Guarantor Definitions Section - PM

Last updated
Save as PDF

Define how a service’s liability is applied for guarantors.

Maximum liability assignment does not affect a service’s total charge.
When entering multiple modifiers, all exception rules must be entered first and the general rule last. If none of the exceptions apply, the final rule is used.

In the Enter New or Edit Existing Fee field, select Enter New to add a maximum liability, or select Edit Existing to edit a maximum liability.
If adding a maximum liability, in the Service Code field, enter the code.
If editing a maximum liability, in the Service Code field, enter the code, and select a value from the Results list. Click Select Fee Definition To Edit. The Edit Maximum Liability Assignment By Guarantor Definition dialog displays. Select the service, click Ok.
In the Service Code field, enter the service code, select a value from the Results list.
In the From Date field, enter the first date for the liability.
In the End Date field, enter the last date for the liability.
Click the Guarantor Definitions Report button to generate a report detailing the information entered in this form.
In the Practitioner Category field, select the practitioner categories.
The selections made in this field control which practitioners display in the Practitioner field. Practitioners associated with the practitioner categories display in the Practitioner field.
In the Practitioner field, select the practitioners.
In the Location field, select the locations.
In the Program field, select the treatment programs.
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).
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 service date of service.
In the Financial Class field, select the financial classes.
The selections made in this field control which guarantors display in the Guarantor field. Guarantors associated with the financial classes display in the Guarantor field.
In the Guarantor field, select the guarantors.
In the Maximum Amount To Distribute Per Service field, enter the maximum amount of liability for the service that should distribute to the guarantor.
In the Maximum Amount To Distribute Per Unit field, enter the maximum amount of liability per unit that should distribute to the guarantor. This field is only enabled for 'User Defined' service codes (User Defined is selected in the Type of Fee field, Service Codes form).
In the Unit field, enter the unit used in the per-unit calculation.
In the UB-04 Revenue Code field, enter a code and click the search button to select.
In the Alternate Revenue Code Description field, enter the alternate description, if any.
In the CPT-4/HCPCS Code field, enter a code and click the search button to select.
In the CPT-4/HCPCS Modifier field, enter the CPT-4/HCPCS Modifier.
In the Service Code Cross Reference Name field, enter the name of a reference code (such as a crosswalk code) for reporting purposes. This title is for identification purposes and is not used for billing.
In the Medicaid Rate Code fields, enter the appropriate Medicaid rate code(s).
In the State Reporting Code fields, enter the appropriate state reporting code(s).
In the Service Unit of Measurement Code field, select the criteria by which to measure.
In the Quantity field, enter the amount of the criteria selected in the previous field. This is a billing override for the number of units that will display on the bill.
In the Update Liabilities field, select Yes to update liability for services that match the settings made in this form.
Clients with open services using the impacted service code will be flagged for liability update.
If appropriate, click Delete Fee Definition to remove the liability definition.
Click Submit.