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Avatar PM 2023 Update 160

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Product Requirements and Recommendations

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Recommended Update Level

Avatar PM 2022 Update 18
Avatar PM 2023 Monthly Release 2023.04.00
RADplus 2023 Monthly Release 2023.04.00

Product Update Description

The following modifications are made: 1) The registry setting 'Specify Write Off Posting Code In Roll-Up Services Definition' is added. This setting supports new Roll-Up Billing functionality that allows the default write-off posting code specified during the roll-up posting process to be overridden by the write-off posting code defined in the individual roll-up definitions. 2) Roll-Up Billing is enhanced to support transferring roll-up component service liability to the next guarantor or leave the liability with the current guarantor during the roll-up posting process. 3) Roll-Up Billing is enhanced to allow grouping roll-up services and component services on the same claim when preparing 837 Institutional and 837 Professional files. 4) Roll-Up Billing is enhanced to optionally include roll-up components and/or roll-up services in an 837 Institutional or 837 Professional file. 5) The 837 Professional billing process is enhanced to support sorting claims by date of service. 6) An issue is resolved where the Roll-Up Services Compile Report would not display after compiling roll-up group definitions. 7) An issue is resolved where the supervising_practitioner, in_other_rollups, and exclude_from_totals fields in the SYSTEM.rollup_services_worklist table were not populated.

Required Updates

None

Included Updates

2, 7, 10, 11, 16, 17, 18, 21, 25, 29, 31, 32, 33, 34, 35, 39, 43, 44, 48, 56, 57, 58, 59, 62, 63, 64, 65, 66, 67, 72, 73, 76, 77, 78, 79, 82, 84, 85, 86, 88, 89, 93, 94, 96, 97, 98, 100, 101, 102, 103, 104, 105, 106, 108, 109, 110, 115, 116, 119, 120, 121, 122, 125, 128, 129, 130, 133, 134, 135, 136, 139, 140, 143, 149, 152, 153, 154, 156, 157, 159

Details
NEW4 CHANGED0 FIXED1
New (4)
Roll-Up Services Definition - Bill component and roll-up services on one claim
A new feature is implemented allowing users to bill the component service(s) and the roll-up service on the same claim.
Previously, agencies could only bill the roll-up service or the component service, but not on the same claim. This posed a challenge for some agencies. With the new feature, agencies can now easily bill both the component service(s) and the roll-up service on a claim, enhancing the efficiency of their billing process.
Value Added: The new feature adds significant value by enabling agencies to bill both component and roll-up services on the same claim.
Topics
• 837 Professional • Compile/Edit/Post/Unpost Roll-up Services Worklist • Electronic Billing • File Import • Guarantor / Program Billing Defaults • Roll-Up Services Definition
 
Compile Roll-Up Services Worklist
A new feature ensures that run-time roll-up compile/post choices are stored properly and that the data is accurately projected in the respective SQL table. KB0064233 v1.0
With this new feature, users can be confident that their run-time roll-up compile/post choices are being stored correctly. This is achieved through an efficient SQL projection of the data, which ensures accuracy and reliability. Users can now manage their roll-up services worklist more effectively.
Value Added: The feature enhances data accuracy and storage efficiency, making it easier to manage the roll-up services worklist.
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • Roll-Up Services Definition
 
Roll-Up Services Definition - Write-off or Transfer Roll-up Component Services
A new feature introduces several enhancements to the ‘Roll-Up Services Definition’ form, including new fields for ‘Write Off Component Service(s)’, ‘Transfer Code for Component Service(s)’, and ‘Write Off Code’. It also includes a new registry setting for specifying the ‘Write Off Posting Code for Roll-Up Services Definition’.
Value Added: The feature provides more control and flexibility in managing the roll-up services. It allows for more precise configuration of write-off and transfer settings, enhancing the efficiency and accuracy of roll-up service operations.
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • File Import • Quick Billing • Registry Settings • Roll-Up Services Definition
 
Guarantor/Program Billing Defaults - 837 Professional
A new field has been added to group claims for the same Date of Service in the 'Guarantor/Program Billing Defaults (837 Professional)' form.
A new field, 'Sort Claims by Date of Service', has been added to 'Guarantor/Program Billing Defaults (837 Professional)'. This field allows claims to be grouped by the same Date of Service, providing a more granular and specific grouping option compared to the previous method of grouping claims in the same month. This change will require users to select the appropriate option in the 'Guarantor/Program Billing Defaults (837 Professional)' section when setting up their billing templates.
Value Added: The new feature enhances the flexibility of claim grouping in billing templates. By allowing claims to be grouped by the same Date of Service.
Topics
• 837 Professional • Electronic Billing • File Import • Guarantor / Program Billing Defaults
 
Fixed (1)
Compile/Edit/Post/Unpost Roll-Up Services Worklist - Compile Roll-Up Group
An issue is resolved where compiling the group definition and then attempting to run the report produced ‘no information found’. KB0075333 v0.01
Compiling the group definition and then attempting to run the report resulted in ‘no information found’. This issue has now been addressed, ensuring that the report runs as expected after compiling the group definition.
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • Roll-Up Services Definition
 
Acceptance Tests
AV-76585 Summary | Details
Roll-Up Services Definition - Bill component and roll-up services on one claim
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Roll-Up Services Definition
  • Client Ledger
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
  • Create Interim Billing Batch File
  • Electronic Billing
  • Client Charge Input With Diagnosis Entry
  • File Import
  • Registry Settings (PM)
Scenario 1: Roll-Up Services Definition - Form / Field Validation for new Fields
Specific Setup:
  • Service Codes:
  • Service Code 1: Roll-Up service code. 'Type of 'Fee' = desired value. Minutes Per Unit = desired value. Note the service code/value, Minutes Per Unit, and 'Covered Charge Category' for the service code.
  • Service Code 2: Component service code. 'Type of 'Fee' = desired value, Minutes Per Unit = desired value. Note the service.
  • Service Fee/Cross Reference Maintenance:
  • All service codes have a 'Fee', 'UB-04 Revenue Code', and/or 'CPT-4 / HCPCS Code' defined in 'Service Fee/Cross Reference Maintenance'. Note the fees.
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Add' in 'Add/Edit/Delete Roll-Up Services Definition'.
  3. Enter a 'Roll-Up Description'.
  4. Select a 'Roll-Up Service'.
  5. Select desired 'Component Services'.
  6. Select desired 'Required Component Service(s) for Roll-Up to Occur'.
  7. Select desired 'Component Service Date Rules'.
  8. Select desired value in 'Is This Roll-Up Services Dependent On Units, Duration, Or None'.
  9. Select desired 'Date Of Service For Roll-Up Service'.
  10. Enter data in the remaining required fields, noting the values.
  11. Validate that the 'Service Start Time For Roll-Up Service' field is available with the 'Time Of First Component Service' option to the 'Roll-Up Services Definition' form.
  12. Verify the 'Time Of First Component Service' option is unchecked in the 'Service Start Time For Roll-Up Service' field.
  13. Select the 'Time Of First Component Service' in the Service Start Time For Roll-Up Service' field.
  14. Verify the new field 'Bill Roll-Up Service, Component Service(s), or Both' exists and is enabled with the below options.
  15. Roll-Up Service.
  16. Component Services.
  17. Both.
  18. Verify that there is a help text shown when selecting the light bulb.
  19. Click the [Return To Form] link.
  20. Verify that the new field 'Force Component Service(s) and Roll-Up Service on the Same Claim' exists and is disabled with the below options.
  21. Yes.
  22. No.
  23. Select 'Roll-Up Service' in 'Bill Roll-Up Service, Component Service(s), or Both'.
  24. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field is disabled.
  25. Select 'Component Services' in 'Bill Roll-Up Service, Component Service(s), or Both'.
  26. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field is still disabled.
  27. Select 'Both' in 'Bill Roll-Up Service, Component Service(s), or Both'.
  28. Verify that now the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field is enabled and required.
  29. Select 'Yes'.
  30. Click [Submit].
  31. Click [Yes] to return to the form.
  32. Select 'Edit' in 'Add/Edit/Delete Roll-Up Services Definition'.
  33. Select the same definition.
  34. Verify the fields retained the submitted values.
  35. Click [Submit].
  36. Click [No] to return to the form.
  37. Query the below SQL table and validate that the values added for the new fields are present in the table along with their associated values.
  38. SYSTEM.rollup_services_def
  39. Field 1 - bill_rollup_code, bill_rollup_value
  40. Field 2 - force_same_claim_code, force_same_claim_value
  41. Close the SQL window.
Scenario 2: Validate the ability to bill component and roll-up services on Same and Different claim(s)-837 Professional.
Specific Setup:
  • Posting/Adjustment Code Definition:
  • New code created, or an existing code is identified for the below type:
  • Adjustment - "Adj Post Code 1"
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it.
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services.
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Client A:
  • The client is admitted to an outpatient program.
  • The client has active Diagnosis and Financial Eligibility - (Guarantor 1) records.
  • Make a note on the "Financial Class' of "Guarantor 1".
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Guarantor/Program Billing Defaults:
  • Add or identify a template, that includes the guarantor used in the Financial Eligibility record of 'Client A".
  • Template 1
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'Both' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  5. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' become enabled and required.
  6. Select 'Yes' in the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field.
  7. Click [Submit].
  8. Click [No].
  9. Open 'Client Ledger'.
  10. Run the ledger report for "Client A"
  11. Verify that the charges for the roll-up component services are displayed for "Client A".
  12. Click [X].
  13. Click [No].
  14. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  15. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  16. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  17. Click [Compile Worklist].
  18. Click [OK].
  19. Click [Run Report].
  20. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  21. Click [Close Report].
  22. Select 'Post Roll-Up Services Worklist'.
  23. Select the worklist compiled in step 17.
  24. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  25. Click [Post Worklist].
  26. Click [OK].
  27. Click [Discard].
  28. Click [Yes].
  29. Open 'Client Ledger'.
  30. Run the ledger report for "Client A"
  31. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  32. Verify that the roll-up service was created.
  33. Click [X].
  34. Click [No].
  35. Open 'Close Charges'.
  36. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  37. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  38. Select 'Individual'.
  39. Search and select "Client A" in 'Client ID'.
  40. Select the Episode.
  41. Click [Submit].
  42. Open 'Client Ledger'.
  43. Run the ledger report for "Client A"
  44. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  45. Click [X].
  46. Click [No].
  47. Open 'Create Interim Billing Batch File'.
  48. Select 'Create Batch'.
  49. Set the desired value in 'Batch Description'.
  50. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  51. Select 'Yes' in 'Include Zero Charge Services'.
  52. Search and select "Client A" in 'Client ID'.
  53. Select the below values that are relevant to "Client A", noted in setup.
  54. Guarantor.
  55. Program.
  56. Service Codes.
  57. Practitioner.
  58. Click [Process].
  59. Click [X].
  60. Click [No].
  61. Open 'Guarantor/Program Billing Defaults'.
  62. Select 'Edit Template'.
  63. Select "Template 1" in 'Select Template'.
  64. Select '837 Professional'.
  65. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  66. Select 'Yes' in 'Include Zero Dollar Services'.
  67. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  68. Click [Submit].
  69. Click [No].
  70. Open 'Electronic Billing'.
  71. Select '837-Professional' in 'Billing Form'.
  72. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  73. Select 'Individual' in 'Individual Or All Guarantors'.
  74. Select "Guarantor 1".
  75. Select 'Outpatient' in 'Billing Type'.
  76. Select 'Sort File' in 'Billing Options'.
  77. Set a desired value in 'File Description'.
  78. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  79. Select the Interim Batch that is created above.
  80. Select 'No' in 'Create Claims'.
  81. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  82. Select 'All' in 'Include Primary and/or Secondary Billing'.
  83. Click [Process].
  84. Click [OK].
  85. Select 'Dump File' in 'Billing Options'.
  86. Select 'Print'.
  87. Select the file in the 'File' field.
  88. Click [Process].
  89. Verify that the dump file generated has only one "CLM' segment and a separate 'LX' loop for the roll-up parent service (which should be first) and each of the roll-up component services.
  90. Click [X].
  91. Click [No].
  92. Open 'Guarantor/Program Billing Defaults'.
  93. Select 'Edit Template'.
  94. Select "Template 1" in 'Select Template'.
  95. Select '837 Professional'.
  96. Remove the value in the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field.
  97. Click [Submit].
  98. Click [No].
  99. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  100. Select 'Unpost Last Roll-Up Services Worklist'.
  101. Select the worklist posted in step above.
  102. Click [Unpost Worklist].
  103. Click [OK].
  104. Click [Discard].
  105. Click [Yes].
  106. Open 'Roll-Up Services Definition'.
  107. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  108. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  109. Select 'Both' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  110. Select 'No' in the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field.
  111. Click [Submit].
  112. Click [No].
  113. Open 'Client Ledger'.
  114. Run the ledger report for "Client A"
  115. Verify that the component services are reverted to 'Open' and the roll-up service is removed for "Client A".
  116. Click [X].
  117. Click [No].
  118. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  119. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  120. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  121. Click [Compile Worklist].
  122. Click [OK].
  123. Click [Run Report].
  124. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  125. Click [Close Report].
  126. Select 'Post Roll-Up Services Worklist'.
  127. Select the worklist compiled in step 118.
  128. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  129. Click [Post Worklist].
  130. Click [OK].
  131. Click [Discard].
  132. Click [Yes].
  133. Open 'Client Ledger'.
  134. Run the ledger report for "Client A"
  135. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  136. Verify that the roll-up service was created.
  137. Click [X].
  138. Click [No].
  139. Open 'Close Charges'.
  140. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  141. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  142. Select 'Individual'.
  143. Search and select "Client A" in 'Client ID'.
  144. Select the Episode.
  145. Click [Submit].
  146. Open 'Client Ledger'.
  147. Run the ledger report for "Client A"
  148. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  149. Click [X].
  150. Click [No].
  151. Open 'Create Interim Billing Batch File'.
  152. Select 'Create Batch'.
  153. Set the desired value in 'Batch Description'.
  154. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  155. Select 'Yes' in 'Include Zero Charge Services'.
  156. Search and select "Client A" in 'Client ID'.
  157. Select the below values that are relevant to "Client A", noted in setup.
  158. Guarantor.
  159. Program.
  160. Service Codes.
  161. Practitioner.
  162. Click [Process].
  163. Click [X].
  164. Click [No].
  165. Open 'Guarantor/Program Billing Defaults'.
  166. Select 'Edit Template'.
  167. Select "Template 1" in 'Select Template'.
  168. Select '837 Professional'.
  169. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  170. Select 'Yes' in 'Include Zero Dollar Services'.
  171. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  172. Click [Submit].
  173. Click [No].
  174. Open 'Electronic Billing'.
  175. Select '837-Professional' in 'Billing Form'.
  176. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  177. Select 'Individual' in 'Individual Or All Guarantors'.
  178. Select "Guarantor 1".
  179. Select 'Outpatient' in 'Billing Type'.
  180. Select 'Sort File' in 'Billing Options'.
  181. Set a desired value in 'File Description'.
  182. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  183. Select the Interim Batch that is created in step 150.
  184. Select 'No' in 'Create Claims'.
  185. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  186. Select 'All' in 'Include Primary and/or Secondary Billing'.
  187. Click [Process].
  188. Click [OK].
  189. Select 'Dump File' in 'Billing Options'.
  190. Select 'Print'.
  191. Select the file in the 'File' field.
  192. Click [Process].
  193. Verify that the roll-up parent service and the roll-up component services are included in the file, but they are not included in the same claim. Each service should be on a separate claim.
  194. Click [X].
  195. Click [No].
Scenario 3: Validate the ability to bill component and roll-up services on Same and Different claim(s)-837 Institutional.
Specific Setup:
  • Posting/Adjustment Code Definition:
  • New ones are created or existing codes are identified for the below type,
  • Adjustment - "Adj Post Code 1"
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it.
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services.
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Client A:
  • The client is admitted to an Inpatient program.
  • The client has active Diagnosis and Financial Eligibility-(Guarantor 1) records.
  • Make a note on the "Financial Class' of "Guarantor 1".
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Guarantor/Program Billing Defaults:
  • Add or identify a template, that includes the guarantor used in the Financial Eligibility record of 'Client A".
  • Template 1
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'Both' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  5. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' become enabled and required.
  6. Select 'Yes' in the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field.
  7. Click [Submit].
  8. Click [No].
  9. Open 'Client Ledger'.
  10. Run the ledger report for "Client A"
  11. Verify that the charges for the roll-up component services are displayed in the report.
  12. Click [X].
  13. Click [No].
  14. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  15. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  16. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  17. Click [Compile Worklist].
  18. Click [OK].
  19. Click [Run Report].
  20. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  21. Click [Close Report].
  22. Select 'Post Roll-Up Services Worklist'.
  23. Select the desired compiled worklist.
  24. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  25. Click [Post Worklist].
  26. Click [OK].
  27. Click [Discard].
  28. Click [Yes].
  29. Open 'Client Ledger'.
  30. Run the ledger report for "Client A"
  31. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each component service.
  32. Verify that the roll-up service was created.
  33. Click [X].
  34. Click [No].
  35. Open 'Close Charges'.
  36. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  37. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  38. Select 'Individual'.
  39. Search and select "Client A" in 'Client ID'.
  40. Select the Episode.
  41. Click [Submit].
  42. Open 'Client Ledger'.
  43. Run the ledger report for "Client A"
  44. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  45. Click [X].
  46. Click [No].
  47. Open 'Create Interim Billing Batch File'.
  48. Select 'Create Batch'.
  49. Set the desired value in 'Batch Description'.
  50. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  51. Select 'Yes' in 'Include Zero Charge Services'.
  52. Search and select "Client A" in 'Client ID'.
  53. Select the below values that are relevant to "Client A", noted in setup.
  54. Guarantor.
  55. Program.
  56. Service Codes.
  57. Practitioner.
  58. Click [Process].
  59. Click [X].
  60. Click [No].
  61. Open 'Guarantor/Program Billing Defaults'.
  62. Select 'Edit Template'.
  63. Select "Template 1" in 'Select Template'.
  64. Select '837 Institutional'.
  65. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  66. Select 'Yes' in 'Include Zero Dollar Services'.
  67. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  68. Click [Submit].
  69. Click [No].
  70. Open 'Electronic Billing'.
  71. Select '837-Institutional' in 'Billing Form'.
  72. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  73. Select 'Individual' in 'Individual Or All Guarantors'.
  74. Select "Guarantor 1".
  75. Select 'Inpatient' in 'Billing Type'.
  76. Select 'Sort File' in 'Billing Options'.
  77. Set a desired value in 'File Description'.
  78. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  79. Select the desired Interim Batch.
  80. Select 'No' in 'Create Claims'.
  81. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  82. Select 'All' in 'Include Primary and/or Secondary Billing'.
  83. Click [Process].
  84. Click [OK].
  85. Select 'Dump File' in 'Billing Options'.
  86. Select 'Print'.
  87. Select the file in the 'File' field.
  88. Click [Process].
  89. Verify that the roll-up service and the roll-up component services are included in the same claim (CLM segment).
  90. Verify that the 837 Institutional files summarize services (SV2) segments by consecutive days If consecutive-day component services.
  91. Click [X].
  92. Click [No].
  93. Open 'Guarantor/Program Billing Defaults'.
  94. Select 'Edit Template'.
  95. Select "Template 1" in 'Select Template'.
  96. Select '837 Institutional'.
  97. Remove if there is any value in the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field.
  98. Click [Submit].
  99. Click [No].
  100. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  101. Select 'Unpost Last Roll-Up Services Worklist'.
  102. Select the desired posted worklist.
  103. Click [Unpost Worklist].
  104. Click [OK].
  105. Click [Discard].
  106. Click [Yes].
  107. Open 'Roll-Up Services Definition'.
  108. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  109. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  110. Select 'Both' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  111. Select 'No' in the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field.
  112. Click [Submit].
  113. Click [No].
  114. Open 'Client Ledger'.
  115. Run the ledger report for "Client A"
  116. Verify that the component services are reverted to 'Open', and the roll-up service is removed for "Client A".
  117. Click [X].
  118. Click [No].
  119. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  120. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  121. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  122. Click [Compile Worklist].
  123. Click [OK].
  124. Click [Run Report].
  125. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  126. Click [Close Report].
  127. Select 'Post Roll-Up Services Worklist'.
  128. Select the desired compiled worklist.
  129. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  130. Click [Post Worklist].
  131. Click [OK].
  132. Click [Discard].
  133. Click [Yes].
  134. Open 'Client Ledger'.
  135. Run the ledger report for "Client A"
  136. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  137. Verify that the roll-up service was created.
  138. Click [X].
  139. Click [No].
  140. Open 'Close Charges'.
  141. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  142. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  143. Select 'Individual'.
  144. Search and select "Client A" in 'Client ID'.
  145. Select the Episode.
  146. Click [Submit].
  147. Open 'Client Ledger'.
  148. Run the ledger report for "Client A"
  149. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  150. Click [X].
  151. Click [No].
  152. Open 'Create Interim Billing Batch File'.
  153. Select 'Create Batch'.
  154. Set the desired value in 'Batch Description'.
  155. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  156. Select 'Yes' in 'Include Zero Charge Services'.
  157. Search and select "Client A" in 'Client ID'.
  158. Select the below values that are relevant to "Client A", noted in setup.
  159. Guarantor.
  160. Program.
  161. Service Codes.
  162. Practitioner.
  163. Click [Process].
  164. Click [X].
  165. Click [No].
  166. Open 'Guarantor/Program Billing Defaults'.
  167. Select 'Edit Template'.
  168. Select "Template 1" in 'Select Template'.
  169. Select '837 Institutional'.
  170. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  171. Select 'Yes' in 'Include Zero Dollar Services'.
  172. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  173. Click [Submit].
  174. Click [No].
  175. Open 'Electronic Billing'.
  176. Select '837-Institutional' in 'Billing Form'.
  177. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  178. Select 'Individual' in 'Individual Or All Guarantors'.
  179. Select "Guarantor 1".
  180. Select 'Inpatient' in 'Billing Type'.
  181. Select 'Sort File' in 'Billing Options'.
  182. Set a desired value in 'File Description'.
  183. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  184. Select the desired Interim Batch.
  185. Select 'No' in 'Create Claims'.
  186. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  187. Select 'All' in 'Include Primary and/or Secondary Billing'.
  188. Click [Process].
  189. Click [OK].
  190. Select 'Dump File' in 'Billing Options'.
  191. Select 'Print'.
  192. Select the file in the 'File' field.
  193. Click [Process].
  194. Verify that the roll-up parent service and the roll-up component services are included in the file, but they are not included in the same claim. Each service should be on a separate claim.
  195. Click [X].
  196. Click [No].
Scenario 4: Validate the ability to bill component and roll-up services on same claim with Medical Diagnoses-837 Professional.
Specific Setup:
  • Registry Settings:
  • Set 'Use Diagnosis Form for Medical Diagnosis Bills' to "Y".
  • Posting/Adjustment Code Definition:
  • New ones are created, or existing codes are identified for the below type,
  • Adjustment - "Adj Post Code 1"
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Client A:
  • The client is admitted to an outpatient program.
  • The client has active Diagnosis and Financial Eligibility-(Guarantor 1) records.
  • Make a note on the "Financial Class' of "Guarantor 1".
  • Diagnosis:
  • Identify an active diagnosis.
  • Diagnosis 1
  • Diagnosis 2
  • Guarantor/Program Billing Defaults:
  • Add or identify a template which includes the guarantor used in the Financial Eligibility record of 'Client A".
  • Template 1.
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'Both' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  5. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' become enabled and required.
  6. Select 'Yes' in the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field.
  7. Click [Submit].
  8. Click [No].
  9. Open 'Client Charge Input With Diagnosis Entry'.
  10. Add new component services on different dates for "Client A".
  11. Comp 1(a).
  12. Comp 1(b).
  13. Enter a minimum of one diagnosis for each service. (make sure that different diagnoses are entered for each service)
  14. Make a note of the diagnoses for each component service and date of service, for later validation(s).
  15. Diagnosis 1.
  16. Diagnosis 2.
  17. Click [Submit].
  18. Click [No].
  19. Open 'Client Ledger'.
  20. Run the ledger report for "Client A"
  21. Verify that the charges for the roll-up component services are displayed.
  22. Click [X].
  23. Click [No].
  24. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  25. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  26. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  27. Click [Compile Worklist].
  28. Click [OK].
  29. Click [Run Report].
  30. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  31. Click [Close Report].
  32. Select 'Post Roll-Up Services Worklist'.
  33. Select the worklist compiled in step 23.
  34. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  35. Click [Post Worklist].
  36. Click [OK].
  37. Click [Discard].
  38. Click [Yes].
  39. Open 'Client Ledger'.
  40. Run the ledger report for "Client A"
  41. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  42. Verify that the roll-up service was created.
  43. Click [X].
  44. Click [No].
  45. Open 'Close Charges'.
  46. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  47. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  48. Select 'Individual'.
  49. Search and select "Client A" in 'Client ID'.
  50. Select the Episode.
  51. Click [Submit].
  52. Open 'Client Ledger'.
  53. Run the ledger report for "Client A"
  54. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  55. Click [X].
  56. Click [No].
  57. Open 'Create Interim Billing Batch File'.
  58. Select 'Create Batch'.
  59. Set the desired value in 'Batch Description'.
  60. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  61. Select 'Yes' in 'Include Zero Charge Services'.
  62. Search and select "Client A" in 'Client ID'.
  63. Select the below values that are relevant to "Client A", noted in setup.
  64. Guarantor.
  65. Program.
  66. Service Codes.
  67. Practitioner.
  68. Click [Process].
  69. Click [X].
  70. Click [No].
  71. Open 'Guarantor/Program Billing Defaults'.
  72. Select 'Edit Template'.
  73. Select "Template 1" in 'Select Template'.
  74. Select '837 Professional'.
  75. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  76. Select 'Yes' in 'Include Zero Dollar Services'.
  77. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  78. Click [Submit].
  79. Click [No].
  80. Open 'Electronic Billing'.
  81. Select '837-Professional' in 'Billing Form'.
  82. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  83. Select 'Individual' in 'Individual Or All Guarantors'.
  84. Select "Guarantor 1".
  85. Select 'Outpatient' in 'Billing Type'.
  86. Select 'Sort File' in 'Billing Options'.
  87. Set a desired value in 'File Description'.
  88. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  89. Select the Interim Batch that is created in step 55.
  90. Select 'No' in 'Create Claims'.
  91. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  92. Select 'All' in 'Include Primary and/or Secondary Billing'.
  93. Click [Process].
  94. Click [OK].
  95. Select 'Dump File' in 'Billing Options'.
  96. Select 'Print'.
  97. Select the file in the 'File' field.
  98. Click [Process].
  99. Verify that the dump file generated has only one "CLM" segment and a separate "LX" loop for the roll-up parent service (which should be first- LX1) and each of the roll-up component services.
  100. Verify that all the various diagnoses for the individual services are included in the HI segment at the claim level.
  101. Verify that the SV1 segments in each LX loop have correct pointers set for the diagnoses that pertain to those services.
  102. Click [X].
  103. Click [No].
  104. Open 'Guarantor/Program Billing Defaults'.
  105. Select 'Edit Template'.
  106. Select "Template 1" in 'Select Template'.
  107. Select '837 Professional'.
  108. Remove if there is any value in the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field.
  109. Click [Submit].
  110. Click [No].
  111. Repeat 'Electronic Billing' steps and verifications.
Scenario 5: Validate the ability to bill component services only and Roll-Up service only -837 Professional.
Specific Setup:
  • Posting/Adjustment Code Definition:
  • New ones are created, or existing codes are identified for the below type:
  • Adjustment - "Adj Post Code 1"
  • Service Codes:
  • Using the 'Service Codes' form add, or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Client A:
  • The client is admitted to an outpatient program.
  • The client has active Diagnosis and Financial Eligibility-(Guarantor 1) records.
  • Make a note on the "Financial Class' of "Guarantor 1".
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Guarantor/Program Billing Defaults:
  • Add or identify a template which includes the guarantor used in the Financial Eligibility record of 'Client A".
  • Template 1.
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'Component Services' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  5. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' stays disabled and not required.
  6. Click [Submit].
  7. Click [No].
  8. Open 'Client Ledger'.
  9. Run the ledger report for "Client A"
  10. Verify that the charges for the roll-up component services are displayed.
  11. Click [X].
  12. Click [No].
  13. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  14. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  15. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  16. Click [Compile Worklist].
  17. Click [OK].
  18. Click [Run Report].
  19. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  20. Click [Close Report].
  21. Select 'Post Roll-Up Services Worklist'.
  22. Select the desired compiled worklist.
  23. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  24. Click [Post Worklist].
  25. Click [OK].
  26. Click [Discard].
  27. Click [Yes].
  28. Open 'Client Ledger'.
  29. Run the ledger report for "Client A"
  30. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  31. Verify that the roll-up service was created.
  32. Click [X].
  33. Click [No].
  34. Open 'Close Charges'.
  35. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  36. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  37. Select 'Individual'.
  38. Search and select "Client A" in 'Client ID'.
  39. Select the Episode.
  40. Click [Submit].
  41. Open 'Client Ledger'.
  42. Run the ledger report for "Client A"
  43. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  44. Click [X].
  45. Click [No].
  46. Open 'Create Interim Billing Batch File'.
  47. Select 'Create Batch'.
  48. Set the desired value in 'Batch Description'.
  49. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  50. Select 'Yes' in 'Include Zero Charge Services'.
  51. Search and select "Client A" in 'Client ID'.
  52. Select the below values that are relevant to "Client A", noted in setup.
  53. Guarantor.
  54. Program.
  55. Service Codes.
  56. Practitioner.
  57. Click [Process].
  58. Click [X].
  59. Click [No].
  60. Open 'Guarantor/Program Billing Defaults'.
  61. Select 'Edit Template'.
  62. Select "Template 1" in 'Select Template'.
  63. Select '837 Professional'.
  64. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  65. Select 'Yes' in 'Include Zero Dollar Services'.
  66. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  67. Click [Submit].
  68. Click [No].
  69. Open 'Electronic Billing'.
  70. Select '837-Professional' in 'Billing Form'.
  71. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  72. Select 'Individual' in 'Individual Or All Guarantors'.
  73. Select "Guarantor 1".
  74. Select 'Outpatient' in 'Billing Type'.
  75. Select 'Sort File' in 'Billing Options'.
  76. Set a desired value in 'File Description'.
  77. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  78. Select desired Interim Batch.
  79. Select 'No' in 'Create Claims'.
  80. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  81. Select 'All' in 'Include Primary and/or Secondary Billing'.
  82. Click [Process].
  83. Click [OK].
  84. Select 'Dump File' in 'Billing Options'.
  85. Select 'Print'.
  86. Select the file in the 'File' field.
  87. Click [Process].
  88. Verify that the dump file generated has only the roll-up component services, but not the roll-up parent service.
  89. Click [X].
  90. Click [No].
  91. Open 'Guarantor/Program Billing Defaults'.
  92. Select 'Edit Template'.
  93. Select "Template 1" in 'Select Template'.
  94. Select '837 Professional'.
  95. Remove if there is any value in the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field.
  96. Click [Submit].
  97. Click [No].
  98. Repeat 'Electronic Billing' steps and validations.
  99. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  100. Select 'Unpost Last Roll-Up Services Worklist'.
  101. Select the worklist posted above.
  102. Click [Unpost Worklist].
  103. Click [OK].
  104. Click [Discard].
  105. Click [Yes].
  106. Open 'Roll-Up Services Definition'.
  107. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  108. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  109. Select 'Roll-Up Service' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  110. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' stays disabled and not required.
  111. Click [Submit].
  112. Click [No].
  113. Open 'Client Ledger'.
  114. Run the ledger report for "Client A"
  115. Verify that the component services are reverted to 'Open' and the roll-up service is removed.
  116. Click [X].
  117. Click [No].
  118. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  119. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  120. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  121. Click [Compile Worklist].
  122. Click [OK].
  123. Click [Run Report].
  124. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  125. Click [Close Report].
  126. Select 'Post Roll-Up Services Worklist'.
  127. Select the desired compiled worklist compiled.
  128. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  129. Click [Post Worklist].
  130. Click [OK].
  131. Click [Discard].
  132. Click [Yes].
  133. Open 'Client Ledger'.
  134. Run the ledger report for "Client A"
  135. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  136. Verify that the roll-up service was created.
  137. Click [X].
  138. Click [No].
  139. Open 'Close Charges'.
  140. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  141. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  142. Select 'Individual'.
  143. Search and select "Client A" in 'Client ID'.
  144. Select the Episode.
  145. Click [Submit].
  146. Open 'Client Ledger'.
  147. Run the ledger report for "Client A"
  148. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  149. Click [X].
  150. Click [No].
  151. Open 'Create Interim Billing Batch File'.
  152. Select 'Create Batch'.
  153. Set the desired value in 'Batch Description'.
  154. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  155. Select 'Yes' in 'Include Zero Charge Services'.
  156. Search and select "Client A" in 'Client ID'.
  157. Select the below values that are relevant to "Client A", noted in setup.
  158. Guarantor.
  159. Program.
  160. Service Codes.
  161. Practitioner.
  162. Click [Process].
  163. Click [X].
  164. Click [No].
  165. Open 'Guarantor/Program Billing Defaults'.
  166. Select 'Edit Template'.
  167. Select "Template 1" in 'Select Template'.
  168. Select '837 Professional'.
  169. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  170. Select 'Yes' in 'Include Zero Dollar Services'.
  171. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  172. Click [Submit].
  173. Click [No].
  174. Open 'Electronic Billing'.
  175. Select '837-Professional' in 'Billing Form'.
  176. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  177. Select 'Individual' in 'Individual Or All Guarantors'.
  178. Select "Guarantor 1".
  179. Select 'Outpatient' in 'Billing Type'.
  180. Select 'Sort File' in 'Billing Options'.
  181. Set a desired value in 'File Description'.
  182. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  183. Select the desired Interim Batch.
  184. Select 'No' in 'Create Claims'.
  185. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  186. Select 'All' in 'Include Primary and/or Secondary Billing'.
  187. Click [Process].
  188. Click [OK].
  189. Select 'Dump File' in 'Billing Options'.
  190. Select 'Print'.
  191. Select the file in the 'File' field.
  192. Click [Process].
  193. Verify that only the roll-up parent service is included in the file, but not the roll-up component services.
  194. Click [X].
  195. Click [No].
Scenario 6: Validate the ability to bill component services only and Roll-Up service only -837 Institutional.
Specific Setup:
  • Posting/Adjustment Code Definition:
  • New codes are created, or existing codes are identified for the below type,
  • Adjustment - "Adj Post Code 1".
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Client A:
  • The client is admitted to an Inpatient program.
  • The client has active Diagnosis and Financial Eligibility-(Guarantor 1) records.
  • Make a note on the "Financial Class' of "Guarantor 1".
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Guarantor/Program Billing Defaults:
  • Add or identify a template which includes the guarantor used in the Financial Eligibility record of 'Client A".
  • Template 1.
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'Component Services' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  5. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' stays disabled and not required.
  6. Click [Submit].
  7. Click [No].
  8. Open 'Client Ledger'.
  9. Run the ledger report for "Client A"
  10. Verify that the charges for the roll-up component services are displayed.
  11. Click [X].
  12. Click [No].
  13. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  14. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  15. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  16. Click [Compile Worklist].
  17. Click [OK].
  18. Click [Run Report].
  19. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  20. Click [Close Report].
  21. Select 'Post Roll-Up Services Worklist'.
  22. Select the desired compiled worklist.
  23. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  24. Click [Post Worklist].
  25. Click [OK].
  26. Click [Discard].
  27. Click [Yes].
  28. Open 'Client Ledger'.
  29. Run the ledger report for "Client A"
  30. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  31. Verify that the roll-up service was created.
  32. Click [X].
  33. Click [No].
  34. Open 'Close Charges'.
  35. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  36. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  37. Select 'Individual'.
  38. Search and select "Client A" in 'Client ID'.
  39. Select the Episode.
  40. Click [Submit].
  41. Open 'Client Ledger'.
  42. Run the ledger report for "Client A"
  43. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  44. Click [X].
  45. Click [No].
  46. Open 'Create Interim Billing Batch File'.
  47. Select 'Create Batch'.
  48. Set the desired value in 'Batch Description'.
  49. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  50. Select 'Yes' in 'Include Zero Charge Services'.
  51. Search and select "Client A" in 'Client ID'.
  52. Select the below values that are relevant to "Client A", noted in setup:
  53. Guarantor.
  54. Program.
  55. Service Codes.
  56. Practitioner.
  57. Click [Process].
  58. Click [X].
  59. Click [No].
  60. Open 'Guarantor/Program Billing Defaults'.
  61. Select 'Edit Template'.
  62. Select "Template 1" in 'Select Template'.
  63. Select '837 Institutional'.
  64. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  65. Select 'Yes' in 'Include Zero Dollar Services'.
  66. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  67. Click [Submit].
  68. Click [No].
  69. Open 'Electronic Billing'.
  70. Select '837-Institutional' in 'Billing Form'.
  71. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  72. Select 'Individual' in 'Individual Or All Guarantors'.
  73. Select "Guarantor 1".
  74. Select 'Inpatient' in 'Billing Type'.
  75. Select 'Sort File' in 'Billing Options'.
  76. Set a desired value in 'File Description'.
  77. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  78. Select the desired Interim Batch.
  79. Select 'No' in 'Create Claims'.
  80. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  81. Select 'All' in 'Include Primary and/or Secondary Billing'.
  82. Click [Process].
  83. Click [OK].
  84. Select 'Dump File' in 'Billing Options'.
  85. Select 'Print'.
  86. Select the file in the 'File' field.
  87. Click [Process].
  88. Verify that the dump file generated has only the roll-up component services, but not the roll-up parent service.
  89. Click [X].
  90. Click [No].
  91. Open 'Guarantor/Program Billing Defaults'.
  92. Select 'Edit Template'.
  93. Select "Template 1" in 'Select Template'.
  94. Select '837 Institutional'.
  95. Remove if there is any value in the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field.
  96. Click [Submit].
  97. Click [No].
  98. Repeat 'Electronic Billing' steps and validations.
  99. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  100. Select 'Unpost Last Roll-Up Services Worklist'.
  101. Select the desired posted worklist.
  102. Click [Unpost Worklist].
  103. Click [OK].
  104. Click [Discard].
  105. Click [Yes].
  106. Open 'Roll-Up Services Definition'.
  107. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  108. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  109. Select 'Roll-Up Service' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  110. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' stays disabled and not required.
  111. Click [Submit].
  112. Click [No].
  113. Open 'Client Ledger'.
  114. Run the ledger report for "Client A"
  115. Verify that the component services are reverted to 'Open', and the roll-up service is removed.
  116. Click [X].
  117. Click [No].
  118. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  119. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  120. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  121. Click [Compile Worklist].
  122. Click [OK].
  123. Click [Run Report].
  124. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  125. Click [Close Report].
  126. Select 'Post Roll-Up Services Worklist'.
  127. Select the desired compiled worklist.
  128. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  129. Click [Post Worklist].
  130. Click [OK].
  131. Click [Discard].
  132. Click [Yes].
  133. Open 'Client Ledger'.
  134. Run the ledger report for "Client A"
  135. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  136. Verify that the roll-up service was created.
  137. Click [X].
  138. Click [No].
  139. Open 'Close Charges'.
  140. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  141. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  142. Select 'Individual'.
  143. Search and select "Client A" in 'Client ID'.
  144. Select the Episode.
  145. Click [Submit].
  146. Open 'Client Ledger'.
  147. Run the ledger report for "Client A"
  148. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  149. Click [X].
  150. Click [No].
  151. Open 'Create Interim Billing Batch File'.
  152. Select 'Create Batch'.
  153. Set the desired value in 'Batch Description'.
  154. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  155. Select 'Yes' in 'Include Zero Charge Services'.
  156. Search and select "Client A" in 'Client ID'.
  157. Select the below values that are relevant to "Client A", noted in setup.
  158. Guarantor.
  159. Program.
  160. Service Codes.
  161. Practitioner.
  162. Click [Process].
  163. Click [X].
  164. Click [No].
  165. Open 'Guarantor/Program Billing Defaults'.
  166. Select 'Edit Template'.
  167. Select "Template 1" in 'Select Template'.
  168. Select '837 Institutional'.
  169. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  170. Select 'Yes' in 'Include Zero Dollar Services'.
  171. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  172. Click [Submit].
  173. Click [No].
  174. Open 'Electronic Billing'.
  175. Select '837-Institutional' in 'Billing Form'.
  176. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  177. Select 'Individual' in 'Individual Or All Guarantors'.
  178. Select "Guarantor 1".
  179. Select 'Inpatient' in 'Billing Type'.
  180. Select 'Sort File' in 'Billing Options'.
  181. Set a desired value in 'File Description'.
  182. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  183. Select the desired Interim Batch.
  184. Select 'No' in 'Create Claims'.
  185. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  186. Select 'All' in 'Include Primary and/or Secondary Billing'.
  187. Click [Process].
  188. Click [OK].
  189. Select 'Dump File' in 'Billing Options'.
  190. Select 'Print'.
  191. Select the file in the 'File' field.
  192. Click [Process].
  193. Verify that only the roll-up parent service is included in the file, but not the roll-up component services.
  194. Click [X].
  195. Click [No].
Scenario 7: Validate the ability to bill component and roll-up services on same claim with Medical Diagnoses-837 Institutional.
Specific Setup:
  • Registry Settings:
  • Set 'Use Diagnosis Form for Medical Diagnosis Bills' to "Y".
  • Posting/Adjustment Code Definition:
  • New codes are created, or existing codes are identified for the below type:
  • Adjustment - "Adj Post Code 1"
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services"
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Client A:
  • The client is admitted to an Inpatient program.
  • The client has active Diagnosis and Financial Eligibility-(Guarantor 1) records.
  • Make a note on the "Financial Class' of "Guarantor 1".
  • Diagnosis:
  • Identify an active diagnosis.
  • Diagnosis 1
  • Diagnosis 2
  • Guarantor/Program Billing Defaults:
  • Add or identify a template which includes the guarantor used in the Financial Eligibility record of 'Client A".
  • Template 1.
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'Both' in the 'Bill Roll-Up Service, Component Service(s), or Both' field.
  5. Verify that the 'Force Component Service(s) and Roll-Up Service on the Same Claim' become enabled and required.
  6. Select 'Yes' in the 'Force Component Service(s) and Roll-Up Service on the Same Claim' field.
  7. Click [Submit].
  8. Click [No].
  9. Open 'Client Charge Input With Diagnosis Entry'.
  10. Add new component services on different dates for "Client A":
  11. Comp 1(a).
  12. Comp 1(b).
  13. Enter a minimum of one diagnosis for each service. (make sure that different diagnoses are entered for each service)
  14. Make a note of the diagnoses for each component service and date of service, for later validation(s):
  15. Diagnosis 1.
  16. Diagnosis 2.
  17. Click [Submit].
  18. Click [No].
  19. Open 'Client Ledger'.
  20. Run the ledger report for "Client A"
  21. Verify that the charges for the roll-up component services are displayed.
  22. Click [X].
  23. Click [No].
  24. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  25. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  26. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and select it.
  27. Click [Compile Worklist].
  28. Click [OK].
  29. Click [Run Report].
  30. Verify that the report shows the created Roll-Up services and their component services for "Client A".
  31. Click [Close Report].
  32. Select 'Post Roll-Up Services Worklist'.
  33. Select the desired compiled worklist.
  34. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  35. Click [Post Worklist].
  36. Click [OK].
  37. Click [Discard].
  38. Click [Yes].
  39. Open 'Client Ledger'.
  40. Run the ledger report for "Client A"
  41. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  42. Verify that the roll-up service was created.
  43. Click [X].
  44. Click [No].
  45. Open 'Close Charges'.
  46. Select 'Close Charges' in 'Liability Update Or Close Charges'.
  47. Select the desired Thru Date that covers all the services of "Client A" that require closure.
  48. Select 'Individual'.
  49. Search and select "Client A" in 'Client ID'.
  50. Select the Episode.
  51. Click [Submit].
  52. Open 'Client Ledger'.
  53. Run the ledger report for "Client A"
  54. Review the roll-up service and verify that is closed and marked as 'UNBILL'.
  55. Click [X].
  56. Click [No].
  57. Open 'Create Interim Billing Batch File'.
  58. Select 'Create Batch'.
  59. Set the desired value in 'Batch Description'.
  60. Set the 'From Date' and 'Through Date' that cover the charges of "Client A".
  61. Select 'Yes' in 'Include Zero Charge Services'.
  62. Search and select "Client A" in 'Client ID'.
  63. Select the below values that are relevant to "Client A", noted in setup:
  64. Guarantor.
  65. Program.
  66. Service Codes.
  67. Practitioner.
  68. Click [Process].
  69. Click [X].
  70. Click [No].
  71. Open 'Guarantor/Program Billing Defaults'.
  72. Select 'Edit Template'.
  73. Select "Template 1" in 'Select Template'.
  74. Select '837 Institutional'.
  75. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field value to "1".
  76. Select 'Yes' in 'Include Zero Dollar Services'.
  77. Select 'No' in 'Suppress Claim Level Adjustments/Service Level Adjustments When Total Is Zero'.
  78. Click [Submit].
  79. Click [No].
  80. Open 'Electronic Billing'.
  81. Select '837-Institutional' in 'Billing Form'.
  82. Select the financial class of "Guarantor 1" in 'Type Of Bill'.
  83. Select 'Individual' in 'Individual Or All Guarantors'.
  84. Select "Guarantor 1".
  85. Select 'Inpatient' in 'Billing Type'.
  86. Select 'Sort File' in 'Billing Options'.
  87. Set a desired value in 'File Description'.
  88. Select 'Interim Batch' in 'All Clients Or Interim Billing Batch'.
  89. Select the desired Interim Batch.
  90. Select 'No' in 'Create Claims'.
  91. Set the desired date values in 'First Date Of Service To Include' and 'Last Date Of Service To Include date' that includes the services we have for "Client A".
  92. Select 'All' in 'Include Primary and/or Secondary Billing'.
  93. Click [Process].
  94. Click [OK].
  95. Select 'Dump File' in 'Billing Options'.
  96. Select 'Print'.
  97. Select the file in the 'File' field.
  98. Click [Process].
  99. Verify that the dump file generated has only one "CLM" segment and a separate "LX" loop for the roll-up parent service (which should be first- LX1) and each of the roll-up component services.
  100. Verify that all the various diagnoses for all the component services are included in the HI segment at the claim level.
  101. Click [X].
  102. Click [No].
  103. Open 'Guarantor/Program Billing Defaults'.
  104. Select 'Edit Template'.
  105. Select "Template 1" in 'Select Template'.
  106. Select '837 Institutional'.
  107. Remove if there is any value in the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field.
  108. Click [Submit].
  109. Click [No].
  110. Repeat 'Electronic Billing' steps and validations.
Scenario 8: File Import - Roll-Up Services Definition - Validations.
Specific Setup:
  • Posting/Adjustment Code Definition:
  • New codes are created, or existing codes are identified for the below type:
  • Adjustment - "Adj Post Code 1".
  • Payment - "Pay Post Code 1".
  • Transfer - "Trans Post Code 1".
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it.
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • File Import:
  • Create the below .txt file(s) to have the data that we can validate against the 'File Import' feature for 'Roll-Up Services Definition', as mentioned below,
  • File 1:
  • Field 1 value set as "1".
  • Invalid value for field 55 and Invalid value for field 56.
  • All other needed fields with valid values.
  • File 2:
  • Field 1 value set as "1".
  • Value '3-(Both)' for field 55 and field 56 is left blank.
  • All other needed fields with valid values.
  • File 3:
  • Field 1 value set as "1".
  • Invalid value for field 57.
  • All other needed fields with valid values.
  • File 4:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') is left blank.
  • All other needed fields with valid values.
  • File 5:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') has a valid ADJUSTMENT posting code.
  • All other needed fields with valid values.
  • File 6:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') has a valid PAYMENT posting code.
  • All other needed fields with valid values.
  • File 7:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') has an INVALID posting code.
  • All other needed fields with valid values.
  • File 8:
  • Field 1 value set as "1".
  • The value of field 57 is anything other than '3' and field 58 has a valid TRANSFER posting code.
  • All other needed fields with valid values.
  • File 9:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has a valid ADJUSTMENT posting code.
  • All other needed fields with valid values.
  • File 10:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has a valid PAYMENT posting code.
  • All other needed fields with valid values.
  • File 11:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has a valid TRANSFER posting code.
  • All other needed fields with valid values.
  • File 12:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has an INVALID posting code.
  • All other needed fields with valid values.
  • File 13:
  • Field 1 value set as "1".
  • Field 57 ('Write Off Component Services') has the value '2' or '3' and a valid ADJUSTMENT posting code for field 59.
  • All other needed fields with valid values.
  • File 14:
  • Field 1 value set as "1".
  • Value '3-(Both)' for field 55 and valid dictionary value for field 56.
  • Value '1-(Yes)' for field 57 and valid ADJUSTMENT posting code for field 59.
  • All other needed fields with valid values.
  • File 15:
  • Field 1 value set as "2".
  • Field 2 value set as the Valid roll-up ID created in the above step using "File 14".
  • Value '3-(Both)' for field 55 and valid dictionary value for field 56.
  • Value '2-(No - Keep Liability With Current Guarantor)' for field 57 and No values entered for field 59.
  • All other needed fields with valid values.
  • File 16:
  • Field 1 value set as "2".
  • Field 2 value set as the Valid roll-up ID created in the above step using "File 14".
  • Value '3-(Both)' for field 55 and valid dictionary value for field 56.
  • Value '3-(No - Transfer to Next Guarantor)' for field 57 and valid TRANSFER code entered for field 58.
  • No values were entered for field 59.
  • All other needed fields with valid values.
  • File 17:
  • Field 1 value set as "3".
  • Use all other field values the same as in "File 15".
Steps
  1. Open 'File Import'.
  2. Select 'Roll-Up Services Definition' in 'File Type'.
  3. Select 'Upload New File'.
  4. Click [Process].
  5. Select 'File 1'.
  6. Select 'Compile/Validate File'.
  7. Select 'File 1'.
  8. Click [Process].
  9. Validate that the error shows with the text "File 1.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
  10. Click [OK].
  11. Click [Print Errors].
  12. Select 'File 1'.
  13. Click [Process].
  14. Validate that the report shows the appropriate error concerning the 'File 1' from the setup.
  15. Click [Close Report].
  16. Repeat the above steps for Files 2 - File 8.
  17. Click [Discard].
  18. Click [Yes].
  19. Open 'Registry Settings'.
  20. Search and select 'Specify Write Off Posting Code In 'Roll-Up Services Definition'' registry setting.
  21. Set the Registry Setting Value to "N".
  22. Click [Submit].
  23. Click [OK].
  24. Click [No].
  25. Open 'File Import'.
  26. Select 'Roll-Up Services Definition' in 'File Type'.
  27. Select 'Upload New File'.
  28. Click [Process].
  29. Select 'File 9'.
  30. Select 'Compile/Validate File'.
  31. Select 'File 9'.
  32. Click [Process].
  33. Validate that the error shows with the text "File 9.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
  34. Click [OK].
  35. Click [Print Errors].
  36. Select 'File 9'.
  37. Click [Process].
  38. Validate that the report shows the appropriate error concerning the 'File 9' from the setup.
  39. Click [Close Report].
  40. Click [Discard].
  41. Click [Yes].
  42. Open 'Registry Settings'.
  43. Search and select the 'Specify Write Off Posting Code In 'Roll-Up Services Definition'' registry setting.
  44. Set the Registry Setting Value to "Y".
  45. Click [Submit].
  46. Click [OK].
  47. Click [No].
  48. Open 'File Import'.
  49. Select 'Roll-Up Services Definition' in 'File Type'.
  50. Select 'Upload New File'.
  51. Click [Process].
  52. Select 'File 10'.
  53. Select 'Compile/Validate File'.
  54. Select 'File 10'.
  55. Click [Process].
  56. Validate that the error shows with the text "File 10.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
  57. Click [OK].
  58. Click [Print Errors].
  59. Select 'File 10'.
  60. Click [Process].
  61. Validate that the report shows the appropriate error concerning the 'File 10' from the setup.
  62. Click [Close Report].
  63. Repeat above steps for File 11 - File 13.
  64. Select 'Upload New File'.
  65. Click [Process].
  66. Select 'File 14'.
  67. Select 'Compile/Validate File'.
  68. Select 'File 14'.
  69. Click [Process].
  70. Validate that the success message contains "Compiled.".
  71. Click [OK].
  72. Select 'Post File'.
  73. Select 'File 14'.
  74. Click [Process].
  75. Validate that the success message contains "Posted.".
  76. Click [OK].
  77. Select 'Print File'.
  78. Select 'File 14'.
  79. Click [Process].
  80. Validate that the report shows the appropriate values passed/ posted in 'File 14' from the setup.
  81. Click [Close Report].
  82. Click [Discard].
  83. Click [Yes].
  84. Open 'Roll-Up Services Definition'.
  85. Select 'Edit'.
  86. Select the Roll-Up Service Definition posted in Step 75 in the 'Existing Roll-Up Definition' field.
  87. Validate that all the values are populated correctly.
  88. Click [Discard].
  89. Click [Yes].
  90. Open 'File Import'.
  91. Select 'Roll-Up Services Definition' in 'File Type'.
  92. Select 'Upload New File'.
  93. Click [Process].
  94. Select 'File 15'.
  95. Select 'Compile/Validate File'.
  96. Select 'File 15'.
  97. Click [Process].
  98. Validate that the success message contains "Compiled.".
  99. Click [OK].
  100. Select 'Post File'.
  101. Select 'File 15'.
  102. Click [Process].
  103. Validate that the success message contains "Posted.".
  104. Click [OK].
  105. Select 'Print File'.
  106. Select 'File 15'.
  107. Click [Process].
  108. Validate that the report shows the appropriate values passed/ posted in 'File 15' from the setup.
  109. Click [Close Report].
  110. Click [Discard].
  111. Click [Yes].
  112. Open 'Roll-Up Services Definition'.
  113. Select 'Edit'.
  114. Select the Roll-Up Service Definition posted above in the 'Existing Roll-Up Definition' field.
  115. Validate that all the values are populated correctly.
  116. Click [Discard].
  117. Click [Yes].
  118. Open 'File Import'.
  119. Select 'Roll-Up Services Definition' in 'File Type'.
  120. Select 'Upload New File'.
  121. Click [Process].
  122. Select 'File 16'.
  123. Select 'Compile/Validate File'.
  124. Select 'File 16'.
  125. Click [Process].
  126. Validate that the success message contains "Compiled.".
  127. Click [OK].
  128. Select 'Post File'.
  129. Select 'File 16'.
  130. Click [Process].
  131. Validate that the success message contains "Posted.".
  132. Click [OK].
  133. Select 'Print File'.
  134. Select 'File 16'.
  135. Click [Process].
  136. Validate that the report shows the appropriate values passed/ posted in 'File 16' from the setup.
  137. Click [Close Report].
  138. Click [Discard].
  139. Click [Yes].
  140. Open 'Roll-Up Services Definition'.
  141. Select 'Edit'.
  142. Select the Roll-Up Service Definition posted above in the 'Existing Roll-Up Definition' field.
  143. Validate that all the values are populated correctly.
  144. Click [Discard].
  145. Click [Yes].
  146. Open 'File Import'.
  147. Select 'Roll-Up Services Definition' in 'File Type'.
  148. Select 'Upload New File'.
  149. Click [Process].
  150. Select 'File 17'.
  151. Select 'Compile/Validate File'.
  152. Select 'File 17'.
  153. Click [Process].
  154. Validate that the success message contains "Compiled.".
  155. Click [OK].
  156. Select 'Post File'.
  157. Select 'File 17'.
  158. Click [Process].
  159. Validate that the success message contains "Posted.".
  160. Click [OK].
  161. Select 'Print File'.
  162. Select 'File 17'.
  163. Click [Process].
  164. Validate that the report shows the appropriate values passed/ posted in 'File 17' from the setup.
  165. Click [Close Report].
  166. Click [Discard].
  167. Click [Yes].
  168. Open 'Roll-Up Services Definition'.
  169. Select 'Edit'.
  170. Search for the Roll-Up Service Definition deleted above in the 'Existing Roll-Up Definition' field.
  171. Validate that we get "No results found".
  172. Click [Discard].
  173. Click [Yes].
Topics
• 837 Professional • Compile/Edit/Post/Unpost Roll-up Services Worklist • Electronic Billing • File Import • Guarantor / Program Billing Defaults • Roll-Up Services Definition
AV-78042 Summary | Details
Compile Roll-Up Services Worklist
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
Scenario 1: Compile/Edit/Post/Unpost Roll-Up Worklist - Validate the run-time roll-up data stored in table.
Specific Setup:
  • Registry Settings:
  • Set the "Allow Multiple Roll-Ups" registry setting to have the value "Y".
  • Set the "Enable New Practitioner Numbers By Guarantor and Program Form" so that is set to "Y".
  • Service Codes:
  • Using the 'Service Codes' form add, or identify an individual roll-up service code and at least two service codes that will be considered as the component services:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Roll-Up Services Definition:
  • Add or identify a roll-up service definition, for the roll-up service code and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Client A:
  • The client is an active client.
  • The client has an active diagnosis record.
  • The client has a Financial Eligibility record.
  • Practitioner Numbers by Guarantor and Program:
  • Identify a provider who will be the rendering provider of the roll-up component service(s),
  • Practitioner 1.
  • Fill out the 'Supervising Practitioner' field with a different provider,
  • Practitioner 2.
  • Client Charge Input:
  • Charges are created for the roll-up component services on various dates.
  • The rendering provider that was updated in the 'Practitioner Numbers by Guarantor and Program' form will be used as the practitioner for the charges.
Steps
  1. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  2. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  3. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1".
  4. Select "Rollup Def 1" in the 'Roll-Up Definitions' field.
  5. Click [Compile Worklist].
  6. Click [OK].
  7. Click [Run Report].
  8. Verify that the report shows the created Roll-Up service and its component services.
  9. Click [Close Report].
  10. Click [Discard].
  11. Click [Yes].
  12. Query the table "rollup_services_worklist" and validate that values are showing correctly with the compiled worklist data for the following columns:
  13. data_entry_utc
  14. data_entry_time
  15. data_entry_time_j
  16. data_entry_offset
  17. data_entry_timezone_short
  18. supervising_practitioner
  19. in_other_rollups_code
  20. in_other_rollups_value
  21. Verify that the column "supervising_practitioner" shows "Practitioner 2".
  22. Close the SQL window and go back to the NX window.
  23. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  24. Select the 'From Date' and 'Through Date', that cover the services of "Client A".
  25. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1".
  26. Select "Rollup Def 1" in the 'Roll-Up Definitions' field.
  27. Click [Compile Worklist].
  28. Validate that the warning popup shows saying "A compiled roll-up already exists for a selected rule. Continuing will overwrite this compile. Are you sure you want to continue?".
  29. Click [Yes].
  30. Click [OK].
  31. Select 'Post Roll-Up Services Worklist'.
  32. Select the desired compiled worklist.
  33. Validate that the 'Default Write Off Posting Code' field is enabled and required at this point.
  34. Select the desired adjustment code from the 'Default Write Off Posting Code' field.
  35. Click [Post Worklist].
  36. Click [OK].
  37. Click [Discard].
  38. Click [Yes].
  39. Query the table "rollup_services_worklist" and validate that values are showing correctly with the posted worklist data for the following columns:
  40. data_entry_utc
  41. data_entry_time
  42. data_entry_time_j
  43. data_entry_offset
  44. data_entry_timezone_short
  45. supervising_practitioner
  46. in_other_rollups_code
  47. in_other_rollups_value
  48. Close the SQL window.
  49. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  50. Select 'Unpost Last Roll-Up Services Worklist'.
  51. Select the desired compiled worklist.
  52. Click [Unpost Worklist].
  53. Click [OK].
  54. Click [Discard].
  55. Click [Yes].
  56. Query the table "rollup_services_worklist" and validate that values are showing correctly with the un-posted worklist data for the following columns:
  57. data_entry_utc
  58. data_entry_time
  59. data_entry_time_j
  60. data_entry_offset
  61. data_entry_timezone_short
  62. supervising_practitioner
  63. in_other_rollups_code
  64. in_other_rollups_value
  65. Close the SQL window.
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • Roll-Up Services Definition
AV-79875 Summary | Details
Roll-Up Services Definition - Write-off or Transfer Roll-up Component Services
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
  • Roll-Up Services Definition
  • Client Ledger
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
  • Quick Billing
  • Quick Billing Rule Definition
  • File Import
Scenario 1: 'Roll-Up Services Definition' - Validate the new Registry Setting - 'Specify Write Off Posting Code In 'Roll-Up Services Definition'.
Specific Setup:
  • Posting/Adjustment Code Definition:
  • New ones are created, or existing codes are identified for the below types,
  • Payment - "Pay Post Code 1"
  • Transfer - "Trans Post Code 1"
  • Adjustment - "Adj Post Code 1"
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services.
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
Steps
  1. Open 'Registry Settings'.
  2. Search for 'Specify Write Off Posting Code In 'Roll-Up Services Definition'.
  3. Click [View Registry Settings].
  4. Verify that the value of the registry setting is set to "N" (disabled) by default.
  5. Click [Submit].
  6. Click [OK].
  7. Click [No].
  8. Open 'Roll-Up Services Definition'.
  9. Verify that there are two new fields near the bottom of the form,
  10. 'Write Off Component Services'.
  11. 'Transfer Code for Component Services'.
  12. Verify that both the new fields are disabled.
  13. Validate that the field 'Write Off Code for Component Services' does not exists.
  14. Click [Discard].
  15. Open 'Registry Settings'.
  16. Search for 'Specify Write Off Posting Code In 'Roll-Up Services Definition'.
  17. Click [View Registry Settings].
  18. Set the value of the registry setting to "Y".
  19. Click [Submit].
  20. Click [OK].
  21. Click [No].
  22. Open 'Roll-Up Services Definition'.
  23. Verify the new field 'Write Off Code for Component Services' exists near the bottom.
  24. Click the help light bulb message for the 'Write Off Code for Component Services' field.
  25. Review the message.
  26. Click [Return To Form].
  27. Select 'Add' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  28. Select "Rollup 1" as the 'Roll-Up Service'.
  29. Select "Comp 1(a)", and "Comp 1(b)" as the 'Component Services'.
  30. Enter/ Select all the needed values.
  31. Verify that the 'Write Off Component Services' field and its options are enabled:
  32. 'Yes'.
  33. 'No - Keep Liability With Current Guarantor'.
  34. 'No - Transfer to Next Guarantor'.
  35. Verify that the 'Transfer Code for Component Services' field is disabled.
  36. Verify that the 'Write Off Code For Component Services' field is disabled.
  37. Select 'Yes' in the 'Write Off Component Services' field.
  38. Verify that the 'Write Off Code For Component Services' field is enabled.
  39. Verify that the list of available posting codes in the 'Write Off Code for Component Services' field includes only 'Adjustment' type posting codes as defined in the 'Posting/Adjustment Codes Definition' form.
  40. Select 'No - Keep Liability With Current Guarantor' in the 'Write Off Component Services' field.
  41. Verify that the 'Write Off Code For Component Services' field is disabled.
  42. Verify that the 'Transfer Code for Component Services' field is disabled.
  43. Select 'No - Transfer to Next Guarantor' in the 'Write Off Component Services' field.
  44. Verify that the 'Write Off Code For Component Services' field is disabled.
  45. Verify that the 'Transfer Code for Component Services' field is enabled and required.
  46. Verify that the list of available posting codes in the 'Transfer Code for Component Services' field includes only 'Transfer' type posting codes as defined in the 'Posting/Adjustment Codes Definition' form.
  47. Select 'Yes' in the 'Write Off Component Services' field.
  48. Select "Adj Post Code 1" from the 'Write Off Code For Component Services' field.
  49. Click [Submit].
  50. Click [Yes].
  51. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  52. Select the roll-up definition created in step 28 in 'Existing Roll-Up Definition'.
  53. Verify the below fields are appropriately populated with the values entered in the above steps:
  54. 'Write Off Component Services'.
  55. 'Write Off Code For Component Services'.
  56. 'Transfer Code for Component Services'.
  57. Close the form.
  58. Query the 'rollup_services_def' table for the definition created in step 28 and validate that the below new fields are present in the table along with their associated values.
  59. write_off_comp_svc_code,
  60. write_off_comp_svc_value,
  61. transfer_posting_code,
  62. transfer_post_code_value,
  63. write_off_posting_code,
  64. write_off_post_code_value.
  65. Close the SQL Query window.
Scenario 2: Validate Write Off Posting Code for 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'- Individual/Group definitions.
Specific Setup:
  • Registry Settings:
  • Set the "Specify Write Off Posting Code in 'Roll-Up Services Definition'" registry setting to have the value "Y".
  • Set the "Allow Roll-Up Rule Selection During Compile" to have the value '1' or the value '1&2'.
  • Remove the value if any, from the 'Default Write Off Posting Code' registry setting.
  • Posting/Adjustment Code Definition:
  • New ones are created, or existing codes are identified for the below type:
  • Adjustment
  • Adj Post Code 1
  • Adj Post Code 2
  • Adj Post Code 3
  • Service Codes:
  • Using the 'Service Codes' form add or identify two individual roll-up service codes and at least two service codes that will be considered as the component services for each:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup Def 2
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Roll-Up Group Definition:
  • Using the 'Roll-Up Group Definition' section of the 'Roll-Up Services Definition' form, create a new roll-up group that includes the two roll-up definitions created earlier:
  • Rollup Group Def 1
  • Rollup Def 1
  • Rollup Def 2
  • Client A:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Client B:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The charges are created for the roll-up component services on various dates, for "Rollup 2".
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'Yes' in the 'Write Off Component Services' field.
  5. Select "Adj Post Code 1" from the 'Write Off Code For Component Services' field.
  6. Click [Submit].
  7. Click [Yes].
  8. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  9. Select "Rollup Def 2" in 'Existing Roll-Up Definition'.
  10. Select 'Yes' in the 'Write Off Component Services' field.
  11. Leave the 'Write Off Code For Component Services' field blank.
  12. Click [Submit].
  13. Click [No].
  14. Open 'Client Ledger'.
  15. Run the ledger report for "Client A"
  16. Verify that the charges for the roll-up component services are showing for "Client A".
  17. Click [X].
  18. Click [Yes].
  19. Run the ledger report for "Client B"
  20. Verify that the charges for the roll-up component services are showing for "Client A".
  21. Click [X].
  22. Click [No].
  23. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  24. Select the 'From Date' and 'Through Date', that cover the services of "Client A" and "Client B".
  25. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and "Rollup Def 2".
  26. Select both definitions in the 'Roll-Up Definitions' field.
  27. Click [Compile Worklist].
  28. Click [OK].
  29. Click [Run Report].
  30. Verify that the report shows the created Roll-Up services and their component services for both "Client A" and "Client B".
  31. Click [Close Report].
  32. Select 'Post Roll-Up Services Worklist'.
  33. Select the worklist compiled in step 27.
  34. Select "Adj Post Code 2" in 'Default Write Off Posting Code'.
  35. Click [Post Worklist].
  36. Click [OK].
  37. Click [Discard].
  38. Click [Yes].
  39. Open 'Client Ledger'.
  40. Run the ledger report for "Client A"
  41. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  42. Verify that the roll-up service is created for "Client A".
  43. Click [X].
  44. Click [Yes].
  45. Run the ledger report for "Client B"
  46. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 2" was used for each of the component services.
  47. Verify that the roll-up service is created for "Client B".
  48. Click [X].
  49. Click [No].
  50. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  51. Select 'Unpost Last Roll-Up Services Worklist'.
  52. Select the worklist posted in step 35.
  53. Click [Unpost Worklist].
  54. Click [OK].
  55. Click [Discard].
  56. Click [Yes].
  57. Open 'Client Ledger'.
  58. Run the ledger report for "Client A"
  59. Verify that the component services are reverted to 'Open', and the roll-up service is removed for "Client A".
  60. Click [X].
  61. Click [Yes].
  62. Run the ledger report for "Client B"
  63. Verify that the component services are reverted to 'Open', and the roll-up service is removed for "Client B".
  64. Click [X].
  65. Click [No].
  66. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  67. Select the 'From Date' and 'Through Date', that cover the services of "Client A" and "Client B".
  68. Select "Rollup Group Def 1" in the 'Roll-Up Group' field.
  69. Click [Compile Worklist].
  70. Click [OK].
  71. Click [Run Report].
  72. Verify that the report shows the created Roll-Up services and their component services for both "Client A" and "Client B".
  73. Click [Close Report].
  74. Select 'Post Roll-Up Services Worklist'.
  75. Select the worklist compiled in step 69.
  76. Select "Adj Post Code 2" in 'Default Write Off Posting Code'.
  77. Click [Post Worklist].
  78. Click [OK].
  79. Click [Discard].
  80. Click [Yes].
  81. Open 'Client Ledger'.
  82. Run the ledger report for "Client A"
  83. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  84. Verify that the roll-up service is created for "Client A".
  85. Click [X].
  86. Click [Yes].
  87. Run the ledger report for "Client B"
  88. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 2" was used for each of the component services.
  89. Verify that the roll-up service is created for "Client B".
  90. Click [X].
  91. Click [No].
  92. Open 'Registry Settings'.
  93. Search and select the 'Default Write Off Posting Code' registry setting.
  94. Set the code of "Adj Post Code 3" in the 'Registry Setting Value' field.
  95. Click [Submit].
  96. Click [OK].
  97. Click [No].
  98. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  99. Select 'Unpost Last Roll-Up Services Worklist'.
  100. Select the worklist posted above.
  101. Click [Unpost Worklist].
  102. Click [OK].
  103. Select 'Compile Roll-Up Services Worklist'.
  104. Select the 'From Date' and 'Through Date', that cover the services of "Client A" and "Client B".
  105. Select "Rollup Group Def 1" in the 'Roll-Up Group' field.
  106. Click [Compile Worklist].
  107. Click [OK].
  108. Click [Run Report].
  109. Verify that the report shows the created Roll-Up services and their component services for both "Client A" and "Client B".
  110. Click [Close Report].
  111. Select 'Post Roll-Up Services Worklist'.
  112. Select the worklist compiled in step 106.
  113. Verify that the field 'Default Write Off Posting Code' is populated with "Adj Post Code 3".
  114. Click [Post Worklist].
  115. Click [OK].
  116. Click [Discard].
  117. Click [Yes].
  118. Open 'Client Ledger'.
  119. Run the ledger report for "Client A"
  120. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  121. Verify that the roll-up service is created for "Client A".
  122. Click [X].
  123. Click [Yes].
  124. Run the ledger report for "Client B"
  125. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 3" was used for each of the component services.
  126. Verify that the roll-up service is created for "Client B".
  127. Click [X].
  128. Click [No].
Scenario 3: Validating the Write Off Posting Code for 'Quick Billing'
Specific Setup:
  • Registry Settings:
  • Set the "Specify Write Off Posting Code in 'Roll-Up Services Definition'" registry setting to have the value "Y".
  • Posting/Adjustment Code Definition:
  • New ones are created, or existing codes are identified for the below type:
  • Adjustment
  • Adj Post Code 1
  • Adj Post Code 2
  • Service Codes:
  • Using the 'Service Codes' form add or identify two individual roll-up service codes and at least two service codes that will be considered as the component services for each:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Set 'Yes' for the 'Write Off Component Services' field.
  • Select "Adj Post Code 2" in the 'Write Off Code for Component Services' field.
  • Rollup Def 2
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Set 'Yes' for the 'Write Off Component Services' field.
  • Leave the 'Write Off Code for Component Services' field EMPTY.
  • Client A:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The client's Guarantor, Financial class, Treatment setting, and Program are noted for validation.
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Client B:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The client's Guarantor, Financial class, Treatment setting, and Program are noted for validation.
  • The charges are created for the roll-up component services on various dates, for "Rollup 2".
Steps
  1. Open 'Registry Settings'.
  2. Search for 'Execute Roll-Up Prior To Quick Billing'.
  3. Click [View Registry Settings].
  4. Select 'Execute Roll-Up Prior To Quick Billing Registry Setting Value:'.
  5. Set the registry setting value to "Adj Post Code 1".
  6. Click [Submit].
  7. Click [OK].
  8. Click [No].
  9. Open 'Quick Billing Rule Definition'.
  10. Select 'Add New'.
  11. Set any desired value for 'Rule Description'.
  12. Select the Roll-up and the Component services in the 'Service Codes' field:
  13. "Rollup 1"
  14. "Comp 1(a)"
  15. "Comp 1(b)"
  16. "Rollup 2"
  17. "Comp 2(a)"
  18. "Comp 2(b)"
  19. Select all the required values that are relevant to "Client A" and "Client B" from the setup.
  20. Select the roll-up definitions from the setup in 'Roll-Up Definitions To Include' field:
  21. "Rollup Def 1"
  22. "Rollup Def 2"
  23. Click [Submit].
  24. Click [No].
  25. Open 'Client Ledger'.
  26. Run the ledger report for "Client A"
  27. Verify that the charges for the roll-up component services are showing for "Client A".
  28. Click [X].
  29. Click [Yes].
  30. Run the ledger report for "Client B"
  31. Verify that the charges for the roll-up component services are showing for "Client A".
  32. Click [X].
  33. Click [No].
  34. Open 'Quick Billing'.
  35. Select 'Add New'.
  36. Select the 'First Date Of Service To Include' and 'Last Date Of Service To Include', that cover the services of "Client A" and "Client B".
  37. Select the Quick Billing rule created in step 11 in the 'Billing Rule To Execute' field.
  38. Select the needed tasks in 'Quick Billing Tasks to Execute'. (Minimum selections should be made as listed below)
  39. Create Batch.
  40. Close Charges.
  41. Select the desired value for 'Date Of Claim'.
  42. Click [Submit].
  43. Click [OK].
  44. Click [No].
  45. Open 'Client Ledger'.
  46. Run the ledger report for "Client A"
  47. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 2" was used for each of the component services.
  48. Verify that the roll-up service is created for "Client A".
  49. Click [X].
  50. Click [Yes].
  51. Run the ledger report for "Client B"
  52. Review the roll-up component services and verify that they are marked as 'Roll-Up' and that "Adj Post Code 1" was used for each of the component services.
  53. Verify that the roll-up service is created for "Client B".
  54. Click [X].
  55. Click [No].
Scenario 4: Validating Posting Roll-Ups Without Write Off or Transfer of Component Services
Specific Setup:
  • Registry Settings:
  • Set the "Specify Write Off Posting Code in 'Roll-Up Services Definition'" registry setting to have the value "Y".
  • Set the "Allow Roll-Up Rule Selection During Compile" to have the value '1' or the value '1&2'.
  • Remove the value if any, from the 'Default Write Off Posting Code' registry setting.
  • Posting/Adjustment Code Definition:
  • New ones are created or existing codes are identified for the below type:
  • Adjustment
  • Adj Post Code 1
  • Service Codes:
  • Using the 'Service Codes' form add or identify two individual roll-up service codes and at least two service codes that will be considered as the component services for each:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup Def 2
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Client A:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Client B:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The charges are created for the roll-up component services on various dates, for "Rollup 2".
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'No - Keep Liability With Current Guarantor' in the 'Write Off Component Services' field.
  5. Click [Submit].
  6. Click [Yes].
  7. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  8. Select "Rollup Def 2" in 'Existing Roll-Up Definition'.
  9. Select 'Yes' in the 'Write Off Component Services' field.
  10. Leave the 'Write Off Code For Component Services' field blank.
  11. Click [Submit].
  12. Click [No].
  13. Open 'Client Ledger'.
  14. Run the ledger report for "Client A".
  15. Verify that the charges for the roll-up component services are displayed.
  16. Click [X].
  17. Click [Yes].
  18. Run the ledger report for "Client B".
  19. Verify that the charges for the roll-up component services are displayed.
  20. Click [X].
  21. Click [No].
  22. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  23. Select the 'From Date' and 'Through Date', that cover the services of "Client A" and "Client B".
  24. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and "Rollup Def 2".
  25. Select both definitions in the 'Roll-Up Definitions' field.
  26. Click [Compile Worklist].
  27. Click [OK].
  28. Click [Run Report].
  29. Verify that the report shows the created Roll-Up services and their component services for both "Client A" and "Client B".
  30. Click [Close Report].
  31. Select 'Post Roll-Up Services Worklist'.
  32. Select the worklist compiled in step 26.
  33. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  34. Click [Post Worklist].
  35. Click [OK].
  36. Click [Discard].
  37. Click [Yes].
  38. Open 'Client Ledger'.
  39. Run the ledger report for "Client A".
  40. Review the roll-up component services and verify that they are marked as 'Roll-Up'.
  41. Verify that there are no adjustments created for the component services.
  42. Verify that the roll-up service is created.
  43. Click [X].
  44. Click [Yes].
  45. Run the ledger report for "Client B"
  46. Review the roll-up component services and verify that they are marked as 'Roll-Up'.
  47. Verify that adjustments were posted as expected for the component services using "Adj Post Code 1".
  48. Verify that the roll-up service was created.
  49. Click [X].
  50. Click [No].
  51. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  52. Select 'Unpost Last Roll-Up Services Worklist'.
  53. Select the worklist posted in step 34.
  54. Click [Unpost Worklist].
  55. Click [OK].
  56. Click [Discard].
  57. Click [Yes].
  58. Open 'Client Ledger'.
  59. Run the ledger report for "Client A"
  60. Verify that the component services are reverted to 'Open', the roll-up charges are removed, and none of the component services are marked 'roll-up'.
  61. Click [X].
  62. Click [Yes].
  63. Run the ledger report for "Client B"
  64. Verify that the component services are reverted to 'Open', the roll-up charges are removed, all adjustments are removed, and none of the component services are marked 'roll-up'.
  65. Click [X].
  66. Click [No].
Scenario 5: Validating Posting Roll-Ups and Transferring Component Service Liability to Next Guarantor
Specific Setup:
  • Registry Settings:
  • Set the "Specify Write Off Posting Code in 'Roll-Up Services Definition'" registry setting to have the value "Y".
  • Set the "Allow Roll-Up Rule Selection During Compile" to have the value '1' or the value '1&2'.
  • Remove the value if any, from the 'Default Write Off Posting Code' registry setting.
  • Posting/Adjustment Code Definition:
  • New ones are created, or existing codes are identified for the below types:
  • Transfer - "Trans Post Code 1"
  • Adjustment - "Adj Post Code 1"
  • Service Codes:
  • Using the 'Service Codes' form add or identify two individual roll-up service codes and at least two service codes that will be considered as the component services for each:
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Roll-Up Services Definition:
  • Add or identify roll-up service definitions, for each of the roll-up service codes and its associated component services:
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup Def 2
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Client A:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The charges are created for the roll-up component services on various dates, for "Rollup 1".
  • Client B:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has active Diagnosis and Financial Eligibility records.
  • The charges are created for the roll-up component services on various dates, for "Rollup 2".
Steps
  1. Open 'Roll-Up Services Definition'.
  2. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  3. Select "Rollup Def 1" in 'Existing Roll-Up Definition'.
  4. Select 'No - Keep Liability With Current Guarantor' in the 'Write Off Component Services' field.
  5. Click [Submit].
  6. Click [Yes].
  7. Select 'Edit' in the 'Add/Edit/Delete Roll-Up Service Definition' field.
  8. Select "Rollup Def 2" in 'Existing Roll-Up Definition'.
  9. Select 'No - Transfer to Next Guarantor' in the 'Write Off Component Services' field.
  10. Select "Trans Post Code 1" in the 'Transfer Code for Component Services' field.
  11. Click [Submit].
  12. Click [No].
  13. Open 'Client Ledger'.
  14. Run the ledger report for "Client A"
  15. Verify that the charges for the roll-up component services are displayed.
  16. Click [X].
  17. Click [Yes].
  18. Run the ledger report for "Client B"
  19. Verify that the charges for the roll-up component services are displayed.
  20. Click [X].
  21. Click [No].
  22. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  23. Select the 'From Date' and 'Through Date', that cover the services of "Client A" and "Client B".
  24. Verify that the 'Roll-Up Definitions' field shows "Rollup Def 1" and "Rollup Def 2".
  25. Select both definitions in the 'Roll-Up Definitions' field.
  26. Click [Compile Worklist].
  27. Click [OK].
  28. Click [Run Report].
  29. Verify that the report shows the created Roll-Up services and their component services for both "Client A" and "Client B".
  30. Click [Close Report].
  31. Select 'Post Roll-Up Services Worklist'.
  32. Select the worklist compiled in step 26.
  33. Select "Adj Post Code 1" in 'Default Write Off Posting Code'.
  34. Click [Post Worklist].
  35. Click [OK].
  36. Click [Discard].
  37. Click [Yes].
  38. Open 'Client Ledger'.
  39. Run the ledger report for "Client A"
  40. Review the roll-up component services and verify that they are marked as 'Roll-Up'.
  41. Verify that there are no adjustments created for the component services.
  42. Verify that the roll-up service was created.
  43. Click [X].
  44. Click [Yes].
  45. Run the ledger report for "Client B"
  46. Review the roll-up component services and verify that they are marked as 'Roll-Up'.
  47. Verify that the transfers were posted for the component services and that "Trans Post Code 1" was used for each of the component services.
  48. Verify that the roll-up service was created.
  49. Click [X].
  50. Click [No].
  51. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  52. Select 'Unpost Last Roll-Up Services Worklist'.
  53. Select the worklist posted in step 34.
  54. Click [Unpost Worklist].
  55. Click [OK].
  56. Click [Discard].
  57. Click [Yes].
  58. Open 'Client Ledger'.
  59. Run the ledger report for "Client A"
  60. Verify that the component services are reverted to 'Open', and the roll-up service is removed.
  61. Click [X].
  62. Click [Yes].
  63. Run the ledger report for "Client B"
  64. Verify that all the transfers are removed, and none of the component services are marked 'roll-up'.
  65. Click [X].
  66. Click [No].
Scenario 6: File Import - Roll-Up Services Definition - Validations.
Specific Setup:
  • Posting/Adjustment Code Definition:
  • New codes are created, or existing codes are identified for the below type:
  • Adjustment - "Adj Post Code 1".
  • Payment - "Pay Post Code 1".
  • Transfer - "Trans Post Code 1".
  • Service Codes:
  • Using the 'Service Codes' form add or identify an individual roll-up service code and at least two service codes that will be considered as the component services for it.
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • File Import:
  • Create the below .txt file(s) to have the data that we can validate against the 'File Import' feature for 'Roll-Up Services Definition', as mentioned below,
  • File 1:
  • Field 1 value set as "1".
  • Invalid value for field 55 and Invalid value for field 56.
  • All other needed fields with valid values.
  • File 2:
  • Field 1 value set as "1".
  • Value '3-(Both)' for field 55 and field 56 is left blank.
  • All other needed fields with valid values.
  • File 3:
  • Field 1 value set as "1".
  • Invalid value for field 57.
  • All other needed fields with valid values.
  • File 4:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') is left blank.
  • All other needed fields with valid values.
  • File 5:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') has a valid ADJUSTMENT posting code.
  • All other needed fields with valid values.
  • File 6:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') has a valid PAYMENT posting code.
  • All other needed fields with valid values.
  • File 7:
  • Field 1 value set as "1".
  • Value '3-(No - transfer to next guarantor)' for field 57 and field 58 ('Transfer Code for Component Services') has an INVALID posting code.
  • All other needed fields with valid values.
  • File 8:
  • Field 1 value set as "1".
  • The value of field 57 is anything other than '3' and field 58 has a valid TRANSFER posting code.
  • All other needed fields with valid values.
  • File 9:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has a valid ADJUSTMENT posting code.
  • All other needed fields with valid values.
  • File 10:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has a valid PAYMENT posting code.
  • All other needed fields with valid values.
  • File 11:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has a valid TRANSFER posting code.
  • All other needed fields with valid values.
  • File 12:
  • Field 1 value set as "1".
  • The value of field 57 is '1'.
  • Field 59 ('Write Off Code for Component Services") has an INVALID posting code.
  • All other needed fields with valid values.
  • File 13:
  • Field 1 value set as "1".
  • Field 57 ('Write Off Component Services') has the value '2' or '3' and a valid ADJUSTMENT posting code for field 59.
  • All other needed fields with valid values.
  • File 14:
  • Field 1 value set as "1".
  • Value '3-(Both)' for field 55 and valid dictionary value for field 56.
  • Value '1-(Yes)' for field 57 and valid ADJUSTMENT posting code for field 59.
  • All other needed fields with valid values.
  • File 15:
  • Field 1 value set as "2".
  • Field 2 value set as the Valid roll-up ID created in the above step using "File 14".
  • Value '3-(Both)' for field 55 and valid dictionary value for field 56.
  • Value '2-(No - Keep Liability With Current Guarantor)' for field 57 and No values entered for field 59.
  • All other needed fields with valid values.
  • File 16:
  • Field 1 value set as "2".
  • Field 2 value set as the Valid roll-up ID created in the above step using "File 14".
  • Value '3-(Both)' for field 55 and valid dictionary value for field 56.
  • Value '3-(No - Transfer to Next Guarantor)' for field 57 and valid TRANSFER code entered for field 58.
  • No values were entered for field 59.
  • All other needed fields with valid values.
  • File 17:
  • Field 1 value set as "3".
  • Use all other field values the same as in "File 15".
Steps
  1. Open 'File Import'.
  2. Select 'Roll-Up Services Definition' in 'File Type'.
  3. Select 'Upload New File'.
  4. Click [Process].
  5. Select 'File 1'.
  6. Select 'Compile/Validate File'.
  7. Select 'File 1'.
  8. Click [Process].
  9. Validate that the error shows with the text "File 1.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
  10. Click [OK].
  11. Click [Print Errors].
  12. Select 'File 1'.
  13. Click [Process].
  14. Validate that the report shows the appropriate error concerning the 'File 1' from the setup.
  15. Click [Close Report].
  16. Repeat the above steps for Files 2 - File 8.
  17. Click [Discard].
  18. Click [Yes].
  19. Open 'Registry Settings'.
  20. Search and select 'Specify Write Off Posting Code In 'Roll-Up Services Definition'' registry setting.
  21. Set the Registry Setting Value to "N".
  22. Click [Submit].
  23. Click [OK].
  24. Click [No].
  25. Open 'File Import'.
  26. Select 'Roll-Up Services Definition' in 'File Type'.
  27. Select 'Upload New File'.
  28. Click [Process].
  29. Select 'File 9'.
  30. Select 'Compile/Validate File'.
  31. Select 'File 9'.
  32. Click [Process].
  33. Validate that the error shows with the text "File 9.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
  34. Click [OK].
  35. Click [Print Errors].
  36. Select 'File 9'.
  37. Click [Process].
  38. Validate that the report shows the appropriate error concerning the 'File 9' from the setup.
  39. Click [Close Report].
  40. Click [Discard].
  41. Click [Yes].
  42. Open 'Registry Settings'.
  43. Search and select the 'Specify Write Off Posting Code In 'Roll-Up Services Definition'' registry setting.
  44. Set the Registry Setting Value to "Y".
  45. Click [Submit].
  46. Click [OK].
  47. Click [No].
  48. Open 'File Import'.
  49. Select 'Roll-Up Services Definition' in 'File Type'.
  50. Select 'Upload New File'.
  51. Click [Process].
  52. Select 'File 10'.
  53. Select 'Compile/Validate File'.
  54. Select 'File 10'.
  55. Click [Process].
  56. Validate that the error shows with the text "File 10.txt contains one or more errors. These errors can be reviewed using 'Print Errors' action.".
  57. Click [OK].
  58. Click [Print Errors].
  59. Select 'File 10'.
  60. Click [Process].
  61. Validate that the report shows the appropriate error concerning the 'File 10' from the setup.
  62. Click [Close Report].
  63. Repeat above steps for File 11 - File 13.
  64. Select 'Upload New File'.
  65. Click [Process].
  66. Select 'File 14'.
  67. Select 'Compile/Validate File'.
  68. Select 'File 14'.
  69. Click [Process].
  70. Validate that the success message contains "Compiled.".
  71. Click [OK].
  72. Select 'Post File'.
  73. Select 'File 14'.
  74. Click [Process].
  75. Validate that the success message contains "Posted.".
  76. Click [OK].
  77. Select 'Print File'.
  78. Select 'File 14'.
  79. Click [Process].
  80. Validate that the report shows the appropriate values passed/ posted in 'File 14' from the setup.
  81. Click [Close Report].
  82. Click [Discard].
  83. Click [Yes].
  84. Open 'Roll-Up Services Definition'.
  85. Select 'Edit'.
  86. Select the Roll-Up Service Definition posted in Step 75 in the 'Existing Roll-Up Definition' field.
  87. Validate that all the values are populated correctly.
  88. Click [Discard].
  89. Click [Yes].
  90. Open 'File Import'.
  91. Select 'Roll-Up Services Definition' in 'File Type'.
  92. Select 'Upload New File'.
  93. Click [Process].
  94. Select 'File 15'.
  95. Select 'Compile/Validate File'.
  96. Select 'File 15'.
  97. Click [Process].
  98. Validate that the success message contains "Compiled.".
  99. Click [OK].
  100. Select 'Post File'.
  101. Select 'File 15'.
  102. Click [Process].
  103. Validate that the success message contains "Posted.".
  104. Click [OK].
  105. Select 'Print File'.
  106. Select 'File 15'.
  107. Click [Process].
  108. Validate that the report shows the appropriate values passed/ posted in 'File 15' from the setup.
  109. Click [Close Report].
  110. Click [Discard].
  111. Click [Yes].
  112. Open 'Roll-Up Services Definition'.
  113. Select 'Edit'.
  114. Select the Roll-Up Service Definition posted above in the 'Existing Roll-Up Definition' field.
  115. Validate that all the values are populated correctly.
  116. Click [Discard].
  117. Click [Yes].
  118. Open 'File Import'.
  119. Select 'Roll-Up Services Definition' in 'File Type'.
  120. Select 'Upload New File'.
  121. Click [Process].
  122. Select 'File 16'.
  123. Select 'Compile/Validate File'.
  124. Select 'File 16'.
  125. Click [Process].
  126. Validate that the success message contains "Compiled.".
  127. Click [OK].
  128. Select 'Post File'.
  129. Select 'File 16'.
  130. Click [Process].
  131. Validate that the success message contains "Posted.".
  132. Click [OK].
  133. Select 'Print File'.
  134. Select 'File 16'.
  135. Click [Process].
  136. Validate that the report shows the appropriate values passed/ posted in 'File 16' from the setup.
  137. Click [Close Report].
  138. Click [Discard].
  139. Click [Yes].
  140. Open 'Roll-Up Services Definition'.
  141. Select 'Edit'.
  142. Select the Roll-Up Service Definition posted above in the 'Existing Roll-Up Definition' field.
  143. Validate that all the values are populated correctly.
  144. Click [Discard].
  145. Click [Yes].
  146. Open 'File Import'.
  147. Select 'Roll-Up Services Definition' in 'File Type'.
  148. Select 'Upload New File'.
  149. Click [Process].
  150. Select 'File 17'.
  151. Select 'Compile/Validate File'.
  152. Select 'File 17'.
  153. Click [Process].
  154. Validate that the success message contains "Compiled.".
  155. Click [OK].
  156. Select 'Post File'.
  157. Select 'File 17'.
  158. Click [Process].
  159. Validate that the success message contains "Posted.".
  160. Click [OK].
  161. Select 'Print File'.
  162. Select 'File 17'.
  163. Click [Process].
  164. Validate that the report shows the appropriate values passed/ posted in 'File 17' from the setup.
  165. Click [Close Report].
  166. Click [Discard].
  167. Click [Yes].
  168. Open 'Roll-Up Services Definition'.
  169. Select 'Edit'.
  170. Search for the Roll-Up Service Definition deleted above in the 'Existing Roll-Up Definition' field.
  171. Validate that we get "No results found".
  172. Click [Discard].
  173. Click [Yes].
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • File Import • Quick Billing • Registry Settings • Roll-Up Services Definition
AV-83057 Summary | Details
Compile/Edit/Post/Unpost Roll-Up Services Worklist - Compile Roll-Up Group
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Charge Input
  • Client Ledger
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
Scenario 1: Validate 'Roll-Up-Compile Report' generated with the correct data for both Individual and Group definitions.
Specific Setup:
  • Registry settings:
  • Set the "Allow Roll-Up Rule Selection During Compile" registry setting to have the value "1&2".
  • Service Codes:
  • Using the 'Service Codes' form add or identify two individual roll-up service codes and at least two service codes that will be considered component services to each roll-up service code.
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Roll-Up Services Definition:
  • Add or identify two different roll-up service definitions, one for each of the two roll-up service codes and their associated component services.
  • Rollup Def 1
  • Rollup 1
  • Comp 1(a)
  • Comp 1(b)
  • Rollup Def 2
  • Rollup 2
  • Comp 2(a)
  • Comp 2(b)
  • Roll-Up Group Definition:
  • Using the 'Roll-Up Group Definition' section of the 'Roll-Up Services Definition' form, create a new roll-up group that includes the two roll-up definitions created earlier.
  • Rollup Group Def 1
  • Rollup Def 1
  • Rollup Def 2
  • Client A:
  • The client is admitted to an inpatient/ outpatient program.
  • The client has an active diagnosis record.
  • The client has the Financial Eligibility record.
Steps
  1. Open 'Client Charge Input'.
  2. For "Client A" add several days of charges for each of the roll-up component services from the Setup.
  3. Comp 1(a)
  4. Comp 1(b)
  5. Comp 2(a)
  6. Comp 2(b)
  7. Open 'Client Ledger'.
  8. Verify that the charges for the roll-up component services are showing for "Client A".
  9. Click [X].
  10. Click [No].
  11. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  12. Set the 'Through Date' to today's date by clicking 'T'.
  13. Verify that the 'Roll-Up Definitions' field shows the below Roll-Up definitions,
  14. Rollup Def 1.
  15. Rollup Def 2.
  16. Select both the definitions used above.
  17. Click [Compile Worklist].
  18. Verify the "Compile complete" message is received.
  19. Click [OK].
  20. Click [Run Report].
  21. Verify that the report contains the roll-up services that are created during the compile process along with the component services.
  22. Close the report.
  23. Click [Discard].
  24. Click [Yes].
  25. Open 'Compile/Edit/Post/Unpost Roll-Up Services Worklist'.
  26. Set the 'Through Date' to today's date by clicking 'T'.
  27. Verify that the 'Roll-Up Group' field shows the below Roll-Up groups:
  28. Rollup Group Def 1.
  29. Select the group from Step 21.
  30. Click [Compile Worklist].
  31. Verify that the alert message displays: "A compiled roll-up already exists for a selected rule. Continuing will overwrite this compile. Are you sure you want to continue?".
  32. Click [Yes].
  33. Verify the "Compile complete" message is received.
  34. Click [OK].
  35. Click [Run Report].
  36. Verify that the report contains the roll-up services created during the compile process and the component services for both Roll-Up Definitions.
  37. Close the report.
  38. Select 'Post Roll-Up Services Worklist'.
  39. Select the posted Roll-Up worklist date range in the 'Through Date' field.
  40. Select any desired Adjustment code in the 'Default Write Off Posting Code' field.
  41. Click [Post Worklist].
  42. Verify the success message says "Post complete.".
  43. Click [OK].
  44. Click [Discard].
  45. Click [Yes].
  46. Open 'Client Ledger' for "Client A".
  47. Verify that the rollup services are shown along with the component services marked as 'Roll-Up' with their respective posting code.
  48. Click [X].
  49. Click [No].
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • Roll-Up Services Definition
AV-92620 Summary | Details
Guarantor/Program Billing Defaults - 837 Professional
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Electronic Billing
  • File Import
Scenario 1: Validate 'Guarantor Program Billing Defaults', 'Sort Claims by Date of Service' = Yes.
Specific Setup:
  • Guarantor:
  • A new one is created or an existing guarantor is identified.
  • Guarantor 1
  • Guarantor/Program Billing Defaults Template:
  • A Guarantor/Program Billing Defaults template is identified that includes "Guarantor 1"
  • Template 1
  • Client A:
  • Client has unbilled, closed services in a three-month date range.
  • The services should be for "Guarantor 1".
  • The tester knows the date range, financial class of the guarantor, and the program.
  • Some of the service dates will have one service only.
  • Some of the service dates will have two services.
  • Some of the service dates will have five services.
  • Create Interim Billing Batch File:
  • An Interim billing batch is created that covers the services of "Client A".
  • Batch 1
Steps
  1. Open 'Guarantor/Program Billing Defaults'.
  2. Select 'Edit Template'.
  3. Select "Template 1" from the 'Select Template' field.
  4. Select the '837 Professional' section.
  5. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field to blank.
  6. Select 'Yes' in the 'Sort Claims by Date of Service' field.
  7. Click [Submit].
  8. Click [No].
  9. Open 'Open 'Electronic Billing'.
  10. Create a bill for the services entering all the dates of service(s) in the billing date range by selecting "Batch 1".
  11. Review the dump file.
  12. Validate that the client has more than one CLM segment.
  13. Validate that the services are grouped into different claims on the bill.
  14. Validate that the LX segments after each CLM segment(s) are for all the services that are on the same day.
  15. Click [X].
  16. Click [No].
  17. Open 'Guarantor/Program Billing Defaults'.
  18. Select 'Edit Template'.
  19. Select "Template 1" from the 'Select Template' field.
  20. Select the '837 Professional' section.
  21. Set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field to "2".
  22. Select 'Yes' in the 'Sort Claims by Date of Service' field.
  23. Click [Submit].
  24. Click [No].
  25. Open 'Open 'Electronic Billing'.
  26. Create a bill for the services entering all the dates of service(s) in the billing date range by selecting "Batch 1".
  27. Review the dump file.
  28. Validate that the client has more than one CLM segment.
  29. Validate that the services are grouped into different claims on the bill.
  30. All services that are on the same day are grouped into one claim, unless there are more than two services.
  31. The system will create three claims when 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field is set to "2" and there are five services.
  32. The first two claims will have two LX segments. The third claim will have one LX segment.
  33. Click [X].
  34. Click [No].
Scenario 2: Validate 'Guarantor Program Billing Defaults', 'Sort Claims by Date of Service' = No and None is selected.
Specific Setup:
  • Guarantor:
  • A new one is created or an existing guarantor is identified.
  • Guarantor 1
  • Guarantor/Program Billing Defaults Template:
  • A Guarantor/Program Billing Defaults template is identified that includes "Guarantor 1"
  • Template 1
  • The 'Sort Claims by Date of Service' field in the '837 Professional' section of "Guarantor 1" has no values selected.
  • Client A:
  • Has unbilled, closed, services for a two or three-month(s) date range.
  • The services should be for "Guarantor 1".
  • The tester knows the date range, financial class of the guarantor, and the program.
  • Create Interim Billing Batch File:
  • An Interim billing batch is created that covers the services of "Client A".
  • Batch 1
Steps
  1. Open 'Guarantor/Program Billing Defaults'.
  2. Select 'Edit Template'.
  3. Select "Template 1" from the 'Select Template' field.
  4. Select the '837 Professional' section.
  5. Leave the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field blank.
  6. Verify that the 'Sort Claims by Date of Service' field exists and has the below options,
  7. Yes
  8. No
  9. Verify that for the first time when it's accessed no values are selected in the 'Verify the Sort Claims by Date of Service' field.
  10. Click [Submit].
  11. Click [No].
  12. Open 'Open 'Electronic Billing'.
  13. Create a bill for the services entering all the dates of service(s) in the billing date range by selecting "Batch 1".
  14. Review the dump file.
  15. Validate that the client has only one CLM segment.
  16. Validate that the LX segments after the first CLM segment are for all the dates of services.
  17. Click [X].
  18. Click [No].
  19. Open 'Guarantor/Program Billing Defaults'.
  20. Select 'Edit Template'.
  21. Select "Template 1" from the 'Select Template' field.
  22. Select the '837 Professional' section.
  23. Leave the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' field blank.
  24. Select 'No' in the 'Sort Claims by Date of Service' field.
  25. Click [Submit].
  26. Click [No].
  27. Open 'Open 'Electronic Billing'.
  28. Create a bill for the services entering all the dates of service(s) in the billing date range by selecting "Batch 1".
  29. Review the dump file.
  30. Validate that the client has only one CLM segment.
  31. Validate that the LX segments after the first CLM segment are for all the dates of services.
  32. Click [X].
  33. Click [No].
Scenario 3: File Import - GPBD Template - Add/ Edit - Validating the new field 'Sort Claims by Date of Service'.
Specific Setup:
  • File Import (Guarantor/Program Billing Defaults Template):
  • Below .txt (file import) files are created,
  • File A.
  • To Add Template 1, with all the required values for 837P.
  • With no values entered for the 'Sort Claims by Date of Service' field.
  • File B.
  • To Edit Template 1.
  • With the value 'N' for the 'Sort Claims by Date of Service' field.
  • File C.
  • To Edit Template 1.
  • With the value 'Y' for the 'Sort Claims by Date of Service' field.
Steps
  1. Open 'File Import'.
  2. Select 'Guarantor/Program Billing Defaults Template' in 'File Type'.
  3. Select 'Upload New File' from the 'Action' field.
  4. Click [Process Action].
  5. Select "File A" from the setup.
  6. Verify that the file loaded successfully.
  7. Select 'Compile/Validate File' from the 'Action' field.
  8. Select the uploaded file from the 'File(s)' field.
  9. Click [Process Action].
  10. Verify the success message shown that says "Compiled.".
  11. Click [OK].
  12. Select 'Post File' from the 'Action' field.
  13. Select the file compiled in Step 10 from the 'File(s)' field.
  14. Click [Process Action].
  15. Verify the success message shown that says "Posted.".
  16. Click [OK].
  17. Select 'Print File' from the 'Action' field.
  18. Select the file posted in Step 15 from the 'File(s)' field.
  19. Click [Process Action].
  20. Validate that the report text contains all the values that are filed for "Template 1", which also includes the new field "Sort Claims by Date of Service" and its value.
  21. Close the report.
  22. Click [Discard].
  23. Click [Yes].
  24. Open 'Guarantor/Program Billing Defaults'.
  25. Select 'Edit Template'.
  26. Select "Template 1" from the 'Select Template' field.
  27. Select '837 Professional' section.
  28. Verify that the 'Sort Claims by Date of Service' field has no values selected.
  29. Click [Discard].
  30. Click [Yes].
  31. Open 'File Import'.
  32. Select 'Guarantor/Program Billing Defaults Template' in 'File Type'.
  33. Select 'Upload New File' from the 'Action' field.
  34. Click [Process Action].
  35. Select File B" from the setup.
  36. Verify that the file loaded successfully.
  37. Select 'Compile/Validate File' from the 'Action' field.
  38. Select the uploaded file from the 'File(s)' field.
  39. Click [Process Action].
  40. Verify the success message shown that says "Compiled.".
  41. Click [OK].
  42. Select 'Post File' from the 'Action' field.
  43. Select the file compiled in Step 40 from the 'File(s)' field.
  44. Click [Process Action].
  45. Verify the success message shown that says "Posted.".
  46. Click [OK].
  47. Select 'Print File' from the 'Action' field.
  48. Select the file posted in Step 45 from the 'File(s)' field.
  49. Click [Process Action].
  50. Validate that the report text contains all the values that are filed for "Template 1", which also includes the new field "Sort Claims by Date of Service" and its value.
  51. Close the report.
  52. Click [Discard].
  53. Click [Yes].
  54. Open 'Guarantor/Program Billing Defaults'.
  55. Select 'Edit Template'.
  56. Select "Template 1" from the 'Select Template' field.
  57. Select '837 Professional' section.
  58. Verify that the 'Sort Claims by Date of Service' field has the value 'No' selected.
  59. Click [Discard].
  60. Click [Yes].
  61. Open 'File Import'.
  62. Select 'Guarantor/Program Billing Defaults Template' in 'File Type'.
  63. Select 'Upload New File' from the 'Action' field.
  64. Click [Process Action].
  65. Select "File C" from the setup.
  66. Verify that the file loaded successfully.
  67. Select 'Compile/Validate File' from the 'Action' field.
  68. Select the uploaded file from the 'File(s)' field.
  69. Click [Process Action].
  70. Verify the success message shown that says "Compiled.".
  71. Click [OK].
  72. Select 'Post File' from the 'Action' field.
  73. Select the file compiled in Step 70 from the 'File(s)' field.
  74. Click [Process Action].
  75. Verify the success message shown that says "Posted.".
  76. Click [OK].
  77. Select 'Print File' from the 'Action' field.
  78. Select the file posted in Step 75 from the 'File(s)' field.
  79. Click [Process Action].
  80. Validate that the report text contains all the values that are filed for "Template 1", which also includes the new field "Sort Claims by Date of Service" and its value.
  81. Close the report.
  82. Click [Discard].
  83. Click [Yes].
  84. Open 'Guarantor/Program Billing Defaults'.
  85. Select 'Edit Template'.
  86. Select "Template 1" from the 'Select Template' field.
  87. Select '837 Professional' section.
  88. Verify that the 'Sort Claims by Date of Service' field has the value 'Yes' selected.
  89. Click [Discard].
  90. Click [Yes].
Topics
• 837 Professional • Electronic Billing • File Import • Guarantor / Program Billing Defaults
Table Changes
Table Column Change
SYSTEM.rollupservicesworklist supervising_practitioner Edit
SYSTEM.rollupservicesworklist in_other_rollups_code Edit
SYSTEM.rollupservicesworklist exclude_from_totals Edit
SYSTEM.rollupservicesworklist data_entry_utc Add
SYSTEM.rollupservicesworklist data_entry_offset Add
SYSTEM.rollupservicesworklist data_entry_time_j Add
SYSTEM.rollupservicesworklist data_entry_timezone_info_all Add
SYSTEM.rollupservicesworklist data_entry_timezone_short Add
SYSTEM.rollupservicesworklist adjustment_posting_code Add
SYSTEM.rollupservicesworklist adjustment_posting_value Add
SYSTEM.RollUpServiceRules bill_rollup_code Add
SYSTEM.RollUpServiceRules bill_rollup_value Add
SYSTEM.RollUpServiceRules force_same_claim_code Add
SYSTEM.RollUpServiceRules force_same_claim_value Add
SYSTEM.table837pfacilityprovnum sort_clms_by_date_of_service_code Add
SYSTEM.table837pfacilityprovnum sort_clms_by_date_of_service_value Add
SYSTEM.fileimportgpbdtp837 sort_clms_by_date_of_service_code Add
SYSTEM.fileimportgpbdtp837 sort_clms_by_date_of_service_value Add