myEvolv NX 11.0.0075 Details

ECS-32526 Summary | User Acceptance Tests

Finance NX now supports setting a cap on how many units a client can bill for in a day. Claims that exceed this count will still be created, but they will be withheld from claim outputs and the GLs will be written off.

The Daily Cap categories are defined under "Finance Setup > General Setup > Setup Tables > Daily Client Unit Cap Category". Users can set the "Max Units" - the maximum units per day that a client can bill to all rate headers pointing to this Cap category. Units billed to rates that do not point to this Cap Category do not count against the unit max. You also set "Action When Exceeds" - this is the type of write-off that is automatically applied to claims that exceed the unit cap. When using Daily Unit Cap, for a single billing run if units exceed the cap, priority will be given to the "most expensive" units. Most expensive is calculated by units x amount charged. Separate billing runs will look at units created already. A separate billing run cannot go back and remove previously billed services to make room for more expensive ones. Claims that belong to different Daily Unit Cap Categories will never consolidate with each other. Claims that are billed will never consolidate with claims that exceeded the count – however, the former and the latter can consolidate with themselves. The logic for which claims to bill and which to mark as exceeding is applied prior to any consolidation. This was designed to work with the “Break Service-Details by Timechart” feature. For example: On Agency-Program-Service link, set service to break up its service-details by hour. The Rate for the service is tied to a category with a 6-unit cap, bills one unit per hour, and uses standard daily consolidation. A 7-hour service is entered. Billing will produce one 6-unit claim normally, and one 1-unit claim which is written off, and will be excluded from output. - This is not the same thing as an Evolv Billing Authorization. Both features can be used together. While this cap category is daily only, the Billing Authorization is typically used to cover longer periods. Claims that exceed the unit count will not bill, but they are not “held”. Claims that are held (unrelated to this functionality) do count against the unit caps. Claims that exceed the unit count are marked as “Exclude From Output”. These claims are not held, and therefore cannot be “released” to be billed without reprocessing the billing run. Claims that exceed the unit count will not output in the 837, CMS-1500, or UB-04. These excluded claims will show up on the Claim Details Report with ** next to the claim number. These excluded claims will have the write-off action selected in the Cap Category applied automatically. The A/R balances will always be 0, with balances on Revenue and the Write-Off account. Submitting the batch does not create any GLs for excluded claims.