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Avatar PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

The following issues are resolved with CCBHC bills: 1) "Service [service description] is still awaiting remittance from private insurance." error message is incorrectly reported. 2) "Service [service description] is still awaiting remittance from private insurance." error message is incorrectly reported when billing CCBHC guarantor on secondary 837 bill for the services that have already been claimed by the billing guarantor. 3) A CCBHC enumerated service is incorrectly included on the 837 bill even when it has been claimed on a prior bill. 4) "Missing Field/Invalid Format: Industry Code - Diagnosis Code ..." is incorrectly reported when billing a CCBHC add-on service.

Required Updates

None

Included Updates

None

Details
NEW0 CHANGED0 FIXED4
Fixed (4)
CCBHC Billing - CCBHC 837 Professional Billing
An issue is resolved where for a specific scenario, CCBHC 837P billing gives incorrect error about waiting on remittance from private insurance when the service has no liability remaining and the service is claimed.
The issue was that if a service had been contractually adjusted off in full at the time of service entry, and it contained a claim number, an error message would appear in the 837P report. This was preventing the client from determining the actual remittance errors. Note, this scenario will not error. If the contractual adjustment is taken in full at the time of service entry, the posting code cannot be changed.
Topics
• 837 Professional • CCBHC
 
CCBHC Billing - Subsequent Bills
An issue is resolved where the CCBHC service that was appearing on the error report had already been previously billed and claimed. KB0074877 v0.01
Topics
• 837 Professional • CCBHC
 
CCBHC Billing - Secondary CCBHC billing from a non-CCBHC primary guarantor
An issue is resolved where a CCBHC enumerated service was incorrectly included on the 837 bill even when it had been claimed on a prior bill. KB0075517 v0.01
With this update, users will find that a Certified Community Behavioral Health Clinic (CCBHC) enumerated service is now correctly handled on the 837 bill. This corrects the previously reported error where the service was incorrectly included even when it had been claimed on a prior bill.
Topics
• 837 Professional • CCBHC
 
CCBHC Billing - Enhanced Secondary Claims Handling
An issue is resolved where secondary claims for a CCBHC 837P bill were missing the 2300-HI segment for diagnosis codes.
With this update, users will find that secondary claims for a Certified Community Behavioral Health Clinic (CCBHC) 837 Professional bill now include the necessary 2300-HI segment, ensuring accurate submission of diagnosis codes. This corrects the previously reported error and aligns with compliance requirements.
Topics
• 837 Professional • CCBHC
 
Acceptance Tests
AV-85064 Summary | Details
CCBHC Billing - CCBHC 837 Professional Billing
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Electronic Billing
Scenario 1: CCBHC Billing - 837 Professional - Primary and Add-on Enumerated CCBHC services rendered to the client
Specific Setup:
  • 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.
Steps
  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].
Scenario 2: CCBHC Billing - 837 Professional - Enumerated CCBHC service – Partially paid and transferred remaining liability to CCBHC guarantor from the Non CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 3: CCBHC Billing - 837 Professional - Enumerated CCBHC service –Liability fully transferred to non CCBHC guarantor from the CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 4: CCBHC Billing - 837 Professional - Enumerated CCBHC service distributed to the primary contract CCBHC guarantor and CCBHC PPS service distributed to the another contract CCBHC secondary guarantor
Specific Setup:
  • 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.
Steps
  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].
Topics
• 837 Professional • CCBHC
AV-90104 Summary | Details
CCBHC Billing - Subsequent Bills
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Electronic Billing
Scenario 1: CCBHC Billing - 837 Professional - Primary and Add-on Enumerated CCBHC services rendered to the client
Specific Setup:
  • 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.
Steps
  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].
Scenario 2: CCBHC Billing - 837 Professional - Enumerated CCBHC service – Partially paid and transferred remaining liability to CCBHC guarantor from the Non CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 3: CCBHC Billing - 837 Professional - Enumerated CCBHC service –Liability fully transferred to non CCBHC guarantor from the CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 4: CCBHC Billing - 837 Professional - Enumerated CCBHC service distributed to the primary contract CCBHC guarantor and CCBHC PPS service distributed to the another contract CCBHC secondary guarantor
Specific Setup:
  • 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.
Steps
  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].
Topics
• 837 Professional • CCBHC
AV-91569 Summary | Details
CCBHC Billing - Secondary CCBHC billing from a non-CCBHC primary guarantor
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Electronic Billing
Scenario 1: CCBHC Billing - 837 Professional - Primary and Add-on Enumerated CCBHC services rendered to the client
Specific Setup:
  • 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.
Steps
  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].
Scenario 2: CCBHC Billing - 837 Professional - Enumerated CCBHC service – Partially paid and transferred remaining liability to CCBHC guarantor from the Non CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 3: CCBHC Billing - 837 Professional - Enumerated CCBHC service –Liability fully transferred to non CCBHC guarantor from the CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 4: CCBHC Billing - 837 Professional - Enumerated CCBHC service distributed to the primary contract CCBHC guarantor and CCBHC PPS service distributed to the another contract CCBHC secondary guarantor
Specific Setup:
  • 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.
Steps
  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].
Topics
• 837 Professional • CCBHC
AV-92019 Summary | Details
CCBHC Billing - Enhanced Secondary Claims Handling
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Electronic Billing
Scenario 1: CCBHC Billing - 837 Professional - Primary and Add-on Enumerated CCBHC services rendered to the client
Specific Setup:
  • 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.
Steps
  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].
Scenario 2: CCBHC Billing - 837 Professional - Enumerated CCBHC service – Partially paid and transferred remaining liability to CCBHC guarantor from the Non CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 3: CCBHC Billing - 837 Professional - Enumerated CCBHC service –Liability fully transferred to non CCBHC guarantor from the CCBHC guarantor
Specific Setup:
  • 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.
Steps
  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].
Scenario 4: CCBHC Billing - 837 Professional - Enumerated CCBHC service distributed to the primary contract CCBHC guarantor and CCBHC PPS service distributed to the another contract CCBHC secondary guarantor
Specific Setup:
  • 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.
Steps
  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].
Topics
• 837 Professional • CCBHC