Receiver Information

Menu Path

Finance Setup > Agency Setup > Claim Receivers Setup

Receiver General Info

• Self Pay Receiver - Flag noting whether this is a self pay receiver. The Self Pay receiver is already entered into the system by Netsmart.  For this receiver, you can only change the Receiver Name, Output type and/or GL accounts.
• Receiver Name - Name describing the name of the Receiver.
• Identification Code - This is used to identify to whom you are sending bills to. This is provided by your Receiver of bills.  For Regular County Room & Board, you may have to make up a # if you do not have one.
• Claim Output Format - The type of output to send to the receiver. Choose among many including 837p, 837i, CMS1500, General Format or Custom Outputs created for specific agencies. 
• Output File Name (Prefix) - The standard naming convention to start the file name when EDI files are produced.
• Alternative Claim Output Format - This allows for an alternate output to be chosen by the end user. This would allow for, for example, printing an CMS 1500 form if the receiver was temporarily unable to accept the usual 837. 
• Days for Late Claims - The amount of days, or grace period for a claim.  For example, if 90 is entered, claim submitted can be 90 days after service date without being marked/noted as late on output.  Mostly used in NYS.  If you are not sure if this field applies to your agency, please contact a Netsmart Representative. Note: Late Claims will be submitted with a Reason and Reason Code.
• Default Late Claim Reason - When claims are produced after timely filing, the default reason code you wish to supply with the claim if none has been indicated for the claim.
• Default Location (Catch all) - The default billing place of service.  Claims use this value if place of service is not entered.
• Days in AR Without an Action - After this many days, the claims are routed to a person or workgroup for attention. This workgroup is identified here: Finance Setup > General Setup > Other Setups > Claim Routing Bundle Assignment Setup 
• Default Cash Account and Default Temp AR Account - Fields added to Receiver to aid in automatic remittance/835. These data entered here will be auto-filled by default when entering a cash receipt in the remittance area and will be used by 835 Auto remittance processing.
• Default Program Unit - Select the Default Program Unit (Codes that correspond to a particular facility and program; in other words: Program Unit  =  Site + Program.)
• Provider Level Adjustment Account - 
• Default Overpayment Action - When an overpayment comes through on an 835, this action will automatically be applied. 
• Allow Duplicate Status from 835 - By default, an 835 import will never import a status on a claim if: there is an existing status with the same status, reference number, and amount. Check this box to skip that validation. 

Receiver Setup X12

Enter Information specific to X12 Submissions (837I and 837P)

Hold Claims Conditions

Select the conditions under which to hold claims. Held means the claim is produced with appropriate GL transactions, however it will not be included when you generate claim output and mark it as sent to the receiver of the claim.

• Hold Claims if No Diagnosis - Flag if the claims are to be Held Claims if there is no Primary Diagnosis on file for a Client.
• Hold Claims if No Policy # - Flag if the claims are to be Held Claims if there is no Policy Numbered entered on a Client's Benefit Assignment entry. 
• Hold Claims if Over Late Days Limit - Select this if the claims are to be Held Claims if the claim is late beyond the number entered in the Days for Late Claim field.
• Hold Claims If Missing any of the Staff Billing Info Below - All of this information is entered in Agency > Staff & Security > Staff Information > Staff Profiles with Security, under the 'Billing Information' tab. These fields inform myEvolv that those particular entries are required for billing. 
  • No Staff NPI 
  • (Service Only) - This field become available when the 'No Staff NPI' option is chosen, and indicates that the staff NPI number is only necessary if the billable event is a service. 
  • No Staff Taxonomy
  • No Staff License Number - 

Receiver Address

The system will send claims to an address entered in this area. If this is blank, the system will send claims to the Payer's address. address of the Payer will be used.

Contact Information

Enter the Contact Information for this receiver.

*834 Setup

(For North Carolina Only.) Contact a Netsmart Systems representative if in need of assistance.

HCFA 1500 Setup

These flags will only come available if HCFA 1500 type is selected in the Claim Output Format. They allow you to add override information  in Boxes 26, 32 and 33.
The Receiver Type for HCFA can be defined in this area.

Generic Output Setup

On the Generic Statement produced, this flag allows you to display the client's social security number in the ID area, and to identify the first day of the week for weekly billing purposes. 

Default Referring Organization

If entered, data here will be supplied for all clients who don't have individual referring physician entered on their Benefit Assignment.

State-Specific Tabs

Contains state-specific parameters and required information including:

• Information needed specific to CA and HI in regards to 837 submissions. Contact a Netsmart Representative if in need of assistance.
• 270/271 Setup
  270/271 is the electronic interchange between your agency and receiver to verify client demographic and eligibility information. Contact a Netsmart representative if in need of assistance.
• *NYS SSPS
  Use Agency ID flag

Notes

EDI Cost Avoidance Settings

270/271 Setup

For more information on the 270/271 Setup, refer to the 270/271 Setup User Guide.