Avatar PM 2024 Quarterly Release 2024.02 Acceptance Tests

• Registry Settings:
• Payor Based Authorizations >> Enable Payor Based Authorizations = Y.
• Payor Based Authorizations >> Enable CPT Based Payor Authorizations Registry Setting Value = N.
• Authorization Group >> Require Authorizations at Guarantors/Payors Level Registry Setting Value = Y.
• Authorization Group Definition:
• New Authorization group(s) created. Note the authorization group number/names.

1. Open 'Payor Based Authorizations’ form.
2. Select 'Add' in the 'Add/Edit/Delete' field.
3. Select desired guarantor from the 'Guarantor' field.
4. Select desired program(s) from the 'Program' field.
5. Enter desired date in the 'Effective Date' field. Note the date.
6. Leave the 'Expiration Date' field empty.
7. Select desired group number from the 'Authorization Group' field.
8. Validate 'Service Codes' selected based on the selected 'Authorization Group'.
9. Enter desired authorization number in the 'Authorization Number' field.
10. Click [Submit].
11. Open the 'Crystal Report' or any other SQL data viewer.
12. Locate the PM namespace of the system.
13. Query - select * from SYSTEM.table_payor_auths where GUARANTOR_ID=[desired guarantor id].
14. Verify the 'effective_date' displays the correct date that is entered during creating a payor based authorization record.
15. Verify the 'expiration_date' displays "NONE" because the field was blank during creating a payor based authorization record.
16. Verify the 'authorization_number' field displays the correct authorization number.
17. Open the 'Payor Based Authorizations’ form.
18. Select 'Edit' from the 'Add/Edit/Delete' field.
19. Click [Select Authorization To Edit/Delete].
20. Select desired authorization record from the 'Edit Entry' list box.
21. Click [OK].
22. Update the 'Effective Date' field to different date. Note the date.
23. Enter desired date in the 'Expiration Date' field. Note the date.
24. Click [Submit].
25. Open the 'Crystal Report' or any other SQL data viewer.
26. Locate the PM namespace of the system.
27. Query - select * from SYSTEM.table_payor_auths where GUARANTOR_ID=[desired guarantor id].
28. Verify the 'effective_date' displays correct date that is changed during updating a payor based authorization record.
29. Verify the 'expiration_date' displays correct date that is changed during updating a payor based authorization record.
30. Verify the 'authorization_number' field displays the correct authorization number.
31. Open the 'Payor Based Authorizations’ form.
32. Select 'Edit' from the 'Add/Edit/Delete' field.
33. Click [Select Authorization To Edit/Delete].
34. Select desired authorization record from the 'Edit Entry' list box.
35. Click [OK].
36. Update the 'Effective Date' field to different date. Note the date.
37. Enter same date in the 'Expiration Date' field. Note the date.
38. Click [Submit].
39. Open the 'Crystal Report' or any other SQL data viewer.
40. Locate to the PM namespace of the system.
41. Query - 'select * from SYSTEM.table_payor_auths where GUARANTOR_ID=[desired guarantor id]'.
42. Verify the 'effective_date' displays correct date that is changed during updating a payor based authorization record.
43. Verify the 'expiration_date' displays correct date that is changed during updating a payor based authorization record.
44. Verify the 'authorization_number' field displays the correct authorization number.
45. Open the 'Payor Based Authorizations’ form.
46. Select 'Delete' from the 'Add/Edit/Delete' field.
47. Click [Select Authorization To Edit/Delete].
48. Select desired authorization record from the 'Edit Entry' list box.
49. Click [OK].
50. Click [Submit].
51. Open the 'Crystal Report' or any other SQL data viewer.
52. Locate to the PM namespace of the system.
53. Query - 'select * from SYSTEM.table_payor_auths where GUARANTOR_ID=[desired guarantor id]'.
54. Verify the 'effective_date' displays correct date that is changed during updating a payor based authorization record.
55. Verify the 'expiration_date' displays correct date that is changed during updating a payor based authorization record.
56. Verify the 'authorization_number' field displays the correct authorization number.
57. Close the report.

1. Open the ‘Registry Settings’ form.
2. Set the ‘Limit Registry Setting to the Following Search Criteria’ field to the ‘Validate Program For’.
3. Click [View Registry Settings].
4. Validate the ‘Registry Setting’ field equal to ‘Avatar PM->Practitioner->Enrollment->->->Validate Program For Staff Guarantor Coverage’.
5. Validate the ‘Registry Setting Details’ field contains ‘[FACILITY SPECIFIC] Enter 'Y' to add the 'Program' field to 'Practitioner Enrollment' (Guarantor Coverage). This will allow the service to be validated against the selected Programs when checking the Practitioner's Guarantor Coverage in the bills. Enter 'N' to remove the 'Program' field and the associated logic.’.
6. Validate the ‘Registry Setting Value’ field defaults to ‘N’.
7. Close the form.
8. Open the ‘Practitioner Enrollment’ form.
9. Select desired practitioner from the ‘Select Staff’ field.
10. Select the ‘Guarantor Coverage’ section.
11. Validate the ‘Guarantor Coverage’ section does not contain ‘Program’ field.
12. Close the form.
13. Open the ‘Registry Settings’ form.
14. Set the ‘Limit Registry Setting to the Following Search Criteria’ field to the ‘Validate Program For’.
15. Click [View Registry Settings].
16. Validate the ‘Registry Setting’ field equals to ‘Avatar PM->Practitioner->Enrollment->->->Validate Program For Staff Guarantor Coverage’.
17. Set the ‘Registry Setting Value’ field to ‘Y’.
18. Click [Submit].
19. Click [OK].
20. Click [No].
21. Open the ‘Practitioner Enrollment’ form.
22. Select desired practitioner from the ‘Select Staff’ field.
23. Select the ‘Guarantor Coverage’ section.
24. Validate the ‘Guarantor Coverage’ section contains ‘Program’ field.
25. Validate the ‘Program’ value displays in scrolling text box.
26. Close the form.
27. Open the ‘Registry Settings’ form.
28. Set the ‘Limit Registry Setting to the Following Search Criteria’ field to the ‘Validate Program For’.
29. Click [View Registry Settings].
30. Validate the ‘Registry Setting’ field equals to ‘Avatar PM->Practitioner->Enrollment->->->Validate Program For Staff Guarantor Coverage’.
31. Click [View Registry Settings].
32. Set the ‘Registry Setting Value’ field to ‘1’.
33. Validate the error dialog contains ‘The selected value is not valid in the current system code for the following reason: Invalid Response - Example:'Y' or 'N'’.
34. Click [Enter].
35. Click [OK].
36. Set the ‘Registry Setting Value’ field to ‘m’.
37. Validate the error dialog contains ‘The selected value is not valid in the current system code for the following reason: Invalid Response - Example:'Y' or 'N'’.
38. Click [Enter].
39. Click [OK].
40. Set the ‘Registry Setting Value’ field to ‘YES’
41. Validate the error dialog contains ‘The selected value is not valid in the current system code for the following reason: More than 1 characters.
42. Click [OK].
43. Set the ‘Registry Setting Value’ field to ‘’.
44. Click [Submit].
45. Validate the ‘Filing Error’ dialog box contains: ‘The following fields are missing: Registry Setting Value’.
46. Click [OK].
47. Set the ‘Registry Setting Value’ field to ‘Y’.
48. Click [Submit].
49. Click [OK].
50. Click [No].
51. Open the ‘Practitioner Enrollment’ form.
52. Select the ‘Guarantor Coverage’ section.
53. Select desired practitioner from the ‘Select Staff’ field.
54. Select ‘Create New’ from the ‘Guarantor Coverage Entry’ field.
55. Select desired guarantor from the Guarantor field.
56. Select desired program(s) form the ‘Program’ field.
57. Set the ‘Effective Date’ field to desired date.
58. Set the ‘Lapse Date’ field to desired date.
59. Click [File Mapping].
60. Validate the ‘Filed!’ dialog box contains: ‘Saved. Please note: The changes will take effect when you submit the form.’
61. Click [OK].
62. Click [Submit].
63. Open the ‘Practitioner Enrollment’ form.
64. Select the same practitioner as above from the ‘Select Staff’ field.
65. Select the ‘Guarantor Coverage’ section.
66. Validate the ‘Guarantor Coverage’ text area contains ‘Guarantor’, ‘Program’, ‘Effective Date’ and ‘Lapse Date’ as defined in above steps.
67. Click [Submit].

• Registry Setting:
• The 'Validate Program For Staff Guarantor Coverage' registry setting is set to 'Y'.
• Guarantors/Payors:
• An existing guarantor is identified to be used and all the options are checked in the 'Inhibit Billing if Practitioner is not Covered by this Guarantor' field. Note the guarantor's code/name.
• Service codes:
• An existing service code is identified to be used. Note the service code/description.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the service code identified in the 'Service Codes' form.
• Practitioner Enrollment:
• An existing practitioner is identified, or a new practitioner is created. The guarantor coverage record for the staff is created that includes guarantor identified in the 'Guarantors/Payors' and desired program(s). Note the guarantor and program.
• Admission:
• An existing client is identified, or a new client is admitted in a program which is defined in the guarantor coverage for the practitioner in the 'Practitioner Enrollment' form. Note client id, admission program, admission date.
• Financial Eligibility:
• A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
• Client Charge Input:
• A service is rendered to the client. Note service date, service code.
• Client Ledger:
• A service distributed correctly to the assigned guarantor.
• Close Charges:
• The service(s) rendered to the client is closed.
• Create Interim Billing Batch:
• An interim billing batch is created that includes desired client, service and the guarantor. Note the batch number.

1. Open the 'Electronic Billing' form.
2. Compile an unclaimed 837 Professional bill for the client.
3. Verify the bill compiles successfully.
4. Select 'Run Report' in 'Billing Options' field.
5. Select 'Print' in 'Print Or Delete Report' field.
6. Select the 'File' field.
7. Click [Print 837 Report].
8. Validate that the report launches successfully and contains correct client, service, and guarantor.
9. Close the report.
10. Close the form.
11. Open the 'Crystal Report' or any other SQL data viewer.
12. Locate to the PM namespace.
13. Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
14. Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form.
15. Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
16. Verify the 'guarantor_id' column displays correct guarantor id for the guarantor assigned to the client in the 'Financial Eligibility' form.
17. Verify the 'program_code' column displays correct program(s) code set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
18. Verify the 'program_shval' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
19. Verify the 'program_value' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
20. Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
21. Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
22. Close the 'Crystal Report' or SQL data viewer.
23. Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
24. Select the 'Guarantor Coverage' section.
25. Select an existing guarantor coverage entry from the 'Guarantor Coverage Entry' field.
26. Verify the admission program is selected in the 'Program' field.
27. Click [Delete Mapping].
28. Click [Yes].
29. [OK].
30. Verify the guarantor coverage record removed from the 'Guarantor Coverage' text area.
31. Select 'Create New' from the 'Guarantor Coverage Entry' field.
32. Select the guarantor which is assigned to the client as a primary guarantor.
33. Select the program different from the admission program of the client in the 'Program' field.
34. Enter desired date in the 'Effective Date' and 'Lapse Date' fields.
35. Click [File Mapping].
36. Click [Submit].
37. Verify the user navigates to the home page.
38. Open 'Electronic Billing' form.
39. Compile an unclaimed bill for the client.
40. Validate that a message is received stating: No Valid Information Found. Please Check The Error Report.
41. Click [OK].
42. Select 'Run Report' in 'Billing Options'.
43. Select 'Print' in 'Print Or Delete Report'.
44. Select the 'File'.
45. Click [Print 837 Report].
46. Validate that the report launches and contains a link to 'Required Data Missing: Patient Claim Data'.
47. Click the 'Required Data Missing: Patient Service Data' link.
48. Verify that the error is - 'No Guarantor Coverage in Effect for Rendering Practitioner'.
49. Close the report.
50. Close the form.
51. Open the 'Crystal Report' or any other SQL data viewer.
52. Locate to the PM namespace.
53. Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
54. Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form.
55. Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
56. Verify the 'guarantor_id' column displays correct guarantor id for the guarantor set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
57. Verify the 'program_code' column displays correct program(s) code for the program set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
58. Verify the 'program_shval' column displays correct program(s) description for the program set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
59. Verify the 'program_value' column displays correct program(s) description for the program set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
60. Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
61. Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
62. Close the 'Crystal Report' or SQL data viewer.
63. Open the 'Registry Settings' form.
64. Set the 'Validate Program For Staff Guarantor Coverage' registry setting to 'N'.
65. Click [Submit].
66. Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
67. Select the 'Guarantor Coverage' section.
68. Verify the guarantor coverage record exist in the 'Guarantor Coverage' text area.
69. Close the form.
70. Verify the user navigates to the home page.
71. Open the 'Electronic Billing' form.
72. Compile an unclaimed 837 Professional bill for the client.
73. Verify the bill compiles successfully.
74. Select 'Run Report' in 'Billing Options' field.
75. Select 'Print' in 'Print Or Delete Report' field.
76. Select the 'File' field.
77. Click [Print 837 Report].
78. Validate that the report launches successfully and contains correct client, service, and guarantor.
79. Close the report.
80. Close the form.
81. Verify the user navigates to the home page.

• Registry Setting:
• The 'Validate Program For Staff Guarantor Coverage' registry setting is set to 'Y'.
• Guarantors/Payors:
• An existing guarantor is identified to be used and all the options are checked in the 'Inhibit Billing if Practitioner is not Covered by this Guarantor' field. Note the guarantor'scode/name.
• Service codes:
• An existing service code is identified to be used. Note the service code/description.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the service code identified in the 'Service Codes' form.
• Practitioner Enrollment:
• An existing practitioner is identified, or a new practitioner is created. The guarantor coverage record for the staff is created that includes guarantor identified in the 'Guarantors/Payors' and desired program(s). Note the guarantor and program.
• Admission:
• An existing client is identified, or a new client is admitted in a program which is defined in the guarantor coverage for the practitioner in the 'Practitioner Enrollment' form. Note client id, admission program, admission date.
• Financial Eligibility:
• A guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.
• Client Charge Input:
• A service is rendered to the client. Note service date, service code.
• Client Ledger:
• A service distributed correctly to the assigned guarantor.
• Close Charges:
• The service(s) rendered to the client is closed.
• Create Interim Billing Batch:
• An interim billing batch is created that includes desired client, service and the guarantor. Note the batch number.

1. Open the 'Electronic Billing' form.
2. Compile an unclaimed 837 Institutional bill for the client.
3. Verify the bill compiles successfully.
4. Select 'Run Report' in 'Billing Options' field.
5. Select 'Print' in 'Print Or Delete Report' field.
6. Select the 'File' field.
7. Click [Print 837 Report].
8. Validate that the report launches successfully and contains correct client, service, and guarantor.
9. Close the report.
10. Close the form.
11. Open the 'Crystal Report' or any other SQL data viewer.
12. Locate to the PM namespace.
13. Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
14. Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form.
15. Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
16. Verify the 'guarantor_id' column displays correct guarantor id for the guarantor assigned to the client in the 'Financial Eligibility' form.
17. Verify the 'program_code' column displays correct program(s) code set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
18. Verify the 'program_shval' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
19. Verify the 'program_value' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
20. Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
21. Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
22. Close the 'Crystal Report' or SQL data viewer.
23. Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
24. Select the 'Guarantor Coverage' section.
25. Select an existing guarantor coverage entry from the 'Guarantor Coverage Entry' field.
26. Verify the admission program is selected in the 'Program' field.
27. Click [Delete Mapping].
28. Click [Yes].
29. [OK].
30. Verify the guarantor coverage record for the admission program of the client is removed from the 'Guarantor Coverage' text area.
31. Click [Submit].
32. Open the 'Crystal Report' or any other SQL data viewer.
33. Locate to the PM namespace.
34. Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
35. Verify the guarantor coverage created for the client's admission program is deleted from the SQL table.
36. Close the 'Crystal Report' or SQL data viewer.
37. Verify the user navigates to the home page.
38. Open 'Electronic Billing' form.
39. Compile an unclaimed bill for the client.
40. Validate that a message is received stating: No Valid Information Found. Please Check The Error Report.
41. Click [OK].
42. Select 'Run Report' in 'Billing Options'.
43. Select 'Print' in 'Print Or Delete Report'.
44. Select the 'File'.
45. Click [Print 837 Report].
46. Validate that the report launches and contains a link to 'Required Data Missing: Patient Claim Data'.
47. Click the 'Required Data Missing: Patient Service Data' link.
48. Verify that the error is - 'No Guarantor Coverage in Effect for Rendering Practitioner'.
49. Close the report.
50. Close the form.
51. Open the 'Registry Settings' form.
52. Set the 'Validate Program For Staff Guarantor Coverage' registry setting to 'N'.
53. Click [Submit].
54. Click [OK].
55. Click [No] on the [Form Return] dialog.
56. Verify the user navigates to the home page.
57. Open the 'Electronic Billing' form.
58. Compile an unclaimed 837 Institutional bill for the client.
59. Verify the bill compiles successfully.
60. Select 'Run Report' in 'Billing Options' field.
61. Select 'Print' in 'Print Or Delete Report' field.
62. Select the 'File' field.
63. Click [Print 837 Report].
64. Validate that the report launches successfully and contains correct client, service, and guarantor.
65. Close the report.
66. Close the form.
67. Verify the user navigates to the home page.

• Registry Setting:
• The 'Validate Program For Staff Guarantor Coverage' registry setting is set to 'Y'.
• Guarantors/Payors:
• An existing guarantor is identified to be used and all the options are checked in the 'Inhibit Billing if Practitioner is not Covered by this Guarantor' field. Note the guarantor's code/name.
• Practitioner:
• An existing practitioner is identified, or a new practitioner is created. Note the practitioner id.
• Admission:
• An existing client is identified, or a new client is admitted in a desired program. Note the client id, admission program, admission date.
• Financial Eligibility:
• The guarantor identified in the 'Guarantors/Payors' form is assigned to the client as a primary guarantor.

1. Access SOAPUI or any other web service tool.
2. File the 'AddPractitionerGuarantorCoverage' method of the WEBSVC.PractitionerRegister web service for the desired guarantor and practitioner by entering desired value to the 'Guarantor', 'EffectiveDate', 'LapseDate','Program', and 'PractitionerID' fields. Note all the values.
3. Verify the web service files successfully.
4. Open the 'Crystal Report' or any other SQL data viewer.
5. Locate to the PM namespace.
6. Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
7. Verify the 'ID' column displays unique id for the guarantor coverage entry created in the 'Practitioner Enrollment' form. Note this 'ID' number for later use.
8. Verify the 'STAFFID' column displays the correct practitioner id which is set up in the setup section.
9. Verify the 'guarantor_id' column displays correct guarantor id for the guarantor assigned to the client in the 'Financial Eligibility' form.
10. Verify the 'program_code' column displays correct program(s) code set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
11. Verify the 'program_shval' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
12. Verify the 'program_value' column displays correct program(s) description set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
13. Verify the 'effective_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
14. Verify the 'lapse_date' column displays the correct date set up in the guarantor coverage entry for the practitioner in the 'Practitioner Enrollment' form.
15. Close the 'Crystal Report' or SQL data viewer.
16. Login to myAvatar.
17. Open the 'Practitioner Enrollment' form for the practitioner identified in the setup section.
18. Select the 'Guarantor Coverage' section.
19. Verify the guarantor coverage entry created through the 'AddPractitionerGuarantorCoverage' is available in the 'Guarantor Coverage Entry' text area.
20. Close the form.
21. Open the 'Client Charge Input' form.
22. Render a service to the client identified in the setup section. Note the service date, service code.
23. Open the 'Client Ledger' form.
24. Verify the service distributed correctly to the assigned guarantor.
25. Open the 'Close Charges' form.
26. Close the service rendered to the client.
27. Open the 'Create Interim Billing Batch' form.
28. Create an interim billing batch that includes desired client, service, and the guarantor. Note the batch number.
29. Close the form.
30. Open the 'Electronic Billing' form.
31. Compile an unclaimed 837 Professional bill for the client.
32. Verify the bill compiles successfully.
33. Select 'Run Report' in 'Billing Options' field.
34. Select 'Print' in 'Print Or Delete Report' field.
35. Select the 'File' field.
36. Click [Print 837 Report].
37. Validate that the report launches successfully and contains correct client, service, and guarantor.
38. Close the report.
39. Close the form.
40. Access SOAPUI or any other web service tool.
41. Locate to the 'DeletePractitionerGuarantorCoverage' method of the WEBSVC.PractitionerRegister web service.
42. Enter the practitioner id in the 'PractitionerID' field which is used in the 'AddPractitionerGuarantorCoverage' method.
43. Enter the value noted above from the 'ID' field of the SYSTEM.staff_guarantor_coverage SQL table in the 'PractitionerGuarantorCoverageID' field.
44. Submit the request.
45. Verify the web service files successfully.
46. Open the 'Crystal Report' or any other SQL data viewer.
47. Locate to the PM namespace.
48. Query the 'Select * from SYSTEM.staff_guarantor_coverage'.
49. Verify the row with the ID used in the 'DeletePractitionerGuarantorCoverage' is deleted.
50. Close the report.
51. Open 'Electronic Billing' form.
52. Compile an unclaimed bill for the client.
53. Validate that a message is received stating: No Valid Information Found. Please Check The Error Report.
54. Click [OK].
55. Select 'Run Report' in 'Billing Options'.
56. Select 'Print' in 'Print Or Delete Report'.
57. Select the 'File'.
58. Click [Print 837 Report].
59. Validate that the report launches and contains a link to 'Required Data Missing: Patient Claim Data'.
60. Click the 'Required Data Missing: Patient Service Data' link.
61. Verify that the error is - 'No Guarantor Coverage in Effect for Rendering Practitioner'.
62. Close the report.
63. Close the form.
64. Open the 'Registry Settings' form.
65. Set the 'Validate Program For Staff Guarantor Coverage' registry setting to 'N'.
66. Click [Submit].
67. Click [OK].
68. Click [No] on the [Form Return] dialog.
69. Verify the user navigates to the home page.
70. Open the 'Electronic Billing' form.
71. Compile an unclaimed 837 Professional bill for the client.
72. Verify the bill compiles successfully.
73. Select 'Run Report' in 'Billing Options' field.
74. Select 'Print' in 'Print Or Delete Report' field.
75. Select the 'File' field.
76. Click [Print 837 Report].
77. Validate that the report launches successfully and contains correct client, service, and guarantor.
78. Close the report.
79. Close the form.
80. Verify the user navigates to the home page.

• Registry Settings:
• The 'Enable DRG Codes' must be enabled.
• The 'Import File Delimiter' registry setting is set to value to "2".. This will change the delimiter type to tabs.
• Site Specific Section Modeling:
• Field 'DRG Code (ICD-10)' must be added to Avatar PM 'Diagnosis' form.
• The following file import files are created to add and/or update the DRG Code Table. Note the location and of the files.
• File import file to add 2-digit DRG code in the system.
• File import file to delete the 2-digit DRG code from the system.
• File import file to update the 2-digit DRG code to 3-digit DRG code by adding leading zero in the system.
• Guarantor/Program Billing Defaults:
• The 'Enable Using DRG Code In 2300-HI-Diagnosis Related Group (DRG) Information' must be set to 'Yes' in applicable template for 837 Institutional billing file generation.
• Access to Crystal Reports or other SQL reporting tool.
• Guarantors/Payors:
• An existing guarantor is identified to be used. Note the guarantor's code/name.
• Service codes:
• An existing service code is identified to be used. Note the service code/description.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the service code identified in the 'Service Codes' form.
• Admission:
• An existing client is identified, or a new client is admitted in the desired program. Note client id, admission program, admission date.
• Financial Eligibility:
• The guarantor identified in the 'Guarantors/Payors' form is assigned to the client as the primary guarantor.
• Diagnosis:
• Diagnosis record exists with value for 'DRG Code (ICD-10)' included/filed.
• Client Charge Input:
• A service is rendered to the client. Note service date, service code.
• Client Ledger:
• The service distributed correctly to the assigned guarantor.
• Close Charges:
• Create Interim Billing Batch File:
• An interim billing batch is created to include client, services and guarantor in the batch. Note the batch number.

1. Open 'File Import' form.
2. Select "DRG Code Table" from the 'File Type'.
3. Select "Upload New File" in the 'Action' field.
4. Click [Process Action].
5. Select 'DRG Code Table' import file to import 2-digit DRG code.
6. Click [Open].
7. Select "Compile/Validate File" in the 'Action' field.
8. Select loaded import file.
9. Click [Process Action].
10. Verify that 'Compile/Validate File' action completes, and message 'Compiled' is displayed.
11. Click 'OK' button.
12. Select "Print File" in 'Action' field to view successfully compiled import data.
13. Select compiled import file.
14. Click [Process Action].
15. In 'DRG Code Table' File Import Report, verify that all valid import row(s) are included in the report with segment/value details.
16. Select "Post File" in 'Action' field to post successfully compiled import data.
17. Select compiled import file.
18. Click [Process Action].
19. Verify that 'Compile/Validate File' action completes, and message 'Posted' is displayed.
20. Open Crystal Reports or other SQL reporting tool.
21. Access the SQL table 'SYSTEM.file_import_drg_codes'.
22. Verify that all 'DRG Code Table' File Import rows are included in the table with values from the import data file.
23. Access the 'SYSTEM.table_drg_codes' table.
24. Verify that all successfully posted 'DRG Code Table' File Import rows are reflected as new (or updated) DRG Code entries in table.
25. Repeat the steps from 1 through 24 to update the 2 digit code with leading zero.
26. Open the 'Diagnosis' form.
27. Add/update the diagnosis record for the client for the date of service.
28. Select the updated DRG code to the diagnosis record.
29. Submit the form.
30. Open the 'Electronic Billing' form.
31. Select 837 Institutional in 'Billing Form' field.
32. Select values for 837 bill generation in the 'Type of Bill', 'Individual or All Guarantors' and 'Billing Type' fields.
33. Select "Sort File" in the 'Billing Options' field.
34. Select/enter values for service inclusion in 'All Clients or Interim Billing Batch', 'Program(s)'
35. Select value for 'Create Claims' field (and enter value for 'Date of Claim' if 'Yes').
36. Enter/select values 'First Date of Service to Include' and 'Last Date of Service to Include' fields.
37. Enter/select values for any other bill sorting criteria fields as required/desired.
38. Click [Process].
39. Verify the bill compiles successfully.
40. Select 'Dump File' in the 'Billing Options' field.
41. Select 837 file generated.
42. Click [Process].
43. For 837 Institutional format billing files generated - ensure that the 'DRG Code (ICD-10)' value associated to applicable Diagnosis record/entries for service(s) included in bill is present in 2300-HI-Diagnosis Related Group (DRG) Information claim loop. (Example: 'HI*ABK:O2402:::::::Y~HI*ABJ:O24013~HI*DR:079')
44. Close the report.
45. Close the form.

• Registry Settings:
• The 'Enable DRG Codes' must be enabled.
• The 'Import File Delimiter' registry setting is set to "2". This will change the delimiter type to tabs.
• The file import record layout for the Avatar 'DRG Code Table' is available for the user.
• The file import files are created for the Avatar 'DRG Code Table to add, update and delete the DRG Code Table. Note the location of the files.
• Access to Crystal Reports or other SQL reporting tool

1. Open 'File Import' form.
2. Select "DRG Code Table" from the 'File Type' field.
3. Select "Upload New File" in the 'Action' field.
4. Click [Process Action].
5. Select 'DRG Code Table' import file to add the new DRG code to the table.
6. Click [Open].
7. Select "Compile/Validate File" in the 'Action' field.
8. Select recently loaded import file.
9. Click [Process Action].
10. Verify that 'Compile/Validate File' action completes, and message 'Compiled' is displayed.
11. Click [OK].
12. Select "Print File" in the 'Action' field to view successfully compiled import data.
13. Select successfully compiled import file.
14. Click [Process Action].
15. Verify all valid import row(s) are included in the report.
16. Select "Post File" in the 'Action' field to post successfully compiled import data.
17. Select successfully compiled import file.
18. Click [Process Action].
19. Validate the message 'Posted' is displayed.
20. Query - select * from SYSTEM.file_import_drg_codes
21. Validate the' add_edit_code' cell is equal to "A".
22. Validate the 'add_edit_value' cell is equal to "Add".
23. Validate the 'Code_set_code' cell is equal to "ICD10".
24. Validate the 'drg_code' cell is equal to the DRG code added in the import file.
25. Validate the drg_value cell is equal to description of the code added in the import file.
26. Verify the 'pkey' cell exists.
27. Query - select * from SYSTEM.table_drg_codes.
28. Validate the 'drg_code' cell is equal to the DRG code added in the import file.
29. Validate the drg_value cell is equal to description of the code added in the import file.
30. Validate the ID cell is equal to the system generated unique id which will be used in the 'pkey' column of the import file. Note the ID.
31. Close the report.
32. Repeat steps 1 through 19 to import the file import file to edit an existing DRG code in the table.
33. Query - select * from SYSTEM.file_import_drg_codes
34. Validate the' add_edit_code' cell is equal to "E".
35. Validate the 'add_edit_value' cell is equal to "Edit".
36. Validate the 'Code_set_code' cell is equal to "ICD10".
37. Validate the 'drg_code' cell is equal to the updated DRG code as listed in the import file.
38. Validate the drg_value cell is equal to description of the code added in the import file.
39. Verify the 'pkey' cell exists.
40. Validate the ‘pkey’ column displays the correct value as listed in the import file.
41. Query - select * from SYSTEM.table_drg_codes.
42. Validate the 'drg_code' cell is equal to the updated DRG code as listed in the import file.
43. Validate the drg_value cell is equal to description of the code added in the import file.
44. Verify the 'pkey' cell exists.
45. Validate the ‘pkey’ column displays the correct value as listed in the import file.
46. Close the report.
47. Repeat steps 1 through 19 to import the file import file to delete an existing DRG code from the table.
48. Query - select * from SYSTEM.file_import_drg_codes
49. Validate the' add_edit_code' cell is equal to "D".
50. Validate the 'add_edit_value' cell is equal to "Delete".
51. Validate the 'Code_set_code' cell is equal to "ICD10".
52. Validate the 'drg_code' cell is equal to the DRG code added in the import file.
53. Validate the drg_value cell is equal to description of the code added in the import file.
54. Verify the 'pkey' cell exists.
55. Validate the ‘pkey’ column displays the correct value as listed in the import file.
56. Query - select * from SYSTEM.table_drg_codes.
57. Validate the 'drg_code' cell does not contain the deleted DRG code which is listed to be deleted in the import file.
58. Close the report.

• Dictionary Update:
• User must populate the following Client dictionary tables: 7104, 7108, 7110, 7113, 7118, 7127, and 7131.
• Registry Setting:
• The 'Include Enhanced Limits' setting must be enabled.
• Guarantors/Payors:
• An existing guarantor is identified to be used. Note the guarantor's code/name.
• Admission:
• An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
• Financial Eligibility:
• The guarantor identified in the 'Guarantors/Payors' form is assigned to the client as the primary guarantor.
• User Definition:
• User has access to the 'Financial Determination Configuration' and 'Financial Determination' forms.
• Financial Determination Configuration:
• Select "Create New" in the 'Configuration' field.
• Enter the leap year day (i.e. 2/29/2024) in the 'Effective Date' field.
• Do not enter any value in the 'Expiration Date' field.
• Enter desired amount in the 'Lump Sum Value Is Net Assets Plus' field.
• Enter desired amount in the 'FICA Tax Rate' field.
• Enter desired amount in the 'Room And Board' field.
• Enter desired amount in the 'Default Income Percentage For Ability To Pay' field.
• Enter desired amount in the 'Each Additional Dependent' field.

1. Select desired client and access the 'Financial Determination' form.
2. Enter the leap year day (ex. 02/29/2024) in the 'Effective Date' field.
3. Do not enter any value in the 'Expiration Date' field.
4. Verify the 'Expiration Date' field is auto populated with the desired date (i.e. 02/28/2025).
5. Clear the date from the 'Expiration Date' field.
6. Change the 'Effective Date' field to non leap year day (i.e. 02/28/2022).
7. Verify the 'Expiration Date' field is auto populated with the desired date (i.e. 02/27/2023).
8. Clear the date from the 'Expiration Date' field.
9. Change the 'Effective Date' field to non leap year day (i.e. 04/20/2024).
10. Verify the 'Expiration Date' field is auto populated with the desired date (i.e. 04/19/2025).
11. Select desired value in the 'Active?' field.
12. Select desired value in the 'Residence Type' field.
13. Select "Create New" in the 'Determination Information' field.
14. Select desired value in the 'Determination Method' field.
15. Select "Create New" in the 'Included Assets' field.
16. Select desired value in the 'Asset Type' field.
17. Enter desired value in the 'Asset Value' field.
18. Select "Create New" in the 'Expense' field.
19. Select desired value in the 'Expense Type' field.
20. Select "Monthly" in the 'Expense Time' field.
21. Enter desired value in the 'Expense Value' field.
22. Validate the 'Total Assets' field contains desired amount.
23. Validate the 'Net Value Of Excluded Assets' field contains desired value.
24. Validate the 'Total Liabilities' field contains desired value.
25. Validate the 'Protected Assets' field contains desired value.
26. Validate the 'Net Assets' field contains desired value.
27. Validate the 'Total Income' field contains desired value.
28. Validate the 'Total Expenses' field contains desired value.
29. Validate the 'Protected Income' field contains desired value.
30. Validate the 'Net Income' field contains desired value.
31. Click [Submit].
32. Validate all the fields filled out in the previous steps remain filled out.
33. Close the form.

• Registry Settings:
• Set the 'Avatar PM->Client Information->Client Demographics->->->Additional Fields Registry Setting Value' to the value that covers the value to add 'Additional Policy Numbers'.
• Set the 'Avatar PM->Billing->Financial Eligibility->->->Enable Default Guarantor Assignment' to 'Y'.
• Default Guarantor Assignment:
• A guarantor is defined to default in 'Cross Episode Financial Eligibility' upon the filing of admission. Note the guarantor code/name.
• Admission (Outpatient):
• A new client is admitted. The guarantor defined above and the policy number of the guarantor are added in the 'Demographics' section. Note the client id, value of the 'Guarantor 1' field and the value added in the 'Policy Number 1' field.

1. Open the 'Cross Episode Financial Eligibility' form.
2. Validate the 'Guarantor #1' field populated correctly with the guarantor added in the 'Demographics' section of the admission form of the client.
3. Navigate to the 'Guarantor Selection' section.
4. Validate the 'Subscriber Policy #' is populated correctly with the policy number of the guarantor added in the 'Demographics' section of the admission form of the client.
5. Click [Submit].
6. Open the 'Default Guarantor Assignment' form.
7. Select desired guarantor in the 'Select Guarantor to Default' field.
8. Select the 'Filing of Admission' option in the 'Default the Guarantor(s) During' field.
9. Select the 'Financial Eligibility' in the 'Add the Guarantor(s) to Which Form' field.
10. Click [Submit].
11. Open the 'Admission' or Admission(Outpatient)' form.
12. Admit a new client.
13. Navigate to the 'Demographics' section.
14. Add the guarantor used in the 'Default Guarantor Assignment' form and add a policy number.
15. Click [Submit].
16. Open the 'Financial Eligibility' form.
17. Validate the 'Guarantor #1' field populated correctly with the guarantor added in the 'Demographics' section of the admission form of the client.
18. Navigate to the 'Guarantor Selection' section.
19. Validate the 'Subscriber Policy #' is populated correctly with the policy number of the guarantor added in the 'Demographics' section of the admission form of the client.
20. Click [Submit].

Internal testing only.

• Guarantors/Payors:
• An existing non contract guarantor is identified that has data on file for the following field. Note the guarantor code/name and value from the field.
• Guarantors/Payors section:
• 837 Section:
• Value to Display in 2330B NM1-09/2430 SVD-01
• Review the help message associated with this field.
• Guarantor/Program Bulling Defaults:
• 837 Professional section:
• Payer Identification # (2010BB/2330B-NM1-09)
• 837 Institutional section:
• Payer Identification Number

1. Open the 'Crystal Report' or any other data viewer.
2. Query the 'SYSTEM.billing_guar_table' for the guarantors identified in the setup section.
3. Verify the 'value_to_display_in_2330B_code' and 'value_to_display_in_2330B_value' fields are added to the 'SYSTEM.billing_guar_table.
4. Verify that the 'value_to_display_in_2330B_code' and 'value_to_display_in_2330B_value' displays data correctly based on the data set up in the 'Value to Display in 2330B NM1-09/2430 SVD-01' field of the 'Guarantors/Payors' form and the 'Payer Identification # (2010BB/2330B-NM1-09)' field set up in the 'Guarantor/Program Billing Defaults' form.
5. Close the report.

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on service with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service, with an add-on service, is rendered to the client.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.
• All CCBHC setup is complete. CCBHC Billing functionality is used by the agency. If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on services with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service is rendered to the client and make sure that the add-on service is also selected for filing.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select desired guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. All other fields are populated as required/needed.
9. Click [Process].
10. Verify 'Compile Complete' message.
11. Select "Run Report" in the 'Billing Options' field.
12. Select "Print" in 'Print Or Delete Report'.
13. Select the recently compiled file from the 'File' dropdown.
14. Click [Print 837 Report].
15. Verify that the primary, Add-on and PPS services are included in the '837 Professional Submission' link.
16. Click [X].
17. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client, and the add-on service has been saved.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The service distributed to the primary guarantor is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The CCBHC PPS charges are closed.
• Create Interim Billing Batch File:
• An interim billing batch is created to include the service transferred to the CCBHC guarantor.
• Electronic Billing:
• The 837 Professional bill is claimed for the CCBHC guarantor.
• The services distributed to CCBHC guarantors are included in the bill.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. All other fields are populated as required/needed.
9. Click [Process].
10. Verify 'Compile Complete' message.
11. Select "Run Report" in the 'Billing Options' field.
12. Select "Print" in 'Print Or Delete Report'.
13. Select the recently compiled file from the 'File' dropdown.
14. Click [Print 837 Report].
15. Verify the enumerated and CCBHC PPS service are included in the '837 Professional Submission' link.
16. Click [X].
17. Compile the bill again for the CCBHC guarantor for the same parameters.
18. Select "Sort File" option from the 'Billing Options'
19. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
20. All other fields are populated as required/needed.
21. Click [Process].
22. Verify 'No Information' found.
23. Verify that system does not compile the bill again as the services are claimed.
24. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value.
• CCBHC Enumerated Service = Yes.
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary, and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a secondary guarantor, and a CCBHC guarantor is assigned to the client as a primary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor only.
• Close Charges:
• Close the enumerated CCBHC charges.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the service.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Close Charges:
• Close the PPS charges.
• Create Interim Billing Batch File:
• An interim billing batch is created to include the services distributed to the CCBHC guarantor.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• Individual Cash Posting:
• The service distributed to the primary guarantor is fully transferred to the secondary Non CCBHC guarantor.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. Set 'Create Claims' field to "No".
9. All other fields are populated as required/needed.
10. Click [Process].
11. Verify 'No Information' found.
12. Verify that system does not compile the bill again as the services are claimed.
13. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• Two contract CCBHC guarantors are identified to be used as a primary and secondary guarantor. Note the guarantor's code/name for each guarantor.
• Configure the primary guarantor for contractual adjustments during liability distribution.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = None.
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1.
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• Two contract guarantors are assigned to the client as a primary and secondary guarantor.
• Customize the benefit plan for the primary guarantor such that it only covers the enumerated service and not the PPS service.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor.
• Close Charges:
• Close the enumerated CCBHC charges.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the service.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor.
• Close Charges:
• Close the PPS charges.
• Electronic Billing:
• The service distributed to the primary guarantor is claimed. Note the claim number.
• The service distributed to the secondary guarantor is claimed. Note the claim number.
• Client Ledger:
• Two services on the separate claims.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select secondary CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. Set 'Create Claims' field to "No".
9. All other fields are populated as required/needed.
10. Click [Process].
11. Verify the 'No Information Found' message found.
12. Click [X].
13. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on service with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service, with an add-on service, is rendered to the client.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.
• All CCBHC setup is complete. CCBHC Billing functionality is used by the agency. If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on services with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service is rendered to the client and make sure that the add-on service is also selected for filing.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select desired guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. All other fields are populated as required/needed.
9. Click [Process].
10. Verify 'Compile Complete' message.
11. Select "Run Report" in the 'Billing Options' field.
12. Select "Print" in 'Print Or Delete Report'.
13. Select the recently compiled file from the 'File' dropdown.
14. Click [Print 837 Report].
15. Verify that the primary, Add-on and PPS services are included in the '837 Professional Submission' link.
16. Click [X].
17. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client, and the add-on service has been saved.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The service distributed to the primary guarantor is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The CCBHC PPS charges are closed.
• Create Interim Billing Batch File:
• An interim billing batch is created to include the service transferred to the CCBHC guarantor.
• Electronic Billing:
• The 837 Professional bill is claimed for the CCBHC guarantor.
• The services distributed to CCBHC guarantors are included in the bill.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. All other fields are populated as required/needed.
9. Click [Process].
10. Verify 'Compile Complete' message.
11. Select "Run Report" in the 'Billing Options' field.
12. Select "Print" in 'Print Or Delete Report'.
13. Select the recently compiled file from the 'File' dropdown.
14. Click [Print 837 Report].
15. Verify the enumerated and CCBHC PPS service are included in the '837 Professional Submission' link.
16. Click [X].
17. Compile the bill again for the CCBHC guarantor for the same parameters.
18. Select "Sort File" option from the 'Billing Options'
19. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
20. All other fields are populated as required/needed.
21. Click [Process].
22. Verify 'No Information' found.
23. Verify that system does not compile the bill again as the services are claimed.
24. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value.
• CCBHC Enumerated Service = Yes.
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary, and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a secondary guarantor, and a CCBHC guarantor is assigned to the client as a primary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor only.
• Close Charges:
• Close the enumerated CCBHC charges.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the service.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Close Charges:
• Close the PPS charges.
• Create Interim Billing Batch File:
• An interim billing batch is created to include the services distributed to the CCBHC guarantor.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• Individual Cash Posting:
• The service distributed to the primary guarantor is fully transferred to the secondary Non CCBHC guarantor.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. Set 'Create Claims' field to "No".
9. All other fields are populated as required/needed.
10. Click [Process].
11. Verify 'No Information' found.
12. Verify that system does not compile the bill again as the services are claimed.
13. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• Two contract CCBHC guarantors are identified to be used as a primary and secondary guarantor. Note the guarantor's code/name for each guarantor.
• Configure the primary guarantor for contractual adjustments during liability distribution.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = None.
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1.
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• Two contract guarantors are assigned to the client as a primary and secondary guarantor.
• Customize the benefit plan for the primary guarantor such that it only covers the enumerated service and not the PPS service.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor.
• Close Charges:
• Close the enumerated CCBHC charges.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the service.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor.
• Close Charges:
• Close the PPS charges.
• Electronic Billing:
• The service distributed to the primary guarantor is claimed. Note the claim number.
• The service distributed to the secondary guarantor is claimed. Note the claim number.
• Client Ledger:
• Two services on the separate claims.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select secondary CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. Set 'Create Claims' field to "No".
9. All other fields are populated as required/needed.
10. Click [Process].
11. Verify the 'No Information Found' message found.
12. Click [X].
13. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on service with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service, with an add-on service, is rendered to the client.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.
• All CCBHC setup is complete. CCBHC Billing functionality is used by the agency. If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on services with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service is rendered to the client and make sure that the add-on service is also selected for filing.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select desired guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. All other fields are populated as required/needed.
9. Click [Process].
10. Verify 'Compile Complete' message.
11. Select "Run Report" in the 'Billing Options' field.
12. Select "Print" in 'Print Or Delete Report'.
13. Select the recently compiled file from the 'File' dropdown.
14. Click [Print 837 Report].
15. Verify that the primary, Add-on and PPS services are included in the '837 Professional Submission' link.
16. Click [X].
17. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client, and the add-on service has been saved.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The service distributed to the primary guarantor is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The CCBHC PPS charges are closed.
• Create Interim Billing Batch File:
• An interim billing batch is created to include the service transferred to the CCBHC guarantor.
• Electronic Billing:
• The 837 Professional bill is claimed for the CCBHC guarantor.
• The services distributed to CCBHC guarantors are included in the bill.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. All other fields are populated as required/needed.
9. Click [Process].
10. Verify 'Compile Complete' message.
11. Select "Run Report" in the 'Billing Options' field.
12. Select "Print" in 'Print Or Delete Report'.
13. Select the recently compiled file from the 'File' dropdown.
14. Click [Print 837 Report].
15. Verify the enumerated and CCBHC PPS service are included in the '837 Professional Submission' link.
16. Click [X].
17. Compile the bill again for the CCBHC guarantor for the same parameters.
18. Select "Sort File" option from the 'Billing Options'
19. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
20. All other fields are populated as required/needed.
21. Click [Process].
22. Verify 'No Information' found.
23. Verify that system does not compile the bill again as the services are claimed.
24. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value.
• CCBHC Enumerated Service = Yes.
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary, and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a secondary guarantor, and a CCBHC guarantor is assigned to the client as a primary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor only.
• Close Charges:
• Close the enumerated CCBHC charges.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the service.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Close Charges:
• Close the PPS charges.
• Create Interim Billing Batch File:
• An interim billing batch is created to include the services distributed to the CCBHC guarantor.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• Individual Cash Posting:
• The service distributed to the primary guarantor is fully transferred to the secondary Non CCBHC guarantor.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. Set 'Create Claims' field to "No".
9. All other fields are populated as required/needed.
10. Click [Process].
11. Verify 'No Information' found.
12. Verify that system does not compile the bill again as the services are claimed.
13. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• Two contract CCBHC guarantors are identified to be used as a primary and secondary guarantor. Note the guarantor's code/name for each guarantor.
• Configure the primary guarantor for contractual adjustments during liability distribution.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = None.
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1.
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• A CCBHC Enumerated service code is created with the following:
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• Two contract guarantors are assigned to the client as a primary and secondary guarantor.
• Customize the benefit plan for the primary guarantor such that it only covers the enumerated service and not the PPS service.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The CCBHC Enumerated service is rendered to the client.
• Client Ledger:
• The liability for the CCBHC Enumerated service is distributed to the primary guarantor.
• Close Charges:
• Close the enumerated CCBHC charges.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the service.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor.
• Close Charges:
• Close the PPS charges.
• Electronic Billing:
• The service distributed to the primary guarantor is claimed. Note the claim number.
• The service distributed to the secondary guarantor is claimed. Note the claim number.
• Client Ledger:
• Two services on the separate claims.

1. Open the 'Electronic Billing' form.
2. Select an "837 Professional" from the 'Billing Form'.
3. Select "Individual" from the 'Individual Or All Guarantors' field.
4. Select secondary CCBHC guarantor from the 'Guarantor' drop down.
5. Select "Outpatient" from the 'Billing Type' field.
6. Select "Sort File" option from the 'Billing Options'
7. Select "Yes" in 'Include CCBHC Services' to include the CCBHC service.
8. Set 'Create Claims' field to "No".
9. All other fields are populated as required/needed.
10. Click [Process].
11. Verify the 'No Information Found' message found.
12. Click [X].
13. Click [X].

• CCBHC Billing functionality is used by the agency. All CCBHC setup is complete.
• If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on service with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service, with an add-on service, is rendered to the client.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.
• All CCBHC setup is complete. CCBHC Billing functionality is used by the agency. If the functionality is desired, but not installed, please contact your Netsmart Client Alignment Representative.
• Guarantors/Payors:
• A commercial guarantor and a CCBHC guarantor are identified. Note the guarantor's code/name for each guarantor.
• Guarantor/Program Billing defaults:
• A 'Guarantor/Program Billing Defaults' template has been created for the guarantor and has a value of 'Yes' in 'CCBHC Template'.
• The guarantors identified above, and the admission program of the client are assigned to this template.
• 837 Professional:
• CCBHC Claim Grouping = Same Claim: Hold PPS Charges for Remittances from Private Insurance and Group with Component Services on the Same Claim
• Maximum Service Information Per Claim Information (Maximum LX Per CLM) =1
• All other fields are populated as required/needed.
• Note the template name, name of the guarantor and name of the admission program.
• An active 'CCBHC PPS Service Definition' exists.
• Dictionary Update:
• A value of "Yes" is added in 'CCBHC Location' in the extended dictionary for 'Client, 10006, Location', for a minimum of one location.
• Service codes:
• An add-on service code is created with the following:
• Service Code Category = Primary Add-On Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• All other fields are populated as required/needed.
• Note the code and definition.
• A primary service code is created to have desired number of add-on services with the following:
• Service Code Category = Primary Code
• Service Code Type = desired value
• Type of Fee = desired value
• CCBHC Enumerated Service = Yes
• Select Multiple Add-On codes = An Add-On code created above is checked
• All other fields are populated as required/needed.
• Note the code and definition.
• Service Fee/ Cross Reference Maintenance:
• A fee definition is created for the primary and add-on service codes created/identified in the 'Service Codes' form.
• Admission:
• An existing outpatient client is identified, or a new client is admitted in the program identified in the 'Guarantor/Program billing defaults' form.
• Note client id, admission program, admission date.
• Financial Eligibility:
• A commercial guarantor is assigned to the client as a primary guarantor and a CCBHC guarantor is assigned to the client as a secondary guarantor identified in the 'Guarantors/Payors' form.
• Diagnosis:
• An active diagnosis record is created for the client.
• Client Charge Input:
• The primary service is rendered to the client and make sure that the add-on service is also selected for filing.
• Client Ledger:
• The liability for the primary and add-on service is distributed to the primary guarantor only.
• Close Charges:
• Close the charges.
• Electronic Billing:
• The services distributed to the primary guarantor are claimed. Note the claim number.
• CCBHC PPS Compile:
• The CCBHC PPS Compile process has been processed for the services.
• Client Ledger:
• The CCBHC PPS service created via compile distributes to the secondary CCBHC guarantor only.
• Individual Cash Posting:
• The primary service is fully paid such that primary guarantor pays the full amount of primary service.
• An add-on service is partially paid, and the remaining liability is transferred to the secondary CCBHC guarantor.
• Close Charges:
• The PPS charges are closed.