Posting/Adjustment Codes Definition - PM

Code Basics

1. Go to: Avatar PM > System Maintenance > System Definition >  Posting/Adjustment Codes Definition
2. In the Add Or Edit Posting Code field, select Add to add a code, or select Edit to edit an existing code.
3. In the Posting Code field, enter the code.
   • If adding a code, enter the code.
   • If editing a code, select the code from the drop-down list.
4. In the Code Definition field, enter the posting or adjustment code description.
5. In the Inactivate Posting/Adjustment Code field, select Yes to deactivate the posting/adjustment code.
6. In the Restrict Posting With This Code to Single Item Posting field:
   • Select Yes to restrict posting payments or adjustments to only a single line item in the client's account.
   • Choose No to allow payments or adjustments to post against multiple lines or all line items within the client's account.
7. In the Adjustment, Payment, or Transfer field:
   • Select Adjustment to alter a service balance without receiving payment (for example: Write-off).
   • Select Payment to post a payment.
   • Select Transfer to transfer liability from one guarantor to another.
8. In the Transfer Type field:
   • Standard Override - transfer liability to the next guarantor in Financial Eligibility without consideration of liability distribution rules (i.e. effective dates, benefit plan, etc...) The service has a billing status of UNBILL.
   • Redistribute (Open) - transfer liability from one guarantor to another guarantor. Liability is distributed based on the client's financial eligibility and liability distribution rules. The service has a billing status of OPEN.
     
     Note: Although the service will still be considered OPEN, it will not re-distribute to a guarantor that is higher in the guarantor order in the instance that a previous guarantor that had been excluded from accepting the liability for the service is changed so that it would now be eligible for said liability. In that instance, the service would need to be transferred again to move upwards through the guarantor order. 
      
   • Redistribute (Close) - transfer liability from one guarantor to another guarantor. Liability is distributed based on the client's financial eligibility and liability distribution rules (i.e. effective dates, benefit plan, etc...).  The service has a billing status of UNBILL.
   • Bad Debt - the service amount is marked as a bad debt.
9. In the Are There Guarantors This Code Should Not Be Used With field:
   • Select Yes to limit the guarantors that the code can be applied to (Exclude Guarantors field).
   • Select No to apply the code to all guarantors.
10. In the Exclude Guarantors field, select the guarantors to exclude from the code.
11. In the Error Message for Excluded Guarantor(s) field, enter the error message to display when an excluded guarantor is selected in a billing form.
12. In the Credit or Debit field:
    • Select Credit to decrease guarantor liability.
    • Select Debit to increase guarantor liability.
13. In the Security Level field, select the level of security required to access the code. Security is defined in the User Definition, and User Role Definition forms (RADplus Utilities).
14. In the Is This A Reversal Code field, select Yes to create a reversal code; select No to create a standard posting code. Every credit code should have a corresponding reversal debit code.
    Note: Every payment code should have a corresponding reversal code.
15. In the Which Pym/Adj Code Is This A Reversal For field, select the posting code.
16. In the Allow Batch Cash Posting field:
    • Select Yes if the code will be used for batch cash posting.
    • Select No if the code will not be used for batch cash posting.
17. In the Is This A Contractual Adjustment Code field, select whether or not the code will be used for contractual adjustments or write-offs. If Yes, this code will become available in the 'Contractual Adjustment' fields of the Contractual Guarantor Information section of the Guarantors/Payors form.
18. In the Is this a Charge Reversal? field, select Yes if the code will be used for charge reversals. Select whether or not this posting/adjustment code will be available for selection in the Charge Reversal Code field on the Delete Service form. This code may then be used to write off liability when a closed service is deleted.

Additional Settings

The following ‘Adjustment Group’ fields work with adjustments that are posted manually.

Note: This field is only visible for systems with myAvatar MSO installed.

1. In the Generate Receipt field, select Yes to generate a receipt when the code is used for payment. Selecting Credit (Credit or Debit field) enables this field.
   Note: Receipts are set up in the Receipt Definition form.

2. In the Validate Transaction Date Against Date of Receipt field, select Yes to verify that the posting date and the transaction date are compatible. If the transaction date is closed, the posting code cannot be applied against the transaction.

3. In the Void Receipt Posting Code field, select the posting code.
   Note: This code is for a rejected payment receipt. This code is used by the Void/Refund Receipt form to generate a receipt for the voided payment.

4. In the ERS Posting Code Category field, enter the category for the ERS posting code.

5. In the Does This Code Affect UMDAP Liability Distribution field, select Yes if the code affects UMDAP client liability.

6. In the Claim Adjustment Group Code (837-2430-CAS) field, select the code.

7. In the Claim Adjustment Reason Code (837-2430-CAS) field, select the value.

8. In the Remark Code field, enter the remark code.

9. In the Bill Charge Created from this Transfer Code As Primary? field, designate if this is a Primary Service.
   Note: This field allows you to transfer services to another guarantor and bill the claim as the primary guarantor. This means that claimed services can be transferred to another guarantor and be billed as the primary guarantor.

10. In the Trigger Retro Claim Adjudication Entry in MSO field:

    • Select Yes to create a Retro Claim Adjudication record in myAvatar MSO for any adjustments filed with the selected adjustment code.
    • Select No to prevent this functionality.
    • In the Include In Self Pay Redistribution Payment Process? field, select whether or not this posting code will be used when looking for self pay credits to redistribute. All codes with Yes selected in this field will be available for use in the Self Pay Payment Redistribution process.
    • Click File Posting/Adjustment Code.

► Additional Sections

• Posting Adjustment Codes Report

► SQL Tables

• SYSTEM.billing_posting_codes

► Registry Settings

• Cost Avoidance Override/Zero Fill Logic
• Enable Security Level Maximum Amount
• Other Subscriber Secondary ID Logic