Service Fee/Cross Reference Maintenance - PM

Fee/Cross Reference

1. Go to: Avatar PM > System Maintenance > System Definition > Service Code Maintenance > Service Fee/Cross Reference Maintenance
2. In the Enter New or Edit Existing Fee field, select Enter New to add a new service fee, or select Edit Existing to edit a service fee.
3. If adding a service code, in the Service Code field, enter the code.
4. If editing a service code, in the Service Code field, enter the code, and select a value from the Results list. Click Select Fee Definition To Edit. The Edit Service Fee Definition dialog displays. Choose the service fee, click Ok.
5. In the From Date field, enter the service fee start date.
6. In the End Date field, enter the service fee end date.
7. In the Update Liabilities field, select Yes to update liability for services that match the settings made in this form.
   Note: Clients with open services using the impacted service code will be flagged for liability update.
8. Click 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 click OK.
9. Click Service Fee/Cross Reference Definition Report to display the Service Fee Definition report, which details all myAvatar service fee definitions.
   Note: If no selection is made in the any of the following fields, the service fee is applied to all values for that field: Practitioner Category, Practitioner, Location, Program, Duration Range, and Age Range.
10. In the Practitioner Category field, select the practitioner categories.
    Note: 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.
11. In the Practitioner field, select the practitioners.
12. In the Location field, select the locations.
13. In the Program field, select the treatment programs.
14. In the Duration Range field, enter the range of minutes that the service must be within for this fee to apply. The duration range must be in the format XXX-XXX (for example, 0-15, 16-30, 31-99).
15. 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.
16. In the Fee field, enter the service fee.
17. In the Unit field, enter the number of service units.
    • The number of units will override the number of units defined for the service code (Service Codes form) on the client ledger.
    • This field is enabled when the service code is a fixed fee code (Type Of Fee field, Service Codes form).
18. If appropriate, click Delete Fee/Cross Reference Definition to remove the service fee definition.
19. In the UB-04 Revenue Code field, enter a code and click the search button to select. This is the billing code the guarantor recognizes for the service delivered. It is used for billing on a Paper UB form and/or an 837 Institutional file.
20. In the CPT-4/HCPCS Code field, enter a code and click the search button to select. This is the billing code the guarantor recognizes for the service delivered. It is used for billing on a Paper HCFA form and/or an 837 Professional file.
21. In the Service Unit Of Measurement Code field, select the criteria by which to measure.
22. 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.

Codes

23. In the CPT-4/HCPCS Modifier field, enter the CPT-4/HCPCS modifier to accompany the CPT-4/HCPCS Code.
24. 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.
25. In the Medicaid Rate Code fields, enter the appropriate Medicaid rate code(s) for NY Medicaid billing.
26. In the State Reporting Code fields, enter the appropriate state reporting code(s).
27. Click Submit.

► Additional Sections

• Guarantor Definitions
• Restore Definitions

► Registry Settings

• Additional Service Fee Configuration Fields
• Alternate Revenue Code Description
• Edit Service Fee Maintenance Display Sort
• Enable Automatic Contractual Adjustment Based On Fee Table
• Enable Incident-To Practitioner
• Enable Maximum Liability Assignment By Combination Of Guarantors
• Enable Minimum Liability Assignment
• Enable Program Search
• Evaluate X-Ref At Level Of Precision
• File Information (Loop 2400)
• Filter Program Selection By Treatment Service(s)
• Import Process Type
• Include CPT-4 Modifier If Not First Instance For Service Date
• Include Notes From Service Code Cross Reference
• Measure Reporting CPT Selection Priority
• Number Of Service Fee Decimal Places
• Service ID Qualifier (Loop 2400)
• Specify Service Modifier Location/Concatenating Order

► See Also

• How to Export Service Fee/Cross Reference Fee Definitions 

► SQL Tables

• SYSTEM.billing_tx_history
• SYSTEM.billing_tx_max_liab_by_guar
• SYSTEM.billing_tx_master_fee_table