Program Maintenance - PM

Program Basics

1. Go to: Avatar PM > System Maintenance > System Definition > Program Maintenance
2. In the Add Or Edit Program field, select Add to add a program, or select Edit to edit a program.
3. In the Program Code field, enter the program code to add a program, or select the program from the drop down menu to edit a program.
   Note: The program code cannot be changed after this form has been filed.
4. Select Print All Programs to generate a report that displays current program information.
5. In the Active field, select Yes to activate a program; select No to deactivate a program. Deactivated programs cannot be selected in myAvatar forms.
6. In the Description field, enter the program description.
7. In the Treatment Setting field, select whether the program is grouped as Inpatient/Residential, Outpatient, or Partial Hospitalization.
   Note: This is the highest level grouping of programs within the system. The treatment setting assigned to the program defines the clinical workflow and affects how services and charges are processed in the application. To safeguard the integrity of the workflow, the treatment setting cannot be changed once the program is filed.
8. In the Treatment Service field, select the treatment service.
9. In the RRG field, select the revenue reporting group.
10. In the Program Type field:
    • Select Admit for programs used in the Admission, or Admission (Outpatient) forms.
    • Select Call Intake for programs in the Call Intake form.
    • Select Pre-Admit for programs used in the Pre-Admit form.

Advanced Settings

1. In the Allow Transfer Only to the Following Programs field, select the programs that clients will be allowed to transfer into.
2. Enter the Room and Board Billing Code. Select the appropriate value from the Results list.
3. Enter the Admission Charge Code. Select the appropriate value from the Results list.
4. Enter the Daily Charge Code. Select the appropriate value from the Results list.
5. In the Location field, select the program location.
6. In the Primarily Medical Program field, select Yes to define the program as a medical program.
7. In the Program Tax ID field, enter the program tax ID.
8. For the 'Program' demographic fields, enter the associated treatment program information.
9. In the Unit field, select the unit. If a unit is selected for an inpatient program, that unit populates the Admission, and Program Transfer forms.
10. In the HCO Id field, enter the ID number for the Health Care form. This is the unique identifier assigned to the health care organization (HCO) by the National Association of State Mental Health Program Directors Research Institute, Inc. (NRI).
11. Enter the Other Program Grouper/Identifier, if any.
12. Enter the Program Taxonomy Code, if any.
13. In the Allow Charge Entry field, select Yes to allow charge entry.
14. In the Display Only Active Episodes in Lookup field, select Yes to show only active episodes. Select No to show all client episodes, regardless of active or inactive status.
15. In the 'Should A User Receive A Warning' field, choose the behavior when a client service occurs after a client has been discharged:
    • Select Error if users will not be able to discharge the client.
    • Select Warning if a message will display, and the user will be able to discharge the client.

16. In the Emergency Room Program field, indicate whether or not it is an emergency room program.

Facility

1. Select the Facility Identification Code Qualifier from the drop-down.
2. Enter the Facility Identification Code.
3. Select the Facility Reference Identification Qualifier.
4. Enter the Facility Reference Identification.

Additional Settings

1. In the Primary Care Program field, select whether or not this is a primary care program.
2. In the Encounter CPT Code field, enter a value to associate a program with a CPT code. This CPT code will appear in the encounter XML record of the CCD.
3. In the Require Admitting Practitioner field, select whether or not to require the admitting practitioner for Inpatient/Residential or Partial programs during admission. This field will make the Admitting Practitioner field required for admissions to programs that have an Inpatient/Residential or Partial Hospitalization treatment setting.
4. Note: Inpatient billing (UB-92, UB-04, 837I) may require the presence of admitting practitioner information.
5. In the Is This Program Associated With An External Ambulatory Provider? field, select Yes or No. All programs with Yes selected will be available in the Program Associated With Target Ambulatory Provider field on the Export Health Information form. All other programs will not be available.
6. In the Exclude Program From Measures Reporting field, check the Exclude box to exclude the selected program from the measures reporting process. The episode-related information associated with this program will still be sent to the Netsmart Cloud, however, the visits associated with this program will not display in myHealthpointe, or be included in the measures reporting calculations.
7. In the Encounter SNOMED Code (MU Hospital) field, enter the code. This field appears when the IMO search is implemented. This is used for a procedure code SNOMED search for Meaningful Use CQM testing.
8. In the Financially Responsible Party for Lab Charges field, select which party is responsible to pay for lab costs:
   • Patient - The individual will pay the lab charges.
   • Facility - Your facility will pay the lab charges. Facility information will then be sent in the payor segment of the Order Outbound Payload.
   • Insurance - The client's designated payor will pay the lab charges. This includes all active guarantors assigned to the client. Guarantor information will then be sent in the payor segment of the Order Outbound Payload.
9. In the Facility Address to Send to Lab Vendor field, select whether to send the Program (defined in this form) or Facility (defined in the Facility Defaults form) address over to the lab vendor.
10. In the Medicaid Provider ID field, enter the ID. This is used in Electronic Billing to format the 2400-NTE-02 field with the Medicaid Provider ID and up to five evidence-based practices entered on the Edit Service Information, Client Charge Input, and/or Progress Notes forms.
11. Select File Program when done.

► Additional Sections

• Assign Services To Program
• Site Specific Extended Dictionaries
• Day Program Services
• Day Program Schedule
• Day Program Schedule Exceptions
• Assign Units To Program
• Client Treatment Plan Service Restriction Exceptions

► Registry Settings

• ADAMH Bill for Gaps
• Activate Program/Service Code Filter
• Activate Program/Unit Filter
• Add Default Days For Expected Discharge
• Allow Multiple Inpatient Admissions During Leave
• Emergency Indicator (2400-SV1-09)
• Enable 'Admission vs. Service Program' Functionality
• Enable California Billing
• Enable Enrollments
• Enable 'Limit Open Active Episodes To One' Functionality
• Enable Program Level 42 CFR Part 2 Regulations Check
• Enable Program Search
• 'Limit Open Active Episodes To One' Override Security Level
• Number of Daily Charge Codes
• Require Prior Admission

► SQL Tables

• SYSTEM.table_program_definition