E-Billing with Configurable Overrides

A Group is defined as a collection of Offices that have the same E-Billing override settings. To add or edit an Office Group Configuration, click the Edit link.

The E-billing Configuration screen opens with the Default tab selected. The Default tab contains the default settings for the Contract fields serve as a template and are not editable. Default settings (values) are initially defined by System Administration in conjunction with an Agency. To add a group, click the Add Group button.

The E-Billing Office Groups window opens. Enter a Group Name in the required field marked with a red asterisk. If applicable, specify Start and/or End Date, to specify a time frame during which the E-Billing overrides should be applied. From the dropdown menu, select the applicable Offices which are part of the group.

Click the Save button to finalize. Click OK on the confirmation.

Once the Group is saved, it appears as a tab in the E-Billing Configuration window. In this example, a group named Manhattan has been created which includes 2 offices UAT-Exclusion and Billing/Payroll and has E-Billing override values to be used starting 6/1/2018 without any specified end date.

From this window the Values can be configured accordingly. In addition, the Office(s) as well as the Start/End Dates can be updated by clicking the Edit link. Click the Save button to save any changes.

• To remove applied changes and reload the last saved information, click the Reset button.

• To delete the Group, click the Delete button.

The Billing Diagnosis Code functionality applies to both Billing Diagnosis Update types and Validation rules and is the same as the Mileage functionality for visits.

There are 3 options when updating a diagnosis including: update Diagnosis for one Individual record, All records within the invoice, or All records within the billing batch.

On the Cash Payment module, the Mileage feature is implemented in the following pages: Search Payment, New Payment, New Refund, Search Invoice, and Bulk Adjustments (same as visit).

Several Billing Review validation rules apply to Mileage, where required fields must include values, such as Patient Name, Patient Address, Caregiver NPI Number, etc.

The following rules do NOT apply to Billing Review, but are used in Export process:

• Bill all visits on the same day with the same Service Code in 1 claim (Medicaid Flag).

• Bill the visits with same Patient, same Visit Date and same Export Code in one LX loop.

• TRN Number Required

• Require Delay Reason Code when visits in claim are older than limit.

In the Collection Module (Action > Collection), Add TRN (link to add a TRN) and + (link to Add Notes) have been added for Mileage Events, as illustrated in the following image.

1. Go to Billing > Electronic Billing > E-Submission Batches to locate the E-Billing batches. There are two options to export claims/visits according to configured e-billing groups.

   • Click the Batch Number link to view details and export, or

   • Select the Export option under the Actions column to export directly.

     

2. Click the Batch Number to view the Batch Details. Click the Export button to continue.

   

3. Click the Export button to open the Export E-Submission Batch Claim window. Click the Download button to continue.

   

   Additional files may appear available to download if there are other associated Office groups.

4. The downloaded file appears on the lower left side of the screen. Click thefile and follow the system prompts to open the file.

   

The Mileage Event feature in the e-Billing and Cash Payment modules provide the ability to export mileage and post payments against new Mileage Events. Use this feature to create claims, resubmit claims and post payments against invoices with mileage. The following sections demonstrate how mileage is shown in the various applicable screens.

Once the E-Billing Configuration is activated, go to the Admin > Contract Setup > Billing/Collections tab and select the Enable Office Level E-Billing Configurations checkbox to set up overrides. If this option is not activated, then this checkbox (option) does not display in the Billing/Collections tab.

Once selected, the Office(s) field populates; otherwise the message No office selected is displayed. Click the Edit link to go to the E-Billing Configuration page to add or edit applicable Offices.

Once an Office Group E-Billing Configuration has been set, a list of groups and associated offices display to include the Group Start and End Dates. Click the Edit link to update as needed or to add new groups.

To prevent accidentally deleting any Office E-Billing Configurations, the system has been set with a double-alert warnings in the Billing/Collection tab of Contract Page.

An Office E-Billing Configuration cannot be removed if the following conditions apply:

• the Enable E-Billing Office Configurations checkbox is selected, and

• there is data (visits) in at least one office configuration.

If the Enable E-Billing Office Configuration checkbox is deselected, then the system alerts with the following messages in respective order:

• This action will DELETE all office configurations in addition to deactivating this feature. Are you sure you want to do this?

  • Select Yes to proceed or No to cancel.

• Confirmation. This action will DELETE ALL OFFICE CONFIGURATIONS. Are you sure you want to do this?

  • Select Yes to disable Office Configurations and delete ALL Groups (NOT ALL OFFICES).

  • Select No to cancel.

On the Resubmit Claims E-submission Batch page, mileage is indicated under the Schedule column. The functionality mirrors that of a visit; click the Edit icon to edit mileage and resubmit as an Adjustment of Void.

After mileage is billed and E-billing roles are satisfied, mileage records display on the Claim Search page. From here, select and add/delete a Mileage Event to the original claim e-submission batch window (just like a service). The following image displays the various columns where mileage is indicated:

• The Billed Hours column displays the number of miles

• The Billed Units column displays number of units

• The Billed Amount column provides the total billed amount