Bypass Prebilling Validations

Even if a visit does not meet one of the validations covered in the previous section, it may avoid being held if the Service Code associated with the visit is setup to bypass Prebilling validations. This section covers how to setup a Service Code to bypass Prebilling validations as well as which validations may be avoided using this feature.

Complete the following steps to setup a Service Code to bypass Prebilling validations.

  1. Go to Admin > Reference Table Management.

  2. Select Contract Service Code from the Reference Table dropdown. Click the Add button to create a new Service Code or click theService Contract link to edit an existing one.

  3. The Contract Service Code window opens. Select the Bypass Prebilling Validations checkbox.

    There is an option to bypass Billing Review validations on this window.

    Bypass Prebilling Validations

  4. Click Save.

The below-listed Prebilling validations are exempt if Prebilling Bypass options are selected for Service Codes assigned to scheduled visits.

  • Authorization

  • Caregiver Compliance

  • Clinical Documentation

  • Insufficient Duty Minutes

  • Medicaid Compliance

  • Overlapping Shifts

  • POC Compliance

  • Timesheet

  • Unbalanced Visit

To bypass the Authorization validation, visits completely ignore a Patient’s Authorizations. This means the visit is exempt from any rules stipulated by the Authorization. Additionally, the visit does not affect the number of hours or units allotted for visits in the Authorization.

On the Patient Calendar page, any visit scheduled with a Service Code setup to ignore Prebilling validations display in white to indicate it is governed by any Authorizations:

Visit Scheduled with Bypass Prebilling Validation Service Code

Required to successfully process payroll, the following Prebilling validations remain in effect, even when Bypass Prebilling Validations is selected for a Service Code:

  • Incomplete Confirmation

  • With TEMP Caregiver

  • OT/TT Not Approved

  • Restricted Caregiver

The fields Place of Service, Allow Temporary Caregivers, and No Authorization Required for Billing in the Contract Service Code window under Admin > Reference Table Management > Contract Service Code allow Providers to bypass prebilling rules for visits that do not require EVV Electronic Visit Verification. When any of these is selected, Providers can bill visits associated with the Service Code, without these issues at prebilling.

These bypass prebilling rules settings vary per Service Code and selected Contract. For example, if an Internal Contract is selected, then all fields are available to select/edit by the Provider. Place of Service is prepopulated according to the information in the system for the Contract. All fields are optional for Providers when an Internal Contract is selected.

Contract Service Code: Bypass Prebilling Rules Settings

Bypass Rule

Description

Place of Service

Select the place of service (POS) from the dropdown (Home, Telehealth, Telephone, Community Center, etc.). Click thePlace of Service Code Set link to see available options.

The system allows only one service location per contract.

Allow Temporary Caregivers

Select to allow billing when a TEMP Caregiver is assigned to the visit.

No Authorization Required for Billing

For some services an Authorization is not necessary, particularly for minimal services performed less frequently. This setting is typically at the contract level and now also available at the Service Code level.

For Linked Contracts, all three fields are read-only and not available to edit.

Linked Contract Service Code: Bypass Prebilling Rules Settings