Centricity® Services - Cpstraining

Transcription

GEHC IT
Centricity®
Practice Solution Practice Management
Administration
CPS 9.0 Training Manual
Centricity® Services
Table of Contents
Administration………..……………………..………...……...………………… 4
List Editor vs. Edit Menu.…. ……………………..…………................ 5
Schedule Folder ..……………………………………………………………….. 6
Registration Folder…………………………………………………………….. 11
Financial Folder .…………….………………………………………………….. 27
Claims Folder…………….……………………………………....................... 36
Reports Folder…………………………………………………………………….. 80
Codes Folder…………………..………………………………....................... 82
System Folder…………...………………………….…………………………….. 85
Allocation Set………………………..…………………………………………….. 101
Appointment Type………………………...……………………………………. 103
Batches……………………………...………………………………………………… 105
Charge Sets…………………………………………………………………………. 106
Clearinghouse Settings……………...……………………………………….108
Companies……………………..……………………………………………………. 114
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Confidential and Proprietary Information
GEHC IT
Centricity®
Practice Solution Practice Management
Administration
CPS 9.0 Training Manual
Centricity® Services
Table of Contents (Continued)
Diagnosis…………………………………………………………………………….. 121
Employers……………………………..…………………………………………….. 123
Facilities………………………………….……………………………………………. 124
Fee Schedule………………………………………………..………………………139
Guarantor……………………………………………………. …………………….. 147
Insurance Carriers……………………………………………………………….148
Insurance Groups……………………………………………………………….. 163
Inventory Items…………………………………………………………………… 165
Pharmacy……………………………………………………………………………. 168
Plug-ins………………………………………………………………………………… 169
Procedures………………………………………………………………………….. 170
Referring Provider………………………………………………………………. 179
Resources……………………………………………………..…………………….. 184
Responsible Provider………………………………………………………….. 185
Transaction Column Sets…………………………………………………… 208
Vendors………………………………………………………………………………… 217
Zip Codes……………………………………………………………………………… 219
Batch Closing, Batch Closing Override, Closing Date…….. 220
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Confidentiality and Proprietary Rights and Limitations and Conditions of Use
This document is the confidential property of GE Healthcare, a division of General
Electric Company (“GE Healthcare”) and is furnished to you, a current GE Healthcare
customer, pursuant to an agreement between you and GE Healthcare. If you are not
(i) a current GE Healthcare customer, and (ii) subject to a non disclosure obligations
pursuant to an agreement with GE Healthcare, you are not authorized to access this
document. No part of this document may be reproduced in any form, by photostat,
microfilm, xerography, or any other means, or incorporated into any information
retrieval system, electronic or mechanical, without the written permission of GE
Healthcare. Contact your GE Healthcare representative with any inquiries regarding
copying and/or using the materials contained in this document outside of the limited
scope described herein.
GE Healthcare reminds you that there may be legal, ethical, and moral obligations for
medical care providers to protect sensitive patient information when dealing with
vendors such as GE Healthcare. You should obtain explicit written consent from both
the patient and GE Healthcare before you disclose sensitive patient information to GE
Healthcare.
Trademarks
GE, the GE Monogram, and Centricity are trademarks of General Electric Company. All
other product names and logos are trademarks or registered trademarks of their
respective companies
Copyright Notice
Copyright 2009 General Electric Company. All rights reserved.
Disclaimers
Any information related to clinical functionality is intended for clinical professionals.
Clinical professionals are expected to know the medical procedures, practices and
terminology required to monitor patients. Operation of the product should neither
circumvent nor take precedence over required patient care, nor should it impede the
human intervention of attending nurses, physicians or other medical personnel in a
manner that would have a negative impact on patient health.
General Electric Company reserves the right to make changes in specifications and
features shown herein, or discontinue the products described at any time without
notice or obligation. This does not constitute a representation or warranty regarding
the product or service featured. All illustrations or examples are provided for
informational or reference purposes and/or as fictional examples only. Your product
features and configuration may be different than those shown.
GE Healthcare IT
540 West Northwest Highway
Barrington, IL 60010 U.S.A.
www.gehealthcare.com
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Administration
The Administration component of Centricity Practice Solution 9.0 (CPS)
software may be accessed from the Main Menu screen by clicking on the
Administration button. This window is also accessible by clicking on the
Administration icon at the top of the Main Menu screen. Likewise, using
the tool bar, the Administration module can be accessed by clicking on
File, Open and Administration. The Administration component is
where all the user defined tables are created that will be used throughout
CPS. There are two main areas used to customize CPS to your practice.
They are the List Editor and the Edit Menu.
4
List Editor vs. Edit Menu
The List Editor contains
tables that generally
build drop-down box
lists used throughout
the product.
The Edit Menu contains
tables that build earchable
fields used throughout the
product and may draw from
the drop-down box lists
created in the List Editor.
When the Administration component opens, the List Editor displays along the
left side of the window.
The following folders will be utilized:
•Schedule
•Registration
•Financial
•Claims
•Reports
•Codes
•System
The Edit Menu is accessed by clicking Edit on the toolbar. Each table listed
under Edit Menu will determine searchable fields that will be used within the
product.
We will begin with the List Editor in this manual, then follow with the Edit
Menu.
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Schedule Folder - Appointment Cancel
Appointment Cancel options set up explanations associated with the
cancellation of appointments. The product comes shipped with a few standard
cancel reasons, and more can be added as desired by the practice.
To add a new Appointment Cancel reason, click New, then enter a short
description in the Description field. The system will generate an ID number upon
saving this table. In the Delete Appointment field, mark if the appointment is to
be deleted from the patient’s history or not. If the Delete Appointment field is
marked “N”, then the appointment will be removed from the schedule, but the
patient’s appointment history will be marked with this appointment and reason for
cancellation.
If the Delete Appointment field is marked “Y”, then the appointment will be
removed from the schedule and there will be no historical evidence of this
appointment on the patient’s appointment history as well. Generally speaking, this
option would be for Operator Error or similar situations where the patient’s
appointment history should not be marked.
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Schedule Folder - Appointment Status
Appointment Status options track the current standing or status of an
appointment (for example, patient reminded, on time, no show, confirmed, left
message, arrived, completed, etc.).
Centricity Practice Solution comes shipped with Appointment Statuses of Arrived
and Completed. The status of Arrived is when a patient is marked as “checkedin” on the schedule, while the status of Completed is marked when payment is
received from the patient for the visit. All other Appointment Statuses are user
defined and added to this table during the Administrative set-up. Generally those
statuses added are those used for appointment confirmation purposes.
Each status can have a color associated with it. As seen in this example, the
status of Arrived is Blue. Double click in the Color field to see color options
available. The color chosen for each status will display on the left side of the
patient appointment on the schedule and will change as the status is changed for
that appointment.
The Category field is used to indicate if the associated status is “Checked-in”,
“Checked out”, or “Neither”. Checked-in is generally used for the status of
Arrived, Checked-out is generally used for the status of Completed, and Neither is
for any other status created that does not related to checked-in or out.
Notes can be added, as desired, for each Appointment Status.
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Schedule Folder - Recall Method
Recall methods are associated with each patient record. The Recall Method table
Identifies the method by which the patient is contacted (for example, letter, email,
phone, other) for Recalls.
Create a Recall Method list option:
1. In the Schedule folder, select Recall Method.
2. Select New.
3. Fill in the following fields:
•Description - Enter a name of the contact method, such as Letter, Email,
Phone, Other.
•Notes - type any reference notes in this area. These notes are visible in
this screen only and do not print anywhere.
4. Click Save. The list option you just created is added to the bottom of the
Description list.
Repeat steps 2–4 to continue creating Recall Method list options.
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Schedule Folder - Resource Type
Resource Types are categories of Resources (Resources will be addressed in the Edit
Menu section of this manual). Be sure to indicate the appointment type that the resource
type you are adding belongs to: Doctor or Resource. Examples of resources other than
doctors are: Nurse Practitioner and Equipment/Room.
Rule: A Resource record must be built in the Edit Menu for each Resource type created.
A resource is always associated with a resource type in the Doctor and Resource tables
discussed later.
Create a resource type, from within Administration, click the Schedule folder:
1. Select Resource Type.
2. Click New.
3. Type (resource desired) in the Resource Type.
4. Click Save. Centricity saves the description you just created at the bottom of the
Description list box.
Tip: You can rearrange the view order of the Resource Type names by selecting the
Resource Type name in the Description list and clicking the appropriate arrow key to the
left of this list.
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Schedule Folder - System Based Settings
System Based Settings are options for the scheduling component. The settings
selected are global scheduling settings for the system.
Default Appointment Type – For appointment types that do not have a color
assigned; select a default color.
Default Facility – For facilities that do not have a color assigned; select a default
color.
Appointment Search Limits are settings that apply to the use of appointment
search criteria.
To create the Appointment Search Limits:
1. Place a check mark next to each setting that is desired.
2.
When the list is complete, click SAVE to save the list, or continue specifying
the settings.
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Registration Folder - Benefit Assignment
The Benefit Assignment list option indicates whether a patient has assigned
benefits to the provider. This option prints an “X” in box 27 of the paper HCFA
and box 53 (a-c) on the paper UB-92 form.
These codes are shipped with the product and have associated ANSI codes.
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Registration Folder - Bill Code
The Bill Code identifies and tracks how a patient is billed (whether a patient
receives a statement or not). The feature also provides a method for grouping
patients for custom reporting purposes.
The system comes shipped with “Statement,” “No Statement” and “Payment
Plan.”
If you need additional Bill Codes, select New, and complete required fields. Be
sure to indicate “Y” or “N” for the Print Statement field. .
12
Registration Folder - CHAMPUS Branch, Grade &
Status
CHAMPUS Branch
CHAMPUS stands for Civilian Health and Medical Program of the Uniformed
Services. CHAMPUS is a health plan that serves active duty military personnel,
and retired military personnel and their dependents. A CHAMPUS Branch list
option identifies and tracks the branch of the military to which a patient belongs.
CHAMUS Grade
Enter applicable grades, i.e., Sergeant, Lieutenant, Commander, etc.
CHAMPUS Status
A CHAMPUS Status list option identifies and tracks the current status of a patient
in the military (whether active or retired).
**Note: CHAMPUS Status list options are not system-defined and will not be
populated unless options have been previously created by either the System
Administrator or user.
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Registration Folder - Contact Relationship
Contact Relationship is a label that is used to identify how a contact is related to
a patient (for example, Mother, Child, Spouse, Neighbor, Pharmacy, etc.).
Create a Contact Relationship list option:
1. In the Patient Information folder, select Contact Relationship.
2. Select New.
•Description - Enter a description of the contact relationship, as stated
above.
Description list.
Repeat steps 2–4 to continue creating Contact Relationship list options.
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Registration Folder - Employment Status
The Employment Status table identifies and tracks the employment status of
patients, if desired. This information prints an “X” in box 8 of the paper HCFA.
Three statuses come shipped with the product; Employed, Unemployed and
Retired, and are recognized by the government. Self-employed patients are
considered “Employed.”
15
Registration Folder - Marital Status
The Marital Status table identifies and tracks groupings of patients, by marital
status. This information prints in box box 8 of the HCFA paper form and box 16 of
the UB-92 paper form and is used for electronic filing purposes.
Create a Marital Status list option:
1. In the Patient Information folder, select Marital Status.
2. Click New.
•
Description - Enter a description of the marital status, such as Married,
Single, or Divorced.
•
NSF Code - Not used for ANSI electronic transmission.
4. HCFA Check - Click the down-arrow to select the box desired to mark on the
standard HCFA form for the marital status.
Repeat steps 2–5 to continue creating marital status list options.
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Registration Folder - Patient Defaults
To Set up Identifier Defaults in Registration:
1) Enter the following default patient identifiers:
• Enter the Medical Record No. Label or patient medical record number
(MRN) label. If your clinic or enterprise typically calls the Medical
Record Number by another name, such as Chart No. or Med. Rec.
No., you can use registration defaults to change the label to the term
that's most familiar to your staff.
• Enter the External ID Label (used with DemographicsLink). This name
makes it easier for users to recognize patient ID numbers that are
imported from your practice management system.
• Enter the Patient Identifier Preferred for Printed Materials as the
default identifier displayed on printed information for patients.
The Demographic Defaults can be used to save time when registering new
patients in CPS. The same registration defaults are shared by all locations of care
on this CPS database. When you change the patient registration defaults, your
changes do not affect patient information entered previously. Only new patient
registration information is affected.
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Registration Folder - Patient Relationship
The Patient Relationship identifies and tracks a patient’s relationship to the
insurance holder. This information prints in box 6 of the HCFA paper form and box
59 of the UB-92 paper form, and is used for electronic filing purposes.
These codes are shipped with the product and associated with ANSI codes.
Note: If there is a need to add to this list,
please contact GE Support or EDI for assistance.
18
Registration Folder - Privacy Policy
Acknowledgement
The Privacy Policy Acknowledgment indicates if a patient has signed the doctor's
privacy policy or has refused to sign it.
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Registration Folder - Race
The Race list option identifies the race of the patient. The Race list option is an
optional field that can be used as desired.
Create a Race list option
1. In the Patient Information folder, select Race.
2. Click New.
•Description - Enter a description of the race, such as Hispanic, Asian,
Caucasian, or African American.
•NSF Code – Not used in ANSI electronic transmission.
Repeat steps 2–4 to continue creating race list options.
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Registration Folder - Referral Source
A Referral Source identifies the source a patient used when identifying and
selecting your organization (for example, through the Yellow Pages, from a
Patient, or from another Physician).
Create a Referral Source list option:
1. In the Administration window, select the Patient Information folder, then select
Referral Source.
2. Click New.
• Description - Enter a description of the referral source, such as Yellow
Pages, Patient, Radio, or Physician.
• Patient - Select Y to indicate that the referral source is a patient.
Select N to indicate that the referral source is not a patient.
Repeat steps 2–4 to continue creating referral source list options.
21
Registration Folder - Release of
Information Indicator
The Release of Information Indicator identifies whether a provider has on file a
signed statement by the patient authorizing the release of medical information to
other organizations.
The statement that reads “Yes, provider has a signed statement…” is the default
selection.
22
Registration Folder - Residence Type
A Residence Type option identifies where the patient resides, typically used for
patients in nursing homes, private home, etc. Residence type is an optional table
the practice may wish to use.
Create a Residence Type list option:
1. In the Administration window, select the Patient Information folder, then select
the Residence Type option.
2. Click New.
•Description - Enter a description of the residence type, such as Private Home,
Nursing Home, or Residential Treatment Center.
Repeat steps 2–4 to continue creating residence type list options.
23
Registration Folder - Required Fields
Use Required Fields table to specify on a system wide basis, which patient
fields are required for entering a new patient or patient appointment in
addition to the last name. A red check to the left of the field name indicates a
required field. Once fields have been designated as required, if a value is not
entered on either the Patient Information window or the New Patient window,
the following error message displays: [Field Name] is a required field and
has not been populated.
Note: You must have necessary security rights to specify required
fields.
To create the Required Field list:
1. Place a red check mark next to each required field that is desired.
2. When the list is complete, highlight the next option in the list editor and a
pop up will open asking “Do you want to save the required fields?” Click
YES to save the list, or click NO to continue creating the list.
Note: The patient’s Last Name and Date of Birth is not an option because it
is already required by Centricity.
24
Registration Folder - Signature Source
Box 13 on the standard HCFA is required to be signed and dated by either the
insured or an authorized representative. The Signature Source list option prints
on the standard HCFA, providing authorization for the release of medical
information necessary to process a claim. It also authorizes payment of benefits to
physicians accepting assignment.
When a new patient is created, the Signature Source is defaulted to “Signature
on File.”
25
Registration Folder - Student Status
A Student Status option identifies if a patient is a student and whether that
student is full or part-time. This information is used when filing an insurance claim,
and prints an “X” in box 8 of the paper HCFA.
26
Financial Folder - Adjustment Types
The product is shipped with a few common Adjustment Types, but each practice
may have particular Adjustment Types they prefer to use. When adding new
Adjustment Types, click the New button and enter the description in the
Description field. Also, decide if this adjustment IS collectable, or IS NOT
collectable. For instance, a Disallowed adjustment based on a payer’s contracted
fee would be considered NOT collectable. Therefore, in the Collectable field,
enter “N”. However, in the case of a Courtesy or Bad Debt adjustment, these
generally ARE collectable amounts and “Y” would be entered in the Collectable
field.
The Ledger field may be used to interface with accounting software, if set up to
do so.
The Notes field offers an area to document notes related to the highlighted
Adjustment Type.
Note: It is recommended to place the most used Adjustment Types at the top of
the list.
27
Financial Folder - Allocation Type
Allocation Types are also found in the Financial folder. These will be used to create
Allocation Sets which are created in Administration under Edit/Allocation Sets.
Allocation Types are created to reflect the different co-pay amounts patients are
responsible for. Allocation Sets allow the ability to determine which codes to collect copay amounts for. For example, all E&M visits will require a co-payment be collected, but
all other codes may be filed to insurance, with no patient responsibility.
Add Allocation Types for each co-pay amount encountered by patients visiting the
practice. Use the following logic under the List Item Data for each Allocation Type
created:
Description: 100% Patient; Insurance % = 0; Patient $ = 0; Notes – enter as needed.
Description: 100% Insurance; Insurance % = 100; Patient $ = 0; Notes – enter as needed.
For specific co-pay amounts, enter each co-pay amount with the following format:
Description: 5 Co-pay; Insurance % = 100; Patient $ = 5.00; Notes – enter as needed.
Description: 10 Co-pay; Insurance % = 100; Patient $ = 10.00; Notes – enter as needed
Description: 15 Co-pay; Insurance % = 100; Patient $ = 15.00; Notes – enter as needed
Etc…
For indemnity type plans, enter these percentage plans with the following format:
Description: 80/20 Plan; Insurance % = 80; Patient $ = 0; Notes – enter as needed.
28
Financial Folder - Collections Group
Collections Groups lump carriers by the person(s) or positions responsible for
collection activities for these carriers. Collection Groups can be used to
categorize insurance carriers together using a group designation. This list option
allows the practice to specify, in the Collections component of CPS, one of the
collection groups, rather than having to select individual insurance carriers.
Collections Groups can also be used for reporting purposes in the Reports
component.
The Collections group is an optional table that may be built and used as needed.
29
Financial Folder - Collections Status
Collections Status identifies and tracks the correspondence and activity surrounding a
patient account once it drops into the Collections module. When a collection status is
created, a collection letter can be associated with that collection status. Visits are
moved to a collection status individually, as CPS is a visit based system, rather than
an entire account.
To create a Collections Status list option, within Administration under the
General/Administration folder:
1. Click Collections Status
2. Click New.
Field
Description
Description
Type a description of the collections status.
Contact Period (Days) The system will automatically assign the next contact date
based on the number of days entered here.
Letter
Select the appropriate letter from the list to be associated
with this status. When this status is selected for a visit, the
associated letter may be printed from within that visit.
These letters are located in the Reports component under
the Letters subfolder in the Collections folder. See the
Reports Manual to create letters.
Notes
Type any notes pertaining to this collections status option.
4. Click Save. The list option just created is added to the Description list box.
5. Repeat steps 2 - 4 to continue creating collections status list options.
30
Financial Folder - Credit Card Types
Credit Card Types identify and track the various credit cards your practice
accepts. This information also prints on statements and various reports.
To add Credit Card Type, click New then enter the card name (I.e., Visa,
Mastercard, etc.) in the Description field. Notes can be added as necessary to
each Credit Card Type.
31
Financial Folder - Departments
Departments are applied to CPT codes for custom reports and use of conversion factors
to determine fees when using RVUs. Be sure to create a department for all CPT codes
used in your practice. Examples of departments include: E&M Visits, Surgery,
Laboratory, and X-Ray, and are usually based on the department divisions of your
Superbill. Departments can be assigned when loading CPT codes.
**Note: A procedure can be a member of only one department.
To create a department list option open the Administration Component, click the
Financial folder
1. Click Department.
2. Click New.
3. Type Department desired (E&M Visits, Surgery, etc.) in the Description box.
4. Click Save.
5. Repeat steps 2 through 4 to add additional departments.
CPS saves the description just created in the Description list box.
Tip: Rearrange the view order of the Department names by selecting the Department
name in the Description list and clicking the appropriate green arrow key to the left of this
list.
32
Financial Folder - Financial Class
A Financial Class identifies and tracks groups of patients for statements and reporting
purposes, seen in:
•Doctor information
•Visit information
•Patient Information–If it is in Patient Information database, it populates to the visit
information.
Examples of financial classes include: Private Pay, Medicare, Medicaid, and PPO. You
can assign a financial class to insurance carriers and/or Patient Information files.
Financial classes can also be used to determine which fee schedules are utilized.
**Note: A financial class MUST be included on a visit. If a financial class has not
been associated with a visit, charges cannot be entered.
Create a Financial Class list item:
1. In the Financial folder, select Financial Class.
2. Click New.
•Description -Type a description of the financial class, such as Private Pay,
Commercial, or Medicaid.
•Ledger- Only if applicable, type the alpha-numeric general ledger number to be
used for integration with third-party accounting systems. The maximum number of
characters you can type in this field is 10.
4. Click Save. CPS saves the description just created at the bottom of the Description list
box.
33
Financial Folder - Payment Type
Payment Types identify and track payment transactions made against patient
accounts (for example, NSF Check, Payment, Refund, etc.).
Note that Refund is listed as a Payment Type (rather than an adjustment).
To enter a new Payment Type, click New, then enter the description in the
Description field. (The Ledger field may be used to interface with accounting
software, if set up to do so.) Notes may be added in the Notes field regarding the
associated Payment Type.
Note: Please add the Payment Type of “Conveyance” to this table. Conveyance
is the term used to move money from one visit to another for the same patient, or
from one patient to another to correct a payment posted to the wrong patient in
error. Although Conveyance is a Payment Type, when used, monies associated
with this Payment Type will not appear on the Deposit Slip as it is money that has
already been posted. Using the Conveyance is simply “moving” the money,
therefore should not affect the daily Deposit Slip.
34
Financial Folder - Quick Note
A Quick Notes provide an easy method for defining commonly used text that can
be linked to a transaction (for example, an adjustment, transfer, or payment) and
are generally used in the Payment Entry component. These Quick Notes will also
print on statements.
To add a Quick Note, click New, then type a short description in the Description
field, such as “Transfer due to deductible.” Indicate if this Quick Note is to Show
On Statement by choosing either “Y” or “N.” In the Quick Note field, type the note
to the patient EXACTLY as you would like the patient to see it on their statement.
35
Claims Folder - Filing Methods
Filing Methods identify the various methods by which insurance claims are filed.
CPS is shipped with the three standard filing methods: HCFA, UB-92, and a
Custom HCFA. However, you can also add other filing methods that are
appropriate for your office workflow. These filing methods are also important
when dealing with cycle billing.
Cycle Billing has four options. You associate each option with an insurance
carrier. These options are:
• None
• Once a month
• Twice a month
• Unlimited
Tip: You can rearrange the view order of the Filing Methods names by selecting
the Filing Methods name in the Description list and clicking the green arrow key to
the left of this list.
Note: Status Inquiry can be added here for Michigan claims.
36
Claims Folder - Type of Service Code
Items in the Type of Service Code table carry to Box 24C of the standard HCFA.
Insurance carriers may require a Type of Service Code on the standard HCFA
when billing. This code identifies the type of service performed during the patient
visit for each CPT code. These codes are associated with a procedure in the
New/Modify Procedures window and Procedures/Information tab.
Note: Type of Service Codes are not sent in the electronic claim file as a
default. If a specific carrier requires a Type of Service Code you can use
special settings on the insurance carrier to accomplish this. Be aware, if
you send Type of Service and it is not required for that carrier, the claim
could be denied.
37
Claims/EDI Folder - Carrier Types
The Carrier Type identifies and tracks the various categories for government
insurance carriers associated with a patient visit. This item marks the check box
in Box 1 of the standard HCFA form and electronically describes the type of
carrier to which you are transmitting. These Carrier Types come pre-loaded in the
system, and have ANSI codes associated with them.
Tip: The view order of the Carrier Type names can be rearranged by selecting
the Carrier Type name in the Description list and clicking the green arrow key to
the left of this list.
38
Claims/EDI Folder - Claim Note Code
Claim Note Code identifies the type of note being used. This code accompanies
the claim note field on the visit.
39
Claims/EDI Folder - Contract Type Code
The Contract Type Code identifies the type of contract associated with a claim
and is used in very limited situations.
The Contract Type Codes come shipped with the product and are associated with
an ANSI code.
40
Claims/EDI Folder - Co-Pay Status Code
The Co-Pay Status Code indicates whether co-payment requirements were met
on a line by line basis. This field is required if the patient is exempt from co-pay.
41
Claims/EDI Folder - Delay Reason Code
The Delay Reason Code indicates why a claim was delayed. This code is
required when a claim is submitted late (past the contracted filing limitation). It can
also be used when a claim is transmitted in response to a request for information
(for example, a 277), and the response has been delayed.
Note: Please follow your carrier’s billing guidelines for proper set up of these
tables.
42
Claims/EDI Folder - Drug/Unit Basis for
Measurement & Emergency Indicator
The Drug Unit/Basis for Measurement indicates the type of units drugs are
being measured. For example, by grams, milligrams, and so forth.
The Emergency Indicator list option is required by some insurance carriers.
Check with your insurance carrier(s) to determine your filing requirements for the
emergency indicator.
Please follow your carrier’s billing guidelines for proper set up of these tables.
43
Claims/EDI Folder - EPSDT Referral
Condition Indicator
The EPSDT Referral Condition Indicator specifies the status of a referral. For
example, whether a referral was not used, the patient is under treatment, and so
forth.
Please follow your carrier’s billing guidelines for proper set up of this table.
44
Claims/EDI Folder - Insurance Policy Types
The Insurance Policy Type table identifies and tracks the type of claims
associated with a patient record and is used for electronic filing purposes.
45
Claims/EDI Folder - Local Use
Local Use stores user defined descriptions that can be used on boxes 10d and 19
of the paper HCFA 1500 form. These descriptions will be available on the Filing 1
tab of the visit in a drop-down box to choose from.
Create the most common statements that are typically used by your practice in
boxes 10d and 19 of the paper HCFA 1500 form.
To enter a new descriptions, while highlighting Local Use, click the New button on
the bottom of the screen. Enter the desired information in the Description box.
Click the Save button to save the information.
46
Claims/EDI Folder - Medicare Secondary
Type
A Medicare Secondary Type explains why Medicare is the secondary insurance
for a patient. It provides more patient insurance information to help ensure
continued Medicare coverage. Examples: Medicare Secondary Disabled
Beneficiary Under Age 65 with Large Group Health Plan (LGHP); Black Lung; etc.
These policy types are shipped with the product with associated ANSI codes.
47
Claims/EDI Folder - Nature of Condition Code
The Nature of Condition Code indicates the nature of a patient’s spinal
condition. For example, acute or chronic condition.
48
Claims/EDI Folder - Oxygen Test Condition
Finding Code
&
The Oxygen Test Condition Code indicates a patient's physical state during the
oxygen test. Examples: Sleeping, Exercising.
The Oxygen Test Findings Code indicates what the test revealed, such as a
depending edema suggesting congestive heart failure.
The codes for these tables are shipped with the product and have associated
ANSI codes. Please follow your carrier’s billing guidelines for proper set up of this
table.
49
Claims/EDI Folder - Payer ID Number Code
The Payer ID Number Code identifies any payer. These codes come shipped
with the product, associated with an ANSI code and should not be changed.
50
Claims/EDI Folder - Place of Service Code
Place of Service Code stores the codes for each place a provider can give
treatment. A Place of Service (POS) code prints in Box 24B of the standard
HCFA and also on electronic claims to show the location where the treatment is
performed. Billing charges require a place of service code; all places a doctor
practices MUST have a Place of Service code. An insurance carrier will not pay if
there is no Place of Service code. CPS supplies default codes, however, other
codes are available, and can be added to this list.
Note: Recommend assigning Place of Service codes to
Facility items when building the database.
51
Claims/EDI Folder - Procedure Code Qualifier
The Procedure Code Qualifier indicates the type of code being used to identify
the procedure. For example, HCFA, National Drug Code, and so forth.
The Procedure Code Qualifiers are shipped with the product and are associated
with an ANSI code.
52
Claims/EDI Folder - Procedure Note &
Procedure Note Code
A Procedure Note provides an easy method for defining commonly used notes
that can be linked to a procedure. The notes set up here can be selected when
posting procedures in the Billing component, on the procedure code. These notes
are both sent electronically and printed on paper claims. Procedure Notes are
user defined, but must be associated with a Procedure Note Code in the Note
Type field.
The Procedure Note Code accompanies notes entered for procedures and
describes the type of note used for the procedure.
The codes for the Procedure Note Code are shipped with the product and have
associated ANSI codes. Please follow your carrier’s billing guidelines for proper
set up of this table.
53
Claims/EDI Folder - Provider ID Number
Type
The Provider ID Number Type references the type of provider number, such as
PPO or HMO number, Medicare or Medicaid provider number.
54
Claims/EDI Folder - Report Type Code &
Attachment Transmission
The Report Type Code indicates the title or contents of the report.
The Report/Attachment Transmission Code indicates whether reports will be
sent and the method in which they will be sent.
The codes in these tables are shipped with the product and have associated ANSI
codes. Please follow your carrier’s billing guidelines for proper set up of this table.
55
Claims/EDI Folder - Service Authorization
Exception Code
The Service Authorization Exception Code indicates the reason why
authorization was not obtained for a service.
56
Claims/EDI Folder - SF-Claim Type & Other
Insurance Code
SF Tables are generally used by
Michigan clients, required by
carriers in this state.
Some insurance carriers require additional information when submitting secondary
claims electronically. The codes entered in the SF Tables can be used when
filing secondary or other claims. This feature allows identification of any special
SF-Other Insurance Codes as applicable in your state.
57
Claims/EDI Folder - SF-Secondary Insurance
Code & Status
SF Tables are generally used
by Michigan clients, required
by carriers in this state.
Some insurance carriers require additional information when submitting secondary
claims electronically. The codes entered here can be used when filing secondary
or other claims. This feature allows identification of any special information
required by your specific insurance carrier(s). Use the SF-Claim Type and Other
Insurance Codes as applicable in your state.
58
Claims/EDI Folder - SI-Claim Status, Type, &
Reason for Inquiry Code
SI Tables are generally used
by Michigan clients, required
by carriers in this state.
After a claim has been transmitted, the SI–Claim Status is sent from the
clearinghouse to describe the status of a claim. In addition, you can request a
status from a clearinghouse, for example, InfoRequested, meaning more
information is needed to process the claim.
SI-Claim Type & SI-Reason for Inquiry Code - Some insurance carriers require
a hardcopy form when filing a Status Inquiry. This feature allows you to identify
any information you want to maintain for your specific insurance carrier using
these two tables.
Please follow your carrier’s billing guidelines for proper set up of these tables.
59
Claims/EDI Folder - Special Date Qualifier
The Special Date Qualifier indicates the type of date or time, or both date and
time. For example, Arterial Gas Blood Test, Latest Visit or Consultation.
60
Claims/EDI Folder - Special Procedure Unit
Code
The Special Procedure Unit Code identifies the units of measurement of the
procedure being billed, for example, days or international units. If needed, this
code can be associated with a procedure in the procedure code file.
These Special Procedure Unit Codes come shipped with the product and are
associated with ANSI codes.
61
Claims/EDI Folder - Special Program Reason
The Special Program Reason indicates the special program under which the
services rendered to the patient were performed.
codes. Please follow your carrier’s billing guidelines for proper set up of these
tables.
62
Claims/EDI Folder - Subscriber ID Qualifier
A Subscriber ID Qualifier identifies the type of number being transmitted for this
subscriber ID.
63
Claims/EDI Folder - Test Result
Measurement Qualifier & Test Result Type Code
The Test Result Measurement Qualifier indicates the type of measurement
used for a test. For example, Epoetin Starting Dosage.
The Test Result Type Code indicates the type of test performed. For example,
original starting dosage.
tables.
64
Claims/EDI Folder - Weight Measurement
Qualifier
The weight measurement qualifier indicates whether the weight is measured in
grams, pounds, or some other unit of measure.
To create a weight measurement qualifier
1. Click New.
2. Enter a description of the weight measurement qualifier.
3. Enter the ANSI code for the weight measurement qualifier.
4. Enter any notes pertaining to this weight measurement qualifier.
5. Click Save.
65
Claims/EDI/Ambulance Folder Ambulance Codes
The Ambulance Certification Condition indicates the situation requiring the
ambulance.
The Ambulance Transport Code indicates the type of ambulance trip.
The Ambulance Transport Reason indicates the ambulance trip reason.
Codes for these three tables are shipped with the product and associated with
ANSI codes.
66
Claims/EDI/Dental Folder - Oral Cavity
Designation Code
The Oral Cavity Designation Code indicates the area of the oral cavity (the part
of the mouth) where service was performed. For example: Lower Left Quadrant.
67
Claims/EDI/Dental Folder - Tooth Status &
Surface Codes
A Tooth Status Code is the status of the tooth at the time of the visit. Examples:
impacted, missing.
A Tooth Surface Code is the location of the tooth area that is to receive service.
Examples: facial, distal.
tables.
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Claims/EDI/DMERC Folder - CMN
Certification Type & Unit/Basis for Measurement
CMN Certification Type indicates whether the certification is an initial, renewed,
or revised certification.
The CMN Unit/Basis for Measurement specifies the unit or manner in which a
measurement is being taken. For example, days, weeks, or months.
Codes for these tables are shipped with the product and have associated ANSI
codes.
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Claims/EDI/DMERC Folder - DME
Frequency Code & DMERC Condition Indicator
Code
The DME Frequency Code indicates the frequency at which medical equipment
is billed. For example, daily, weekly, or monthly.
The DMERC Condition Indicator Code indicates the status of medical
equipment. For example, whether the equipment is stationary, the equipment is a
replacement item, and so forth.
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Claims/EDI/Institutional Folder Admission Source
Within the Visits/Claims folder are tables that are specifically related to visits and
claims.
The Admission Source identifies the various ways a patient may be admitted.
This code is used for UB92 filing, and prints in box 20 of the UB92 form.
Note: Please follow your carrier’s billing guidelines for proper set up of this table.
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Claims/EDI/Institutional Folder Admission Type
Admission Types identify methods used to admit patients. Admission type may
be required for certain types of inpatient facility claims.
Information from this table is used to populate the UB-92 form, and prints in box
19 of the UB92 form.
Note: Please follow your carrier’s billing guidelines for proper set up of this table.
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Claims/EDI/Institutional Folder Condition Code
A Condition Code identifies a condition or circumstance related to a bill that may
affect payer processing. Condition codes are used in determining eligibility and
administering primary and secondary responsibility for UB-92 claims.
Note: Please follow your carrier’s billing guidelines for proper set up of these
tables.
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Claims/EDI/Institutional Folder Occurrence Code
An Occurrence Code defines a significant event related to a bill that may affect
payer processing. Occurrence codes are used in determining liability,
coordinating benefits, and administrating subrogation clauses in contract/benefit
programs. This list option is for UB-92 claims only.
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Claims/EDI/Institutional Folder - Patient
Status
A Patient Status is used to indicate a patient’s status as of the “Through Date” of
a billing period. These special patient status codes are used when filing some UB92 claims, and may print in box 22 of the UB-92 form.
75
Claims/EDI/Institutional Folder - Value
Code
A Value Code is required for benefit determination. The value code table is
intended to provide reporting capability for those data elements that are routinely
used, but do not warrant dedicated fields.
76
Claims/EDI/Spinal Manipulation Folder Subluxation Level Code & Treatment Duration
The Subluxation Level Code indicates a specific level of chiropractic adjustment,
for example, lumbar 2, thoracic 5, sacrum, and so forth.
The Treatment Duration indicates the intervals by which spinal manipulation is
performed. For example, daily, weekly, or monthly, or yearly.
The Treatment Duration codes are shipped with the product and have associated
ANSI codes. Please follow your carrier’s billing guidelines for proper set up of
these tables.
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Claims/EDI/Vision Folder - Vision Item
Replacement Reasons & Vision Item Type Code
The Vision Item Replacement provides the reason a vision item is being
replaced. For example, loss, theft, or damage.
The Vision Item Type Code indicates a type of vision item. For example, contact
lenses, spectacle lenses, and frames.
codes. Please follow your carrier’s billing guidelines for proper set up of this table.
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Claims/EDI/X12 Response Codes Folder
The X-12 Response Code folder exists to house the technical information that is
returned from a supported Clearinghouse. This folder is not to be altered in any
way.
DO NOT EDIT, ADD OR DELETE INFORMATION CONTAINED
WITHIN THIS TABLE.
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Reports Folder - Business Report (ReportsClaims, Patient Profile, Receipt, Statement &
Superbill)
The reports contained in this area relate to the Claim (or paper HCFA), the
Patient Profile, Receipts, Statements and Superbills. Each of these reports
are linked to something called a “Stored Procedure.” Changing information
on the “Modify Report Criteria for…” window may affect the stored
procedure. Therefore, please discuss changes to this window with your
Applications Specialist, or GE support as needed.
However, you can go into the Report Set-up area as shown above for any of
these reports to adjust the margins as needed. This is particularly helpful for
aligning HCFA or UB-92 forms.
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Reports Folder - Business Report Footer
The Business Report Footer stores the footers that display on reports that are
run from the Reports component. These footers can be customized for each
company, facility, doctor. In the Footer Text, type the footer information that
corresponds with the footer desired. The footers added here populate the Footer
field when setting up criteria for reports in the Reports component, and display at
the bottom of printed reports. (Footer text cannot exceed 114 characters and the
font is set at an 8 point font size.) CPS automatically applies the date stamp.
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Codes/Billing System Folder - Billing
Modifiers
The Modifiers table comes shipped with the most common modifiers used in a typical
physician’s office. Modifiers are used in conjunction with a CPT code to explain
treatment and/or enhance reimbursement. This information prints on the standard HCFA
form and is used for electronic filing purposes. We suggest you review this list carefully,
as the description you recognize may differ from that stored in the software. It may also
be necessary to add and/or delete items from this list to suit your office. After creation in
the List Editor, you can attach modifiers to a fee schedule or to procedure codes, or input
them at the point of charge entry.
Build a modifier
In the Administration window, open the Codes folder, then open the Billing System
folder. Click New.
2. As and example Type QY-Anesthesia Services in the Description box.
3. Type QY in the NSF code field.
4. Type Anesthesia services only in the Notes box, if desired.
5. Click Save.
CPS saves the description you just created at the bottom of the Description list box.
Tip: Add the modifier number in the Description field so it will be easily recognized by
users.
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Codes/Billing System Folder - Load-ICD 9
Codes
NOTE: Be sure to
check each
applicable
specialty for the
codes listed in this
window prior to
Loading the codes.
From the Administration, select the Codes folder, then the Billing System folder.
Once the Billing System folder is open, click on Load ICD-9 Codes.
1. Complete the following fields:
• Codes: This button allows a search for a range of codes by number.
• From–Type the first code number in the search range.
• To–Type the last code number in the search range.
• Description: Click this button to alphabetically search for a range of codes.
• From–Type the first alphabet description in the search range.
• To–Type the last alphabet description in the search range.
• Search: Click this button to search for the codes that meet the defined
criteria. The codes display in the Code/Description list box. Uncheck the
box next to those code(s) you do not want to load.
• Specialty: Click the box next to the specialty(ies) to associate loaded
codes.
• Effective: Type the effective date for loading. (Optional)
• Expiration: Type the expiration date for loading. (Optional)
2. Click the Load button. The “Add the [#] selected items to the system?”
prompt displays.
3. Click Yes. The load process is initiated and completed.
Note: The load process can take several minutes if you are loading a large number
of codes.
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Codes/Billing System Folder - LoadHCPCS and CPT Codes
Codes can be loaded by
department, i.e., search for all
Hospital codes, and choose the
Hospital (or related) department.
All codes must be loaded with
the Procedure Code Qualifier
appropriate to the practice.
NOTE: Be sure to check
each applicable specialty
for the codes listed in this
window prior to Loading
the codes.
To load HCPCS/CPT codes:
• Codes: This button allows a search for a range of codes by number.
• From–Type the first code number in the search range.
• To–Type the last code number in the search range.
• Description: Click this button to alphabetically search for codes.
• From–Type the first alphabet description in the search range.
• To–Type the last alphabet description in the search range.
• Search: Click this button to search for the codes that meet the defined criteria. The
codes display in the Code/Description list box. Uncheck the box next to the code(s)
not to load.
• Specialty: Click the box next to the specialty(ies) to associate loaded codes. Clicking
acts as a toggle to select or deselect a specialty.
• Department: Click the down-arrow to select the department to associate the
selected codes. Note: It may be best to load codes by the department they will be
associated with.
• Effective:Type the effective date for loading. (Optional)
• Expiration:Type the expiration date for loading. (Optional)
2. Click the Load button. The Add the [#] selected items to the system? prompt
displays.
3. Click Yes. The load process is initiated and completed.
Note: The load process can take several minutes if you are loading a large number of
codes.
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System Folder - Attachment Name
CPS allows scanning of documents such as insurance cards, photo IDs, and other pertinent
paperwork that needs to be scanned into the patient’s record. Attachment Name is where the
document names are created to choose for the document that is scanned.
The attachment name stores custom labels for attachments in:
• Patient Information component
• Payment Entry component
• Case Management component
• Actual Visit
To associate an Attachment with a Component:
1. Click Attachment Name.
2. Click New.
3. Type the name desired for the document in Description (i.e., Insurance Card).
4. Using the drop-down arrow for Component, click the appropriate component desired for this
document to be viewed. The attachment name can be associated with one or all components as
indicated here.
5. Click Save. CPS saves the description just created in the Description list box.
Note: The ID fields within the Administrative tables will auto-populate when the record is
saved.
Tip: You can rearrange the order of the Attachment names by selecting the Attachment Name in
the list and clicking the appropriate arrow key to the left of this list.
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System Folder - Application
Application stores Plug-ins for Global Approvals and the Global Master
Patient Index; Patient ID Sort Methods; Statement Options; Charge Import
and Collections settings. It also stores the month the practice fiscal year
begins as well as the Signature Expiration Days for HIPAA compliancy.
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System Folder - Collection Parameters
Use the Collections section of the Administration window, in Application to set up how the
product determines when a visit is sent to collections due to an overdue patient payment, an
overdue Insurance payment, or both. A warning may also be displayed when accessing a
patient who has one or more visits in collections, has a status of Bad Debt, or a guarantor
with a payment plan. Choosing one of the options to “Automatically move visits…”will allow
the system to handle actions based on settings within this window to move visits into the
Collections status.
Automatically move visits to collections if patient balance is greater than (dollar
amount) and is at least (number of days) old.: A nightly update will move a visit status to
Collections for visits with a patient balance meeting the specified criteria.
Automatically move visits to collections if insurance balance is greater than (dollar
amount) and is at least (number of days) old.: A nightly update will move a visit status to
Collections for visits with insurance balance meeting the specified criteria.
Automatically move visits to collections if total balance is greater than (dollar amount)
and is at least (number of days) old.: A nightly update will move a status to Collections for
visits with a total balance meeting the specified criteria.
Warn if accessing a patient in Collections: Sends a warning to when accessing a patient
record that has a visit in a status of Collections.
Warn if accessing a patient in Bad Debt: Sends a warning to when accessing a patient
record that has a visit in a status of Bad Debt.
Guarantor-based Collection Letter: Allows the system to send one letter per guarantor for
all visits in a status of Collections.
Warn if accessing a guarantor having an active payment plan: Sends a warning to when
accessing a patient record in which the guarantor is set up on a payment plan.
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System Folder - Other Application Folder
Settings
Global Approval Plug-in: A third party purchased plug-in.
Global Master Patient Index Plug-in: A third party purchased plug-in used when
several sites want to share the same Patient Information.
Reports-Patient ID Sort Method: Choose Alpha-numeric(when your patient IDs
contain letters and numbers) or Numeric(when your patient IDs contain only
numbers). This will determine how reports will be sorted.
Fiscal Year: Select the month when your fiscal year begins. Changing this field will
change the way year to date appear on reports, regardless of whether a report is
generated by date of service or by date of entry.
Signature Expiration Days- Privacy Policy Exp. Days: Select this option to
indicate that your practice uses signature expiration days. In the Alert after __
days field, type the number of days the privacy policy will remain in effect from the
date it is entered. The system will notify you when you access a patient whose
signature on a privacy policy has expired.
Release Pt Info, Benefit Assignment: Select this option to indicate that your
practice uses a patient information release form and tracks whether a patient has
assigned benefits to the provider. In the Alert after __ days field, type the number
of days the patient release form and benefit assignment form will remain in effect
from the date it is entered. The system will notify you when you access a patient
whose signature on a patient release form and benefit assignment form has
expired.
Charge Import: Select this option to allow the bulk import of charges for patients
with open cases.
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System Folder - Statement Options
Statement Options are where specific settings are made regarding what
information will be displayed on patient statements.
This is also the area that dunning messages will be set for on-demand or
individual statements. Dunning messages for bulk statements are created in
the Reports component along with criteria set to print or electronically send
bulk statements.
**Please Reference the Statements Manual for detailed information.
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System Folder - Phone Type
Phone Type identifies and tracks the most common locations for a patient’s
telephone (for example, Home, Office, or Mobile).
Note: Create only the most common options here. The Phone Type text box is
one of the few combo boxes within CPS that allows you to also manually type the
information in the appropriate areas throughout the application.
Create a Phone Type list option:
1. In the System folder, select Phone Type.
2. Click New.
•Description - Type a description of the phone type.
Repeat steps 2–4 to continue creating Phone Type list options.
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System Folder - Selection Limits
The Selection Limits list option allows setting limits on the number of rows of
information that displays in various windows. For example, it allows you to limit the
number of patient visits displayed in the Billing window. This improves the speed
of information in computer configurations where searches run slowly.
Notes: CPS comes preloaded with all the items which
can have assigned selection limits. New items cannot be added.
Best Practice: Leave default settings that come shipped with the product.
91
System Folder - Visit Owner
The Visit Owner table allows the user to create a category identification that can
be assigned to a visit for sorting purposes and follow-up in addition to other
criteria. This information is accessible in the Billing, Payment Entry/Transaction
Distribution, Accounts Receivable, and Collections components.
Create a Visit Owner of “Unassigned,” then create other appropriate Visit Owners
for your practice. Once owners are created, the first owner in the list is
assigned to all new visits by default. Recommend listing the first Visit Owner
as “Unassigned.”
The visit owner is not restricted by closing date rules. The visit owner designation
can be changed at any time and in any location in which it appears in the product.
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System Folder - Visit Status
Visit Status’ in this area cannot be added, changed or deleted. The color, however can be changed
based on system preference. Double click on the color bar to change the color for each status as
desired. Best Practice: Leave default settings until the product is in use and there is a consensus
regarding issues with colors.
New: A visit that has a status of NEW does not have any charge capture related data entered on the
Visit. It is generated from the Scheduling component as a booked appointment.
In Progress: The visit is IN PROGRESS of being prepared. This can be generated from manual data
entry of co-pays, charges, or adding any data to the visit. Note: 1.) A visit can transfered to this status
by an accidental opening of the Visit in Billing and clicking OK. 2.) When a visit transfers to this status
it separates itself from automatically updating based on changes to Registration.
Approved Failed: The visit can fail the 1st CPS internal edit. This edit is system based and checks to
see that a paper claim can be “cleanly” generated. The edit does not check clinical appropriateness
(ie. Dx, CPT accuracy). A visit can fail due to one or all of the following general reasons: 1.) Patient
Information Errors 2.) Charge Entry Errors 3.)Administrative Setup Errors Note: The Notes Tab of the
visit will contain the reasons for the failure.
Approved: The visit has passed the 1st CPS edit/scrub and the claim will be cleanly printed to paper
or is ready for the 2nd CPS edit/scrub (Batching for Electronic Submission).
Filed: Filed Primary, Secondary, Tertiary or Alternate: the visit has been printed to paper to one of
these carriers. The Claims tab of the visit will contain the details of the filing history. The visit is now
waiting for payments and/or adjustments. Note: 1.) This can be triggered manually at Payment Entry
or by Remittance. When manually transitioning the status for these visits the Claims tab will NOT
contain the filing history. 2.) CPS will prompt the user, “Would you like to update the visit status of the
paper claims to Filed?”, when printing or previewing a claim form. Clicking YES will transition the
status to FILED, regardless of what it was before.
Batched: This status is seen in filing to a supported Clearinghouse. A visit has been successfully
prepared (passed 1st and 2nd CPS edits/scrubs) and “Batched” in a file for submission to the
Clearinghouse. Note: 1.) If you delete a “Batched” visit (claim) in EDI Submission Mgt, the visit status
of this visit will return to the status of APPROVED.
93
Sent: If filing to a supported Clearinghouse, and the transmission was successful, the Visit will transition to
SENT. This status will update again once the clearinghouse has succeeded or rejected the Visit (claim).
Note: 1.) The visit may not transition to this status if the Clearinghouse provides instant feedback on the
claim. The visit may transition from BATCHED to either FILED SUCCEEDED or FILED REJECTED
immediately.
Filed Rejected: This status can have 2 different definitions: Internal and External.
Internal- This status indicates that the visit has failed the 2nd CPS edit/scrub as it attempts to
“cleanly” prepare the visit for electronic submission. This edit is system based and organizes the
data for electronic filing to the Clearinghouse. The edit does not check for clinical appropriateness
(ie. Dx, CPT accuracy). A visit can reject due to 1 or all of the following general reasons: 1.) Patient
Info Errors 2.) Charge Entry Errors 3.) Administrative Set up Errors. The Notes Tab of the visit will
contain the reason for Failure.
External- If using a supported Clearinghouse AND if the payer’s reports are capable of being
processed by CPS, the visit will be rejected when…1.) It does not meet the clearinghouse’s
electronic “clean” claim edits AND/OR 2.) It does not meet the payer’s electronic “clean” claim edits.
The rejection details are located on the Claims tab of the visit or within the EDI Reports Note: 1.)
When resubmitting these visits don’t forget to Re-Approve before Re-Batching!
Filed Succeeded: If filing to a supported Clearinghouse, the Visit transitions to this status when the
Clearinghouse has accepted the Visit as a “Clean” claim. Upon receiving dates from the payer, the visit status
will stay as FILED SUCCEEDED if the payer has also accepted the visit as a “Clean” claim. If not, the status
will transition to FILED REJECTED. CAUTION: 1.) Always check your EDI Response Management Reports.
2.)In some cases, it will not transfer to FILE REJECTED when a payer has rejected the claim. In this case the
rejection details are in the EDI Report 3.) If not checked on EDI Report they could be false FILE
SUCCEEDED statuses.
Balance Forward: A visit status of BALANCE FORWARD is achieved when the Balance Forward component
is utilized to “bring over” a credit or debit balance into CPS from an outside product process.
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Waiting Patient Payment: The visit status will transition when the ONLY balance (responsibility)
is for the patient. In other words, insurance has paid or adjusted off their balance.
Paid: The visit status will transition to PAID when there is no longer any balance on the visit.
Patient and Insurance responsibility are $0.00.
Collection: Once the visit reaches the pre-defined collection parameters for the Patient’s Balance,
the visit status will transition to COLLECTION. Note: 1.) Only the visit that met the predefined
collection parameters will automatically transition to COLLECTION, not all the patient’s visits. 2.) A
visit can manually be transitioned into or out of a COLLECTION status per office policy &
procedure.
Overpaid: The visit status will transition to OVERPAID when TOTAL payments for the VISIT have
exceeded the TOTAL Visit Balance.
Hold, Refile, Refund: These are manually transitioned, user defined Visit statuses that are
typically used according to office policy and procedure. Sometimes they are used in conjunction
with the Visit Owner feature.
Note:
1) CPS does not auto transfer to these visit statuses.
2) Once a visit is manually transfers to these statuses, it is extremely important to have a process
to work these statuses.
3) Always check these statuses in the Billing component to see the volume of Visits.
4) Hold can also be set as preference to be generated when retrieving charges from the Centricity
EMR, if there are incomplete orders.
Bad Debt: Bad Debt is a new visit status that can be manually selected, or selected when
performing a bulk write-off of bad debt within reports.
Retrieval Error: A visit is assigned a Retrieval Error status when there is an error retrieving
charges from an EMR interface.
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System/Users/Location Setup Folder Users
Note: This will only be visible for the databases that have been licensed for
the Chart module.
A user can be created under their Home location of care.
To create a user:
1) Highlight the user’s home location of care
2) Click either New Provider or New Resource (Note: A resource is anyone
who will need access to the Chart module or Desktop.)
3) The New Provider or New Resource window box will appear
NOTE: Please reference the CPS Chart Administration Manual for setting up
Locations of Care.
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System/Users/Location Setup Folder User Preference Group
A preference group is defined as a group of job-like individuals. This allows
preferences to be set for the staff members who use the application in the same
way.
To add a User Preference Group, Click New and enter a User Label.
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System/Users/Location Setup Folder User Preferences
Preferences are settings that let staff customize the CPS application’s appearance
and behavior.
Enterprise preferences are the default preference settings for all staff members in
the CPS database. All new users start out with these preferences.
Group preferences can be defined for clinic staff members who use the CPS
application in similar ways. You can also create groups for people with similar
jobs. You can assign staff members to groups when you add each user to the
CPS application. Group preferences override enterprise preferences.
User preferences apply only to an individual. User preferences override group and
enterprise preferences.
NOTE: Individual users have the ability to set their own preferences with no
special privileges required.
The preferences that are applicable to CPS PM:
•Patient Information
•Schedule
•Payment Entry
•Visit Claims
•System>Application
98
System/Users/Location Setup Folder Specialties
The Specialty list option identifies and groups the most common procedures and
diagnoses, by specialty, for viewing and reporting purposes. The Taxonomy codes must
be attached to the providers in your practice. However, Taxonomy codes do not need to
be attached to referring physicians specialties, if created.
**Note: Specialties should be created prior to using the Load Codes option,
discussed later in this manual.
Create a Specialty list option within the Administration component, select the
System>User/Location Setup Folder and click Specialty:
1. Select New.
• Description - Enter the name of specialty.
• NSF Code – Leave blank
• Taxonomy Code - Enter the taxonomy for this specialty. Taxonomy specifies a provider
type and provider area of specialization for all medical related providers. These codes are
available at www.wpc-edi.com.
• Ledger If applicable – Leave blank unless used for integration with third-party
accounting systems.
• Notes – Enter applicable notes regarding this taxonomy code, if needed.
3. Click Save.
4. Repeat steps 1–3 to continue creating specialty list items.
99
System/Users/Location Setup Folder Security
When the product opens the first time, a popup may appear asking if you
have the appropriate security rights, click Cancel and go immediately to
System>User/Location Setup>Security. Assign yourself rights to
everything available using the steps that follow. Close Centricity PM and
restart it for the security setting to take effect. There is no need to restart
your system.
Note: By default, the system assigns “Everyone” to have Allow rights for all
available security items. If Everyone is removed or change Everyone’s
permission is changed to Disallow in the Main Menu folder, no one will be able to
access the application nor will anyone be able to add it back. Best practice is to
add users who will have security to access all components, then remove the
Everyone user.
Security rights can be assigned to others for all of the available security items,
individual items, or individual components. With the Fill Down feature, the product
copies your selections for security users to all items within it. If you have placed
your selections at the Main Menu level you can have the product assign the rights
to every available security item.
Assign group security based on job function.
100
System/Users/Location Setup Folder Security
Assign security rights to all available security items:
1.
2.
3.
From the Users/Location Setup folder, click Security.
Place the cursor on the Main Menu folder, (or any specific component folder or component
item within the folder) and click Add.
Click the check box next to the name of the individual(s) or group(s) desired.
4.
Click OK to exit the Add Security window and place the selected names in the right pane of
the Security window.
• Note: The product automatically enters the name with Allow rights by default.
Change the rights to Disallow for any component or items within a component.
**Please note: A Disallow overrides an Allow.** Names can also removed as
necessary.
5.
Click Fill Down to fill down security rights set for the selected user to assign the same security
into the folders below..
Note: The product globally assigns Allow rights to every component and its items available.
Step 1: Add the Administrator(s) to the security function Main Menu and give full privileges
Step 2: While the Main Menu folder is highlighted, select Fill Down.
Step 3: While the Main Menu folder is highlighted, select Everyone from the top right and click
Remove
Step 4: Now any users/groups that will need access can be added to their respective
components/features. Note: If a user/group is not added, then by default they will not have
access to that component/feature.
101
Edit Menu
The Edit Menu is where many of the
search tables are located that will be
used throughout the system.
From the Administration component, access the Edit Menu by clicking Edit on the
menu bar.
102
Allocation Set
Allocation Sets are nearly identical to allocation types; however allocation
sets expand the functionality of allocation types, automatically allocating
payment responsibility, either by list fee or allowed amount for all procedures
used. Also, allocation sets can be used to specify co-pay and allocation
percent for a single procedure or a range of procedures. You can calculate
to the penny what the patient owes. Allocation sets are found on the Visit
and in Patient Information.
To create Allocations Sets open the Administration component and click on
the Edit menu and select Allocation Set. On the Select Allocation Set
window, click New…
103
Allocation Set
Add CPT Carve Out Rows
Modify <all> row
Once New… is clicked, the Modify Allocation Set window opens. In the Name field,
give the Allocation Set a name. In this example, we will set up a $5 Co-pay Allocation
Set.
First, the <all> row must be modified to indicate the overall Allocation Type (such as
100% Insurance). Click the drop down box under the Allocation Type area of the
Allocation Set Range window and choose 100% Insurance. This default row tells the
system that all codes will be filed at 100% insurance responsibility. Next, we will create
exceptions or carve-outs to this rule.
A new row must be created for each range of codes that will require a co-pay, or
something other than the 100% Insurance allocation. The Ranges section of this
window lists the ranges of CPT codes included in the allocation set, including the type
of procedure code and the associated allocation type. In this example, our carve-outs
to collect a $5 co-pay on will be 99201 through 99215. Continue to create new range
rows for other carve-outs such as preventative care, etc. Also indicate on the Range
Type if range is CPT Based (default) or Revenue Based. These carve-outs create a
proactive way to determine the patient’s responsibility for specified codes where a copay needs to be collected for the visit. Note: There are two system required
Allocation Sets that must be set up: ONE FOR 100% INSURANCE & ONE FOR
100% PATIENT. These will have a default row only with the appropriate
responsibility for insurance or patient.
On the Add/Modify Allocation Set window, there is the option to Calculate the Patient
Portion from Fee or Allowed Amounts. Choose Fee to calculate the patient portion from
the procedure fee or Allowed to calculate the patient’s portion from the insurance
carrier’s allowed amount for this procedure. There is also an option to select
“Automatically Adjust Totals Based on Allowed Amount” based on the allowed amounts
for the carrier’s fee schedule. This is not recommended unless your fee schedules
are strictly monitored and updated.
104
Appointment Types
Doctor/Resource
Appointment Type
Patient
Appointment
Type
Appointment Types need to be created within the Administration component,
Edit/Appointment Type. Creating Appointment Types allows the use of “allocated”
appointment types in schedule templates, and also are associated to the doctors or
resources that can use them. Therefore, Appointments for different physicians or
resources can be associated with pertinent Appointment Types.
At the Select Appointment Type window, to create a new Appointment Type:
1. Click the New button.
2. Type a Name for the Appointment Type (Note: If using EMR, Appointment Type
needs to be typed EXACTLY as it appears in EMR).
3. The system will automatically assign an ID number.
4. Choose the Category as either Patient or Doctor/Resource. All Appointment
Types created for patients should be under the Category “Patient.” Block
appointment types, Meeting appointment types, etc., should be under the Category
“Doctor/Resource.”
5. Enter the Duration or length of time this Appointment Type requires.
6. Each Appointment Type can have it’s own Color associated with it as well. Click
on the Color field to choose colors for each Appointment Type.
Tip: Use the color “Gray” for Doctor/ Resource Appointment Types as gray typically
means the time is “unavailable.”
105
Assign Appointment Types
To assign Appointment Types to a Resource (Doctors or Resources), from
the Appointment Type window:
1. Click “Add.”
2. Double click in the Resource(s) field of the Appointment Type
Assignment, or click the binoculars, select resources to associate with this
Appointment Type.
3.Click OK.
4.To add a Pop-Up note for an Appointment Type, when selecting the
resources, enter the desired note and check the Pop-Up box as shown
above. (Notes can be added at any time by modifying the Appointment Type
for each Resource.)
5.Then click OK again and the Resources will list in the Assignments
section of the Appointment Type window, as well as any pop-up notes
entered.
Note: Resources are any persons, equipment or rooms that have a
schedule created within the system.
106
Batches
Management of Batches are performed via the Edit Menu. Using this feature
allows a user to Modify a batch, and with security rights to Delete or
Reassign a batch.
Edit – The Name of the batch can be modified as needed, however the Date
of Entry, once the batch has been created cannot be modified.
Delete – An open batch can be deleted, however, all instances of
transactions must be reassigned to another batch before the delete process
can be completed. The system will prompt the user to reassign transactions.
• A user cannot delete an effectively closed batch.
• Soft closed batches, that is, batches that have been closed individually
but not “Hard Closed” by the closing date, can only be reassigned to or
from another batch when in Batch Closing Override mode.
• A “Hard Closed” batch (one that has been closed by setting the Closing
Date) cannot be deleted, nor can anything be reassigned to or from a
hard closed batch.
107
Charge Sets
A Charge set can also be used to enter charges. A Charge Set is a group of
diagnosis and procedure codes and their accompanying information. Charge Sets
are used to enter charge scenarios which are used routinely in a practice in order
to reduce manual data entry. To create a new Charge Set, click New.
Note: While this feature is especially helpful when using CPS alone, it is not
beneficial if the EMR software is integrated as the charges are imported as ‘sets’
from the EMR product.
108
Charge Sets
2.
4.
3.
1.
5.
6.
7.
To add a new Charge Set from the Edit Menu, choose Charge Set:
1. Select New… in the Select Charge Set screen. A screen entitled, New Charge Set
will display.
2. Enter a name in the Charge Set field.
3. Choose the New… button located in the Diagnosis View List section and search for
or enter a Diagnosis. Click the Next> button on the Diagnosis Entry window to enter
additional Diagnosis codes for this Charge Set.
4. Click OK in the Diagnosis Entry screen.
5. Click New… in the Procedures View List section and search for or enter a Procedure
Code. Complete additional information needed. Click the Next> button to add additional
Procedure codes for this Charge Set and add information as necessary.
6. Click OK in the Procedure Entry Screen.
7. Click OK in the Select Charge Set screen.
Repeat this process to add additional Charge Sets the practice will use frequently.
Note: Diagnosis codes and CPT codes must be loaded prior to setting up Charge Sets.
109
Clearinghouse Settings
A clearinghouse is an interface that allows you to file claims or statements
electronically. Using this feature, you can add, modify, or delete clearinghouse
information. In addition, you can specify, at the clearinghouse level, which plugins to use to create, transmit, and process files.
**Please Note: Before creating clearinghouse settings for plug-ins, please be sure
that the Claim File Creators tab, Eligibility File Creators tab, Statement File
Creators tab, File Transmitters tab, and File Processors tab have been ‘Verified’
on the Plug-ins window to confirm that the Plug-in is working properly. Plug-ins
are programs that may be purchased to interface with clearinghouses.
To open the Clearinghouse table open the Administration component, click on
Edit on the tool bar, and select Clearinghouse.
110
Adding a New Clearinghouse
When Clearinghouse is selected from the Edit Menu, a search window will display
allowing selection of a Clearinghouse. To create a new Clearinghouse record, click New.
This action opens the New Clearinghouse Settings window.
The File Transmission/Processing tab houses general information for the plug-ins that
allow File Transmission, File Processing, and Statement Creation.
Check-marking the Inactive check box acts as a toggle to enable/disable this feature.
Checkmark the box to hide this clearinghouse from the Clearinghouse lists throughout
CPS. When a clearinghouse is marked as Inactive, the feature does not delete the
clearinghouse from the CPS database, the clearinghouse is simply not visible from list
boxes when selecting a clearinghouse.
To add a Clearinghouse, click New… On the File Transmission/Processing tab enter:
Clearinghouse Name – Type a descriptive name for this clearinghouse.
The Submitter Information area contains information about the doctor’s office:
Name – Type the legal business name of the company or office that is submitting the
transmission.
Contact – Type the name of the contact person at this site.
Phone – Type the phone number of the contact person at this site.
Logon ID – Type the Logon ID for this clearinghouse. The Logon ID is provided by the
clearinghouse either directly or through GE, depending on which clearinghouse is used.
Logon Password – Type the Logon Password for this clearinghouse. The Logon
Password is provided to you by the clearinghouse either directly or through GE,
depending on which clearinghouse is used. **Please Note: The password is case
sensitive.
111
File Transmission Settings
1.
2.
The Plug-ins area contains information about the File Transmission, File Processor and Statement
Creator plug-ins. The settings are specific to each plug-in.
File Transmission – This feature is used to electronically batch and transmit claims to the
clearinghouse. You must use the connection specified in your clearinghouse enrollment. Using the
drop-down arrow, select the alias (name) of the file transmitter to be used. Click Settings to
specify additional information for this plug-in. Note: These aliases are set up on the File
Transmitters tab on the Plug-ins window.
There are 3 modes of transmission available:
1. Dial-Up
2. Secure FTP
3. HTTPS
Depending on the equipment and/or software set-ups at your practice, you will use one of these
modes.
Centricity EDI Clearinghouse will use secure FTP to transmit your claims. The settings for this
plugin are as
on the screen:
UserID: Enter FileTransfer
Click on the Reset URL button to automatically populate the URL field
Select your current time zone
112
File Processor
Advanced Tip:
When setting up
for Remittance,
complete File
Processor per GE
guidelines.
The File Processor feature is used to process electronic remittance files received
from the carrier, via the clearinghouse.
Using the drop-down arrow, select the alias (name) of the file processor to be
used.
Click Settings to specify additional information for this plug-in.
Note: These aliases are set up on the File Processors tab on the Plug-ins
window.
Note: Please see the EDI Manual for Remittance set-ups.
113
Statement Creator
The Statement Creator is used when a plug-in for electronic Statements is
purchased. The Settings button allows defining how many guarantors will be
batched in a file at one time. In the example above, this means that if there are
150 statements to send, they will be batched as 3 files of 50 guarantors, or
statements per file.
Using the drop-down arrow, select the alias (name) of the statement creator to be
used.
Click Settings to specify additional information for this plug-in.
Note: These aliases are set up on the Statement Creators tab on the
Plug-ins window.
114
Clearinghouse File Creator Tab
The File Creator tab stores information specific to the clearinghouse used by the
practice.
The Settings button must be opened for the clearinghouse to be used and enter practice
information.
NOTE: The settings are different for each clearinghouse.
Highlight the File Creator Plug-in that will be used for this Clearinghouse setup and click
the Settings button to display this information. The window that displays is customized to
the plug-in selected.
Billing ID will be pre-populated and grayed out.
The Company Address information should be completed with the address of the
company responsible for submitting claims to the clearinghouse.
NOTE: Region is not a required field, unless indicated by your clearinghouse.
The Claim File Settings area will allow you to setup how the claims will be batched and
transmitted.
Test - Select the Test option to submit test claim files.
Production - Select the Production option to submit live claim files, unless you are
required to send test claims per your clearinghouse/carrier specifications.
Max Claims per File – Allows you to determine the maximum number of claims to be
batched together for electronic transmission. Recommend 150 Max Claims per File.
115
Companies
A Company is a single legal entity generally with one Tax ID. It can be either a
doctor or a corporation.
A Company record is the primary item to which money is associated in CPS.
At least one Company must be created for each database. However, there can
be more than one Company within one database.
At least one Company must be created for each tax ID that providers will bill
claims under. However, there can be more than one Company with the same tax
ID.
To open the Company table open the Administration component, click on Edit
on the tool bar and select Company.
To create a new Company click on the New button.
116
Company Information Tab
Inactive – Check-mark this check box to indicate when this Company is no longer
active. Check-marking this box prevents the Company from being listed as an
option in a list of available Companies. However, this Company can be included in
a report if you search for "inactive" Companies.
Name (Required) - Type the legal name of the company that you would like to see
printed on reports and statements.
List Name (Required) - Type the company name under which you would like to
search (the way the name will appear in the search list box). This field defaults to
the same entry as the Name fields when the tab key is pressed from the name
field. However, this field can be overridden to be unique from the name field.
ID (Required) – CPO-PM will automatically assign an ID for each company
created. If you would like a specific ID for each company you can manually type
in the wanted ID and the system will not override the specified ID. If a system ID
has been assigned to the company you can modify the ID to match the specific ID
you wish the company to have.
NOTE: Each company must have a unique ID.
117
Address (Required) – Type the address of the company that you would like to appear as
the ‘Pay To’ address on statements and receipts. Two fields are available for inputting
address information (PO Box, etc.).
NOTE: No punctuation should be used when entering an insurance carrier address.
City/State/Zip (Required) – Type or search for the zip code. If the zip code has been
added to the Zip Code table, then a zip code entry populates the city and state.
NOTE: Zip Code entries should be limited to 5 digits. Nine digit zip codes should never
be used.
NOTE: No punctuation (dashes) should be used when populating zip codes.
Country – This field is most commonly not used. Only type the country where the
insurance carrier is located when the insurance carrier is located outside of the United
States.
NOTE: Only the two digit country code should be populated in this field.
Phone 1/Phone 2 – Type the phone number(s) for the company. Click the down-arrow to
select the type of the phones, or manually type in the phone type.
NOTE: Only 10 digit phone numbers should be populated. Extensions should not be
added to the phone number. . . This can cause rejections.
Filing: Doctor Fees (default) – Select this option if filing professional fees for a doctor of
this company.
NOTE: This option allows HCFA 1500 forms to be printed and 837 Professional format to
be transmitted electronically.
Filing: Facility Fees – Select this option if filing institutional fees for a facility.
NOTE: This option allows UB-92 forms to be printed and 837 Institutional format to be
transmitted electronically.
Federal Tax ID - Type the tax identification number for this company.
NOTE: No punctuation (dashes) should be used when populating the Tax ID.
o SSN – Select this option if the company’s Federal Tax ID is a social security
number.
o EIN – Select this option if the company’s Federal Tax ID is an employer
identification number.
o NPI – Select this button to type a national provider identifier number in the text
box.
o McKesson, ENS and Centricity EDI ONLY – Enter the NPI on the
information tab.
o Other Clearinghouses - DO NOT enter the NPI on the information
tab.
Ledger – This field is used with third party accounting software. If applicable, type the
alpha-numeric general ledger number to be used for integration with third-party
accounting systems. The maximum number of characters you can input in this field is 10.
118
Company Identification Tab
The Company Identification tab is where all insurance carrier assigned group
numbers are stored.
The first row created on the identification tab must not contain any ID numbers.
This row is known as the default row and should be set up to use with each
company.
Subsequent rows specific to an insurance plan can be added to store required
group identification numbers. These are known as exception rows.
To create a default or exception row click on the New button.
119
Company Default All Row
The default row allows the tax identification number to identify the
company/provider to the insurance carriers that have not assigned provider
numbers.
The fields of a standard company default all row are setup as follows:
Facility – This field is commonly left at the default ‘all’. If necessary, select the
appropriate facility that a carrier assigned group number has been associated
with.
All Insurance Carriers – Select this option to print or transmit the tax
identification number to all insurance carriers that have not assigned a specific
group number to the company.
• Do not select Insurance Carrier or Group on the All Row.
Facility – This field is left blank on the company table. This field should be
populated on the facility table.
120
PIN – This field is left blank on the company table. This field should be populated
on the doctor table.
GRP – This field is left blank in the company default all row.
EMC – This field is left blank in the company default all row.
Additional ID 1 / Additional ID 2 – These fields are left blank in the company
default all row.
Type – This field is left blank on the company table. This field should be
CLIA – This field is left blank on the company table. This field should be
Mammography Cert. – This field is left blank on the company table. This field
should be populated on the facility table.
Place of Service – This field is left blank on the company table. This field should
be populated on the facility table.
NPI –
•McKesson, ENS and Centricity EDI ONLY - All row and exception rows, leave
blank.
•Other Clearinghouses - All row – Leave as is. Exception rows – Add the NPI
number.
Federal Tax ID – The tax identification number field should be left blank in this
table. When the tax identification number field is left blank in this table it is pulled
from the information tab of the company.
121
Company Ins Carrier Exception Row
The qualifier drop
list pulls from the
Administration->
General/Admin
folder ->Provider ID
number types.
An insurance carrier exception row should be created when one specific insurance
carrier has assigned a group number to the company.
The fields of a standard insurance carrier exception row are setup as follows:
appropriate facility that a carrier assigned group number has been associated with.
Insurance Carrier – Select this option to print or transmit a group ID number
specific to one insurance carrier (ex: Medicare). Type or search for the specified
insurance carrier in this field.
Facility – This field is left blank on the company table. This field should be
PIN – This field is left blank on the company table. This field should be populated
on the doctor table.
GRP – Type the carrier assigned group number in this field. This number prints in
box 33 on the standard HCFA form. A qualifier must be selected from the adjacent
drop list.
NOTE: This field should mirror the EMC field.
122
EMC – Type the carrier assigned group number in this field. This number
transmits in loop 2010AA of the ANSI 837 Professional electronic format. A
qualifier must be selected from the adjacent drop list.
NOTE: This field should mirror the GRP field.
Additional ID 1 / Additional ID 2 – This field allows multiple carrier assigned
identification numbers to be transmitted for one company. This field is most
commonly not used. The insurance carrier will inform you if they require more
than one carrier assigned identification number to be sent. A qualifier must be
selected from the adjacent drop list.
Type – This field is left blank on the company table. This field should be
populated on the Facility table.
CLIA – This field is left blank on the company table. This field should be
populated on the Facility table.
should be populated on the Facility table.
be populated on the Facility table.
NPI –
blank.
number.
123
Company Ins Group Exception Row
When the same group number is assigned by several carriers (i.e., BCBS, Blue
Cross Blue Shield, Blue Shield all use the same group number), an insurance
group exception row should be created on the Company table. The fields of a
standard insurance carrier exception row are setup as follows:
appropriate facility that a carrier assigned group number has been associated
with.
Insurance Group – The purpose of insurance groups are 1) Ease of entry for
payment posting; 2) Reporting; 3) Ease of entry at the company and doctor
exception rows. Select this option to print or transmit a group identification
number specific to a group of insurance carriers (ex: Blue Cross Blue Shield).
Type or search for the specified insurance carrier in this field.
Caution: When creating an exception row for an insurance group, make sure that
every carrier in that group will use the number entered. For example: Medicare
can be an insurance group that contains both Medicare and Railroad Medicare
carriers for reporting purposes however, these two carriers do not require the
same group number, therefore, Insurance Group would not be used in this
instance.
Facility – This field is left blank on the company table, and should be populated
on the facility table.
124
PIN – This field is left blank on the company table, and should be
populated on the doctor table.
GRP – Type the carrier assigned group number in this field. This number prints in
box 33 on the standard HCFA form. A qualifier must be selected from the adjacent
drop list.
NOTE: This field should mirror the EMC field.
EMC – Type the carrier assigned group number in this field. This number
transmits in loop 2010AA of the ANSI 837 Professional electronic format. A
qualifier must be selected from the adjacent drop list.
NOTE: This field should mirror the GRP field.
identification numbers to be transmitted for one company. This field is most
commonly not used. The insurance carrier will inform you if they require more
than one carrier assigned identification number to be sent. A qualifier must be
selected from the adjacent drop list.
Type – This field is left blank on the company table, and should be populated on
the Facility table.
CLIA – This field is left blank on the company table, and should be populated on
the Facility table.
should be populated on the Facility table.
be populated on the Facility table.
NPI –
blank.
number.
125
Diagnosis
Before posting charges to a visit, the commonly used diagnosis codes for the
practice must fist be set up in the database. A Superbill is a good resource for
compiling a list of the most frequently used diagnoses. ICD-9 Codes can be
manually entered or downloaded using the Load menu. (Please refer to the Load
portion of this manual for further instruction on this process.)
To create or modify a diagnosis code open the Administration component, click on
the Edit Menu and choose Diagnosis.
New – Click New… to add a new diagnosis.
Modify - To modify a diagnosis, first search for the ICD-9 code that needs to be
modified. This can be done by entering the ICD-9 code, Code (internal name), or
Description. Then highlight the code and click on the Modify button.
Delete – To delete an ICD-9 code, search for the ICD-9 code, highlight and click
the Delete button.
**Note: When searching, if you know only a partial description you can use the %
sign as a wildcard. For example, if searching for a code that starts with
Hypertension enter in the description field Hypertension%, then click Search. This
will give results in which the Description will start with “Hypertension”. If you are
unsure where in the diagnosis Hypertension is found, enter in the description field
%Hypertension%, then click Search. This will give results in which anywhere in the
Description “Hypertension” can be found.
126
Diagnoses
If the “Load” feature of the product is purchased, Diagnoses will be entered into the
system using this feature. New/Edit Diagnosis Window fields:
Inactive - Click this check box to indicate when this diagnosis is no longer active.
Once a diagnosis is tied to charge it cannot be deleted. However, old diagnoses
can be inactivated by checking the inactive box on the modify diagnosis window.
Code (Required) - Type the code for this diagnosis. This can be the same as the
ICD-9 code or an internal code.
ICD-9 Code (Required) – Type the ICD-9 code for this diagnosis.
Effective (Optional) - Type the effective date for using this diagnosis.
Expiration (Optional) -Type the expiration date for using this diagnosis.
Description - Type a description of the diagnosis code.
Notes (Optional) - Type any notes pertaining to this diagnosis. These notes are
informational only, and do not print.
Specialty – (Required) Click the check box that corresponds to the specialties that
applies to this diagnosis. This field is used to group diagnoses for searching and
reporting purposes. Use the scroll bar, if required, to mark the specialties.
To Add a Diagnosis manually, click New on the Select Diagnosis window (previous
page). Complete the Code, the ICD-9 Code, Description, and click all Specialties
that apply. Click OK. The Effective, Expiration and Notes fields are optional.
127
Employers
Employers are usually added to the system from the registration component, when
necessary. However, known Employers can be added from the Administration/Edit
Menu. To add an Employer, click the New button on the Select Employer window.
This action will open a New Employer window to enter appropriate information.
Note: The ID will be created by the system when OK is clicked.
Notice at the bottom of the New Employer window, there is Workers Compensation
Carrier Information. Workers Compensation (W/C) carriers are accessed from the
Employers table, although they actually live in the Insurance Carriers table. It is
important to enter the W/C carrier in the Employer table for those W/C patients in
order to pull the correct carrier for a W/C claim.
128
Facilities
A Facility is the actual location where a doctor’s services are rendered. A Facility
should be created for each location where your doctor renders services.
To open the Facility table open the Administration component, click on Edit on
the tool bar and select Facility.
It may be necessary to build multiple tables for one Facility if that Facility could fall
under multiple Place of Service codes.
To create a new Facility click on the New button.
NOTE: No punctuation should be used when entering data in the
facility table.
129
Facilities-Information Tab
Complete the Information tab for each Facility created:
Inactive – Check-mark this check box to indicate when this facility is no longer active.
Check-marking this box prevents the facility from being listed as an option in a list of
available facilities. However, this facility can be included in a report if you search for
"inactive" facilities.
Color – Select the color that will represent the facility.
Name (Required) - Type the name of the facility that you would like to see printed on
your reports, statements and claims.
List Name (Required) - Type the facility name under which you would like to search (the
way the name will appear in the search list box). This field defaults to the same entry as
the Name fields when the tab key is pressed from the name field. However, this field can
be overridden to be unique from the name field.
ID (Required) – CPOPM will automatically assign an ID for each facility created. If you
would like a specific ID for each facility you can manually type in the wanted ID and the
system will not override the specified ID. If a system ID has been assigned to the facility
you can modify the ID to match the specific ID you wish the company to have.
NOTE: Each facility must have a unique ID.
NOTE: No punctuation should be used when entering data in the facility table.
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Address (Required) – Type the address of the facility that you would like to appear as the
service location address on claims. Two fields are available for inputting address
information (PO Box, etc.).
City/State/Zip (Required) – Type or search for the zip code. If the zip code has been
added to the Zip Code table, then a zip code entry populates the city and state.
NOTE: Zip Code entries should be limited to 5 digits. Nine digit zip codes should never be
used.
facility is located when the facility is located outside of the United States.
NOTE: Only the two digit country code should be populated in this field. (ex: CA or
MX)
Phone 1/Phone 2 – Type the phone number(s) for the facility. Click the down-arrow to
NOTE: Only 10 digit phone numbers should be populated. Extensions should not be
added to the phone number. . . This can cause rejections.
Federal Tax ID – This field should be left blank on this table. When this field is left
blank on this table the tax identification number is pulled from the information tab of the
Company table.
NPI – If there is a Facility NPI number, place it in this field.
State License – Type the facility’s state license number in this field only if a state license
number has been assigned to the facility.
NOTE: Do not populate this field with a doctor’s state license number.
Additional License - Reserved for future use.
Specialty License - Reserved for future use.
Ticket Number Prefix – This option allows prefixes to be populated at the beginning of
the appropriate assigned ticket numbers. This is a helpful option when printing Superbills
for multiple facilities and there is a need to be able to identify Superbills by facility. Up
to 5 alphanumeric characters may be used as the prefix.
Default Company – This option allows a default company to be designated for a specific
facility. If this option is selected, when creating a visit, the company field will
automatically be populated when the facility is selected.
NOTE: No punctuation should be used when entering data in the facility table.
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Place of Service – Type or search for the appropriate place of service code.
NOTE: If a location could have more than one POS, then multiple facilities will
need to be created with the appropriate POS code (ex: Hospital IP, Hospital OP,
Hospital ER)
Ledger – This field is used with third party accounting software. If applicable, type
the alphanumeric general ledger number to be used for integration with third-party
accounting systems. The maximum number of characters you can input in this
field is 10.
Specialty – This field is only used when filing UB-92 forms. Type or search for the
appropriate specialty associated with the facility. This code prints on the standard
UB-92 form and is transmitted in the ANSI 837 Institutional electronic format when
the company table is marked as
filing Facility Fees.
Type of Bill – This field is only used when filing UB-92 forms. Type the
appropriate three-digit type of bill code. This code prints on the standard UB-92
form and is transmitted in the ANSI 837 Institutional electronic format when the
company table is marked as filing facility fees.
Tax Rate – If applying sales tax to charges, type the tax rate for this facility in a
decimal format . (ex: 8.25% should be typed as 0.0825).
NOTE: Use of this option in combination with the Charge highest value only for
anesthesia procedures option is not supported.
NOTE: No punctuation should be used when entering data in the facility
table.
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Facilities-Identification Tab
The Facility Identification tab is where all facility information stored.
The first row created on the identification tab must not contain any identification
numbers. This row is known as the default row and should be set up to use with
each facility.
facility identification numbers. These are known as exception rows.
To create a default or exception row click on the New button.
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Facility- Default All Row
The Facility default row links the doctor default row to the company default row
and allows the Federal Tax ID to identify the company/provider to the carrier.
The fields of a standard facility default all row are setup as follows:
Company – This field is commonly left at the default ‘all’. If necessary, select the
appropriate company that a carrier assigned identification number has been
associated with.
Facility Address Same as Company – This option should not be check-marked.
NOTE: When this option is selected the facility address is not transmitted in the
appropriate loop and rejections can occur.
All Insurance Carriers – Select this option to print or transmit the tax
identification number to all insurance carriers that have not assigned a specific
identification number to the facility.
Facility – This field should be set to ‘from company’ in the default all row.
PIN – This field should be set to ‘from company’ on the facility table. This field
should be populated on the doctor table.
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GRP – This field should be set to ‘from company’ on the facility table. This field
should be populated on the company table.
EMC – This field should be set to ‘from company’ on the facility table. This field
Additional ID 1 / Additional ID 2 – This field should be set to ‘from company’ on
the facility table. This field should be populated on the company or doctor table.
Type – Type the appropriate facility type code in this field.
NOTE: The most commonly used facility type used is ‘FA’ which is defined as
“Facility”
CLIA – When applicable, type the carrier assigned CLIA number in this field.
NOTE: The Laboratory box must be check-marked in the fee schedule tab of the
procedure table for the CLIA number to be printed/transmitted.
NOTE: This field should be set to ‘from company’ when not populated with a CLIA
number.
Mammography Cert. – When applicable, type the carrier assigned
mammography certification number in this field.
NOTE: The mammography box must be check-marked in the fee schedule tab of
the procedure table for the mammography cert number to be printed/transmitted.
NOTE: This field should be set to ‘from company’ when not populated with a
Mammography Cert. number.
Place of Service – This field should not be marked “from company” and should
be left blank. When this field is left blank the POS is pulled from the information
tab of the facility table.
NOTE: If a location could have more than one POS, then multiple facilities will
need to be created with the appropriate POS code (ex: Hospital IP, Hospital OP,
Hospital ER)
Federal Tax ID – The tax identification number field should be marked on the right
and left blank in this table. When the tax identification number field is left blank in
this table it is pulled from the information tab of the company.
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Facility- Ins Carrier Exception Row
The facility exception row links the doctor exception row to the company exception
row and allows the assigned identification number to be printed/transmitted to
identify the company/provider to the carrier.
The fields of a standard facility exception row are setup as follows:
appropriate company that a carrier assigned identification number has been
associated with.
NOTE: When this option is selected the facility address is not transmitted in the
appropriate loop and rejections can occur.
Insurance Carrier – Select this option to print or transmit facility identification
numbers specific to one insurance carrier (ex: Medicare). Type or search for the
specified insurance carrier in this field.
Facility – When applicable, type the carrier assigned facility number in this field. A
qualifier must be selected from the adjacent drop list. Facility ID number is not a
valid qualifier – the most commonly qualifiers used are Medicare and Blue Cross.
NOTE: This field should be set to ‘from company’ when not populated.
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PIN – This field is left blank on the facility table. This field should be populated on the
doctor table.
GRP – This field is left blank on the facility table. This field should be populated on the
company table.
NOTE: This field should be set to ‘from company’ when not populated. The field should
be grayed out to prevent unwanted information from being inadvertently populated in the
field.
EMC – This field is left blank on the facility table. This field should be populated on the
company table.
field.
Additional ID 1 / Additional ID 2 – This field is left blank on the facility table. This
field should be populated on the company or doctor table.
field.
Type – Enter the appropriate facility type code in this field.
NOTE: The most commonly used facility type used is ‘FA’ which is defined as “Facility”
Mammography Cert. – When applicable, type the carrier assigned mammography
certification number in this field.
NOTE: The mammography box must be check-marked in the fee schedule tab of the
procedure table for the mammography cert number to be printed/transmitted.
Place of Service – This field should not be marked “from company” should be left blank.
When this field is left blank the POS is pulled from the information tab of the facility table.
NOTE: If a location could have more than one POS, then multiple facilities will need to be
created with the appropriate POS code (ex: Hospital IP, Hospital OP, Hospital ER)
Federal Tax ID – The tax identification number field should be marked on the right and
left blank in this table. When the tax identification number field is left blank in this table it
is pulled from the information tab of the company.
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Facility- Ins Group Exception Row
The Facility exception row links the doctor exception row to the company exception row and
allows the assigned identification number to be printed/transmitted to identify the company/provider
to the carrier.
The fields of a standard facility exception row are setup as follows:
Company – This field is commonly left at the default ‘all’. If necessary, select the appropriate
company that a carrier assigned identification number has been associated with.
NOTE: When this option is selected the facility address is not transmitted in the appropriate loop
and rejections can occur.
Insurance Group – The purpose of insurance groups are 1) Ease of entry for payment posting; 2)
Reporting; 3) Ease of entry at the company and doctor exception rows.
Caution: When creating an exception row for an insurance group, make sure that every carrier in
that group will use the number entered. For example: Medicare can be an insurance group that
contains both Medicare and Railroad Medicare carriers, for reporting purposes however, these two
carriers do not require the same group number, therefore, Insurance Group would not be used in
this instance.
Select this option to print or transmit a group identification number specific to a group of insurance
carriers (ex: Blue Cross Blue Shield). Type or search for the specified insurance carrier in this field.
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Facility – When applicable, type the carrier assigned facility number in this field. A
qualifier must be selected from the adjacent drop list. A qualifier must be selected from
the adjacent drop list. Facility ID number is not a valid qualifier – the most commonly
qualifiers used are Medicare and BlueCross.
PIN – This field should be set to ‘from company’ on the facility table. This field should be
populated on the doctor table.
GRP – This field should be set to ‘from company’ on the facility table. This field should be
populated on the company table.
EMC – This field should be set to ‘from company’ on the facility table. This field should be
populated on the company table.
Additional ID 1 / Additional ID 2 – This field should be set to ‘from company’ on the
facility table. This field should be populated on the company or doctor table.
Type – Type the appropriate facility type code in this field.
NOTE: The most commonly used facility type used is ‘FA’ which is defined as “Facility”
Mammography Cert. – When applicable, type the carrier assigned mammography
certification number in this field.
NOTE: The mammography box must be check-marked in the fee schedule tab of the
procedure table for the mammography cert number to be printed/transmitted.
Place of Service – This field can be left blank. When this field is left blank the POS is
pulled from the information tab of the facility table.
NOTE: If a location could have more than one POS, then multiple facilities will need to be
created with the appropriate POS code (ex: Hospital IP, Hospital OP, Hospital ER).
Federal Tax ID – The tax identification number field should marked on the right and left
blank in this table. The tax identification number field pulled from the information tab of
the company table.
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Fee Schedule
Fee Schedules are designed to set up the general rules for calculating charges
against procedures. In CPS, this allows the flexibility of either using flat fees or
RVU fee schedules.
The system can have multiple fee schedules based on carrier reimbursements,
which may be accessed throughout the system. You can also copy existing fee
schedules, rename it, and set the percentage by which the Fee or Allowed should
be increased/decreased.
To create a fee schedule in the Administration component, click on the Edit Menu
and choose Fee Schedule. Click on the New button to add a new fee schedule.
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Fee Schedules
Once OK is clicked on the Select Fee Schedule window, the Add/Modify Fee Schedule
window appears.
To add a new Fee Schedule:
Name the Fee Schedule (ex. Standard Fee Schedule, or Office Fee Schedule).
Calculate Based On - Click the appropriate button to identify whether you want to
calculate fees and allowed amounts based on a Flat fee or RVUs. The default selections are
Fee/Flat and Allowed/Flat.
Round Computed Fee to the nearest - Click the down-arrow to designate the rounding of
fee or allowed amounts (restricted to either .01, .05, .25, .50, or 1.00).
Round Computed Allowed to the nearest - Click the down-arrow to designate the
rounding of fee or allowed amounts (restricted to either .01, .05, .25, .50, or 1.00).
Contract Type – If necessary, select the type of contract associated with the claim using
this fee schedule. Examples: per diem, variable per diem, flat, capitated, percent.
Terms Disc % - If necessary, type the terms discount percentage. This is available to the
purchaser if an invoice is paid on or before the terms discount due date.
Contract % - If necessary, type the contract percentage for all procedures on this fee
schedule.
Calculate Time Units - This section is usually used in an anesthesia environment or similar
environment where billing may occur in minutes.
Order procedures based on highest dollar amount - Click this check box to list posted
procedures based on the highest dollar amount on the claim. This feature is not commonly
used.
Notes - Enter notes for this fee schedule as appropriate.
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Fee Schedule
These fields are
used for
Anesthesia billing.
The following fields are for anesthesia billing
• Calculate time units (Anesthesia specific): This check box allows designation of
time to unit conversions. This check box enables all the objects in this group box.
• Minutes per Unit spin box– Click the up-down control to identify the total
number of minutes you want to equate to one unit (1 to 1440).
• Maximum Minutes spin box– Click the up-down control to identify the maximum
number of minutes to which the ‘minutes per unit’ rule should apply (1 to 1440).
• After Minutes/Minutes per Unit spin box– Click the up-down control to identify
the number of minutes to equate to one unit after so much time elapses (1 to
1440).
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Fee Schedule
These fields are
used for
Anesthesia billing.
• Allow partial units–Click this button if you want to include partial units when calculating
fees and allowed amounts.
• Round to the nearest–This button is enabled when you select partial units. It
designates how partial units should be rounded (restricted to
either .1, .01, .001, .0001).
**Note: This option is mutually exclusive of the next option. You can select either
partial units or whole units.
Allow only whole units (default)–Click this button if you want to calculate fees
based on only whole units of time. This button controls the ‘round up to the next
unit after # minutes’ text box.
•Round up to the next unit after # minutes (this control is not turned on unless
the ‘Allow only whole units’ button is selected)–Click the up-down control to
designate the number of minutes after which you want to round up to the next
whole unit (1 to 1440).
Charge highest value only for anesthesia procedures: Click this check box to
perform procedure edits when charges are posted. When enabled, CPS will determine
which procedure posted to a visit has the highest RVU and posts this procedure, while
converting lesser value procedures to $0.00.
Note: Use of this option in combination with the Tax Rate option is not
supported (applicable to anesthesia related procedures and insurance billings only)
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Fee Schedule- Modifiers Tab
The Modify tab provides a columnar list of the information for the various
modifiers. In this tab, clicking Edi with a modifier selected opens the Edit
Modifiers window to update modifier information on the fee schedule.
Edit Modifier field descriptions, if applicable:
Inactive - Click this check box to indicate when this modifier is no longer active.
Modifier - This text box is for informational purposes only.
Force Paper Filing - Click this check box to indicate that this modifier is to be
forced to paper filing regardless of the filing method.
Concurrency - N/A–Click this button to indicate that this modifier is not
concurrency related.
•Medically Directed Procedure–Click this button to indicate that this modifier
is used with anesthesia related procedures in visits where a resource is specified.
The modifier will be added based on the concurrency of the procedure.
Concurrent procedures from–Specify the number of procedures (1-100)
performed at the same time during a medically directed visit. When the
designated number of procedures exists on a visit, then this modifier is
applied when the concurrency process is initiated from the Concurrency
button on the Billing window.
•Non-Medically Directed Procedures–Click this button to indicate that this
modifier should be used with anesthesia related procedures where a resource is
not specified.
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Fee Schedule- Modifiers Tab
Modify Charge Calculation By
•Additional Units–Click this button to designate the number of units to be
added to the units already associated with the selected procedure when
calculating procedure fees (for fees calculated using RVUs).
•Flat Override–Click this button to designate a predetermined number of units
when calculating procedure fees (for fees calculated using RVUs). This entry
overrides any other unit calculations associated with this procedure.
•Percent Adjustment–Click this button to indicate whether to increase or
decrease the fee or RVU by a certain percentage when this modifier is used.
Selecting this button activates the adjacent Apply to list.
•Apply to–Select whether you want specified adjustments made against fees or
RVUs.
The Next button at the bottom left of this window will allow the user to toggle to
the next (or Previous) modifier while remaining in this window.
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Fee Schedule-Conversion Tab
The Conversion Factors tab on the Modify Fee Schedule window stores the
conversion factor for each department of procedures. Remember that this can be
a whole or partial number. There can be a different conversion factor for each
department. This information is required when calculating fees using RVUs. The
Procedures table stores the RVU.
Department – Those departments created in the List Editor under Departments.
Fee – Enter the conversion factor for this fee.
Allowed – Enter the conversion factor for the Allowed Amount.
To Modify Conversion Factors, click the Modify button. The Department field is a
read-only field, but the Fee and Allowed conversion factors can be modified.
The <Prev and Next> buttons allow the user to scroll through the different
departments to enter conversion factors from this window.
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Copy Fee Schedule
The Copy feature eliminates the need for manually inputting information for a new
fee schedule when a fee schedule that already exists can be used with a few
modifications. Simply make a copy of the fee schedule that applies to most of your
needs and then make any necessary changes.
To Copy a fee schedule:
1. From the Select Fee Schedule window highlight the fee schedule to copy.
2. Click Copy. The Copy Fee Schedule window opens.
3. Change the name to the new fee schedule name.
4. Adjust the fees by a percentage, for example, to increase fees for the new fee
schedule by 20%, type 120% in the Adjust Fees by field. Choose rounding
preferences, and type the desired amount to Adjust Allowed by, and round as
desired.
5. Click OK to save your entries. The newly created fee schedule now displays in
the list box on the Select Fee Schedule window.
6. Highlight the fee new schedule and click Edit. The Edit Fee Schedule
window opens.
7. Verify that the fee schedule information is accurate or make modifications as
necessary. See Creating a Fee Schedule Record for guidelines if necessary.
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Guarantors
Guarantors in the Edit Menu allows deleting a Guarantor by a user with security
rights. Guarantors are not added to the system under the Edit Menu, but rather
are entered in the Registration component. However, to manage duplicate
guarantor entries, Merge allows a merge of the duplicate guarantors, or Delete
allows deletions of an inappropriate guarantor.
Rules regarding deleting guarantors are as follows:
• The user must have appropriate security rights before deleting a guarantor.
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Insurance Carriers
Insurance Carriers are used throughout the system to track carrier information
for filing claims and for tracking insurance payments. There are many fields to
address when creating insurance carriers; accuracy is critical for claim edits and
reimbursement.
To open the Insurance Carrier table open the Administration component, click
the Edit Menu on the tool bar, and select Insurance Carriers.
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Insurance Carrier-Information Tab
Inactive – Check-mark this check box to indicate when this insurance carrier is no
longer active. Checkmarking this box prevents the insurance carrier from being
listed as an option in a list of available insurance carriers. However, this carrier
can be included in a report if you search for "inactive" carriers.
Name (Required) – Type the business name of the insurance carrier. This name
is printed on the standard HCFA 1500 and is transmitted electronically.
List Name (Required) – Type the name of the insurance carrier as you would like
it to appear in the Select Insurance Carrier list box when the search feature is
activated. This field defaults to the same entry as the Name field when the tab key
is pressed from the name field, but can be changed to a shorter “internal” name.
ID – CPO-PM will automatically assign an ID for each insurance carrier created. If
you would like a specific ID for each insurance carrier you can manually type in
the desired ID and the system will not override the specified ID. If a system ID has
been assigned to the insurance carrier you can modify the ID to match the specific
ID you wish the insurance carrier to have.
NOTE: Each insurance carrier must have a unique ID.
NOTE: You can search for an insurance carrier by using the Dot ID feature – in
the ID field type a dot (.) and the unique ID to quickly locate the insurance carrier
you are searching for (ex: .101)
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Address (Required) – Type the address of the insurance carrier. Two fields are
available for inputting address information (P. O. Box, etc.).
NOTE: No punctuation should be used when entering an insurance carrier
address.
City/State/Zip (Required) – Type or search for the zip code. If the zip code has
been added to the Zip Code table, then a zip code entry populates the city and
state.
NOTE: Zip Code entries should be limited to 5 digits. Nine digit zip codes should
never be used.
Country – This field not used for insurance carriers within the United States. Only
type the country when the insurance carrier is located outside of the United
States.
NOTE: Only the two digit country code should be populated in this field. (ex: CA or
MX)
Phone 1/Phone 2 – Type the phone number(s) for the insurance carrier. Click the
down arrow to select the type of the phones, or manually type in the phone type.
NOTE: Only 10 digit phone numbers should be populated. Extensions should not
be added to the phone number. . . This can cause rejections.
Contact – Type the name of the primary contact person at the insurance carrier.
Notes – Type any notes pertaining to this insurance carrier. These notes live on
this table only.
Alert Notes – Type any alert notes pertaining to this insurance carrier. These
notes will display in a pop-up window when you access a patient account or visit
with this carrier as an active carrier.
Include Claim Office Number – Check-mark this check box if you want to
include the claim office number as part of the insured ID when setting up a patient
record. This is not a commonly used field. The insurance carrier will inform you if
this number is required.
Payer ID # Type – Select the type of payer ID. Use this field only if it is required
by the carrier.
Other Payer ID # - Type the payer ID number. Use this field only if it is required
by the carrier.
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Insurance Carrier Information Tab
Filing Method (Required) – Select a filing format and filing method type for this
insurance carrier.
None (default)– Select this method if claims are not generated for this insurance
carrier.
NOTE: If this option is chosen, the filing method drop-down list is disabled.
Paper – Select this method if the insurance carrier generates paper claims.
Electronic – Select this method if the insurance carrier generates electronic
claims.
NOTE: If you select an Electronic filing method, you must set up the File Creators
section of the EDI tab in order to file claims electronically.
Method (drop box) – Required if Paper or Electronic is selected.
None – Select this method if the insurance carrier does not generate claims.
HCFA – Select this method to generate HCFA 1500 forms when printing or
electronically transmitting claims for the insurance carrier.
UB-92 – Select this method to generate UB-92 forms when printing or
electronically transmitting claims for the insurance carrier.
Cycle – Select this method to generate UB-92 forms on a cycled time line.
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Insurance Carrier Information Tab
Carrier Type (Required) – Select the necessary carrier type. This information prints on the
standard HCFA form and sends required electronic payer information if filing claims electronically.
Most common types used are: Other, Group Health Plan, Medicare, Medicaid or Blue Shield.
Financial Class – Select the default financial class for patients that carry this insurance. When
setting up a new patient, the financial class will automatically carry to the patient information area
as the system default when this insurance carrier is selected.
NOTE: If you would like to set the Financial Class at the patient level, rather than at the insurance
carrier level, then you can leave the Financial Class field blank in the insurance carrier table.
Allocation Set – This field is most commonly left blank on the insurance carrier table, so that it can
be selected in the patient information table. This is due to the many co-pay amounts that one
insurance carrier can have.
NOTE: If you populate an Allocation Set in the Insurance Carrier table, then the allocation set will
automatically carry to the patient information area as the system default when this insurance
carrier is selected.
Insurance Group – Select the insurance group to which you want to assign the carrier. If you do
not want the carrier to be assigned to a specific insurance group, then you can leave the field
blank.
Trans. Column Set (Required) – Select the transaction column set to use when posting payments
from this insurance carrier.
NOTE: Payments can not be posted from the insurance carrier if a transaction column set has not
been selected.
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Collections Group – To assign this carrier to a collections group, click the down-arrow
and make a selection.
NOTE: The Collections Group list is created in the General/Administration folder of the
Administration component.
Ledger – This field is used with third party accounting software. If applicable, type the
alphanumeric general ledger number to be used for integration with third-party accounting
systems. The maximum number of characters you can input in this field is 10.
Alternate Payer – Select the insurance carrier to use when splitting a visit with
procedures to be filed to an alternate payer.
NOTE: This field is required in order to split a visit with procedures to be filed to an
alternate payer.
Requires Authorization – Check-mark this feature to indicate that this insurance carrier
requires authorization before scheduling appointments or posting charges to a visit. When
making an appointment for a patient with this primary insurance carrier, a warning
displays informing you that the carrier requires authorization.
Reference Carrier – Select this check box to indicate that this is a reference carrier. This
is for reference only. No claims will be filed to the reference carrier.
Benefit Assignment – This field defaults to “Assigned”. This field is used to specify
whether the provider will accept assignment from this payer. This will be the default value
for patient visits associated with this payer.
NOTE: You can override this value at the time of the visit or in the patient information for
patients who refuse to assign benefits to the provider.
Policy Type (Required) – Select the policy type to be used as the default for this carrier.
The policy type is not printed on the HCFA, but it is transmitted when filing secondary
claims electronically. This field is usually populated with “Other.”
NOTE: If the policy type is Medigap and the valid Medigap ID is set up, a paper claim will
not be printed for the payer, but the visit status will automatically be set to Filed
Secondary, since Medicare automatically forwards the claim.
Policy Type ID – This field is enabled only when the “Medigap” policy type is selected.
An ID is required for Medigap claims. When the “Medigap” policy type is selected you
must type the required ID number in this text box. These IDs are published by Medicare.
Subscriber ID Mask – This feature allows you to setup a specific format that follows the
insurance carrier’s requirements on subscriber IDs. When this field is populated the
subscriber ID, in patient information, must follow the format setup or a popup message
will be displayed stating the subscriber ID does not match the Subscriber ID Mask and
the subscriber ID can not be saved in patient information unless it is modified to match
the format.
NOTE: If an insurance carrier allows more than one subscriber ID format, then this
feature cannot be used.
NOTE: 9=Numeric only, A=Alpha only, N=Alphanumeric only, L=Force lower case,
U=Force upper case, X=Any ASCII character.
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Insurance Carrier-Service Tab
The Service tab of the insurance carrier table provides the ability to override the
master code for specific types of service and place of service.
NOTE: The master codes are valid ANSI codes and should not be overwritten.
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Insurance Carrier-EDI Tab
If an Electronic filing method is selected on the Information tab, then the File
Creators section of the EDI tab must be set up in order to file claims
electronically.
The File Creators box allows specifying which clearinghouse will be used, the
insurance carrier’s assigned payer ID, which plug-in will be used, and which
creator plug-in settings will be selected for creating claims and/or eligibility files for
the insurance carrier, based on company and filing method.
To set up the File Creators section of the EDI tab click on the New button.
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Insurance Carrier EDI Tab>File Creators
Company – Select the company to which the claims and/or eligibility rules apply. “All” is the default.
If all companies are transmitting the same filing method (HCFA or UB-92), then this field should be
set “All”.
Filing Method – Select the filing method to which the claims and/or eligibility rules apply. “All” is the
default. If all companies are transmitting the same filing method (HCFA or UB-92), then this field
should be set “All”.
NOTE: The filing method set on the information tab will be the default filing method for the insurance
carrier.
Claims – Allows you to specify which clearinghouse will be used, the insurance carrier’s assigned
payer ID, which plug-in will be used, and which creator plug-in settings will be selected for creating
claim files.
•Clearinghouse – Select the clearinghouse for which electronic claims files are to be generated.
•Payer ID – Type the insurance carrier’s assigned payer ID number. Each clearinghouse provides
payer lists informing you of each insurance carrier’s assigned payer ID.
NOTE: Each clearinghouse will have their own unique payer lists with their own unique payer IDs for
each insurance carrier. Please visit your clearinghouse website to obtain the Payer ID numbers needed.
•Creator Plug-in – Select the plug-in to be used for transmitting claim files electronically.
•Settings button – Provides exceptions to the standard rules for creating electronic claims. The
settings feature is specific to the plug-in selected.
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Claim Status – This feature is currently unavailable.
Eligibility – Allows you to specify which clearinghouse will be used, the insurance
carrier’s assigned payer ID, which plug-in will be used, and which creator plugin settings will be selected for creating eligibility files.
•Clearinghouse – Select the clearinghouse for which electronic eligibility
files are to be generated.
•Payer ID – Type the insurance carrier’s assigned payer ID number. Each
clearinghouse provides payer lists informing you of each insurance
carrier’s assigned payer ID.
NOTE: Each clearinghouse will have their own unique payer lists with their own
unique payer IDs for each insurance carrier.
Creator Plug-in – Select the plug-in to be used for transmitting eligibility files
electronically.
Settings button– Provides exceptions to the standard rules for creating electronic
claims. The settings feature is specific to the plug-in selected.
Approval – This feature is only activated when an approval plug-in has been
installed.
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Insurance Carrier EDI Tab
The Payer Literals box allows specification of one or more aliases by which this
insurance carrier is known.
NOTE: The payer literal information is required if you are receiving and
processing electronic remittance files.
**Please Reference the Remittance portion of the EDI Manual for detailed
information.
The Response Processors box allows specification of which company and
clearinghouse settings are to be used for processing electronic remittance files
from the insurance carrier.
NOTE: The response processors information is required if you are receiving and
processing electronic remittance files.
**Please Reference the Remittance portion of the EDI Manual for detailed
information.
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Insurance Carrier-Identification Tab
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The Identification tab of the insurance carrier table must be populated for every
insurance carrier created. This information allows carriers to identify each other in
coordination of benefits, as carrier addresses are no longer required in the ANSI
format.
To create a row in the Identification tab click on the New button.
When the insurance carrier is setup to create Paper Claims:
“All Insurance Carriers” – should be selected.
ID Type - Should be selected – usually Payer ID.
ID Number – Type “Unknown”.
When the insurance carrier is setup to create Electronic Claims:
“All Insurance Carriers” – should be selected
ID Type - Should be selected – usually Payer ID
ID Number – Type the same Payer ID populated in the file creators area of the
EDI tab.
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Insurance Groups
Insurance Groups allows a way to group similar Insurance Carriers together for
reporting purposes.
Note in the example above there are several Insurance Groups. The # of Carriers
column indicates how many Insurance Carriers are linked to the corresponding
group. We can see here that there are 7 Insurance Carriers within the Blue
Cross Blue Shield Group.
To add a new Insurance Group, click the New button.
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Insurance Groups
When the New button is clicked, the New Insurance Group window opens.
1. Enter a Name for this insurance group.
2. The ID will auto-populate upon saving this record.
3. Double click in the Trans. Column Set field and select an appropriate
Transaction Column Set, if applicable. This may or may not be appropriate if you
have different types of Transaction Column Sets within the different Insurance
Carriers that will be part of this group.
4. The Ledger field may be used if integrated with an accounting software.
5. Double click in the Insurance Carriers in this group field to select the
Insurance Carriers to include. When OK is selected on the Select Insurance
Carrier window, notice that the Insurance Carriers in this Group indicates the
number of Items (4 Items) that are included in this group. Hovering over this field
will list the items included.
Note: When adding Insurance Carriers to an Insurance Group where the
Transaction Column Set has been identified in the Insurance Group, a system
generated prompt will ask: “would you like to set the selected insurance carriers’
Transaction Column Set to the Transaction Column Set of this Group?” If
appropriate, click yes. If not, click No and the individual carriers within the group
will maintain the Transaction Column Set identified on the Information tab of the
Insurance Carriers.
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Inventory Item
Inventory Items automate inventory tracking.
To create Inventory Items within the Administration component, click on the
Edit Menu and choose Inventory Items. To add a new Inventory Item, click
the New button.
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Inventory Item
Vendors must be set up
prior to entering
Inventory Items. See
Vendors within this
manual.
Add quantities arrived
via the Adjust button.
Any adjustments will
be listed with the date,
quantity and
description.
To add inventory items, complete the New Inventory Item window:
Inactive - Click this check box to indicate when this inventory item is no longer active.
Name -Type the name of the inventory item.
ID - CPS will generate a unique ID upon saving the record.
Vendor - Type or search for the vendor associated with this inventory item. Note: Vendors
must exist in the Vendors table prior to selecting a Vendor.
UPC - Type the Universal Product Code (UPC) for this inventory item, if applicable.
NDC - Type the National Drug Code (NDC) for this inventory item, if applicable.
VPC - Type the Vendor Product Code (VPC) for this inventory item, if applicable. This code
is the manufacturer or reseller’s name and/or number used to identify the item. This code
may be the UPC, NDC, or a unique identification number.
Ledger - If applicable, type the alpha-numeric general ledger number to be used for
integration with third-party accounting systems. The maximum number of characters you
can input in this field is 10.
Notes - Type any notes associated with this inventory item.
Quantity Available - Indicates the number of items currently available (in stock).
Quantity Re-Order - Select the minimum number of items required for inventory. When the
inventory available is less than this number, the inventory item will appear on the Inventory
Re-Order report when run in the Reports component.
Activity - This list box contains a list of adjustments to inventory item rows.
Click Adjust to indicate starting available inventory amounts.
**Note: Once an adjustment to an inventory item’s available quantity is saved, it cannot be
modified or deleted!
Click View to view the adjustment reason for the selected adjustment.
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Attach Inventory Item to Procedure
The Inventory tab of the Procedure allows you to associate inventory items
to the procedure. As the procedure is posted the inventory item count
decrements, thus maintaining count for re-order purposes.
To attach an inventory item to a procedure code from the Edit Menu choose
Procedures and click on the Inventory tab.
To add Inventory Items to a Procedure:
1. Search and select the procedure desired.
2. Click Edit on the Select Procedures window.
3. Go to the Inventory tab of the procedure and click Add.
4. Double click in the Item field.
5. Highlight the Inventory Item desired to attach to the procedure, click
OK.
7. Enter the Quantity of the Inventory Item that will be used for this
procedure.
8. Click OK to close the Add Inventory Item window and save the
information.
9. Click OK to close the Edit Procedure window and save the information.
10. Close the Select Procedure window.
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Pharmacy
To add a Pharmacy, complete the New Pharmacy window.
Name – Type the name of the pharmacy
List Name – Type the name of the pharmacy as you would like it to appear in the Select Pharmacy
list box when the search feature is activated. This field defaults to the same entry as the Name
fields when the tab key is pressed from the name field.
Abbrev. Name – Type an abbreviation for the pharmacy name.
Address - Type the address where pharmacy is located. Two fields are available for inputting
address information (PO Box, etc.).
City/State/Zip - Type or search for the zip code. If the zip code has been added to the Zip Code
table, then a zip code entry populates the city and state.
NOTE: Zip Code entries should be limited to 5 digits. Nine digit zip codes should never be used
Email Address – Type the email address of the pharmacy
Phone1/Phone2/Phone3 – Type the phone number(s) for the pharmacy. Click the down-arrow to
Inactive – Check-mark this check box to indicate when this pharmacy is no longer active. Checkmarking this box prevents the pharmacy from being listed as an option in a list of available
pharmacies. However, this pharmacy can be included in a report if you search for "inactive"
pharmacies.
Id Pharmacy Type Prescribing Method - For Prescribing Method, choose the preferred method for creating and
submitting prescriptions to this pharmacy.
Contact – Enter name of the primary contact at the pharmacy.
Contact By – Enter the preferred method for contacting the pharmacy.
NCPDP Id -
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Plug-ins
When a Plug-in is installed, a line item will drop in this table under the appropriate
tab. Your trainer or GE support will help you with loading Plug-Ins for a new
implementation.
When starting to use a new feature that requires a Plug-in, it’s a good idea to
come to the Plug-ins window, highlight the appropriate Plug-in and click Verify to
verify the plug-in is installed correctly.
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Procedures
Procedures can be manually entered or modified in the database.
To enter a procedure manually click on the New button. If the codes were
loaded in the Load feature under the List Editor/Load folder, then New would
only be used to add brand new codes, or “internal” codes.
To modify a procedure that is in the database enter the CPT Code (enter the
CPT code or Description of the Code) you want to modify, then once the
code is highlighted click on the Edit button.
**Note: If you know only a partial description you can use the % sign as a
wildcard. For example, if searching for a code that starts with Biopsy enter in
the description field Biopsy%, then click Search. This will give results in
which the Description will start with “Biopsy”. If you are unsure where in the
diagnosis Biopsy is found, enter in the description field %Biopsy%, then click
Search. This will give results in which anywhere in the Description “Biopsy”
can be found.
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Procedures- Information Tab
The Information tab is pre-populated with the Code, CPT Code, Health Care
Financing Agency, Description, Department, and Specialties selected when the
Load feature is used. Otherwise, manual entry will require completing these fields.
Inactive - Click this check box to indicate when this procedure is no longer active.
Code (Required) – This code is usually the same as the CPT Code, and must be
unique. If the Load feature was used then this field can not be modified. The
code can also be helpful to add those “in-house” codes that will not be filed to
insurance.
CPT Code - Populates the CPT code that prints on the standard HCFA or the
standard UB-92 forms. Also, in the drop list next to the CPT Code field, select the
CPT code type (HCFA in this example). If an “in-house” code is desired and you do
not wish to send this code to insurance, leave this field blank.
Revenue Code - Type the revenue code that must print on the UB-92, if
applicable.
Description – The description populates with the Load feature, but can be modified
to shorten the description, as this description will print on patient statements.
Department – If not assigned during the Load feature, click the down-arrow and
select the department to which this procedure belongs. This field is used as a
grouping feature for reporting purposes as well as fees/allowed amounts calculated
on RVUs/conversion factors. Note: Each procedure can only be attached to one
department.
Effective - Type the date this procedure becomes effective. A blank field indicates
the procedure is always effective.
Expiration- Type the date this procedure expires and should no longer be used. A
blank field indicates the procedure never expires.
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Ledger- If applicable, type the alphanumeric general ledger number to
be used for integration with third-party accounting systems. The
maximum number of characters you can enter in this field is 10.
Special Proc Units - To specify the types of measurements other than
standard units and minutes (for anesthesia), select an item from the drop list.
Default is None.
UPN/VPN/NDC - Type the UPN, VPN, or NDC (National Drug Code) in the
first field. The second field is a drop list which allows you to select a qualifier
for this code.
Specialty - Click the check box to the left of the specialty(ies) that apply to
this procedure. A red check mark appears. This is a grouping feature by
which you can access your procedures. You can also tie each procedure to
multiple specialties.
Notes - Type any notes pertaining to this procedure.
Note Type – A note type from the drop box must be chosen when the Notes
field is used.
Procedure Default Values:
•Type of Service - Type or search for the type of service code that must
print on the standard HCFA form.
•Place of Service - Leave this field blank because it will pull from the
Facility.
•Flat Fee - Type a flat fee if applicable to this procedure.
•RVU - If calculating fees based on units, an entry is required in this field,
or in each procedure fee schedule that uses RVUs/conversion factors. If
the load feature is used, this field is populated automatically. Otherwise, it
must be manually input.
•Modifiers - Type or search for the modifier(s) that will always be used
for this procedure code, as applicable. Use the Tab key to move between
fields when typing multiple modifiers (do not skip a field).
•Cost - Type the amount it costs you to perform this procedure. This is
for reporting purposes only!
•Ledger - If applicable, type the alpha-numeric general ledger number to
be used for integration with third-party accounting systems. The
maximum number of characters you can enter in this field is 10.
•Global Period (days) - Select the appropriate number of days for the
global period duration for this procedure.
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Internal Procedure Codes
CPT Code Field Blank: This option can be used when the practice wants
to track charges posted for this procedure, but this code would never be
filed to insurance, i.e. Post-op Visits, cosmetic visits, etc. Leaving the CPT
Code field blank does two things: It will leave the checkmark off the code
when posted in Billing and will not file to insurance, and any charges
associated with that code will default to the patient responsibility.
(This feature can also be used, for example, in a Dermatology practice,
where client sells products. These products will never be billed to insurance
and the charges associated need to default to the patient responsibility.)
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Procedures- Fee Schedule Tab
The Procedures Fee Schedule tab is where fees are entered for each procedure. When the
Fee Schedule tab is clicked, all of the Fee Schedules the practice has set up displays.
Highlight a fee schedule (ACME Fee Schedule, as above) and click Edit on the fee schedule
to add or modify fees. Enter in your flat Fee and the Allowed amount for the selected Fee
Schedule. Beyond this, only complete appropriate fields to affect the behavior of this
procedure:
Fee Schedule = Lists the Fee Schedule and CPT Code currently being modified.
Calculate based on:
•Fee – Choose Fee Schedule, Flat or RVU (defaults to Fee Schedule).
•Allowed - Choose Fee Schedule, Flat or RVU (defaults to Fee Schedule).
Fee – Enter the Flat fee or RVU as applicable.
•Conv. Factor – Used in tandem with RVU. Enter the appropriate conversion factor.
•Comp. Fee – Read only field. Displays the computed fee based on the Fee/Flat entry or
the RVU entry & Conversion Factor.
Allowed – Enter the Allowed Flat fee or RVU as applicable for the current fee schedule.
•Conv. Factor – Used in tandem with RVU. Enter the appropriate conversion factor.
•Comp. Fee – Read only field. Displays the computed fee based on the Fee/Flat entry or
the RVU entry & Conversion Factor.
Cost =Type the amount it costs to perform this procedure. reporting purposes only.
Fee Limit – Min/Max - Type the minimum/maximum fee allowed for this procedure, if
applicable.
CPT Code field - Type the specific CPT code that applies to this fee schedule, if other than
the default.
UPN/VPN/NDC - Type the UPN, VPN, or NDC (National Drug Code). In the accompanying
drop list, select the appropriate qualifier for this procedure code for this fee schedule.
Revenue Code = Enter specific revenue code that applies to the specified fee schedule.
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Modifiers - Enter appropriate modifier(s) for this procedure code.
Type of Service - Code that applies to this procedure code. This code is usually
entered on the Information tab.
Place of Service - Code that applies to this procedure code. In general, leave this
field blank as it pulls from the Facility table.
Global Period – Enter number of days allowed for global treatment for this code.
This code is usually entered on the Information tab.
Effective – If left blank, this code is always effective.
Expiration – If left blank if this code never expires.
Ledger - Type the alphanumeric general ledger number to be used for integration
with third-party accounting systems, if applicable. Maximum number of characters
you can use is 10.
Special Proc Units - If the procedure requires special measurements besides
standard units and minutes (for anesthesia), select the appropriate special
procedure unit code from the drop list. Default is None.
Purchased Service - Click to identify that the selected procedure is a service
performed outside the facility where the doctor usually renders services, and that
the patient will be billed for the procedure.
<Prev/Next> buttons – Moves this window between fee schedules for ease of data
entry.
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Procedures- Fee Schedule Tab
There are several items that can be check marked to have a procedure behave in a
particular manner. Complete only those fields that apply to the specified procedure code,
under the specific fee schedule:
Taxable - Click this check box to indicate that this procedure is taxable.
Laboratory - Click this check box to print the CLIA number on the standard HCFA form.
This number identifies the facility that performs lab services. Note: The CLIA number must
have been previously entered for the facility.
Anesthesia - Click this check box to designate this procedure as anesthesia-related. When
this check box is marked, the following occurs when procedures are posted to a visit:
•Time units are calculated.
•Anesthesia related information print on a customized HCFA.
•Procedures become eligible for concurrency calculations.
If the charge highest value option was selected on the fee schedule, an edit occurs which
identifies the procedure with the highest RVU and posts the fee to this procedure. Lesser
value procedures are converted to $0.00.
Mammography - Click this check box to designate this procedure fee schedule as
mammography-related. When a claim is produced that contains a mammography-related
procedure, the mammography certification number prints on the standard HCFA form. Note:
The mammography certification number must have been previously entered for the
associated facility.
Do not multiply Quantity Units - Click this check box to prevent the system from
multiplying the fee of a procedure code where multiple assigned units exist. This feature is
used for global fee arrangements. Note: This feature also applies to drug units, or in any
situation where the payer wants/needs the units to indicate quantity, but does not pay on that
basis. If the fee is $100 and the units are set to 3, then if this check box is disabled (not
checked), the charge will be $300. If the check box is enabled (checked), the charge will be
$100.
Use Doctor as Referring Physician - Click this check box to cause CPS to automatically fill
in the referring physician with the visit doctor, for any visit containing this procedure code.
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Do not include in Concurrency Calculation - Click this check box for anesthesia related
procedures that are not to be included in the calculation of concurrent procedures.
Force Paper Filing - Click this check box to indicate that this procedure should force a
paper filing method regardless of the claim's filing method.
Prescription # Required - Click this checkbox to indicate that this procedure should require
the prescription number field to be filled for patient visit procedures.
Procedure Note required - Click this check box to include a note for this procedure. Note:
This note can be either input in the Procedure Note text box below, or can be input from the
Notes column on the Visit window Charges tab Procedures list box. If this check box is
enabled (checked) and a note is not input, the approval process for the visit using this
procedure will fail.
Referring Physician required - Click this check box to require a referring physician for any
visit containing this procedure code. Note: Enabling this check box causes the billing
approval process to fail if a referring physician is not indicated at the visit level for this
procedure code.
Use Alternate Payer - Indicates if this procedure uses an alternate payer to cause a split
visit to track the alternate payer claim.
Contract Type - Select the type of contract associated with the claim. Examples: per diem,
variable per diem, flat, capitated, percent.
Terms Disc % - Type the terms discount percentage. This is available to the purchaser if an
invoice is paid on or before the terms discount due date.
Contract % - Type the contract percentage for all procedures on this claim.
Type of DME Billing - Indicates whether this procedure requires CMN (Certificate of
Medical Necessity) information.
Note Type - Type or select the procedure notes type. This allows you to select a default
notes type for the procedure notes for this procedure fee schedule.
Procedure Note - Type the note you want to associate with this procedure. This entry
populates the Notes field in the Visit window Charges tab Procedures list box.
Override fee schedule time to units value - Click this check box to override the
time to units values designated on the fee schedule. The overrides designated on
this window apply to this procedure only! Designate the time to units values for the
selected procedure, per the instructions below.
•Minutes per Unit spin box–Click the up-down control to identify the total
number of minutes desired to equate to one unit (1 to 1440) for this procedure.
•Maximum Minutes spin box–Click the up-down control to identify the maximum
number of minutes to which the minutes per unit rule should apply (1 to 1440),
for this procedure.
•After Minutes/Minutes per Unit spin box–Click the up-down control to identify
the number of minutes to equate to one unit after so much time elapses (1 to
1440) for this procedure.
Once the fee has been entered for this procedure, and any pertinent information
marked on this window, click <Prev or Next> to move to the next fee schedule for
the selected procedure. When complete, click OK.
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Referring Providers
The Referring Providers table allows the ability to store physician information
that can be accessed throughout CPOPM.
The Referring Providers table will need to be built for each provider that the
practice will be using as a referring physician, supervising physician, attending
physician, operating physician, admitting physician, primary care physician when
billing claims to an insurance carrier.
The term “Referring Provider” within CPS are not the same as a practice’s billable
provider. However, the practice’s doctor populates in the Referring Providers
table because a Doctor may be the referring physician to another doctor in the
practice or when an insurance carrier requires a referring doctor to be listed.
To open the Referring Provider table open the Administration component, click
on Edit on the tool bar, and select Referring Providers. The Find Referring
Provider window will display, click the New button to add a new physician.
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Referring Provider Information Tab
Complete the Referring Provider Information tab using the following fields:
Inactive – Check-mark this check box to indicate when this referring provider is no longer active.
Check-marking this box prevents the provider from being listed as an option in a list of available
referring providers. However, this provider can be included in a report if you search for "inactive"
referring provider.
Prefix – Prefixes should not be populated. This field should not be used.
First – Type the provider’s first name.
Middle – Type the provider’s middle name.
Last (Required) – Type the provider’s last name.
Suffix – Type any suffix that may follow the provider’s name.
List Name (Required) – Type the name of the provider as you would like it to appear in the Select
Physician list box when the search feature is activated. This field defaults to the same entry as the
Name fields when the tab key is pressed from the suffix field.
ID (Required) – CPOPM will automatically assign an ID for each provider created. If you would like
a specific ID for each provider you can manually type in the wanted ID and the system will not
override the specified ID. If a system ID has been assigned to the provider you can modify the ID
to match the specific ID you wish the provider to have. NOTE: Each provider must have a unique
ID.
Organization – Type the name of the provider’s organization.
Address (Required) – Type the address where provider is located. Two fields are available for
inputting address information (PO Box, etc.).
NOTE: No punctuation should be used when entering provider information.
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City/State/Zip (Required)– Type or search for the zip code. If the zip code has
been added to the Zip Code table, then a zip code entry populates the city and
state.
NOTE: Zip Code entries should be limited to 5 digits. Nine digit zip codes should
never be used.
insurance carrier is located when the insurance carrier is located outside of the
United States.
NOTE: Only the two digit country code should be populated in this field. (ex: CA
or MX)
Phone 1/Phone 2 – Type the phone number(s) for the provider. Click the downarrow to select the type of the phones, or manually type in the phone type.
NOTE: Only 10 digit phone numbers should be populated. Extensions should not
be added to the phone number. . . This can cause rejections.
Specialty – Click the down-arrow and select the specialty if you want to group
providers for tracking purposes. A provider’s specialty is not required for billing
purposes.
NOTE: A table of specialty list options must first be created in the Administration
component for list options to display here.
Ledger – This field is used with third party accounting software. If applicable,
type the alpha-numeric general ledger number to be used for integration with
third-party accounting systems. The maximum number of characters you can input
in this field is 10.
NOTE: No punctuation should be used when entering referring provider’s
information.
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Referring Provider Identification Tab
Referring ID
Number
Grid
Complete the Referring Provider Information tab with the following fields:
Federal Tax ID (Optional) – Select either the SSN (social security number), EIN
(employer identification number), or the NPI (national provider identifier) button.
Then, type the number for the provider in the designated text field.
NOTE: Punctuation should not be used. No dashes, spaces, number signs, etc.
State License # (Optional) - Type the state license number for the provider, if
applicable.
UPIN # - UPIN numbers are no longer required.
NPI – Add Referring Provider NPI
The provider ID number grid lists all referral ID numbers and the insurance
carriers or groups to which these IDs apply. The numbers entered into the
provider ID number grid only print on paper claims (this information is not
transmitted electronically).
NOTE: No punctuation should be used when entering provider’s
information.
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Referring Provider Identification Tab
Physician ID
Number Grid
Create a row of ID numbers by clicking the New button. A default All row needs to be created with
no entries in the ED Numbers area.
Row – CPOPM will automatically assign an row number for each row created.
All Insurance Carriers – Select this option when creating a row which will print the referring
number for all insurance carriers.
Insurance Carrier – Select the insurance carrier when creating a row which will print a unique
referring number for the selected insurance carrier.
Insurance Group – Select the insurance group when creating a row which will print a unique
referring number for the selected insurance group.
Referring # – Type the physician’s referring number (if required). In the adjacent field select the
appropriate referring number qualifier (explain what type of number is being printed).
Type – If the carrier requires a non-standard provider type, then enter the provider type. In the
adjacent field select the appropriate provider type qualifier (explain what type of information is
being printed).
NOTE: This field is most commonly not used.
Office – If the carrier requires a number that identifies the referring physician's office, then enter
the office number. In the adjacent field select the appropriate provider type qualifier (explain what
type of number is being printed).
NOTE: This field is most commonly not used.
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Resources
Resources are defined as any person, place or equipment that may have a
schedule, generally other than a doctor. As noted above, the resources listed are
procedure rooms, equipment (Treadmill), or Other Providers such as Nurse
Practitioners, Physician Assistant, etc.
From the Administration Edit Menu, click Resources, then click New to create a
new Resource. Notice on the New Resource window there are two tabs,
Information and Schedule Template. The Information tab must include the
person, place, or equipment Name, and the Resource Type must be identified.
Resource Types were defined in the List Editor under the General/Administration
folder. The ID field will be auto populated when the record is saved, and the Ledger
field may be used with an integrated third-party accounting program.
Use the Schedule Template tab to create schedules as explained in the Doctor’s
table Schedule Template tab.
Use the Medical Record Access tab to restrict access to Patient Charts and to
individual Locations of Care.
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Responsible Providers
A Responsible Provider is the provider that bills the insurance carrier for medical
services rendered.
To open the Responsible Provider table, open the Administration component,
click on Edit on the tool bar and select Responsible Provider.
Creating a responsible provider table is a four-part process that involves:
1) Creating general provider information on the information tab.
2) Setting up provider ID rows on the identification tab.
3) Associating a fee schedule on the fee schedule tab.
4) Assigning a schedule template on the schedule template tab.
To create a new Responsible Provider click on the New… button.
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Responsible Provider Information Tab
Inactive – Check-mark this check box to indicate when this Provider is no longer active. Checkmarking this box prevents the Provider from being listed as an option in a list of available Providers.
However, this Provider can be included in a report if you search for "inactive" Responsible
Providers.
Responsible Provider/Other Provider – Select Responsible Provider if the provider is
credentialed with all carriers that will be billed. Select Other Provider if the provider will be billing
with a Supervising Doctor or ‘Incident To’ another provider.
Prefix – Prefixes should not be populated. This field should not be used.
First – Type the Provider’s first name.
Middle – Type the Provider’s middle name.
Last (Required) – Type the Provider’s last name.
Suffix – Type any suffix that may follow the Provider’s name.
Organization – Type the name of the Provider’s organization.
List Name (Required) – Type the name of the Provider as you would like it to appear in the select
Responsible Provider list box when the search feature is activated. This field defaults to the same
entry as the name fields when the tab key is pressed from the suffix field.
ID (Required) – CPOPM will automatically assign an ID for each Provider created. If you would
like a specific ID for each Provider, you can manually type in the desired ID and the system will not
override the specified ID. If a system ID has been assigned to the Provider you can modify the ID
to match the specific ID you wish the Provider to have.
NOTE: Each Provider must have a unique ID.
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Address (Required) – Type the address where provider is located. Two fields are available for
inputting address information (P. O. Box, etc.).
NOTE: No punctuation should be used when entering an address.
City/State/Zip (Required)– Type or search for the zip code. If the zip code has been added to the
Zip Code table, then a zip code entry populates the city and state.
NOTE: Zip Code entries should be limited to 5 digits. Nine digit zip codes should never be used.
Country – This field is most commonly not used. Only type the country when the Provider is
located outside of the United States.
NOTE: Only the two digit country code should be populated in this field. (ex: CA or MX).
Phone 1/Phone 2 – Type the phone number(s) for the Provider. Click the down-arrow to select
the type of the phones, or manually type in the phone type.
NOTE: Only 10 digit phone numbers should be populated. Extensions should not be added to the
phone number. . . This can cause rejections.
Federal Tax ID – This field should be left blank on this table. When this field is left blank on this
table the tax identification number is pulled from the information tab of the company table.
State License – Type the doctor’s state license number. This field is where the workers’
compensation ID pulls from for workers’ compensation claims.
Anesthesiologist License – Type the anesthesiologist license number associated with the doctor,
when applicable.
NPI –
• McKesson, ENS and Centricity EDI ONLY - Enter the Provider’s NPI on Information tab.
•Other Clearinghouses - DO NOT enter the NPI on the Information tab.
Non-Participating Insurance Carriers – Type or search for the appropriate insurance carrier(s)
that do not participate with the selected Provider. When populated a warning will pop-up when
accessing these carriers that the Provider does not participate with this plan.
Specialty License – Type the appropriate specialty license for the Provider.
Additional License – Reserved for future use.
UPIN# – Type the unique physician identification number for the Provider.
Specialty – Select the appropriate specialty for this Provider.
Ledger – This field is used with third party accounting software. If applicable, type the alphanumeric general ledger number to be used for integration with third-party accounting systems. The
maximum number of characters you can input in this field is 10.
Resource Types – Select the appropriate resource type(s) to which the Provider belongs.
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Responsible Provider Identification Tab
The Responsible Provider Identification tab is where all doctor identification
numbers are stored.
The first row created on the identification tab must not contain any identification
numbers. This row is known as the default or all row and should be set up to use
with each Provider.
Provider identification numbers. These are known as exception rows.
To create a default or exception row click on the New… button.
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Responsible Provider Default All Row
with an assigned Group Number
The fields of a standard default all row are setup as follows:
appropriate company that a carrier assigned identification number has been associated
with.
appropriate facility that a carrier assigned identification number has been associated with.
Provider is Hospice Employee – This option should be check-marked when the
Provider is employed by a Hospice.
All Insurance Carriers – Select this option to print or transmit the tax identification
number to all insurance carriers that have not assigned a specific identification number to
the provider.
• Insurance Carrier/Insurance Group should not be selected on the all row.
File Claim as Individual – This option can be selected when a tax identification number
is not being shared by providers.
NOTE: This option will change the way provider numbers are pulled on the paper HCFA
and electronically.
File Claim as Part of a Group – This option should be selected when a tax identification
number is being shared by providers.
and electronically.
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Filing Provider – This option is not available when the provider is marked as a
responsible provider on the information tab.
Referring ID – Type the ID number to be used when this Provider is the referring
doctor. Note: This will print in box 17a of the HCFA.
Referring Office – Type the number that identifies this office when the Provider is
the referring doctor. This field is typically not used.
PIN – This field field should be set to ‘from company’ in the default all row.
GRP – This field should be set to ‘from company’ in the default all row.
EMC – This field should be set to ‘from company’ on the default all row.
the default all row. (Except when there is a NPI number, see NPI below).
Type – This field should be set to ‘from company’ on the responsible provider
table. This field is populated on the facility table.
NPI –
•McKesson, ENS and Centricity EDI ONLY - All row – Add Tax ID to Additional
ID 1 field with EIN/SSN qualifier. Mark NPI on right and leave blank (similar to
setup of POS on Facility)
•Other Clearinghouses - All Row – Mark NPI on right and leave blank.
Federal Tax ID – The tax identification number field should be set to ‘from
company’ in this table. When the tax identification number field is left blank in this
table it is pulled from the information tab of the company.
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Responsible Provider Default All Row
with out an assigned Group Number
The fields of a standard default all row are setup as follows:
with.
Provider is employed by a Hospice.
All Insurance Carriers – Select this option to print or transmit the tax identification
number to all insurance carriers that have not assigned a specific identification number to
the doctor.
• Insurance Carrier/Insurance Group should not be selected on the all row.
File Claim as Individual – This option can be selected when a tax identification number
is not being shared by providers.
and electronically.
File Claim as Part of a Group – This option should be selected when a tax identification
number is being shared by providers.
and electronically.
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Filing Provider – This option is not available when the provider is marked as a
responsible provider on the information tab.
Referring ID – Type the ID number to be used when this responsible provider is
the referring doctor. Note: This will print in box 17a of the HCFA.
Referring Office – Type the number that identifies this office when the
responsible provider is the referring doctor. This field is typically not used.
PIN – This field field should be set to ‘from company’ in the default all row.
GRP – This field should be set to ‘from company’ in the default all row. This field
EMC – This field should be set to ‘from company’ on the default all row.
the default all row.
Type – This field should be set to ‘from company’ on the doctor table. This field is
Federal Tax ID – The tax identification number field should be set to ‘from
company’ in this table. When the tax identification number field is left blank in this
table it is pulled from the information tab of the company.
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Responsible
Provider Ins
Carrier Exception
Row with a
carrier assigned
Group Number
The responsible provider exception row is linked to the company exception row by the
facility exception row, and allows the assigned identification number to be
printed/transmitted to identify the company/provider to the carrier.
The fields of a standard responsible provider exception row are setup as follows:
with.
provider is employed by a Hospice.
Insurance Carrier – Select this option to print or transmit doctor identification numbers
specific to one insurance carrier (ex: Medicare). Type or search for the specified
File Claim as Individual – Not used when there is a carrier group number entered at the
company table.
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File Claim as Part of a Group – This option should be selected when a group number is being
shared by providers.
NOTE: This option will change the way provider numbers are pulled on the paper HCFA and
electronically.
Filing Provider – This option is not available when the provider is marked as a provider on the
information tab.
Referring ID – Type the ID number to be used when this provider is the referring provider.
Note: This prints in box 17a of the HCFA.
Referring Office – This field is not typically used.
PIN – Type the carrier assigned provider identification number in this field. The provider
identification number is a number that the insurance carrier assigns to one individual provider.
This number prints in box 24K on the standard HCFA form, when a group number is also being
used. A qualifier must be selected from the adjacent drop list.
GRP – This field should be set to ‘from company’ on the provider table. This field is populated on
the company table.
EMC – This field is left blank on the doctor table when a carrier assigned group number is
populated in the company exception row.
NOTE: This field should be set to ‘from company’.
Additional ID 1 / Additional ID 2 – This field allows multiple carrier assigned identification
numbers to be transmitted for one doctor. This field is most commonly not used. The insurance
carrier will inform you if they require more than one carrier assigned identification number to be
sent. A qualifier must be selected from the adjacent drop list.
Type – This field is left blank on the doctor table. This field should be populated on the facility
table.
NPI –
•McKesson, ENS and Centricity EDI ONLY: Exception rows - Add Tax ID to Additional ID 1 field
with EIN/SSN qualifier. Mark NPI on right and leave blank (similar to setup of POS on Facility)
•Other Clearinghouses: Exception rows – Add Tax ID to the Additional ID 1 field with EIN/SSN
qualifier, Enter NPI number in NPI field.
Federal Tax ID – The tax identification number field should be left blank in this table. When the tax
identification number field is left blank in this table it is pulled from the information tab of the
company.
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Responsible
Provider Ins
Group
Exception Row
with a carrier
assigned Group
Number
Now that we have completed the company and facility tables, the doctor will use information
already entered, therefore, the doctor table will only need to address certain fields.
The fields of a standard doctor exception row when there is a group number on the company table
are setup as follows :
Facility – This field is commonly left at the default ‘all’. If necessary, select the appropriate facility
that a carrier assigned identification number has been associated with.
Provider is Hospice Employee – This option should be check-marked when the provider is
employed by a Hospice.
Insurance Group – The purpose of insurance groups are 1) Ease of entry for payment posting; 2)
Reporting; 3) Ease of entry at the company and doctor exception rows.
Caution: When creating an exception row for an insurance group, make sure that every carrier in
that group will use the number entered. For example: Medicare can be an insurance group that
contains both Medicare and Railroad Medicare carriers, for reporting purposes however, these two
carriers do not require the same group number, therefore, Insurance Group would not be used in
this instance.
Select this option to print or transmit a group identification number specific to a group of insurance
carriers (ex: Blue Cross Blue Shield). Type or search for the specified insurance carrier in this
field.
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File Claim as Individual – This option is not used.
File Claim as Part of a Group – This option should be selected when a group number is being
shared by providers.
NOTE: This option will change the way provider numbers are pulled on the paper HCFA and
electronically.
Filing Doctor – This option is not available when the provider is marked as a doctor on the
information tab.
Referring ID – Type the ID number to be used when this provider is the referring provider.
Referring Office – Type the number that identifies this office when the provider is the referring
provider.
PIN – Type the carrier assigned provider identification number in this field. The provider
identification number is a number that the insurance carrier assigns to one individual provider.
This number prints in box 24K on the standard HCFA form, when a group number is also being
used. A qualifier must be selected from the adjacent drop list.
GRP – This field should be set to ‘from company’, as we have already entered the GRP and EMC
for this carrier on the company table.
EMC –This field should be set to ‘from company’, as we have already entered the GRP and EMC
for this carrier on the company table.
Additional ID 1 / Additional ID 2 – This field allows multiple carrier assigned identification
numbers to be transmitted for one doctor. This field is most commonly not used. The insurance
carrier will inform you if they require more than one carrier assigned identification number to be
sent. A qualifier must be selected from the adjacent drop list.
Type – This field should be set to ‘from company’, as we have already entered the type on the
facility table.
NPI –
•McKesson, ENS and Centricity EDI ONLY: Exception rows - Add Tax ID to Additional ID 1 field
with EIN/SSN qualifier. Mark NPI on right and leave blank (similar to setup of POS on Facility)
•Other Clearinghouses: Exception rows – Add Tax ID to the Additional ID 1 field with EIN/SSN
qualifier, Add NPI number.
Federal Tax ID – The tax identification should be set to ‘from company’. The tax identification
number is pulled from the information tab of the company.
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Responsible Provider Ins Carrier Exception
Row without a carrier assigned Group
Number
Medicaid
G3647
Provider UPIN
91723634
Medicaid provider
91723634
Medicaid provider
Now that we have completed the company and facility tables, the doctor will use information
already entered, therefore, the doctor table will only need to address certain fields.
The fields of a standard doctor exception row when there is no group number on the company
table are setup as follows:
Facility – This field is commonly left at the default ‘all’. If necessary, select the appropriate facility
that a carrier assigned identification number has been associated with.
Provider is Hospice Employee – This option should be check-marked when the provider is
employed by a Hospice.
Insurance Carrier – Select this option to print or transmit doctor identification numbers specific to
one insurance carrier (ex: Medicare). Type or search for the specified insurance carrier in this
field.
Insurance Group – The purpose of insurance groups are 1) Ease of entry for payment
posting; 2) Reporting; 3) Ease of entry at the company and doctor exception rows.
Caution: When creating an exception row for an insurance group, make sure that every
carrier in that group will use the number entered. For example: Medicare can be an
insurance group that contains both Medicare and Railroad Medicare carriers, for reporting
purposes however, these two carriers do not require the same group number, therefore,
Insurance Group would not be used in this instance.
Select this option to print or transmit a group identification number specific to a group of
insurance carriers (ex: Blue Cross Blue Shield). Type or search for the specified
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Number
Medicaid
G3647
Provider UPIN
91723634
Medicaid provider
91723634
Medicaid provider
File Claim as Individual – This option should be selected when there is only one
individual provider number assigned to a specific doctor.
NOTE: This option will change the way provider numbers are pulled on the paper
HCFA and electronically.
NOTE: If this option is selected in this situation, then the PIN will only be
transmitted as the billing provider number, and not as the rendering provider
number. However, special settings on the carrier table can be used to accomplish
this, if needed.
File Claim as Part of a Group – This option should not be used when filing
individually.
Filing Doctor – This option is not available when the provider is marked as a
provider on the information tab.
Referring ID – Type the ID number to be used when this provider is the referring
provider.
Referring Office – This field is typically not used.
PIN – Type the carrier assigned provider identification number in this field. The
provider identification number is a number that the insurance carrier assigns to
one individual provider. This number prints in box 33 on the left on the standard
HCFA form. A qualifier must be selected from the adjacent drop list.
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Number
Medicaid
G3647
Provider UPIN
91723634
Medicaid provider
91723634
Medicaid provider
GRP – This field should be set to ‘from company’.
EMC – Type the carrier assigned provider identification number in this field, the same as
what is entered in the PIN field. A qualifier must be selected from the adjacent drop list.
identification numbers to be transmitted for one doctor. This field is most commonly not
used. The insurance carrier will inform you if they require more than one carrier assigned
identification number to be sent. A qualifier must be selected from the adjacent drop list.
Type – This field should be set to ‘from company’. This information was already entered
in the facility table.
NPI –
•McKesson, ENS and Centricity EDI ONLY: Exception rows - Add Tax ID to Additional
ID 1 field with EIN/SSN qualifier. Mark NPI on right and leave blank (similar to setup of
POS on Facility)
•Other Clearinghouses: Exception rows – Add Tax ID to the Additional ID 1 field with
EIN/SSN qualifier, Add NPI number.
Federal Tax ID – The tax identification number field should be set to ‘from company’. The
tax identification number field is entered in the information tab of the company.
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Other Provider Default All Row:
Filing as Provider
When an “other provider” has been issued a provider ID number, the same rules for
building exception rows apply as discussed for responsible providers. Please see
previous pages for set up as part of a group or individual filing status.
Filing Provider = name of the Other Provider (i.e., Smith, Nancy) – This will identify this
other provider on the claim, as well as pull the PIN numbers provided on this screen.
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Filing with Supervising Provider
Other Providers require special set-up because they cannot always file claims with their
own name. Most carriers require a supervising doctor’s name on the claim. However,
some carriers allow other providers to file as themselves and also issue provider numbers
to these ancillary providers. When this is the case, we will need to create exception rows
for these carriers and enter the other provider’s ID number. The same rules apply when
setting up these rows as for responsible provider.
Filing Provider = Supervising Provider – This option allows the other provider
to bill as the responsible provider on the visit, but send the supervising provider’s
ID numbers.
(Users will be prompted during charge entry to select a supervising doctor for the
visit.)
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Filing with Specified Provider
Other Providers require special set-up because they cannot always file claims with their
own name. Most carriers require a supervising doctor’s name on the claim. However,
some carriers allow other providers to file as themselves and also issue provider numbers
to these ancillary providers. When this is the case, we will need to create exception rows
for these carriers and enter the other provider’s ID number. The same rules apply when
setting up these rows as for doctors.
Filing Provider = Specified Provider – This option allows the other provider to
bill as the provider on the visit, but send a specified provider’s ID number.
(Users will not be prompted during charge entry. The specified provider’s name
will automatically populate in the supervising field.)
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Responsible Provider– Fee Schedule Tab
1.
2.
The Fee Schedule tab in the Responsible Provider table identifies for the
selected provider, which fee schedules will be linked to this provider. If a fee
schedule is accessed when posting a visit charge for a patient, and it is not linked
to the provider providing services here, a warning message will display stating
there is no fee schedule for this provider.
To add, or link, a fee schedule to a provider, click the New button on the Fee
Schedule tab. For the standard office fees, a typical set-up is to:
•Set the Company and Facility fields to <all>, the Financial Class to <all>, and
select the Standard Fee Schedule (or Office Fee Schedule, etc.) by double
clicking and searching in the Fee Schedule field.
To set up a fee schedule for a specific insurance carrier or group:
•Select Insurance Carrier or Insurance Group as appropriate, and identify the
carrier or group, leave the Financial Class as <all>, and double click in the Fee
Schedule field to search and identify the fee schedule to link.
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Responsible Provider– Schedule Template Tab
To begin building Schedule Templates for providers, go to Administration/Edit/
Responsible Providers and select a provider to begin building this provider’s
schedule. Click on the Schedule Template tab, then click the Schedule
Template button to view or create Schedule Templates. To create a New
template, click the New button.
In the Time Slots window, define the time needed for this schedule. In this
example, the provider wants the schedule to be available from 9am to 5pm. Enter
the Facility for this schedule. An Interval of time must be set for this schedule to
the lowest denominator increment. For example, if the doctor sees 10 minute, 20
minute and 30 minute appointments, then the appointment interval needs to be 10
minutes. However, if the doctor sees 10 minute and 15 minute appointments, it is
best to set the interval to 5 minutes so the appointments will display correctly on
the scheduling screen.
“Maximum appointments per time slot” is set to 1 here. In other words, this
provider only sees one patient per time slot and does not overbook. If the doctor
prefers to see 2 patients during one time slot, enter the Limit to as “2.” Choosing
Unlimited will allow an unlimited number of patients to be scheduled per time slot.
Choosing Unavailable will cause the schedule to display in gray for the selected
time as unavailable appointment slots.
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Responsible Provider – Schedule Template Tab
Upon clicking OK, a blank schedule template is created.
Give the schedule a name pertinent to the provider and days or facility uniquely
distinguished from other schedule names.
This schedule shows all “unallocated” slots at this point in 15 minute increments in
yellow. Unallocated slots means that any Appointment Type can be booked into these
time slots.
202
Note the schedule is
grayed out in this
specified timeframe.
For our example, perhaps Dr. Heart wants to allow 1 hour of his schedule for lunch times,
therefore he wishes this time to be “unavailable.” To do this, right click on the 12pm slot,
and choose Time Slots. Enter the time to mark unavailable, in this case, 12pm to 1pm,
be sure the Facility is selected, and mark the Maximum appointments per time slot as
“Unavailable.” Create unavailable times for any time the physician does not want to
consistently allocate to patient appointment time.
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Click the desired time to
add an appointment type
and right click. Choose
Appointment Allocation…
Click Appt
Type… and
search for the
Appointment
Type desired.
Appointment Allocations are set up in the Schedule Templates when a provider wants
an “ideal” template to include specific times to see specific Appointment Types. For
instance, we can set up Allocated slots to see only New Patients for 30 minutes at
7:30am, 8:00am and 8:30am. In addition, we may set up 15 minute follow up
appointments only at 9:00 through 9:45. And at 10:00am, we may set up another New
Patient with two 15 minute follow ups to follow. Also a lunch break needs to be created
from 12pm to 1pm, with Urgent Care only slots in the 60 minutes prior to lunch. The rest
of the day he wants to remain as unallocated time to allow booking of any type of
appointments.
Following these requirements, we will need to create unavailable slots for the 12pm to
1pm time frame, as done for the early morning slots. In addition, we will need to add
“Allocated” appointment types for those times designated by the provider.
To allocate an appointment type, right click on the time slot desired, and choose
Appointment Allocation. This action will open the New Appointment Allocation window.
Note the start and stop times are indicated. To find the Appointment Type desired, click
the Appt Type button. This will allow the user to search and select the Appointment Type
to allocate. In our example, we will choose New Patient – 30.
204
Use a Copy/Paste
function to easily create
like Appointment
Allocations.
Once the appointment type is selected, it will display in the New Appointment Allocation
window. Click OK to drop this appointment type into the template.
An easy way to add the same allocated appointment type in additional slots is to copy
and paste, much like windows functionality. Right-click on the appointment type and
select Copy, then right-click on the new slot and click Paste. Note the copied
appointment type appears with hash marks to indicate this is the appointment type
selected to copy at the moment.
Right-click on the next slot to allocate the next Appointment Type, then right-click and
paste this Appointment Type as necessary.
This template is Dr. Heart’s ideal template for his Tuesday and Thursday appointments.
Now we must “Assign” this template to calendar dates.
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Click the days of the
week to which this
schedule applies.
Enter the date range to
apply the template, click
the Add button.
Dates within the selected range
appear here. These can be
reviewed and remove any
dates that are not applicable by
highlighting and clicking the
Remove button.
Once a schedule has been built, it will have to be assigned by day(s) of the week within a
date range. Click the Schedule Template Assignment tab. Check the day(s) of the week
that this template will reflect – in this example Tuesday and Thursday. Next, add the
effective and expiration dates (Tip: build out date ranges in 6 month increments as not to
bog the system down).
Once all dates to apply this template to are correct, click the Save button to save the
template to the dates specified. This process may take a few minutes to assign the
schedule.
206
Please note, new templates that will be similar to a current template can be copied and
modified to accommodate making minor changes and saving as a new template. To do
this, at the Select Schedule Template screen, and click the Copy button.
All of the existing templates for all providers will list and you can choose the template to
copy into this provider’s schedule templates. Choose the template to copy and click OK.
Then simply modify the copied schedule and re-name to reflect the new template for this
provider. Make adjustments to the template, assign the template to specific dates and
save the template.
207
Responsible Provider –
Medical Record Access tab
A new tab in CPS is the Medical Record Access tab. This tab is used when the
practice is implementing Centricity EMR. Please refer to the Chart Administration
manual for further information.
208
Transaction Column Set (TCS)
For more accurate payment entry records, CPOPM has Transaction Column
Sets. These are user-defined and provide the ability to create columns in the
Payment Entry screens to match the information provided on an insurance
Explanation of Benefits (EOB).
NOTE: Payments cannot be posted without Transaction Column Sets!
When first setting up the system, it is recommended two column sets are built:
one for all insurance carries and one for all patient payments.
To open the Transaction Column Set table, from the Administration
component, click on the Edit Menu on the tool bar, and select Transaction
Column Set.
To create a new Transaction Column Set click on the New button.
209
Creating a New TCS
To create columns in the Transaction Column Set::
1. Click on the New button
2. Click on the Type drop list and choose the desired Type.
3. The Name field will populate with the name of the column type selected.
The Name can be altered/abbreviated.
4. When applicable set the appropriate Action for each column type.
5. When applicable set the default Adjustment Type/Payment Type.
6. When applicable create a Quick Note that can automatically place a
note on the statement.
The column headings created will display in the Name column above. Use the
dashed line (----------) to separate static informational columns from data entry
columns that will be created.
210
TCS Name & Type
NOTE: In the Name field, choose a name that will be meaningful to users so
that they will know exactly what type of information to enter in the column.
For example, Date of Service = DOS; Payment = Pmt; Adjustment = Adj; etc.
Name - This field automatically displays the description selected in the Type field. The Name field can
be edited to a shorter description of the column.
In the Type field, click the down-arrow to select one of the descriptions for this column:
Actual Allowed – Amount the insurance carrier actually pays for a procedure.
Adjustment – Amount that is written off from a balance.
Allocation – Division of fees between patient and insurance carrier, based on an insurance plan.
Allowed – Reimbursement amount you expect to receive from the insurance carrier for a procedure.
Co-Insurance – Balance of a fee the insurance carrier will not pay but is owed by the patient.
CPT Code – Procedure code.
Date of Service – Date the patient received services.
Deductible – The portion of a yearly deductible the patient is responsible for paying.
Fee – Charge made by the provider for medical services.
File to Insurance – Identifies which procedures will be sent to the insurance carrier.
Insurance Balance – Amount owed by the insurance carrier.
Non-payment – Used to record the reason for non-payment, typically as a non-payment code.
Patient Balance – Amount owed by the patient for services rendered.
Payment – Amount to reduce the balance of either patient or insurance carrier balances.
Residual – When electronic remittance is used, CPOPM looks at the Action column to determine what
to do with the insurance balance when the last payer has remitted.
Revenue Code – Procedure code used on UB-92 forms.
Sanction – Amount charged by the insurance carrier against a doctor as a penalty.
Sum of Contractuals – Total of all disallowed adjustments.
Transfer – Transfers responsibility of a balance due from insurance to patient and vice versa.
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TCS Action
An Action must be chosen for each TCS Type. Click the down-arrow to select
a description for this column. Select one of the following:
None – No action is taken. The monetary amount posted in the column will be
read only/for informational purposes only.
Transfer – Moves money from the patient balance to the insurance balance, or
vice versa.
Adjustment – Adjusts money off of the patient or insurance balance.
In this example, we may choose the Action of Transfer to transfer the
insurance balance to the patient’s responsibility based on the EOB stating that
the remaining amount is their co-insurance due.
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TCS Payment Type
The circled Type field above is dependent on what has been chosen in the first
Type field. This associated column displays when creating a column type that
requires the user to select a specific payment or adjustment type when posting
a payment. The options in the drop list are pulled from the Payment Types
and Adjustment Types created in the Payment Information folder found in the
List Editor of the Administration component.
In our example above, because Payment was chosen in the first Type field, the
field below Action becomes a Payment Type field. Choose the most
appropriate Payment Type, in this case “Payment.”
213
TCS Adjustment Settings
If the Type of column selected is an Adjustment, then the appropriate
Adjustment Type should be selected. Depending on the Adjustment Type
selected, other actions can be associated with this column:
Allow Type Override – When this option is selected it allows the user to select
from the Payment Type or Adjustment Type drop list when posting payments.
When this option is not selected it automatically sets the Payment Type or
Adjustment Type to the default, selected in the Type field, when posting
payments.
Contractual – Only enable this option when creating an Adjustment column.
Withhold – Select this check box to allow users to enter contractual
information. Only enable this option when creating an Adjustment column.
Withhold % – Select this check box to allow users to enter withholding
information. Indicate the percentage to withhold.
In the example above, a column Type of Adjustment has an Adjustment Type
of “Disallowed.” However, we will allow users an Adjustment Type Override
(the user can change the Adjustment Type of “Disallowed” to another
Adjustment Type when posting). The Disallowed Adjustment Type is also
notated that it is a Contractual write off, based on settings indicated here.
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TCS Quick Notes
Quick Notes are used when posting payments to send a message to a patient
via their statement. The messages typically used are things such as
Deductible has been met, Co-pay due, Co-insurance due, etc. to communicate
to the patient why they are receiving statements for the balance due.
Quick Notes were set up in the List Editor in the Administration component, and
can be chosen here to associate with a specific column type or action.
Quick Notes – When you select a Type that allows for Quick Notes, the
system enables this text box. Click the down-arrow and select the quick note
desired to associate with the selected Type.
Show notes on statement – If a Type that enables this check box has been
selected, click the check box to show notes on the patient statements.
215
Insurance TCS
Recommended Insurance Payment Transaction Column Set columns:
Above the Dotted Hash Line
• Date of Service
• Code
• Fee
• Patient Balance
• Insurance Balance
Below the Dotted Hash Line columns
• Payment
• Payment Type
• Contract Adjustment
• Contract Adjustment Type
• Actual Allowed
• CoIns/Pt
• CoIns/2ndary
• Ded/2ndar
• Ded/Pt
• Misc Adj
• Misc Adj Type
• Misc Transfer
• File to Insurance
• Line Information
• Split
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Patient TCS
The Patient Transaction Column Set (TCS) is set up similar to the Insurance
TCS, but has fewer columns. In addition, check the box in the top right of the
window that indicates “Use this set for non-insurance payers.”
Recommended Patient Payment Transaction Column Set columns:
Above the Dotted Hash Line columns
• Date of Service
• Code
• Fee
• Insurance Balance
• Patient Balance
Below the Dotted Hash Line columns
• Payment
• Payment Type
• Adjustment
• Adjustment Type
• Transfer
217
Vendors
The Vendor database stores the name and contact information for all
companies from which inventory items are purchased, including the account
number for ordering. CPS links the information directly to the inventory items
table for ease in tracking and reordering products.
To create a vendor open the Administration component, click on the Edit
Menu and choose Vendors. Click on the New button in the Select Vendor
window.
218
Vendors
To Add or Modify a Vendor :
1.
2.
3.
4.
5.
6.
7.
8.
9.
Enter Name of the Vendor
Enter the Account number for the vendor.
Enter the Address.
Enter the Zip Code.
Enter the Phone number.
Enter the Email Address.
Enter the Contact name.
Enter any pertinent Notes.
Click OK to save the vendor information and close the New Vendor
window.
Once Vendors are built in this table, Inventory Items can be built.
219
Zip Codes
The Zip Code table is usually built on-the-fly when entering Patient
Information. However, Zip Codes can be maintained via the Edit Menu/Zip
Code table. Here Zip Codes can be Added, Modified, or Deleted as
necessary.
Best Practice: Enter only the City and State in this table and leave the
Country and Area Code blank.
220
Batch Closing
A batch closing will ensure the charges, payments and adjustments input into
CPS enables you to “lock” all of these transactions so they cannot be changed.
There are two types of batch closings; a ‘soft close’ and a ‘hard close’. Soft
closed batches are closed individually, but not closed by a closing date. These
batches can be reopened (given security rights) to include additional activity. A
hard close permanently closes all batches that fall within the close date. If
changes must be made after the closing date, counter-balancing transactions
must be made to correct any errors.
To close a Batch:
1. From the Administration component, click the Edit menu.
2. Click Batch Closing. The Open/Close Batch window opens.
3. Search for and select the batch by marking the check box to the left of the
name of the batch.
4. Choose Close Batch. A message box opens stating: Are you sure you want to
close the selected batches?
5. Click Yes. The Open status for the selected batch is updated to Closed.
6. Click Close to exit the Open/Close Batch window.
221
Reopening a Closed Batch
There are two choices when modifying a closed batch. You can either re-open the
batch or set the Batch Closing Override option. You must have appropriate
security rights to use these features.
• Reopening a batch changes the Batch Closed status to Open, and allows all
users to make changes to the batch.
• Setting the Batch Closing Override allows you make changes to the batch while
it is still closed to all other users. This is recommended for System Administrators
who are trying to balance the day so only they can make changes.
To Reopen a closed batch:
1. In the Administration component, click Edit, then select Batch Closing. The
Open/Close Batch window opens. Search for, or type the name of the closed
batch you want to modify.
2. Select batches individually, and click the check box to the left of each batch to
reopen. To select all batches, right click in the column heading above the check
boxes and Select All.
3. Click Open Batch. A message window opens stating: Are you sure you want
to open the selected batches?
4. Click Yes. The batch status is updated to Open, then click Close to exit the
Open/Close Batch window.
222
Batch Closing Override
Batch Closing Override allows the user, with security permission, to go into a
closed batch without opening the batch to all users.
In the Administration component, click Edit, then select Batch Closing Override.
The Batch Closing Override warning flashes in the lower right corner of the
screen.
To disable the batch override mode, repeat the above step. The Batch Closing
Override warning will no longer display.
223
Closing Date
CPS requires a permanent Closing Date. The process of closing will permanently
close all open and closed batches prior to the closing date. The date cannot be
reversed, and transactions or charges entered prior to the closing date cannot be
modified. This process should take place on a regular basis, either daily, weekly,
or at the least monthly.
To Set a Closing Date (Hard Close):
• In the Administration component, click Edit, then select Closing Date. The
Closing Date window opens. Enter the closing date in a MM/DD/YYYY format.
Click OK.
• An information window opens, listing all batches that will be permanently closed.
Click OK.
• A warning opens stating: Are you sure you want to set the new closing date?
Once the closing date is set it cannot be reset to before that date. Click Yes. All
charges and transactions through the date input into the active date box are
permanently closed.
Once a Hard Close is performed, the financial data is “set” and visits that are
affected by the Hard Close cannot be modified.
224

Centricity® Services - Cpstraining

Transcription

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