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System Maintenance - Service Consolidation - Cal-PM

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Combine multiple service codes, and define the consolidated code for a guarantor. This form is used with HCFA 1500 and 837 Professional billing. When a client receives a service that is part of a consolidated service code, the consolidated service code will replace the client service on the HCFA bill if the service matches the rules setup in this form.

Prerequisites:

  • The service code must be defined in the Service Codes form.
  • The service code must have a professional component (Yes selected in the Does This Code Have A Professional Component field, Service Codes form).
  1. Go to: Avatar PM > System Maintenance > System Definition > Service Code Maintenance > Service Code Consolidation.
  2. In the Guarantor field, enter the guarantor name/ID, and select the appropriate value from the Results list.
  3. In the Consolidated Service Code field, enter the service code, click the Search button, and select the corresponding entry.
  4. In the Calculate Charge By field, select how the consolidated service code charge is calculated:
    Note: This field is enabled for user user-definedice codes (User Defined selected in the Type of Fee field, Service Codes form). The units for all services included in the consolidated service code are totaled and multiplied by the value of the 'Maximum Amount To Distribute Per Unit' field in the 'Service Fee/Cross Reference Maintenance (Guarantor Definitions)' form for the consolidated service code and guarantor combination. The total of all units for the services are also displayed on the claim.
    • Select Total Charges to add the service fee for all services in the consolidated service.
    • Select Duration to add the durations for all services in the consolidated service code. The total duration is compared to the number of minutes per units (Minutes Per Unit field, Service Codes form).
    • Select Units to add number of units for services in the consolidated service, and multiply by the service code fee.
    • Select Maximum Amount Per Unit to add service fees based on the 'Maximum Amount To Distribute Per Unit' field in the 'Service Fee/Cross Reference Maintenance (Guarantor Definitions) form.
  5. In the Fixed Fee Service Charge Calculation field:
    Note: This field is enabled for fixed fee service codes (Fixed Fee selected in the Type of Fee field, Service Codes form).
    • Select Use Service Charge to use the service charge.
    • Select Multiply Service Charge By Number Of Services to multiply the service charge by the number of services rendered.
  6. In the Required Common Data Elements field, select the data elements that services must have in common to be consolidated:
    • Select Date of Service for services rendered on the same date. (When Date of Service is not selected, only services rendered on consecutive days will be consolidated.)
    • Select Program for services rendered for the same treatment program.
    • Select Location for services rendered at the same location.
    • Select Practitioner for services rendered by the same practitioner.
    • Select Place of Service for services rendered in the same setting.
  7. In the Service Codes to Consolidate field, select the service codes to include in the consolidated service code.
  8. If appropriate, in the Delete Entry field, select Yes to delete the service code consolidation.
    Note: Deleting a service code consolidation does not delete the service code.
  9. Select Submit.
► SQL Tables
  • SYSTEM.billing_tx_consolidation