835 Health Care Claim Payment/Advice - Work Compile
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- 835 Health Care Claim Payment/Advice (PM)
- Admission
- Client Charge Input
- Create Interim Billing Batch File
- Crystal Report Viewer
- Diagnosis
- Electronic Billing
- Financial Eligibility
Scenario 1: 835 Health Care Claim Payment/Advice - Contains no 2110 loop, 'REF*6R*' segment
Specific Setup:
- Admission:
- Select an active client.
- Financial Eligibility: Client has an active record.
- Service:
- The client has a service that distributed to the primary guarantor.
- The service was claimed and the 837 file was used to create an 835 file that contains no 2110 loop, 'REF*6R*' segment. Note the value of the 'SVC01' field.
Steps
- Open the '835 Health Care Claim Payment/Advice' form.
- Compile the 835 payment file.
- Select 'Work Compile' in 'Options'.
- Select the compiled file in 'Select File'.
- Click 'Launch Work Screen'.
- Validate that the 'Billed Code' is populated with the data from the 'SVC01' field in the 835 file.
- Close the grid.
- Close the form.
|
Topics
• 835 Health Care Claim Payment/Advice
|
835 Health Care Claim Payment/Advice
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- 835 Health Care Claim Payment/Advice (PM)
- Admission (Outpatient)
- CCBHC PPS Compile
- CCBHC PPS Service Definition
- Client Charge Input
- Client Ledger
- Crystal Report Viewer
- Diagnosis
- Dictionary Update (PM)
- Financial Eligibility
- Guarantors/Payors
- Practitioner Enrollment
- Practitioner Numbers By Guarantor And Program
- Program Maintenance
- Service Codes
- Service Fee/Cross Reference Maintenance
Scenario 1: 835 Health Care Claim Payment/Advice - CCBHC enumerated service distributed to a non-CCBHC guarantor then transferred to CCBHC guarantor
Specific Setup:
- CCBHC Billing is enabled.
- Admission:
- Client is admitted into a program that provides CCBHC services.
- Financial Eligibility: The primary guarantor is not a CCBHC guarantor. The secondary guarantor is a CCBHC guarantor.
- Service:
- The client has a CCBHC enumerated service that distributed to the primary guarantor.
- The full liability for the service is transferred to the secondary guarantor.
- The service was claimed and the 837 file was used to create an 835 file that contains adjustments for the enumerated service.
Steps
- Open ‘835 Health Care Claim Payment/Advice’.
- Load the file.
- Compile the file.
- Verify that the compile report correctly displays the adjustments made to the enumerated service.
- If desired, post the file.
- Verify that the report correctly displays the adjustments made to the enumerated service.
- Close the report.
- Close the form.
|
Topics
• 835 Health Care Claim Payment/Advice
• CCBHC
|
Registry Setting - Enable Service Unit Splits
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
- Create Interim Billing Batch File
- Diagnosis
- Electronic Billing
- Financial Eligibility
- Guarantors/Payors
- Liability Update
- Registry Settings (PM)
- Service Codes
- Service Fee/Cross Reference Maintenance
Scenario 1: 837 Professional - Validating 'Service Unit (2400-SV1-04)' field- 'Enable Service Unit Splits' registry setting = 2.
Specific Setup:
- Registry Setting:
- The 'Enable Service Unit Splits' registry setting is set to "2".
- Service Code:
- The 'Type of Fee' is 'User Defined'.
- Note the 'Minutes Per Unit'.
- Unit Rounding Logic = Round Over 1/2 Unit.
- Designated Degree Of Rounding = desired value noting the value.
- There is a fee record in 'Service Fee/Cross Reference Maintenance'. Note the amount.
- Admission:
- An existing client is identified, or a new client is admitted.
- Financial Eligibility:
- Two guarantors are assigned to the client as primary and secondary.
- Client Charge Input:
- A service is rendered to a client with a duration that will round and create a partial unit. Example, the 'Minutes Per Unit' = 60, and the duration is 95 minutes.
- Client Ledger:
- The service and all units distribute to the primary guarantor.
- Close the charges.
- An interim billing batch is created for the client and the primary guarantor.
Steps
- Open the 'Electronic Billing' form.
- Compile the 837 Professional bill for the interim billing batch created in the setup section.
- Verify the bill compiles successfully.
- Review the dump file.
- Verify that the units displayed in '2400-SV1-04' contains the partial unit.
- Close the report.
- Close the form.
|
Topics
• 837 Professional
|
Guarantors/Payors - Contractual Guarantor Information
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
- Close Accounting Period
- Diagnosis
- Financial Eligibility
- Guarantors/Payors
- Liability Update
- Open Closed Charges
- Registry Settings (PM)
- Service Codes
- Service Fee/Cross Reference Maintenance
Scenario 1: Contractual Allowance By Liability Distribution - Change Primary Guarantor
Specific Setup:
- Admission:
- Client is enrolled in an outpatient program.
- Financial Eligibility:
- The primary guarantor is a contractual guarantor with a value of ‘Contractual Allowance By Liability Distribution’ in ‘Does This Guarantor Use Contractual Allowance By Batch Or Through Liability Distribution?’
- The secondary guarantor is a non-contractual guarantor.
- Service: A service is rendered to the client and is distributed to the primary guarantor and the adjustments are applied to the service.
- Financial Eligibility:
- Change the secondary guarantor, the non-contract guarantor, to be the primary guarantor.
- Change the original primary guarantor, the contractual guarantor, to be the secondary guarantor.
- Use ‘Liability Update’ to update the liability for the service.
- Use Client Ledger to validate that the service charges are now assigned to the new primary guarantor and that there are no contractual adjustments.
- Close the charge.
- Close the accounting period.
- Use Open Closed Charges to reopen the charge.
- Financial Eligibility:
- Change the primary guarantor to be the original primary guarantor, the contractual guarantor.
- Change the secondary guarantor to the original secondary guarantor, the non-contractual guarantor.
- Use ‘Liability Update’ to update the liability for the service.
Steps
- Open ‘Client Ledger’.
- Process the ‘Simple’ report.
- Validate that the fee is distributed to the current primary guarantors, the contractual guarantor, and that the adjustments are included.
- Close the report.
- Close the form.
|
Topics
• Guarantor/Payors
• Liability Update
|
835 Health Care Claim Payment/Advice
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- 835 Health Care Claim Payment/Advice (PM)
- Admission (Outpatient)
- Claim Adjustment Group/Reason Code Definition
- Client Charge Input
- Client Ledger
- Create Interim Billing Batch File
- Crystal Report Viewer
- Diagnosis
- Electronic Billing
- Financial Eligibility
- Guarantors/Payors
- Registry Settings (PM)
Scenario 1: 835 Health Care Claim Payment/Advice - Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services = YP
Specific Setup:
- Registry Setting: 'Distribute Claim/Service Level Adjustments (2100/2110-CAS) Across All Services' is set to "YP".
- Client has a claimed service and the 837 is used to create an 835 which includes adjustments that overpay the service.
- The 835 payment file is available for compiling.
Steps
- Open the '835 Health Care Claim Payment/Advice' form.
- Compile the 835 payment file.
- Validate that the compile report displays the adjustments correctly.
- If desired, post the file.
- Close the form.
- If the file was posted, open 'Client Ledger' and verify that the service has a credit balance.
- Close the report.
- Close the form.
|
Topics
• 835 Health Care Claim Payment/Advice
|
