Field explanations
This article offers details on various fields and setup areas throughout the system. Some of this setup occurs during implementation but can be changed at a later date.
- ► Foundation Follow-Up Flow
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ICONS What Purpose Illustrate myEvolv Taskbar Viewing of your Referrals, Clients, and Tasks Create and Intake Referral (Myself) Supervisor Taskbar Review and approve services, plans, incidents. Access worker calenders. Generate task lists. Transfer task and caseloads in batches. Frodo Baggins worker Fast Track Taskbar Enter Individual services simultaneously for multiple clients. Not the Group setting. Adult Day Hab Services e-MAR Taskbar Track medication administration to clients Main site, time of day morning. Timesheets Taskbar Direct staff to review and submit services to their supervisor for approval. Recommended if DSR not appropriate for certain staff. Jordan Belfort PTO 4/13/15 Front Desk Taskbar Calendar feature to easily schedule services and search staff availability. A daily checkin feature to checkin, document payment, and notify of arrival. Attendance Facility. 4/7/15 DSR Taskbar Complete services driven by treatment plan. Enter additional if needed. SFE3O. 2/5/15. Semper Fi Crane. Call Center Taskbar Place to document phone conversations i.e. referrals New call, request for a referral. Maintenance Taskbar Administrator level access Show Calendar Taskbar Your personal calendar. Tasks and PTO etc. Show Alerts Taskbar Notifications of tasks, messages, Billing Runs etc. Show Outreach Regular Educating/Providing info to general public or targeted groups of people. People not clearly defined. Can also have Internal use. Show Groups Regular Group of more than one person meeting for a common purpose. Single form for multiple clients. Group notes, but have ability to do individual notes that stay at the client level. Show Incidents Regular Document client, non-client, and staff misconduct. Document a person who was a victim of misconduct. Show Family Cases Regular Allows you to provide family services for those clients tied to a family. Show Order of Operations What Where Notes 1 Agency Setup Agency Setup > Agency > Agency > Agency Information Setup the Agency 2 Holiday Schedule Agency Setup > Agency > Agency > Holiday Schedule > Agency Information 3 Job Titles Agency Setup > Staff and Security Setup > Job Titles > Job Titles 4 Table Maintenance Agency Setup > Agency > Table Maintenance 5 Medication/Substance Setup > Medication/Substance > Setup > Category 6 Drug Categories Setup > Medication/Substance > Drug Library > Drug Category 7 Program Types Agency Setup > Agency > Program Setups > Program Type 1st night 8 Programs Agency Setup > Agency > Program Setups 1st night 9 Program enrollment modifiers Agency Setup > Agency > Program Setups > Enrollment Modifiers 1st night 10 Facility/Service Locations Agency > Service Locations > Sites/Residentials > General Info 1st night 11 Capacity Agency > Service Locations > Sites/Residentials > Capacity NA at minimum 12 Outside Organizations Agency > Service Locations > Outside Organizations > General Info 13 Program/Facility links Agency Setup > Services Setup > By Program > Program Link to Loc 1st night 14 Events/Services Agency Setup > Event Setup > People > Events Setup Activities-most used via simple service entry. Activities Other-subevent within a main service. Test and Assessments for people-can be linked to a form that contains a test. Training-Staff/Foster Homes. Staff Act-Tracking of staff events. 15 Worker Roles Agency Setup > Staff and Security Setup > Worker Roles-Role Setup What you can do! 16 Work Groups Agency > Work Groups > Assigned to All > Info Which clients you see! 17 Navigation Schemes Agency Setup > Staff and Security Setup > Navigation Access-Access Definition What you can see! 18 Placement Disruptions Setup > Placement Disruptions > Definitions > Events 19 Resource Families Resource Families Baggins example. Family must exist. Link programs. Vender covered during FIN Setup. 20 Alerts/Restrictions Setup > Events Setup > Alerts and Restrictions > Events Setup 21 Payer Setup Finance Setup > Payor/Contract Setup > Payors Copying Data from Production System into a Development System
AGENCY HOMEWORK: The Agency should do the following after completing their “homework” and use the development system to test out the system.
To copy the production environment to the development environment:
- Open Internet Explorer and type in the URL to access your production system, adding "/copy_db.asp" to the end of the URL.
- Enter "_dev" and "Dev" for the System Suffix and System Name.
- After the process is complete, you would log into the development system, go to System Maintenance, and run the Recreate Forms XML utility.
- ► Finance Follow-Up Flow
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Order of Operations What Where Notes 1 Chart of Accounts Finance Setup > General Setup > Setup Tables > Chart of Accounts Not a Full Accounting system. Tied to claims/remittance. 2 Cost Centers Finance Setup > General Setup > Setup Tables > Cost Centers 3 Billing Procedure Codes Finance Setup > General Setup > Setup Tables > Billing Procedure Codes 4 Claim Modifiers Finance Setup > General Setup > Setup Tables > Claim Modifiers 5 Claim Adjustment Reasons Finance Setup > General Setup > Setup Tables > Claim Adjustment Reasons 835 remittance reasons 6 Claim Outputs Finance Setup > General Setup > Claims Output > Output Information 7 Place of Service Codes Finance Setup > General Setup > Claims Output > Place of Service Codes Billing location roll-up;
Linked in Plan/Contract rates, Service Entry, Service Link to Program, and receiver setups.8 Unit Time Charts Finance Setup > General Setup > Unit Time Charts > Time Chart Creation of units 9 Submitters Finance Setup > Agency Setup > Submitter Info > Claim Submitter Info Processing Billing-Funder Typers 10 Claim Receivers Finance Setup > Agency Setup > Claim Receivers > Info How bills are output to Funder 11 Billing Provider Finance Setup > Agency Setup > Billing Provider Info > Billing Provider Your organization info i.g. Tax ID 12 Linking the Rate Finance Setup > Payer/Contract Setup > Payers > Plan/Contract Rates Create a new rate
- Select existing rate: rate already configured under the payor to use
- Copy from existing rate: take an existing rate and modify it to what you need
- Outpatient: Multiple rate histories per plan if different rates
- Residential: One rate for placement, but could be a rate per Service Facility. Another level down placement disruption sets exist. Rate per program modifier
- Attendance: One rate for attendance, variable per plan
- School: Manual services type setup with an attendance rate
13 Placement Disruption Rule Finance Setup > General Setup > Placement Disruption Rules > Setup Stop billing sets, each set can have multiple rules. 14 Rate Setup Finance Setup > Billing Rates (A/R) > Manual Services > Rates Setup Additional place for #12 15 Claim Consolidation Category Finance Setup > General Setup > Rates Setup Tables > Claim Consolidation Category Service line consolidations needed for rates (see the myEvolv NX Finance Setup Implementation Guide for more information) 16 Daily Client Unit Cap Category Finance Setup > General Setup > Rates Setup Tables > Daily Client Unit Cap Category Limits the amount of units per client per day for all rates that have this category (see the myEvolv NX Finance Setup Implementation Guide for more information) 17 Default Rate Setup Finance Setup > Payer/Contract Setup > Plan/Contract Maintenance > Default Billing Rate Setup By Payer: Default GL, requirements like auth/hold claims. 18 Interactive Complexity Finance Setup > Billing Rates (A/R) > Manual Services > History Add-On code for complex interactions 19 E/M or Interactive Complexity Agency Setup > Event Setup > People Setup > Events Setup On the event must check if E/M or Interactive Complexity 20 Final Payer List Finance Setup > Payer/Contract Setup > Payers 21 Self Pay Setup Finance Setup > Payer/Contract Setup > Self Pay Setup > Plan/Rate Info Billing Client directly or copays 22 Self Pay Copay AR Finance Setup > Payer/Contract Setup > Self Pay Setup > Self Pay Info Needs a GL account 23 Claim Deduction/Sliding Fee Scale Finance Setup > Payer/Contract Setup > Self Pay Setup > Plan/Rate Info Determines a deduction based on income. Agency chooses a % or Amount. No Match = $0. Client > Client Information > Personal Information > Benefit Assignment Check auto-calculate deduction Client > Client Information > Relationships > Families If a Family: Make sure they are apart of a Family and income is listed. Client > Client Information > Billing/Payment Information > Benefit Assignments If Individual: Edit self pay benefit assignment for deduction amount or % 24 Schemes Finance Setup > Payer/Contract Setup > Payers > Schemes Program-Service-Plan linkage for Billable Services. A scheme could be Professional vs. Institutional for 837p/837i. 2 similar contracts Professional vs. Institutional in which would each have their own Receiver to take into account 837p/837i. 25 Payers/Contracts Setup Finance Setup > Payer/Contract Setup > Payers > Plan/Contract Setups TAB In Contract Network=System books the plan amount on rate history. Output Agency Rate=Agency Rate/Charge goes out on the 837 even though booking the plan amount. Output Expected amount=plan amount goes on any paper statements (on client to ensure custom reports match). TAB Dealing w/unbilled unpaid amounts= Contra account and bad debt. Contra (temp acct to make balanced trans at certain points) examples: 1. Commercial insurance when client has a copay. 2. If a claim was lost, i.g. funder has you run a "Resubmit to Same" billing run. TAB When Need to Return Money or Overpaid: Liability accts for voids, when claims need to be sent to a funder. AP accts for Credit, when wanting to mimic a payback to a funder. Vender to refund: Allows overpayment for specific funder. Overpayment acct: Remit action acct. TAB Remittance Reasons Actions: only if 835 reasons get the same action ALWAYS. 26 Staff NPI and Credential Agency > Staff & Security > Staff Information > Staff Profiles w/Security MD vs. PHD etc. NPI's. This section ties to rates. One active only. Allows for rendering provider info as well, or supervisors name. 27 Staff Taxonomy Agency > Staff & Security > Staff Information > Personal Info If Taxonomy is sent for ALL services to funder 28 Billing Cut off Date Agency Setup > Agency > Agency > Agency Info Change it to your first billable service date when you GO-LIVE. For testing purposes it would be sooner etc. 29 Finance Notification Agency > Workgroups > Notification Workgroup > Information Notification for when staff changes already billed info "Billing Notification" 30 Benefit Assignments Client > Client Information > Billing/Payment Information > Benefit Assignments Will learn in Client Management and Finance End User training. Cover high level. 31 Service Entry Client > Case Management > Service Management > Service Entry Enter services. Fast Track by day, week or month…stopwatch icon. Client @ Taskbar-Fast Track-Fast Track-Fast Track by Client. Staff timesheet at Taskbar-Fast Track-Fast Track-Staff Time Sheet. 32 Test Processing Finance > Processing > Create Claims/Invoices > Processing for a Period Select some real clients with real benefit assignments and services and enter into the system. Good idea to start before FIN EU training to keep concepts fresh. Run report within the batch to review for accuracy. If something wrong correct and resubmit batch process. Next Steps
- Finish Homework entries.
- Enter in real clients to your system for testing.
- Peform testing of setups (ensure all programs/services are encompassed).
- Create a support ticket when you a ready for 837 EDI testing.
- Finance End User Training occurs as scheduled.
- GO LIVE!
GO-LIVE Checklist
- Finance setups completed and tested for go live contracts/programs
- Clients have been enrolled into the system and into appropriate programs
- Clients have correct benefit assignments
- Clients have authorizations entered where applicable
- Clients have dx's entered and are being used in applicable places
- 837 testing and setup completed
- Agency has reviewed all finance reports and documented which reports and parameters needed
- Agency has received FIN EU training
- Agency has trained other finance users
- Agency has submitted ticket for Netsmart to clear finance testing data
- Netsmart has ran script to clear finance testing data
- Agency has updated billing-cutoff date in Agency info
Typical go live activities…
- Agency begins entering services to the system
- Agency adds new clients who start after go-live date, include benefit, dx, auth
- Agency chooses first run date, 1 week and/or 1 month after go-live etc
- Run pre-billing reports identified in FIN EU and any Agency defines
- First billing run in which report is reviewed, verify data, reprocess if corrections needed, Get Output and send, mark batch as sent.
- ► System Kickoff
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What Where Event Shortcuts Notes 1 Agency Setup Agency Setup > Agency > Agency- Project KO Wrench Utility/SQL Verify Foundations Scripts ran. Verify Administrator navigation. 2 Program Setup Agency Setup > Agency > Programs- Project KO Wrench Utility/SQL Verify Foundations Scripts ran. Verify Administrator navigation. 3 Facility Setup Agency > Service Locations > Sites/Residentials > Project KO Wrench Utility/SQL Verify Foundations Scripts ran. Verify Administrator navigation. 4 Capacity Agency > Service Locations > Sites/Residentials > Capacity Project KO 5 Service Setup Agency Setup-Event Setup-People-Event Category Project KO Wrench Utility/SQL Verify Foundations Scripts ran. Verify Administrator navigation. 6 Service + Program+ Facility Agency Setup-Services Setup-By Program-Ind. Services and/or Placement Enrollment Project KO Wrench Utility/SQL Verify Foundations Scripts ran. Verify Administrator navigation. 7 Setup a Staff Member (Client PM) Agency > Staff & Security > Staff Information > Personal Info Project KO 8 Assign Navigation Scheme Agency > Staff & Security > Staff Information > Staff Profiles with Security Project KO 9 Create a New Nav Scheme Agency Setup-Staff & Security Setup-Navigation Access-Access Definition Agency Setup-Staff & Security Setup-Navigation Access-Access to Forms Agency Setup-Staff & Security Setup-Navigation Access-Access to New Button 10 Create a New Worker Role Agency Setup-Staff & Security Setup-Worker Roles-Role Setup Agency Setup-Staff & Security Setup-Worker Roles-Security for Events Agency-Workgroups-Assigned to All-Information 11 Chart of Accounts etc. Finance Setup > General Setup > Setup Tables Finance KO Import Finance Setup Generic Schemes, Default Billing Rate Setup, Link 12 Submitter/Receiver Finance Setup > Agency Setup > Finance KO Import Finance Setup Generic Schemes, Default Billing Rate Setup, Link 13 Rates Setup Finance Setup-Payor/Contract Setup-Payors- Finance KO Import Finance Setup Generic Schemes, Default Billing Rate Setup, Link Finance Setup-Payor/Contract Setup-Plan/Contract Maintenance/Plan Setup Finance KO Import Finance Setup Generic Schemes, Default Billing Rate Setup, Link Finance Setup-Payor/Contract Setup-Self Pay Setup- Finance KO Import Finance Setup Generic Schemes, Default Billing Rate Setup, Link 14 Billing Rates Finance Setup-Billing Rates (A/R) Finance KO Import Finance Setup Generic Schemes, Default Billing Rate Setup, Link Finance Setup-Payor/Contract Setup-Plan/Contract Maintenance/Rate Setup Finance KO Import Finance Setup Generic Schemes, Default Billing Rate Setup, Link 15 Enroll a client in Program/Service Client Module Project KO In production just entering basics for a real client
- ► Checkboxes
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Where What Purpose 1 Agency Setup Enrollment required to receive services OP Program: Requires client to be enrolled in program before receiving services. 2 Agency Setup Show Non-Required Programs in service entry OP Program : Only if (1) unchecked. Hides programs that are not used for providing client services. 3 Agency Setup Services Created for Days of Placement OP Program: Tracks behind the scenes Census. Only if OP requires for billing. 4 Agency Setup Not attendance based service program OP Program: Uncheck if can be tracked in the Attendance Module. 5 Agency Setup Home Health OP Program: Allows additional functionality if HH. 6 Agency Setup Allow enrollment in the future OP Program: Allows client enrollment with future date, like a school. 7 Agency Setup Only show services from treatment plan on DSR OP Program: Daily service recorc, single point of data entry for services provdided to clients. Limits only services designated in a clients treatment plan to be entered using DSR. 8 Agency Setup Event Name Event: How it will display is use/reporting 9 Agency Setup Event Code Event: Optional, used for reporting 10 Agency Setup Is Active Event: Allows deactivation if not needed at a later time 11 Agency Setup Is Service Event Event: Makes it billable if a rate is attached. 12 Agency Setup Has Service form group Event: Required if (11) checked. Allows to be selected in service entry. 13 Agency Setup Requires Service Auth Event: Must have an authorization to perform services and be paid. 14 Agency Setup Has Multiple notes/Has a Single note Event: Self explanatory 15 Agency Setup Has particapants Event: Allows others being present or receiving the service on behalf of the client 16 Agency Setup Require participants Event: Requires entering at least one participant 17 Agency Setup Has materials Event: Allow the user to enter additional materials used (refers to table maintenance list) 18 Agency Setup Has assessment link Event: Will link an assessment to the event 19 Agency Setup Has treament plan link Event: Will link a treatment plan to the event, in accordance with plan goals 20 Agency Setup Require treatment plan link Event: Require the user to select a treatment plan goal 21 Agency Setup Can be scheduled Event: Can schedule events for yourself or others, part of a staff task list 22 Agency Setup Show task sub form Event: Read only form that will show scheduled tasks linked to an event 23 Agency Setup Can be individually entered Event: Can be entered by itself of Service Entry, uncheck if the event must be entered within a subform for another event. 24 Agency Setup Is date required Event: Date required in order to save the form 25 Agency Setup Validate against enrollment/discharge Event: Prevent from entering service prior to intake, events prior to enrollment would not check this. 26 Agency Setup Is Multiday event Event: Takes more than one day to complete, end date will indicate when completed. 27 Agency Setup Is initial event Event: Will be initially scheduled and if it will be used in workflow setup 28 Agency Setup Diagnosis Group Event: Used for billing purposes, would select a group of Diagnosis. 29 Agency Setup Is Controlling agency Agency: Applies to multi agencies only 30 Agency Setup Services cutoff date Agency: System will not create claims prior to 31 Agency Setup Billing cutoff date Agency: Go-Live date, must be on or after (30) 32 Agency Setup Billing mirror Agency: Used for retro payments, adjustments, and reporting. Number of years prior to the start of the FY to be refreshed. 33 Agency Setup Delete held claims Agency: System will delete and recreate held claims once the reason has been resolved. New claim number. 34 Agency Setup Held claim not recognized revenue Agency: Prevents held claims from having a balance until they are released; withholds held claim financials from reporting 35 Agency Setup Prevent services from billing again Agency: Claim will not be created more than once and will not double bill in event of benefit assignment/system changes. 36 Agency Setup Create deposit ticket with Electronic Remit Agency: Automatically creates deposit slip on the 835 import. Might not want to do if cash receipt is very delayed. 37 Setup Send alerts when billing starts Finance: All users logged into the system will get an alert. 38 Setup Auto assign vendor Finance: Auto assigns an ID each time a vender entered into the system. Otherwise a manual process. Vender=Pay To 39 Setup Print Direct deposit checks Finance: If need to print a stub, non negotiable will be printed on the stub. 40 Setup Create mirror claims and invoices Finance: Need to be checked if running census reports and certain finance reports. 41 Finance Setup Consolidate services Finance: Medicaid always consolidates. Always a day unless receiver states otherwise. 42 Finance Setup Consolidate if consecutive days Finance: Allows you to break the claim if if no billable disruption occurred during the service. 43 Finance Setup Create one unit per period Finance: If funder needs to see 1 unit on the claim regardless of the amount of services provided. 44 Finance Setup Include discharge date Finance: If checked, last day of client placement when client is discharged from the Agency, a claim will drop. 45 Finance Setup Rule name Placement Disruption: Name of the rule 46 Finance Setup Break on start and end time Placement Disruption: Use if rate setup allows for billing partial days that a client is on a disruption 47 Finance Setup Unit limit Placement Disruption: # of days billable if a billable event. 48 Finance Setup Bill Code Placement Disruption: Optional, pay may require a certain code to be included on the bills. 49 Finance Setup Is consecutive Placement Disruption: Whether to bill limit days, or to not bill the limit days once the limit is exceeded.
- ► Processing a Billing Run
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What Where Notes 1 Choose Submitter to Process a Bill under. Finance-Processing-Create Claims/Invoices-Processing for a Period *See Actions Crosswalk tab for which formset member to choose under "Processing" i.e. will not always be "Processing for a Period" 2 Produce a Billing Run. *Customize batch to your liking, remember that 837 funders may not accept multiple receivers if different Companion Guides/837 format is required…in this instance you would process just the one Receiver in the batch. 3 Receive Alert Billing Run Complete. *3 alerts…Started, Finished, Completed. 4 Open/Review Resulting Summary Data. *Clicking hyperlink of the receiver once claims produce within the batch. 5 Run Claim/Invoice Reports to see claim detail. *Click "Reports" than "Claims Produced (A/R)" 6 Download 270 eligibility request file. *Within above report, upload to funder. 7 Upload the resulting 271 file. Finance-Electronic eligibility verification-271-file *From the Payor. Populates in client record. 8 Get Output (Electronic or Paper). Finance-Processing-Create Claims/Invoices-Processing for a Period *Within above report "Get Output". 9 Send Output to the funder (837 or etc) *Electronic via Payor or Paper mail. 10 Upload 999 file. Finance-Accounts Recievable-Import 997/999-File *From the Payor if provided. Notice of receipt. 11 Mark Output as sent. Finance-Processing-Create Claims/Invoices-Processing for a Period *This will tell the system final run has been made. Also a visual indicator. 12 Upload a 277. Finance-Accounts Recievable-Import 277-File *Status file from Payor (Paid, Rejected etc). - Co-Pays process with the primary funders billing run, but the self-pay batch must also be processed in order to apply cash receipts.
- Items in Red are the minimum requirements to drop a claim in the system. Completing all steps would be best practice of course.
- ► Remittance - Cash Deposits
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Checks from Funding Source
Order of Operations What Where Notes 1 Enter a Deposit Slip with a "Deposit Date". Finance-AR-Deposit Slip/Batch Checks-Batch 2 Enter "Deposit Posted to the Bank" . Even if money hasn’t hit 3 Link one or more checks to the deposit slip. Checks/Cash from Clients
Order of Operations What Where Notes 1 Someone at agency enters a blank deposit slip. Finance-AR-Deposit Slip/Batch Checks-Batch Beginning of month 2 Enter the "Deposit Date" at the first day of the month. 3 Do NOT enter a "Deposit Date Posted to the Bank" on the deposit slip. 4 When Staff Collects Copay, enter in Self Pay receipt in Client module. Client > Client Information > Personal Information-Self Pay Receipts 5 On Receipt entry, you MUST link to a Deposit Slip. Slip in Step 1 6 If depositied later in the month create a new deposit slip if needed. Repeat 1-5 835 Remittance
Order of Operations What Where Notes 1 Import the 835 Remittance Finance-AR-Import Remittance Batch-Batch 2 Enter a Deposit Date on the import screen. Creates deposit slip auto
- ► Remittance - Applying $ or Action
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Paper Remittances
Order of Operations What Where Notes 1 Enter Deposit Slips and Checks (previous tab). Finance-AR-Deposit Slip/Batch Checks-Batch 2 Goto "Apply Receipts to Claims" area and open the receiver, select remittance, and other parameters. "Get claims". Finance-AR-Payer/Contract Remittance-Apply Receipts to Claims 3 Apply claim statuses using check boxes. Emoticon Faces 4 Enter any supplied reference information. *Funder provided: Ref #, Adjustment Groups/Codes 5 Work the claims via Actions and Action Reasons. Claims Adjudication 835 Remittances
Order of Operations What Where Notes 1 Import remittance file as described earlier. Finance-AR-Import Remittance Batch-Batch 2 Run the "Remittance Report" placing the 835 you loaded as a parameter Finance-Reports-AR-Remittance 3 Review report for claim statuses 4 For patially paid or denied claims goto the "No Action indicated or Performed" area and open the receiver. Finance-AR-Payer/Contract Remittance-No Action Indicated or Performed 4a Choose remittance as a parameter and "Get Claims" 4b Many claims with the same status/reason code can be given the same action through defined parameters. 4c Agency to determine action for partially paid claims, options differentiate based on client COB. 4d Agency to determine which Write Off action is appropriate in different situations. 5 For Paid Claims go to the "Apply Receipts to Claims" area and open the receiver. Finance-AR-Payer/Contract Remittance-Apply Receipts to Claims 5a Choose remittance as a parameter. 5b Choose billing run as a parameter and any additional Not required 5c Flag 'Include Processed Claims'. Click "Get Claims". 5d Work claims as needed. Could include overpayments or data changes requiring voiding, adjusting, paying a funder. Action Results for Paper or Electronic (Action Entered, No addt. Process needed)
Order of Operations What Where Notes 1 Write-Off and Overpayment actions auto apply to GL once saved in the "Apply Recipts to Claims" or "No Action Indicated or Performed" areas. 2 Other actions require additional billing runs once saved. For data change:R3-COB. R4-All other scenarios. New claims created for R3/R4 with links to old claims. Action Results for Paper or Electronic (Action Based Billing Run)
Order of Operations What Where Notes 1 Be sure client or setup data is updated. Various modules 2 Run billing runs with "Billed Though" date as of today. Finance-Processing-Create Claims/Invoices-Processing for a Period GL goes to current month 3 Work billing runs like regular processing. 3a Review reports to verify info corrected. 3b Get Output (File or Print) 3c Mark Batch as Sent
- ► Actions Crosswalk
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Category Action Applied to Claim Claim Status Billing Batch to run New Claim Created? (Invoice) Next Submission of Original Claim is Created? Examples Rebills R1-Resubmit to Same Payor Denied Re-Submit to Same Contract NO YES Benefit changes like Policy/ROI/Priority, utilize original claim. Also if you want to send again for not receiving payment. Rebills R3-Recreate Claim from Current Data Denied Recreate from Current Data YES NO Benefit Assignment changes such as deletion, new, and COB for already billed period. Rebills R4-Recreate Claim from Current Data to Same Payor Denied Recreate from Current Data to Same Payor YES NO All other scenarios such as Service/Placement, Discharge date, Diagnosis, Authorizations, Rate info, and Program Modifier for already billed period. Rebills A-Create Adjustment Claim Paid, Partially Paid Create Adjustment Claims YES NO Incorrect Intake date and overpaid. Length of Service. Always correct client data first. Rebills VR-Create Void Claim and Recreate from Current Data Paid, Partially Paid Void and Recreate YES (Void) YES (Recreate) Used when correcting Benefit Assignment information on Paid or Partially Paid claims. Creates Void Claim on previous claim AND New Claim on updated claim. Use Void and Recreate billing run with the Submitter being the original Funder. Transfers R2-Submit Unpaid Remainder to Next Payor Denied, Paid, Partially Paid Re-Submit to Next Contract NO YES Waterfall billing. Transfers R5-Bill Remainder Directly to Self-Pay Denied, Partially Paid No special run needed, next submission of original claim will be created and attached to open self-pay batch. If no open self-pay batches, then will be attached to the next billing run batch. NO YES Waterfall billing exhausted. Transfers MR2-Submit Unpaid Remainder to Next Payor Overpaid Re-Submit to Next Contract NO YES Used when transferring Manual Claims OR when transferring claim to a different Billing Sequence than the next Billing Sequence. Transfers PTI-Pass Through Invoicing Create Pass-Through Invoices YES NO Used when receiving payment which is immediately transferred on to a Client or Outside Organization via AP. This is most common for Foster Care payments from Funders to families through the Agency. Voids/Refunds V-Create Void Claim Paid, Partially Paid Create Void Claims NO YES Service entered in error, overpaid. Voids/Refunds VI-Create Credit Invoice Paid, Partially Paid Create Credit Invoices INVOICE NO Service entered in error, overpaid. Voids/Refunds VIO-Create Credit Invoice for Overpaid Amount Overpaid Create Invoices for Overpayment Invoice NO Used when a Funder has overpaid on a service and Agency wants Funder to recoup just overpaid amount via refund check to Vendor and corresponding AP Account on Plan/Contract Setup. Creates New Invoice. Use Create Credit Invoices for Overpayments billing run. Voids/Refunds VR-Create Void Claim and Recreate from Current Data Paid, Partially Paid Void and Recreate YES (Void) YES (Recreate) Used when a Funder has paid on a service which should have been billed to another Funder and Agency wants Funder to recoup payment via take back. Creates Void Claim on previous claim using corresponding Liability GL Account on Plan/Contract Setup and New Claim on updated claim. Use Void and Recreate billing run with the Submitter being original Funder. Other DR-Delete and to Pre-R2 Denied Re-Submit to Next Contract NO YES Only for claims with R2 performed. Waterfalled but later realized missing funder. Proceed with new R2 run. Resolutions WOR-Write-off Remainder to Bad Debt Partially Paid No special billing run needed NO NO Used when writing off the full balance (or remaining balance with WOR) to corresponding GL Account on Plan/Contract Setup called Write-off Expense (Bad Debt) Account. There is no billing run. Resolutions WORA-Write-off Remainder to Revenue Adjustment Account Partially Paid No special billing run needed NO NO Used when writing off the full balance (or remaining balance with WORA) to corresponding GL Account on Plan/Contract Setup called Write-off Revenue Account. There is no billing run. Resolutions WORJ-Write-off Remainder & Reverse GL Transaction Partially Paid No special billing run needed NO NO Used when reversing Revenue on the full balance (or remaining balance with WORJ). There is no billing run. Resolutions WORP-Write-off Remainder to Prior Year Account Partially Paid No special billing run needed NO NO Used when writing off the full balance (or remaining balance with WORP) to corresponding GL Account on Plan/Contract Setup called Write Off to Prior Year Write-off Account. There is no billing run. Resolutions WORS-Write-off Remainder to Fee Adjustment Account Partially Paid No special billing run needed NO NO Used when writing off the full balance (or remaining balance with WORS) to corresponding GL Account on Plan/Contract Setup called Write-off Fee Adjustment Account. There is no billing run. Resolutions WO-Write-off to Bad Debt Denied No special billing run needed NO NO Used when writing off the full balance (or remaining balance with WOR) to corresponding GL Account on Plan/Contract Setup called Write-off Expense (Bad Debt) Account. There is no billing run. Resolutions WOA-Write-off to Revenue/System Adjustment Denied No special billing run needed NO NO Used when writing off the full balance (or remaining balance with WORA) to corresponding GL Account on Plan/Contract Setup called Write-off Revenue Account. There is no billing run. Resolutions WOJ-Reverse GL Transactions Denied No special billing run needed NO NO Used when reversing Revenue on the full balance (or remaining balance with WORJ). There is no billing run. Resolutions WOP-Write-off to Prior Year Account Denied No special billing run needed NO NO Used when writing off the full balance (or remaining balance with WORP) to corresponding GL Account on Plan/Contract Setup called Write Off to Prior Year Write-off Account. There is no billing run. Resolutions OP1-Allocate Overpayment to Overpayment Account Overpaid No special billing run needed NO NO Used when a Funder has overpaid on a service and Agency anticipates a future take back from the Funder and corresponds with GL Account on Plan/Contract Setup. OP1 is considered a Liability Account. There is no billing run Resolutions OP2-Allocate Overpayment to Revenue Account Overpaid No special billing run needed NO NO Used when a Funder has overpaid on a service and Agency considers the overpayment as Revenue. OP2 simply increase the Revenue Account on the claim by the overpaid amount. There is no billing run. Resolutions OP3-Create New Submission Line for Overpayment Overpaid No special billing run needed NO YES Resolutions OP4-Allocate Overpayment to Overpayment Account (Alternate Account) Overpaid No special billing run needed NO NO Used as an alternative account to OP1 following the same rules as an OP1
- ► Imports / Exports
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Type File Description In Evolv? Location Claim 837i/p Claim Submission Out Yes Finance > Processing > Create Claims/Invoices > Processing for a Period Remittance 835 Claim Submission In Yes Finance > Accounts Receivable > Import Remittance Batch > Batch Remittance .csv or .xls Import Remittance: allows manual import of remittance to claim records, but only accepts .csv or .xls files -- designed to allow agencies to quickly enter bulk Remittance to claim records vs. manually entering them by hand thru the front end. Yes Finance > Accounts Receivable > Import Remittance Batch > Batch Acknowledgement 997 Claim Submission Acknowledgement Yes Finance > Accounts Receivable > Import 997/999 File Acknowledgement 999 Claim Submission Acknowledgement (updated version of 997 which contains more error information) Yes Finance > Accounts Receivable > Import 997/999 File Claim Status 276 Claim Status Inquiry Out No Claim Status 277 Claim Status Inquiry In Yes Finance > Accounts Receivable > Import 277 > File Eligibility 270 Benefit/Eligibility Coverage Out Yes Finance > Electronic Eligibility Verification > 270 > File Manager Eligibility 271 Benefit/Eligibility Coverage In Yes Finance > Electronic Eligibility Verification > 271 > File Authorization 278 Prior Authorization Review Request/Response Yes Finance > Electronic Health Care Services Review > Import 278 > File Authorization .csv or .xls Import Authorizations: allows manual import of authorizations to client records, but only accepts .csv or .xls files -- designed to allow agencies to quickly enter bulk authorizations to client records vs. manually entering them by hand thru the front end. Yes Finance > AR > Billing Auth Import > Authorization Files
- ► General Ledger
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Contra account is a holding account until actions allocate the money.
Claim Creation I.e. $100 claim AR is debited $100 Billed Revenue is credited $100 Write-Off to Bad Debt I.e. received check for $60 of expected $100 UAR account is debited ($60) Paid AR is credited ($60) 100-60=40 Write-Off Account is debited ($20) 100-80=20 balance AR is credited ($20) 20-20=AR balance Delete Held Claim When your held claim is assigned a new claim number AR account is debited $39 Original Revenue account is credited $39 Original AR account is credited $39 Upon new claim number Revenue account is debited $39 Upon new claim number Denied Claim on 835 Import Denied no GL occurs…..unless you have the Default Actions defined on the Plan/Contract Paid/Partially Paid on 835 Import Cash Transaction is to Debit Cash and Credit Temp UAR Paid/Partially paid portion is to Debit Temp UAR and Credit AR R3/R4 Actions Original claim Revenue and AR are reversed in the GL month of the date entered in "Claim with dates up to" on the billing run. Debit Rev and Credit AR New claim Debit AR and Credit Revenue. Write-Off Action Reverses the GL transactions for the amounts associated to Write-Off. AR and Write-Off accounts. Adjustment and VR Actions AR balance is cleared R2 Actions R2-Contra: Contra account is cleared with a Debit next to with a Debit to the next contracts AR Account R2-Revenue: When marking claim as sent system will Debit AR on next contract as well as Credit Revenue on the next contract
- ► Accounts Payable
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Order of Operations What Where Notes BILLING RUN 1 Choose Submitter to Process an Bill under. Finance-Processing-Create Claims/Invoices-Processing for a Period 2 Produce a Billing Run. 3 Receive Alert Billing Run Complete. *3 alerts…Started, Finished, Completed. 4 Open/Review Resulting Summary Data. *Clicking hyperlink of the receiver once claims produce within the batch. 5 Run Claim/Invoice Reports to see claim detail. *Click "Reports" than "Invoices Produced (A/P)" CHECK BATCH AND PRINTING 6 Batch Check by choosing AP Account Finance-Processing-Create Checks (A/P)-Processing 7 Click New and then "Checks Log" 8 Set Parameters. 9 Review that Vendors hyperlinks for details and historical. Outstanding Invoices tab in particular. NOT A DIMINISHING LIST…DO NOT CONFUSE AS REPEATING CHECKS. 10 Select check box next to Facility. Click "Proceed" Real-Time Produced. No waiting. 11 Click on the Facility Link and then Report to review results. This gives you a list of checks Produced. 12 Click on the Check Number within the report to see details such as Invoices and GL. 13 Click "Print Checks" EVEN IF NOT PRINTING FROM MYEVOLV….MUST GO THROUGH MOTIONS. IF JUST USING FOR GL ONLY YOU DON'T PHYSICALLY HAVE TO SEND IT TO THE PRINTER. JUST HAVE TO MAKE IT TO THE "EvolvCS Check Printing Utility" UPDATES TO PAYMENTS (Past Paid Invoices) 1 Update Program Enrollment/Benefit Assignment Client > Client Information > Critical Information-Enrollment Information Likely tied to Program Enrollment Modifiers if Enrollment. 2 Navigate to the System Utilities Module "Wrench Icon" Taskbar-System Maintenance-Application Maintenance-Utilities. 3 Run "Create Mirror Services and Billing" Utility 4 Navigate to the Past Invoice Verfication Finance-Reports-Accounts Payable-Past Invoice Verification 5 Parameter as needed w/Report Selection=Retro Adjustment Form 6 Click "Preview" Shows Actual vs. Correct Payments. Noting you cannot send a Negative and must recoup over time by selecting as many adjustments as you can per run. Also note if you can get an error it may be because Mirror utility isn't done yet. 7 Choose the AP Account to use and the desired adjustment checkboxes. Click "Proceed" 8 Check Batch and Printing process now or wait until normal Period. VOIDING A CHECK 1 Select the check in question and click "Is Voided" Finance-Accounts Payable-Check Register-Check Information Once saved the invoices release Line 24/25 above NEW CHECK AS A REPLACEMENT OF A VOID 1 Select AP Account. Click "New" then "Checks Log" Finance-Processing-Create Checks (A/P)-Processing 2 Parameter as needed. Check Facility box. Click "Proceed". 3 Click on the Facility and view the report. Should show the originals and the adjustments 4 Repeat the Printing Process Important: Please note that system will NOT generate invoices for Foster Home where child was transferred to in the middle of the month. System will not do this for the first month only. So we will need to create manual invoice and send to new Foster Parents as a separate check this month or include it in to the next month check .
- ► Finance Form Design
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If Correlated (Group #) Type of Form Topic Where Which Form Family Insert Action Column to Use Notes 1 Service Entry for New Fields "Do Not Bill" checkbox Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Do Not Bill Indicator Will stop the service from dropping a claim 2 Service Entry for New Fields "Do Not Pay" checkbox Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Do Not Pay Indicator Will stop the service from dropping an invoice 3 Service Entry for New Fields "Is E/M?" checkbox Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Is E/M Service Notes the Service will have E/M functionality 3 Service Entry for New Fields "E/M Patient Status " Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" E/M Patient Status New vs Establised by Location Type 3 Service Entry for New Fields "E/M Examination" Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" E/M Examination Comprehensive, Detailed…etc 3 Service Entry for New Fields "E/M History" Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" E/M History Comprehensive, Detailed…etc 3 Service Entry for New Fields "E/M Med Dec Making" Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" E/M Med Dec Making High, Low…etc 3 Service Entry for New Fields "E/M CPT Code" Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" E/M CPT Code Based on the above filters down to allow the clinician to select the CPT Code. 4 Service Entry for New Fields "No Show" checkbox Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Is No-Show Will stop the service from dropping a claim or invoice. 4 Service Entry for New Fields "Reason for No Show" Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Reason for No Show Will display a field tied to a maintenance table in which would allow them track reasons for No-Show 5 Service Entry for New Fields Actual Date Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Actual Date Actual Date & Time field 6 Service Entry for New Fields Approval Sent To Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Approval Sent To If needs additional person other than Supervisor to approve. 7 Service Entry for New Fields Duration Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Duration Duration Field 8 Service Entry for New Fields Duration Other Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Duration Other Duration Field for time not to be counted in Billing. In example perhaps they want to track productivity so this field will give them the breakout vs. billable time. Factors into Productivity canned reports. 9 Service Entry for New Fields End Date Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" End Date End Date & Time field 10 Service Entry for New Fields Units Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert EventLog Field" Units Can enter Units on the form for reference if needing to track 11 Service Entry-Report 271 Eligibility History Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" 271 Eligibility History Clinicians will be able to see if Insurance is valid for the Date of Service. 12 Service Entry-Report Active Benefit Assignments for Client Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Active Benefit Assignments for Client Will show the active list of Insurances on file 12 Service Entry-Sub Form Benefit Assignment Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert Eventbased SubForm" Benefit Assignment Will allow you to add a new insurance to Benefit Assignments directly from the Form 12 Service Entry-Sub Form Benefit Assignment Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert Eventbased SubForm" Benefit Assignment Will allow you to add a new insurance to Benefit Assignments directly from the Form 13 Service Entry-Report Billing Authorizations Used Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Billing Authorizations Used Real Time Balances 14 Service Entry-Report Clients Claims 90 day Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Clients Claims 90 day Billing claims on file last 90 days 15 Service Entry-Report Co-Pay Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Co-Pay Co-Pay based on Benefit Assignments 16 Service Entry-Report Diagnosis (People) Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Diagnosis (People) Diagnosis information for the person on file historically. 17 Service Entry-Report Diagnosis (People-Current) Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Diagnosis (People-Current) Current Diagnosis information for the person 18 Service Entry-Report Medicaid Number for a Person Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Medicaid Number for a Person Will display clients Medicaid Number from the Benefit Assignment Policy # field. Payer must be a type MC. 19 Service Entry-Report Placement Disruptions (Current) Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Placement Disruptions (Current) Current list of persons Placement Disruptions 20 Service Entry-Report Self Pay Balance Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert UDF Report" Self Pay Balance Balance of all Self Pay Checks and Mirror Billing 21 Service Entry-Sub Form Diagnosis Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert Eventbased SubForm" Diagnosis Will allow you to add a Diagnosis that is event specific. Useful for Primary Care etc where this Diagnosis would be used to override the Health Information Diagnosis. 22 Service Entry-Sub Form Activities-Other Setup-User Tools-Form Designer-Form Designer Activities-People, Tests and Assessments (People)….etc "Insert Eventbased SubForm" Activities-Other Will allow you to enter Sub-Events within the Host Event form. In some cases Billing will be tied to sub-events as not all of the sub-events would be billable. I.e. Add-On events inside of an Office Visit. Or perhaps Targeted Case Management is the event but we have items we need to track as sub-events and not all are billing......Office Time vs. Travel Time.
- ► Event Scheduling - Workflow Setup
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Order of Operations What Where Notes 1 Create Workflow Header Agency Setup-Workflows Setup-By Type-Workflow Header 1a Modify Workflow Header Agency Setup-Workflows Setup-By Type-Workflow Header 1b Delete Workflow Header Agency Setup-Workflows Setup-By Type-Workflow Header 2 Create Workflow Rule Agency Setup-Workflow Setup-By Type-Client Qualifiers-Details who the workflow rule applies to. Trigger-If Qualifier is met, sets the workflow in action. Initial occurs once like program start date. Ongoing can be completed numerous times. Event-Scheduled once trigger occurs. "Can be scheduled" must be checked on the event setup. Schedule-Single Occurrence or Recurring Occurrence time frames. Can have multiple. 3 View Event Setup details Agency Setup-Event Setup-People-Events Setup
- ►Tests & Assessments
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Order of Operations What Where Notes 1 Create a new answer set Setup-Treatment and Tests-Test Setup-Answers Library 2 Creat new Interpretation set Setup-Treatment and Tests-Test Setup-Interpretation 3 Create a new domain Setup-Treatment and Tests-Test Setup-Domain 4 Create a new test Setup-Treatment and Tests-Test Setup-Test Design/People 4a Review existing test Setup-Treatment and Tests-Test Setup-Test Design/People 4b Copy an existing test Setup-Treatment and Tests-Test Setup-Test Design/People 4c Modify test form Setup-Treatment and Tests-Test Setup-Form Designer 5 Create test event Setup-Treatment and Tests-Test Events for People-Test Events 6 Link test event to program Agency Setup-Services Setup-By Program-Individual Services
- ► Treatment Plans
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Order of Operations What Where Notes 1 To select a category Setup-Treatment and Tests-Treatment Setup-Category 2 To add a problem/need Setup-Treatment and Tests-Treatment Setup-Problem/Needs Setup 3 To add a strength Setup-Treatment and Tests-Treatment Setup-Strengths Setup 4 To add a Goal Setup-Treatment and Tests-Treatment Setup-Goals Library 5 To add an objective Setup-Treatment and Tests-Treatment Setup-Objectives Library 6 To add a method Setup-Treatment and Tests-Treatment Setup-Method Library 7 Link domain to category Setup-Treatment and Tests-Treatment Setup-Linked Domains 8 Create a treatment plan hierarchy Setup-Treatment and Tests-Treatment/Other-Treatment Plan Designer 8a Create a treatment plan hierarchy Setup-Treatment and Tests-Treatment/Other-Treatment Plan Designer 9 Copy/Modify treatment plan component form Setup-Treatment and Tests-Treatment/Other-Design Plan Components 10 To link a treatment plan component to a library Setup-Treatment and Tests-Treatment/Other-Organize Plan Components 11 Modify steps in a treatment plan Setup-Treatment and Tests-Treatment/Other-Treatment Plan Steps Designer 12 To create the initial plan event Setup-Treatment and Tests-Treatment Plan Events-Initial Plan Events 13 Associate Plan Event to a program Agency Setup-Services Setup-By Program-Plan Setup