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Avatar PM 2023 Update 86

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Product Requirements / Recommendations

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Product Update Form Description

The help messages on form 'Guarantor/Program Billing Defaults' for field 'CCBHC Claim Grouping' on tabs '837 Institutional' and '837 Professional' has been updated.

Included Updates

64

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Guarantor/Program Billing Defaults - CCBHC Claim Grouping
The CCBHC Claim Grouping help message has been updated.
Value Added: The help message contains additional information.
Topics
• 837 Institutional • 837 Professional • Guarantor / Program Billing Defaults • NX
 
Acceptance Tests
AV-89987 Summary | Details
Guarantor/Program Billing Defaults - CCBHC Claim Grouping
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Registry Settings (PM)
Scenario 1: Guarantor/Program Billing Defaults - CCBHC Claim Grouping - Help Message
Steps
  1. Open 'Guarantor/Program Billing Defaults'/
  2. Select 'Edit Template' in 'Action'.
  3. Select the desired template in 'Select Template'.
  4. Select the '837 Professional' section.
  5. Click the help message on the 'CCBHC Claim Grouping; field.
  6. Validate that the message contains:
  7. When 'None' is selected, the PPS charge will be billed immediately with no special claims grouping. If a CCBHC component charge associated with the PPS charge is still awaiting remittance from private insurance, it will be indicated on the billing report but the PPS charge will not be inhibited for billing.
  8. When 'Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge will be output to the same claim as the associated CCBHC component services, with the PPS charge listed first. Please Note: Selecting this value will also set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' and 'Maximum Service Information Per Claim Information For Re-Billing (Maximum LX Per CLM)' fields to a value of "1" during the 837 bill creation.
  9. When 'Separate Claims: Hold PPS Charges for Remittances from Private Insurance and Include Component Services on Separate Claims' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge and associated CCBHC component charges will not be output to the same claim. Instead, the billing template associated to each PPS charge and CCBHC component charge will be used, making it possible for them to be output to different claims and/or billing files.
  10. Note: PPS charges are only held for remittances from private insurance when the guarantor for the associated CCBHC component charges have the Extended Dictionary Data Element 'CCBHC Billing - Exclude from check for remittance from private insurance' set to 'No'. This Extended Dictionary Data Element can be found off of the Financial Class (1000) dictionary.
  11. Click 'Return to Form'.
  12. Select the '837 Institutional' section.
  13. Click the help message on the 'CCBHC Claim Grouping; field.
  14. Validate that the message contains:
  15. When 'None' is selected, the PPS charge will be billed immediately with no special claims grouping. If a CCBHC component charge associated with the PPS charge is still awaiting remittance from private insurance, it will be indicated on the billing report but the PPS charge will not be inhibited for billing.
  16. When 'Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge will be output to the same claim as the associated CCBHC component services, with the PPS charge listed first. Please Note: Selecting this value will also set the 'Maximum Service Information Per Claim Information (Maximum LX Per CLM)' and 'Maximum Service Information Per Claim Information For Re-Billing (Maximum LX Per CLM)' fields to a value of "1" during the 837 bill creation.
  17. When 'Separate Claims: Hold PPS Charges for Remittances from Private Insurance and Include Component Services on Separate Claims' is selected, the PPS charge will be inhibited for billing until the remittances for all CCBHC component charges are received. The PPS charge and associated CCBHC component charges will not be output to the same claim. Instead, the billing template associated to each PPS charge and CCBHC component charge will be used, making it possible for them to be output to different claims and/or billing files.
  18. Note: PPS charges are only held for remittances from private insurance when the guarantor for the associated CCBHC component charges have the Extended Dictionary Data Element 'CCBHC Billing - Exclude from check for remittance from private insurance' set to 'No'. This Extended Dictionary Data Element can be found off of the Financial Class (1000) dictionary.
  19. Click 'Return to Form'.
  20. Click [Discard].
  21. Click [Yes].

 
Topics
• 837 Institutional • 837 Professional • Guarantor / Program Billing Defaults • NX