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System Maintenance - Service Fee/Cross Reference Maintenance - Guarantor Definitions Section - Cal-PM

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Note: Maximum liability assignment does not affect a service’s total charge.

  1. In the Enter New or Edit Existing field:

  • Select Enter New to create a new definition.
  • Select Edit Existing to update an existing definition.

  1. In the Service Code field, enter the code and select a value from the Results list.

  2. In the From Date field, enter the service fee/cross reference start date.

  3. In the End Date field, enter the service fee/cross reference end date.

  4. In the Update Liabilities field, select Yes to update liability for services that match the settings made in this form.

  5. Choose the Select Fee/Cross Ref to Edit/Default from Existing Row button. The Edit Service Fee/Cross Reference Definition dialog displays. Choose the service fee and select OK.

  6. Select the Guarantor Definitions Report button to generate a report detailing the information entered in this form.

  7. In the Practitioner Category field, select the practitioner categories. Only practitioners associated with the selected practitioner categories will display in the Practitioner field.

  8. In the Practitioner field, select the practitioners.

  9. In the Location field, select the locations.

  10. In the Program field, select the treatment programs.

  11. In the Duration Range field, enter the number of minutes the service can be performed. The duration range must be in the format XXX-XXX (for example, 0-15, 16-30, 31-99).

  12. In the Age Range field, enter the age range of clients who can receive the service.

  • This age range must be in the format of XXX-XXX (for example, 12-15, 16-20, 21-50).
  • The client’s age is calculated from the date of service.

  1. In the Financial Class field, select the financial classes. Only guarantors associated with the selected financial classes will display in the Guarantor field.

  2. In the Guarantor field, select the guarantor(s).

  3. In the Maximum Amount To Distribute Per Service field, enter the maximum fee.

  4. In the Minimum Amount To Distribute Per Service field, enter the minimum fee. The 'per service' fields are enabled for user defined service codes (User Defined selected in the Type of Fee field, Service Codes form).

  5. In the Maximum Amount To Distribute Per Unit field, enter the maximum fee.

  6. In the Minimum Amount To Distribute Per Unit field, enter the minimum fee. The 'per unit' fields are enabled for fixed fee service codes (Fixed Fee selected in the Type of Fee field, Service Codes form).

Billing Cross Reference and Overrides

  1. In the Unit field, enter the unit used in the per-unit calculation.

  2. In the UB-04 Revenue Code field, enter a code and select Search to select.

  3. In the CPT-4/HCPCS Code field, enter a code and select Search to select.

  4. In the CPT-4/HCPCS Modifier field, enter the CPT-4/HCPCS Modifier.

  5. In the Service Code Cross Reference Name field, enter the service code cross reference name.

  6. In the Medicaid Rate Code fields, enter the appropriate Medicaid rate code(s).

  7. In the State Reporting Code fields, enter the appropriate state reporting code(s).

  8. In the Service Unit of Measurement Code field, select the denomination the units will be measured in.

  9. In the Quantity field, enter the number of units.

  10. If appropriate, select Delete Definition to remove the liability definition.

  11. Select Submit.