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.
  • The client has an active diagnosis record. Note the diagnosis code.
  • The financial eligibility record is:
  • ‘Guarantor # 1’ = Guarantor 2.
  • ‘Guarantor # 2’ = 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:
  • Service for Service Code 1 is rendered to the client.
  • Use 'Client Ledger' to verify that these Enumerated services have liability distributed to Non-CCBHC 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 CCBHC Guarantor 2. Note the 'Date'. Note the 'CHG' amount.
  • 'Guarantor/Program Billing Defaults' for the CCBHC guarantor and the program for Client 1:
  • CCBHC Claim Grouping = Separate.
  • Maximum Service Information Per Claim Information (Maximum LX Per CLM)’ = blank
  • Close the charges.
Steps
  1. Open 'Electronic Billing'.
  2. Create an '837 Professional' for the 'CCBHC guarantor, selecting 'Yes' in 'Include CCBHC Services'.
  3. Select 'Sort File' in 'Billing Options'.
  4. Choose the Program/ Dates and all other mandatory fields and select Process.
  5. Observe that we see the error popup says "No Valid info found and there are Errors".
  6. Select 'Rub Report' in 'Billing Options'.
  7. Select 'Print' in Print Or Delete Report'.
  8. Select the 'File'.
  9. Click [Print 837 Report]. Verify that the PPS charge is correctly held for billing due to the enumerated service still awaiting remittance from private insurance. The PPS charge is not included in the bill.
  10. Click [X].
  11. Click [X].
Topics
• 837 Institutional • 837 Professional • CCBHC • Quick Billing