Shows clients without an Active Benefit Assignment on the date of the service. Note: Benefit assignment may be absent altogether, ended before the service date, or started after the service date. The utility is not checking if the client’s benefit assignment was set up to bill the service.
02 Contract Setup - Program and Service
myEvolv checks if the contract is set up for the program and the service type of the service being checked. Note: The utility is checking only for program/service combination. Other variables are checked separately.
03 Contract Setup - Group Profile Type
myEvolv checks if the group profile type of the facility providing the service matches the one set up on the contract.
04 Contract Setup - Group Profile
myEvolv checks if the facility providing the service matches the specific one set up on the contract.
05 Contract Setup - Program Modifier
The program modifier at the time of service did not match the one set up on the rate link; a service was provided where the client was enrolled into a different program enrollment modifier (or none at all) than what was set up on the contract. Note: This only applies if there is no Program Modifier - All option set up on the contract/rate. Note: This also applies if there is no program modifier enrollment at the time of service, and the rate with No Modifier is not set up.
06 Contract Setup - Managing Office
A rate is configured for a specific managing office, but the billable service is provided at a facility linked to a different managing office, and there is no All Managing Offices option.
07 Contract Setup - Service Authorization
A rate is flagged with Service Authorization Required but the service was provided without a Service Authorization. Note: This only applies to agencies that use Service Authorization logic, not Billing Authorization logic.
08 Contract Setup - Prevent Non-timely filing
When a contract is set up with the Prevent Non Timely Filing flag, myEvolv looks at Number of Days for Timely Entry. Based on the number of days entered in that field, myEvolv returns any services entered after the number of days specified from the date of service. For example, if the number 30 was entered into that field, myEvolv returns any services entered 31 days after the date of service. Note: This reason is not affected by the date the service is billed.
09 Contract Setup - Provided after Due Date
The service was completed after the Due Date on the scheduled service. Note: If no due date was entered, the scheduled date is used for comparison.
10 Rate Effective on Date of Service Not Found
The service was provided outside the rate effective date (before Effective Date or after End Date).
11 Staff credentials providing service are wrong for the service
The service was configured for a specific staff credential, but the service was provided by staff members without that credential.
12 Duration of the service does not match the duration on the rate set-up
The duration for the service was outside the duration on the rate setup. For example, the rate was set up with a minimum time of 0 and a maximum time of 60 (minutes), but the service was entered with a duration of 2 hours.
13 Rate effective for client age is not found
A rate is set up with a specific age range, but the service was provided for a client outside the age range.
14 Plan Setup - Service Must Be Locked
To be considered locked, a service must either be e-signed or submitted for approval. Services do not need to be approved to be considered locked. No claims and/or invoices will be created (or held) if the service is not locked.
15 Incident-To Event Has No Incident-To Supervisor
