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Release Notes - Billing

Version No: 2.0
Build No: 5

 

Introduction

             A number of new features related to PrognoCIS Billing have been released in Version 2.0 Build 5.

Following is a list of these new additions in brief:


New Features

 

Patient Registration

 

  1. Billing>Appointment>Patient: New Button “ptApptHist” added on Patient Registration Screen.

 

New button “ptApptHist” is added on Patient Registration so that user can view details of patient’s appointment history.

 

 

  1. SSN and Tax ID of patient will be sent as digits only while sending claims electronically.

 

SSN and Tax ID of patient must be digits only for sending the claim electronically else the claim is rejected. Even if masking is ‘ON’, it will un-mask SSN and Tax ID by removing spaces and dashes and send digits only while sending the claims electronically.

 

PreAuth

 

  1.  
    1. Duplicate Pre Authorization number will not be allowed to save for same Insurance on pop up ‘Pre Auth’ of Screen ‘Patient Insurance’.

 

Duplicate Pre Authorization number is not allowed to save for same Insurance on pop up ‘Pre Auth’ of Screen ‘Patient Insurance’. A error message is displayed when duplicate Pre Authorization number is tried to save for same Insurance. Message displayed is ‘Error: Pre Auth No. xxxxxx is Duplicate’.

 

Figure 1: Duplicate Pre Auth number not allowed for same Insurance with error message.

preauth duplicates

 

    1. On Pop up Pre Auth; ‘open’ Pre Auth entries will be displayed on top followed by ‘closed’ Pre Auth entries chronologically.

 

Earlier Pre Authorization entries were displayed in the sequence in which those were entered irrespective of whether these were open or closed.

 

Now pop up ‘Pre Auth’ first displays open Pre Authorization Numbers followed by closed Pre Authorization Numbers in chronological order. Pre Authorization Numbers are rearranged as and when Pre Authorization state is changed from ‘open’ to ‘closed’ by checking the checkbox ‘Closed’.

 

Figure 2: Open Pre Auth numbers arranged chronologically and Closed Pre Auth number at bottom.

 

 

   

Insurance Eligibility

 

  1. Insurance Eligibility request 271IE will now process Telephone number of PCP.

 

              Screen ‘Patient Insurance Details’à Insurance Eligibility request 271IE will now process and display Telephone Number of

              Primary Care Provider (PCP) from PER Segment when Insurance Eligibility is fetched using ‘Eligibility Check’ for a patient.

 

 

Insurance Master

 

  1. Insurance Master has a new field ‘Institutional Payer ID’ on pop-up: Extra Info

 

Insurance Master Screen; A new field ‘Institutional Payer ID’ is added on pop up ‘Extra Info’. Institutional Payer Id is must for Institutional Claims(UB04).If the Insurance is EDI enabled, and a UB04 claim with EDI enabled Insurance is marked as ‘Ready to Send’, an alert is displayed forcing the users to first enter the Institutional Payer ID on Insurance Master Screen.

 

  1. Button Extra Info on Insurance Master is visible to all users.

 

Insurance Master Screen; Button ‘Extra Info’ is now visible not only to ‘Admin Admin’ user but all users who log in to the system. Earlier Button ‘Extra Info’ was only visible to ‘Admin Admin’ user and was allowed edit EDI & Non EDI fields on ‘Extra Info’ pop up.

Now Button ‘Extra Info’ is visible not only to ‘Admin Admin’ but to all users. But the difference being that Admin user can edit all the fields (EDI and Non EDI) on pop up ‘Extra Info’ whereas other users can edit only Non EDI (like ‘Subscriber Id length, Subscriber EDIN Reqd., Institutional Payer Id) fields on pop up ‘Extra Info’.

 

Figure 3: Insurance MasteràButton ‘Extra Info’: New field ‘Institutional Payer Id’ is added in ‘Insurance Extra Information’ pop up

 

Extra Info Button.png

 

 

PAT A/c Screen

 

 

  1. Pat A/c ScreenàClaims section; Encounter Zoom Button is displayed under Claims table in ‘Visit Id’ column on Pat A/c screen for new claim (Dummy Billing) created from billing module.

 

Pat A/c Screen àClaims section; Encounter Zoom button is displayed under Claims table in ‘Visit Id’ column on Patient A/c screen. Whenever new claim is created for the patient from ClaimsàNew Screen then under Claims table on Pat A/c Screen, new claim entry is created. The information about new claim entry is stored in TRN_ENCOUNTER table (EMR module) and TRN_BILLING_HEAD and TRN_BILLING_HEAD (Billing module) tables as well. In ‘Visit Id’ column, ‘Encounter Zoom’ button is now displayed. On click button of ‘Encounter Zoom’, Encounter Screen is displayed of the patient for whom claim is created. As this claim is created from Billing module without creating encounter (meaning claim not created from EMR side, without having created encounter of the patient), ‘Encounter Type’ is set as ‘Dummy Billing’.

 

If claim is in 'E' (Entered) stage or Claim having status ‘S’ (Ready to Send) then on reopening its encounter which is of type ‘Dummy Billing’ allows us to change ‘Visit Date’ from Encounter and reflect changes on billing side without creating a new claim.

But if claim is in 'P' (Processed) status then on reopening its dummy billing encounter, it does not allow making changes in visit date.

 

Figure 4: Button ‘Encounter Zoom’ on Patient A/c screen .

 

 

 

  1. Patient Ledger: A new property has been added ‘ledger.print.only.ins.paid’ for changing the format of Patient Ledger.

 

A new property has been added ledger.print.only.ins.paid for changing the format of Patient Ledger. If this property is set to Y, then Patient Ledger will be displayed as follows:
The column ‘Receipt’ for Insurance would show only the actual amount paid by Insurance instead of printing the sum total of Paid + Adjustments + Write-Off for each charge code. Currently, in the description, the Total paid amount is displayed, but not in the Insurance ‘Receipt’ column of each charge row.

            Note: Since the adjustments and write-offs are not printed, the amounts Billed to Insurance and Amounts paid columns will not match.

 

Copay Screen

 

  1. New field ‘Attending Doc’ is added on button ‘Info’ Pop up Copay and Screen Patient Copay.

 

On Pop ups for Copay($) & Remittanceà Pat Co-Pay Screen; On click of button ‘Info’, now new field is added so that ‘Attending Doc’ can be selected and associated to Co-pay entry. This information is used for reporting purpose.

 

Figure 5: New field ‘Attending Doc’ is added on button ‘Info’.

 

 

  1. Title of pop up screen on button ‘Info’ has been changed to ‘View for Copay Collection’.

 

On every Co-pay screen, the button ‘Info’ is displayed with four drop down list for Location, Business Unit, Rendering Doc, and Attending Doc. The title of this pop up Copay is changed to ‘View for Copay Collection’.

 

Figure 6: Title of Co-pay Screen changed to ‘View for Copay Collection’.

 

 

 

Claims >>Edit

 

  1. ClaimsàEdit; Reminder Alert message is displayed when CrossOver Code is applicable to charge code in claim on ‘Ready to Send’.

 

When applicable Cross Over is applied to charge code at claim level then on ‘Ready to Send’, alert message is displayed to user – ‘Crossover Applicable. Do you want to keep ‘Ready to Send checked?’. User can ignore the message if required and claim is allowed to send.

This feature acts as a reminder to the user about used cross over codes applicable to charge code at charge level.

 

Figure 7: Alert Message displayed for CrossOver code applied to Charge Code

 

 

  1. On claims ‘I’ button, ‘Duration’ is computed automatically using inputs from ‘Anesthesia Start Time’ and ‘End Time’ fields.

 

ClaimsàEdit Screenà ‘I’ button; Earlier ‘Duration’ field was filled manually but now it is calculated automatically using inputs filled in ‘Anesthesia Start Time’ and ‘End Time’ fields and is displayed on claim’s ‘I’ button in ‘Duration’ field. ‘Duration’ is computed on Save and reload of the page. As it is computed automatically using ‘Anesthesia Start Time’ and ‘End Time’, chances of error while computing ‘Duration’ is none and hence it is correctly computed. Duration is in HH:MM format for 24 hrs.

 

  1. ClaimsàEdit Screen; Space between Charge line Modifier edit control and search icon is reduced.

 

Space between Charge line Modifier edit control and search icon is reduced. This is UI related changes on ClaimsàEdit Screen so that data under column is displayed properly.

 

  1. ClaimsàEdit Screen; Space between Charge line, ICDs Edit control and search icon is reduced.

 

Space between Charge line, ICDs Edit control and search icon is reduced.


 

  1.  ClaimsàEdit Screenà CMS flag; By default, ‘Unit of measures’ drop down list is set to ‘Units’ and ‘Admin Qty’ to ‘units’ under charge code table on CMS flags pop up for ‘J Codes along with NDC code’ in charge line.

 

On ClaimsàEdit ScreenàCMS flag; J Codes along with NDC code in a charge line automatically sets  ‘Unit of measures’ drop down list to ‘Units’ and ‘Admin Qty’ drop down list to units for J Code. Earlier, ‘Unit of measures’ drop down list was set to ‘International Units’ and ‘Admin Qty’ was set to ‘1’.

 

Note: Claims with J Codes along with NDC code; if Charge units are changed after saving the claim, charge units change will not be reflected on click button of CMS Flag.

 

Figure 8: Claimsà J CodesàCMS flag; NDC Codeà Default Unit of measure: ‘Units’ and Admin Qty: ‘Units’ on charge line.

 

 

 

  1. ClaimsàEdit Screen; Location and Business Unit drop down list now display Code and Name.

 

On ClaimsàEdit Screen; Location and Business unit drop down list displays the code and name. If single Business unit is defined in ConfigurationàMasters, then Business Unit drop down list is not populated.

 

 

Claims >> Edit Screen>>CMS1500

 

  1. Tertiary CMS radio button disabled in Preview / Print pop up in case no charge code is billed to Tertiary Insurance.

 

Earlier, Tertiary CMS radio button used to remain enabled on Preview / Print Pop up even if charge code was not billed to it. Now it has been fixed. If any charge code is not billed to Tertiary Insurance then Tertiary CMS radio button is disabled on Print/ Preview pop up.

 

  1. New tags added to CMS form to print Total Paid Amount and Charge Balance Amount in Cell29.

 

New tags are added to print Total Amount Paid and Charge Balance Amount in CMS 1500 for claims. These two tags are

BLH_CELL29_TOTPAIDUSD – Prints Total Paid Amount in Cell 29 of CMS form.

BLH_CELL29_TOTPAIDCENT tag is used to print Cell29 = Pri Amt Adjusted+ Primary paid writeoff+ Sec Amt Adjusted+ Secondary  paid writeoff.

 

  1. Now Qualifier Id. and Taxonomy Code is printed in Secondary Insurance CMS form.

 

Now ‘Qualifier Id.’ and ‘Taxonomy Code’ is printed for Secondary Insurance in CMS1500. The ‘Qualifier Id.’ is printed in ‘Cell 24I’ in the gray band and ‘Taxonomy Code’ is printed in ‘Cell 24J’ in white band opposite to ‘NPI’ box in CMS1500.

 

Figure 8: CMS 1500 with ‘Qualifier Id’ and ‘Taxonomy Code’ printed in ‘Cell24I’ and ‘Cell24J’.

 

 

Cell 24I and Cell 24J equivalent in EDI is sent in 2310B (Rendering Provider Loop). NPI always needs to be sent by EDI (if the claim is billed as BU). Taxonomy code, if available in provider master, then it is send with qualifier as ZZ in 2310B-REF segment. If the claim is billed under AD (rendering provider, then 2310B is not required to be send).

 

  1. Now ‘Edit CMS’ button is added CMS template screen if template subtype is CMS1500.

 

Settingsà ConfigurationàBillingà Templates; A new button ‘Edit CMS’ has been added on CMS template screen to make editing of HTML tags associated with CMS1500 simple & easy. If template subtype selected is CMS1500 then ‘Edit CMS’ button is visible on Template screen. On click of button ‘Edit CMS’, ‘Edit Template’ pop up is displayed which is in readable form. This pop up has ‘CMS Cell Title’, ‘Default Tag’, ‘Tag Used’ as columns on pop up. User can edit the tag(s) on this pop up. These changes are reflected on the CMS 1500 once ‘Edit Template’ pop up closes.

Earlier it was tedious job to search a tag in the ‘HTML’ view and replace/ change the required tag.

But now with ‘Edit CMS’, CMS editing is made simple and easy with the help of user interface for tags used in CMS1500.

 

            Note: Fields in columns ‘Cell Title’ and ‘Default Tag’ are displayed as defined in file ‘CMS1500.csv’. It is saved in datafiles folder

‘blSummaryLayout’. The details of columns tag used are pulled from template currently displayed.

 

Figure 9: ‘Edit Template’ Screen for CMS 1500.

 

Edit CMS.png

 

 

  1. New property 837.accept.assignment introduced in EDI and CMS.

 

New property 837.accept.assignment has been introduced in EDI and CMS. This property is related to accept assignment feature to check whether patient has given consent to assign medical benefits to someone according to his / her choice. Assign Benefits checkbox is present on ClamàEdit Screen. It can be configured using SettingsàConfiguration. By default, this property is set as blank but there are options which can be set according to requirement. These options are –

·   Assigned

·   Assignment accepted on Clinical Lab Services Only

·   Not Assigned

·   Patient Refuses to Assign Benefits

 

It is displayed in Cell12 and Cell13 of CMS 1500.

 

Figure 10: Consent to Medical benefits assigned by patient is printed in Cell12 and Cell13 of CMS 1500.

 

  1. ClaimsàEdit: 3 years check for New Patient charge codes(99201 – 99205) has been extended to consider unique Taxonomy code of Rendering Docs and allow billing them.

 

For multi-specialty clinics, the check that ‘New Patients’ charge codes (99201 to 99205) will not be allowed to be billed for 3 years after its first use’ has been relaxed a little. Now, in addition to above check, the Taxonomy code of the rendering providers in previous and this claim will also be compared. If they are different, and even if the claim exists with New Patient codes billed in less than 3 years, the system will allow billing ‘New Patient’ charge codes again. This will be useful in cases where a patient has to be seen by different specialists in same clinic for totally different issues. From the specialists’ perspective, the patient is a new patient, even if seen by other specialist as new patient less than 3 years back.

 

  1. ClaimsàEdit Screen: ‘CoIns’ Hyperlink will be now displayed only after Secondary responsibility is created.

 

The hyperlink ‘CoIns’ is shown on Claim screen only after the Primary Insurance has paid and Secondary Responsibility has been created. Once displayed, it continues to display, even after the Secondary has paid or Patient has paid and claim is settled. The ‘CoIns’ Hyperlink was earlier displayed as soon as Claim was processed and till secondary responsibility was created, when clicked on, it used to display blank screen.

Cases: a. Sec Paid First will display the hyperlink ‘CoIns’ only after Primary Remittance is 

posted.

b. Charge Next Responsible action taken for Primary Remittance will not display
             the hyperlink ‘CoIns’.

 

Figure 11: ‘CoIns’ hyperlink is displayed only after Secondary responsibility is created

 

 

 

  1. Claims-->Edit Screen; EPSDT Used for Pediatric patients now prints appropriate values in Cell 24H of CMS1500 as per option selected in Specialty Test ‘EPSDT Condition Indicator’ drop down on EMR side.

 

Claims-->Edit Screen; EPSDT Used for Pediatric patients; If EPSDT flag is checked on Claims Charge row AND on the EMR Side the Specialty Test 'EPSDT Indicator Code' is selected as S2 Or ST, then the Tag BLD_TICK_EPSDTFP prints it as '03' in the Cell 24H of CMS1500 paper claim else it will print 'Y'. No change is applied in the printing on Gray Band for Cell 24H. It will continue to print appropriate Specialty Test 'EPSDT Indicator Code' drop down value 'AV'/'NU'/'S2'/'ST'. Earlier for any option selected in the Specialty Test ‘EPSDT Indicator Code’ in EMR Side, cell 24H of CMS1500 used to print only ‘Y’.

 

Figure 12: ‘EPSTD Condition Indicator’ printed in Cell24H of CMS 1500

 

 

  1. ClaimsàEdit Screen; Claims when resent after ‘Reopen Claim to Resend’ would send only those charge codes which were Denied and action taken ‘Reopen to Resend’.

 

For supporting this functionality, a new flag has been introduced in database ‘BLD_BOOL_DO_NOT_SEND’. Only those charge codes which do not have this flag set, will be sent when the claim will be re-processed after Reopening using Denied ‘Reopen to Resend’.

 

Claims >>Edit>>UB04

 

  1.  ClaimsàEdit Screen: UB04 claims; ‘Other Insurance’ hyperlink is removed for UB04 claims.

 

Earlier hyperlink under ‘Other Insurance’ used to remain active even for UB04 claims. UB04 claims are Institutional Claims and Tertiary claims for UB04 claim is not supported therefore the hyperlink under ‘Other Insurance’ is now removed.

 

  1. ClaimsàEdit Screen: Now UB04 claims can be processed as EDI 837I claims.

 

Earlier UB04 claims for Hospital Billing were not supported to be send as EDI 837 claim. Now UB04 claims are allowed to send as EDI 837I claims.

Note: Institutional Payer Id is must for UB04 claims to get created as EDI claims in Pri-EDI and Sec-EDI buckets of Send Claims screen. Otherwise checkbox ‘Paper Ins Form’ remains checked on Claim screen.

 

28.         ClaimsàEdit Screen: Validation is applied to mark UB04 claims as paper insurance if Institutional Payer Id is not defined in Insurance Master associated to the UB04 claims.
 
ClaimsàEdit Screen: As UB04 claims are Institutional claims, Institutional Payer ID is must to process these types of claims as EDI claim. If user has selected the insurance for a claim where ‘Institutional Payer Id’ is not defined in Insurance Master and claim is created as UB04 without Institutional Payer Id then system automatically marks checkbox ‘Paper Ins Form’ on ClaimsàEdit Screen and drops it to Pri-UB04 and Sec-UB04 buckets as paper claim on Send Claims Screen.
 

Figure 13:  Claimsà Edit: UB04 Claimà Checkbox ‘Paper Ins Form’ is marked where Institutional Payer Id is not defined in Insurance master.

 

 

 

  1. Now Property 837.2310D.notrequired supports comma separated values along with Boolean values of claim filing codes for UB04 claims.

 

Property 837.2310D.notrequired is used to generate EDI 837 for 2310D segment when it is set to ‘Y’. This property is being used for professional 837 claim generation. Now usage of this property has been extended to Institutional claims (UB04) as well where you can enter comma separated claim filing codes (for example: MB, MC, BS etc.). When these comma separated values are used by user with property ‘837.2310D.notrequired’ for UB04 claims then service locations are not printed in 2310D segment of EDI 837 for UB04 claims.

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  1. ClaimsàEdit Screen: Validation is applied to check ‘Pay to Provider Type’ as Non Person Entity on ‘Ready to Send’ of UB04 Claims.

 

ClaimsàEdit Screen: Validation is applied on ‘Ready to Send’ for UB04 claims to check if ‘Pay to Provider Type’ is set as Non Person Entity. UB04 claims are institutional claims where payment is received by hospital or corporate therefore this validation is applied before post. ‘Non Person Entity’ are ‘Business Unit, ‘Service Location’. For UB04 claims, set ‘Pay to Provider Type’ either as ‘Business Unit’ or ‘Service Location’ using button ‘I’ on ClaimsàEdit Screen. Unless ‘Pay to Provider Type’ is set to ‘Non Person Entity’, UB04 claims are not allowed to post.

 

Figure 14:  Claimsà Edit: UB04 Claim postà ‘Select Pay to Provider type as Non Person Entity’.

 

 
 
  1. ClaimsàEdit Screen: Now ‘Claim Id’ is hyperlinked to display ‘Claims Update History’ pop up with latest updated dates at the Header and detail levels for Claims and Charge Code level.

 

           Now latest update history for Claim at header and details level (i.e. Claims and charge code level) is available on click of hyperlink  

           ‘Claim Id with display of pop up ‘Claim Update History’. ‘Claim Update History’ pop up displays ‘Code’(Charge code which were updated), ‘User’

            (name of user who has updated the remittance/claim/charge code), ‘TimeStamp’ (Date and time of updation).

                         

Figure 15:  Claimsà Edit Screen: ‘Claims Update History’ pop up displayed when hyperlinked ‘Claim Id’ is clicked.

 

           

 

 

Claims >>Send Claims>>115 message

 

  1. On Send Claims Screen; For Minor Patients with Age < 100 days: if Medicaid/Medicare insurance was associated to them, if subscriber relation was not 'self' then claim processing was not allowed from Screen ‘Send Claims’ as validation (Legend status – 115) was applicable and message (Legend status – 115) - 'Ins Relation Not Self for Medicare / Medicaid' was displayed.

 

Send Claims Screen; Click of button 'process'; For New born patients having Medicaid/ Medicare Insurance, the insurance takes up to 90 days to issue subscriber id. During this period, these insurances accept Parent's/legal guardian's subscriber id for claims billed for such minor patients. However, validation (Legend status – 115) - 'Ins Relation Not Self for Medicare / Medicaid' did not allow these types of claims to be processed.

 

Now validation (legend -115) has been bypassed for minor patients with age less than 100 days and not having Subscriber Id for Insurance associated with them. Now claims are allowed to process for these minor patients if their age is less than 100 days and subscriber relation is not 'self'.

 

Claims >>Send UB04

 

  1. ClaimsàSend UB04 screen: Pri-EDI and Sec-EDI buckets are now enabled to display all Institutional claims to be processed as EDI and on click of button process, send them as EDI 837I claims.

 

Now UB04 claims where EDI enabled Insurances are associated to claims are allowed to send as EDI 837I from Send UB04 claims screen. Therefore on Send UB04 Claims ScreenàPri-EDI and Sec-EDI buckets are enabled which displays all institutional claims to be processed as EDI and on click of button ‘process’, are sent as EDI 837I claims.

 

Figure 16: Pri-EDI and Sec-EDI buckets are enabled for UB04 claims.

 

 

 

Claims>Outstanding / Claims Center / Charges Center >>Resend Claims

 

  1. Validation is applied on ‘Resend Claims’ button to check if charge codes associated to claims have some amount billed to Insurance when multiple claims are selected to resend from Outstanding / Claims Center / Charges Center Screen.

 

A validation is applied on click of button ‘resend’ before resending multiple claims from Outstanding / Claims Center / Charges Center Screen. This validation will now check if any of the claims selected does not have associated charge code where no amount is billed to insurance. That claim where associated charge code does not have billed amount to insurance is not allowed to resend.

 

Claims Ledger

 

  1. Claims>Ledger; On Claims Ledger Screen; New columns ‘Charge desc’, ‘Primary Excess Amt’, ‘Sec Excess Amt’ added. Also its layout and color combination of the table is changed.

 

Claims>>Ledger; On Claims Ledger Screen; New columns ‘Charge desc’, ‘Primary Excess Amt’, ‘Sec Excess Amt’ added and also layout and color combination of the table is changed. It now displays Excess amount for extra amount. Total Amount is not yet incorporated in table.

 

Figure 17: ClaimsàLedger; New Columns ‘Charge desc’, ‘Primary Excess Amt’, ‘Secondary Excess Amt’.

 

 

 

Remittance>>EOB

 

  1. Remittance>EOB Screen: Charge code : Claim Id pair list is displayed for EOB’s with non-zero balance on EOB post.

 

Now along with this message on EOB screen additional pop up message having ‘Claim id : Charge code’ pair list is displayed on post of such EOB where charge codes associated to claims has ‘Non-Zero’ balances in ‘Bal’ column under charge code table. Therefore, message makes it more intuitive and user comes to know about those claim ids where there are non-zero balances are associated to charge codes. EOB with non-zero balances are not allowed to post.

 

Earlier whenever EOB was posted where there were charge codes associated with it had some non-zero balances, message used to display on EOB screen -‘Cannot Post with Non-Zero Balance’ and EOB was not allowed to post. But, it was not clear from that message that which were those ‘Claim Id : Charge Code’ pairs where non-zero balance were associated.

 

Figure 18: RemittanceàEOB; Claim Id: Charge code pair list displayed message for charge code associated with Non-zero balance.

 

 

  1. RemittanceàEOB; Code and description is displayed on ‘Remark Info Screen’ on click of button ‘Remark’ for a charge code associated to claim.

 

Remittance>>EOB; ELE is received from Insurance company is in .837 format. Button ‘Remark’ is placed for each charge code which is associated to a claim whose remittance is received. In case, if there are some problems related (for example: Reason for Denial, code: C045) to particular charge code, on click of button ‘Remark’, only code reason was displayed on pop up ‘Remarks Info’. But now, click of button ‘Remark’ displays code as well as description related to charge code on pop up ‘Remarks Info’.

 

  1. RemittanceàEOB/ERA screen: A new button ‘Claim Amts’ has been added on Remittance screen to give quick Amounts summary for each column like Paid Amt, CoIns Amt, Bal Amt for all claims selected for that Remittance entry.

 

Many times, if a EOB is big with huge number claims, it becomes difficult to find out where there is still a balance amount left or ‘CoIns’ responsibility added. Now, this summary of various amounts at claim level for all claims in a EOB will be displayed in this pop-up shown on clicking button ‘Claim Amt’. This will avoid the need to click on one claim at a time to see the claim level amounts.

There is a ‘Print’ button provided on this pop-up so that Claim level Amounts can be printed.

 

Figure 19: RemittanceàEOB/ERA; A new button ‘Claim Amts’ has been added on Remittance screen to give quick Amounts summary

 

  1. Remittance-->EOB; Secondary Insurance is allowed to change if claim is reopened with denied action or at least one charge code is paid if EOB was already received.

 

Consider a case where the claim was billed with Secondary Insurance as Sec1 and some EOB was posted against this Sec1. Now let’s say, if users try to change the Secondary Insurance on claim from Sec1 to Sec2 because Sec2 is the right insurance and they did the payment, there was no check to see if Sec1's EOB was a denial or deleted. As a result, the users were not allowed to change the secondary insurance on claim from Sec1 to Sec 2 just because Sec1 had EOB posted with Status Denied: Denied (any action)

OR Sec1's EOB was deleted after Reopening and archived entry was present.

Now, there is couple of validations added as exception when Secondary Insurance is tried to be changed on the claim.

1. Now, even if earlier Secondary Insurance has a Denied EOB posting, the
                 secondary insurance can be changed.

2. Even if earlier Secondary Insurance EOB was posted and later reopened and
                 deleted, the archived entry of that EOB will be ignored and secondary
                 insurance will be allowed to be changed on the claim.

The other checks like valid payment EOB present for secondary (posted or Entered state) still remain, not allowing the users to change the Secondary Insurance.

 

 

  1. RemittanceàEOB/ERA Screen: Claim ‘Del’ button toggles to Claim ‘Edit’ button to allow editing claims without reopening posted claims.

 

Remittance>EOB/ERA Screen; Now for posted EOB, same button ‘Del’ toggles/changes to ‘Edit’ claim button and posted claims are allowed to edit without reopening it. Therefore, now with single button two actions can be performed according to state of EOB.

 

One claim can be reopened at one time. While posting EOB, untouched charge rows get dropped off. When Claim is reopened, those charge rows can be populated on reopening claim to edit. Sec, I and A2 are also available. It allows changing the Status like Approved, Denied, Pending, etc….and actions as well, like write-off the Patient Responsibility, etc. The Total paid amt via check cannot be changed with this option.

 

Earlier on Remittance>EOB/ERA Screen, claims which were in ‘Entered’ state were allowed to delete using button ‘delete’ under claims table. In order to edit claims which were in ‘posted’ state, claims were required to ‘Reopen’.

 

 

  1. Remittance àEOB / ERAàAdditional validation applied ‘On Post’ of Secondary Insurance EOB to check if Primary Insurance EOB is posted prior to Secondary Insurance.

 

Remittance > EOB / ERA Screen: An additional validation is applied on post of Secondary Insurance EOB to check that Primary Insurance EOB is already posted before Secondary Insurance EOB. While posting Secondary Insurance EOB if it is found that Primary Insurance EOB (in entered state) is not yet posted then alert message (‘Primary EOB not posted’) is displayed to the user. This alert message displays Primary Insurance EOB details and claim id.

 

This validation will allow user to avoid the ‘On Hold’ scenario for Secondary Insurance EOB.

 

Figure 20: Remittance > EOB / ERA Screen: Check if Primary EOB not posted on Secondary EOB Post

 

 

 

  1. Remittance>ERA; ERA auto generated due to CHARGE NEXT RESP action on EOB is not displayed in Pat A/c Screen under Remittance table.

 

Whenever action ‘CHARGE NEXT RESP’ is performed on a charge code in EOB, a new system generated Remittance (ERACNxxxxxx) is created in database. This system generated ERA entry was displayed under Remittance table in Pat A/c screen which could be reopened. This action of reopening the system generated Remittance (ERACNxxxxxx) by user used to result in Amount Totals mismatch on Pat A/c screen and Financial Analysis report. Now ERA generated from Remittance>EOB due ‘CHARGE NEXT RESP’ action is not displayed under Remittance table in Pat A/c screen.

 

  1. Remittance>EOB; Files attachment from Attach center to Remittance>>EOB in Posted or Entered state is allowed.

 

MessagesàAttach Screen; File can be attached from folder on Server datafile to EOB. Select file from any folder like ‘detach’/’Fax’/’Scan’/’move’. Select ‘Eob’ from Attach drop down list to attach it to the Remittance>>EOB. New feature allows adding attachment to EOB easily. There are two properties which must be set so that ‘Attach’ feature works properly.

Properties related to attach feature are:

prognocis.attach.filetypes - The directory where images are moved after detaching.
prognocis.attach.folders     - Comma Separated directory paths where incoming faxes are stored corresponding to the above machine sequence.

 

  1. Remittance>EOB/ERA; Status Pop-up: Denied Reason: Binocular added to search Denied reason making it easy for searching for the keywords anywhere in the string.

RemittanceàEOB/ERA Screen; Earlier if a charge code was assigned with ‘Denied Reason’ Action then user had to type few first letter of the reason sentence which was tedious and user had to remember the keyword in order to type letters so that auto complete feature could complete the sentence. But now for entering ‘Denial Reason’, status pop is displayed on search icon is clicked. The status pop up displays ‘Reason’ list and selection can be made accordingly. Binocular (Search) icon has made easy to search these keywords.

  1. Remittance>>Collection Receipts; On post of ‘EOB’ and ‘Patient Receipts’, system sets appropriate mode of payment received for a claim by Insurance Company.

 

Remittance>>Collection Receipts; For collection Receipts, it is important that amounts are stored in proper fields in database against various mode of payment used to pay amount by Insurance Companies and patients. When EOB for patient receipts are posted, the amount received against claim is set in ‘ERH_AMOUNTS’ field of ‘TRN_ERA_HEAD’ table. Along with amount set, information about the mode of payment received from Insurance Company is also stored. There are four fields in ‘TRN_ERA_HEAD’ table where information about mode of payment is stored. These fields are:

ERH_BANK_AMOUNT- ‘cheque’ is stored in this database field if cheque payment is received.

ERH_CASH_AMOUNT- ‘cash’ is stored in this database field if cash payment is received.

ERH_CC_AMOUNT – ‘cc’ is stored in this database field if payment by credit card is received.

ERH_ELE_AMOUNT – ‘ele’ is stored in this database field if payment is received electronically from Insurance Company.

 

The information stored in above fields are also reflected in TRN_NOTES table and when Remittance, Claims, Receipts, Copay, Statements, Attached documents are printed on this screen.

 

  1. Remittance>>AutoWriteOff screen: A new menu option is added under Remittance.

 

RemittanceàAutoWriteOff screen; A new screen is added under Remittance for ‘Autowrite off Claims’. There are claims where patient responsibility amount is not paid within specified duration to pay their responsibilities. In such cases, the claims are assigned to collection agency to recover patient responsibilities and afterwards, such claims may be written off. On ‘Autowrite off Claims’ screen, claims where some patient responsibility is pending beyond specified duration to make payment is shown.

 

To assign claims to collection agency on Autowrite off Claims screen, select claims by checking them and use ‘Assign To’ icon.

To Auto write off claims on ‘Autowrite off Claims’ screen, select claims by marking the check box and click button ‘process’ to ‘write off’ selected claims. A message is displayed on the screen when claims are written off.

 

‘Autowrite off Claims’ screen provides list of those claims where patient responsibility is not paid within specified duration to pay their responsibility and also has an added capability to write off such claims and / or assign such claims to collection agency to recover pending patient responsibility from patient.

 

Autowrite Off reason is displayed on Patient Ledger and Claims Ledger screen.

 

Figure 21: RemittanceàAutoWriteOff; Autowrite off Claims Screen

 

 

 

  1. Remittance>>EOB Screen; Secondary Insurance checkbox is now editable on claim row to change the insurance from Primary Insurance to Secondary insurance and vice versa.

 

Remittance>EOB screen – Checkbox ‘Sec’ is now editable on Claim row to change the Insurance from Primary to Secondary and vice versa. This will be helpful when the claim is selected forcefully from wrong bucket using ‘ALL’ checkbox either manually or while processing ELE in case of Carrier.

If checkbox ‘Sec’ is checked after the claim is selected on an EOB, the responsibilities will appropriately change and Allowed Amt etc would be applicable Sec resp.

If Status ‘Duplicate’ (Red) is marked for charge codes before checking the ‘Sec’ checkbox, it will not remove it automatically. It will have to be manually changed to Normal.

Example: Scenario:

When ELE comes from Insurances, the flag for Sec is sometimes not set when payment comes from Secondary. As a result, PrognoCIS processes such claims as Duplicate Payments from Primary.

Such ELE if posted without corrections, results in duplicate payment record for Primary for that claim.

Now, if the users realize this mistake and would like to correct it, there was no way to easily mark a claim as Secondary responsibility. The only option was to delete the claim from ELE, reselect it from Sec list of claims, enter amounts again and then post it as Sec EOB.

Instead of taking all these steps, the users can now check the Sec checkbox, manually change the status as ‘Normal’ from ‘Duplicate’ and then post the Secondary payment.

 

  1. Remittance>>EOB Screen: ‘Remittance No’ is now hyperlinked to display ‘Remittance Update History’ pop up with latest updated dates at the Header and Detail levels.

 

           Now latest update history for Remittance at header and details level (i.e. EOB, Claims and charge code level) is available on click of hyperlink   

           ‘Remittance No’ with display of pop up ‘Remittance Update History’. ‘Remittance Update History’ pop up displays ‘Claim’ (Claim Id), ‘Code’
           (Charge code which were updated), ‘User’ (name of user who has updated the remittance/claim/charge code), ‘TimeStamp’ (Date and time of
           updation).

 

Figure 22:  Remittanceà EOB/ERA Screen: When hyperlinked ‘Remittance No.’ is clicked, ‘Remittance Update History’ pop up is displayed.

  

                         

Reports

 

  1. New Menu option ‘Collection’ is added under Reports with various filter to generate collection report for vouchers or claims.

 

On Reportsà Collection Pop up; New Collection Reports pop up is displayed and new filter options are provided for transactions so that appropriate reports can be generated for claims or vouchers. You can select any or all transaction from options like ‘Encounter’, ‘Insurance EOB’, ‘Patient Receipt’, and ‘Capitation Receipt’. Collection reports can be generated for vouchers or claims against status ‘Posted’/ ‘Non Posted’/ ‘Both’.

 

Figure 23: ReportsàCollection; Collection Report Pop up

 

 

  1.  Search option provided for ‘Batches’ field on Collection Report pop up.

 

ReportsàCollection; On Collection Report pop up, Search option with binocular is provided under ‘Filter By’ group. It makes search easy for ‘Batches’ on the Collection pop up and select the appropriate batch to generate Collection report.

 

50           Reports à Summary: ‘Zoom / Breakup’ feature added to display detailed breakups of Amounts 352(Move to Adv), 353(Used from Adv) and 414(Move to Adv EOB), 415 (Used from Adv EOB) on financial Summary report. 
           
           
ReportsàSummary: New feature ‘Zoom/ Breakup’ is introduced to display detailed breakups of Amounts 352(Move to Adv), 353(Used from
            Adv) and 414(Move to Adv EOB), 415 (Used from Adv EOB) on financial Summary report. Whenever Amounts ‘352, 353, 414, 415’ are displayed
            in the financial Summary Report, a hyperlink is displayed under headers for these amounts under respective category (Like Pat Receipt,
            Remittance). When hyperlink is clicked, the detailed breakups of amount for respective headers are displayed on the pop up. Therefore, it
            now displays detailed amounts breakup for each Amounts ‘352, 353, 414, 415’ on a separate pop up having columns ‘Post Date’, ‘Doc. No’,
            ‘Patient / EOB’, ‘Amount’. User can view these amounts for various Patients or EOB at a glance.
            Earlier these amounts were displayed on the Financial Summary Report with cumulative amount.    
         

 

51    Reportsà Graphs- Now properly displays ‘Amount’ in Graph.

 

SettingsàConfigurationàReportsàGraphs; Now ‘Amount’ is properly displayed in the graphical representation of data in graph. Earlier representation of amount field in graph was not displayed properly in the graph. Now Amount field is converted from string format to integer format and then it is properly displayed in graph.

 

 

52    Reportsà Graphs; ‘upto’ Date for period on MIS Graph pop up is displayed in standard format (mm-dd-yyyy).

 

Earlier ‘upto’ date on SettingsàConfigurationàReportsàGraphsà MIS Graph pop up was not displayed in standard date format (mm-dd—yyyy) when date range was selected as option for ‘Period’ field. Now ‘upto’ date is displayed in standard format (mm-dd-yyyy).

 

53    ReportsàSummary; Button ‘Upload/ Download’ is added for xls/csv associated with ‘Select File’ list box option.

 

Now ReportsàSummary supports ‘Upload/Download’ of ‘xls/csv’ associated with ‘Select File’ drop down list option. This feature has added capability to upload file from local or network machine to Serverà datafile folder. If user uploads a xls/csv with a different name, it will be copied to respective folder, and will get renamed and overwrite the filename corresponding to the selected drop down List option.

 

Figure 24: ReportsàSummary; supports ‘Upload/download’ of ‘xls/csv’.

 

 

Reports>>Dashboard

 

54    Reports-àDashboard; New menu option is added under Reports for dashboard with properties to define Dashboard details.

 

ReportsàDashboard; New menu option is added under Reports to create ‘Dashboard’.

Dashboard is new menu option added under Reports. Dashboard is graphical representation of various transactions related to Billing data. There are nine cells of dashboards on Dashboard screen. These nine cells can display reports as well as gauges related to

a.       Insurance Payer Mix

b.      Billed Amount Data

c.       Copay Collection Data

d.      Daily Billing Data

e.       Billed Amount

f.       Copay 20

g.      Patient Receipt

h.      EOB

i.        Claims Billed

 

There are nine set of properties starting with Facesheet.9.cell which will decide what each cell of dashboard would display on ‘Dashboard’ screen.

Facesheet.9.cell is now being used for displaying Dashboards for Billing module and is not available from EMR side.

For Example: facesheet.9.cell_1 = The valid types allowed in the face sheet.

In order to customize dashboards to print in various cells, use property ‘guage’.

For Example: A set of property defined for a Dashboard

guage.1.sql = SELECT SUM(BLH_BILL_AMOUNT) FROM TRN_BILLING_HEAD WHERE BLH_TRNTYPE = 'BL' AND BLH_BOOL_INACTIVE = 0 AND BLH_FROM_DATE = [TODAY]

guage.1.maxamt = 100000

guage.1.minamt = 10000

guage.1.title = Billed Amt

 

 

Settings>>Configuration

 

55    Now 'Business Unit' also visible under SettingsàConfigurationàVendors from EMR side.

 

Earlier 'Business Unit' was visible under Settings-->Configuration-->Clinic column from Billing side. Now 'Business Unit' is also added under 'Vendors' column in EMR side as it is required for turning 'ON' Insurance Eligibilty where 'Business Unit' entry has to be defined. Therefore, it is made easy to turn 'ON' Insurance Eligibility without having dependency on Billing side. 

 

56    Import Log: New screen in Billing module to track ELE 835 Failures.

 

Many Electronic Remittances don’t get processed because of wrong data sent by Insurances in ELE (EDI 835) files. To get a list of such ELEs, new screen ‘Import Log’ has been introduced on screen Settings>Configuration. This option when clicked would show a list of ELEs under Failure option. The Log File can be viewed and Error message can be read to understand the reason for failure of the ELE. The Success option when chosen, will give a list of ELEs which were successfully processed.

 

Figure 25: Settings>Configuration; Import Log Screen Introduced to track ELE 835 failures.

 

 

Settings>>Configuration>>System Templates

 

 

57    System Specialty Templates are not allowed to delete.

 

SettingsàConfiguration: Specialty Templates are sometimes a must for proper functioning of the program. These templates are now not allowed to delete by user anymore. A flag (‘NODELETE’) is set in database table ‘MST_TEMPLATE’ for these systems defined templates while creating them and button ‘delete’ is disabled on these systems defined templates screen. Examples of such system defined templates is Specialty Templates used for Billing ‘Injury and illness Details’. This template can be inactivated if not required but should not be deleted. Now, it will not be allowed to delete.

 

 

58    System defined template name length is allowed up to 50 characters.

 

SettingsàConfiguration; Length of template name in System defined template is now allowed to be up to 50 characters. You can enter name of the template up to 50 chars when new system template is saved.

 

 

Settings>> Configuration>>Diagnostics

 

59    A new case has been added on screen Settings>Configuration>Diagnostics: "51” to fix all cases of missing responsible person associated a patient.

 

 

A new case has been added on screen Settings > Configuration > Diagnostics: "51: Fix All Patients who DO NOT have a valid Responsible Person.( See option 10)”. It is a fix for case: 10. If a Responsible Person who is associated to a patient is deleted (field ’RP_ID’ from MST_RESP database table) but entry about deleted Responsible Person remains in ‘PAT_RESP_PERSON_ID’ field of database table ‘MS_PATIENT’. This case will now check for cases where Responsible person is missing for those patients where it was associated and fix those cases by associating appropriate Responsible person to patient. It is useful for admin users.

 

60    A new case has been added on screen Settings >Configuration>Diagnostics: List and fix all cases of patients who DO NOT have a valid Financial Class.

 

Two new cases have been added on Settings > Configuration> Diagnostics screen; To list all those patients who do not have valid Financial class and another diagnostic case which will assign default financial class to these kind of patients where financial class is not available.

 

Diagnostics Case ‘53’: List All Patients who DO NOT have valid Financial Class.: This case will list out all those patients where financial class is not defined.

 

Diagnostics Case ‘54’: Fix All Patients who DO NOT have valid Financial Class.: This case will assign default financial class to all those patients where financial class was not defined. Financial class is defined in SettingsàConfigurationàGroup TypesàNon SystemàFinancial Class (B3).

 

61    A new case has been added on screen Settings >Configuration>Diagnostics: Claim without Ins, but having EOB.

 

Settings > Configuration > Diagnostics screen: Diagnostics Case ‘60’: Claim without Ins, but having EOB: This case will list out those claims which does not have Insurance assigned to it but EOB is received against such claims. Diagnostic cases can be executed by Admin only.

 

 

EDI837I

 

62    A new property ‘837.extra.folder to create one more folder EDI837EXTRA which will have the Edi837 message files generated.

 

        Property ‘837.extra.folder’ when set to ‘Y’ creates one more folder EDI837EXTRA. During EDI file creation, system will copy same file in 
        folder: /EDI/<clearing house name>/<pool name>/EDI837EXTRA. User can use FTP set up to transfer these files to his external entity. For that Tech 
        Support will have to be contacted. Tech Support will configure ServU(FTP Voyager Server) or Bizupload with client's computer to transmit these  
        files and delete them upon sending from folder: /EDI/<clearing house name>/<pool name>/EDI837EXTRA. 
            
 

 

Settings>>Configuration>>Scheduled Process

 

63    Scheduled ProcessàBulk Statement will now print date when Bulk Statement for Claim was printed for the first time.

It is the actual date on which bulk statement for that claim was printed for a patient. It means that from that date onwards, patient responsibility starts as patient comes to know about his/her responsibility. It is would be used in Patient aging and Pat Statement generation later. 

When a Scheduled Process is run for printing bulk statement for a claim for the first time, then the first date of printing the bulk statement for that claim is now stored in “BLH_1ST_STATEMENT_DATE” field of  TRN_BILLING_HEAD database table.

 

64    Scheduled ProcessàBulk Statement; an entry is created under downloaded files with the same name as specified for Self Scheduled Process and primary filename of generated document is displayed under ‘Filename’ column.

 

Whenever Bulk statements were printed using self scheduled process, an entry for that bulk statement was always created in SettingsàConfigurationà Clinic àDownload files. On Download files screen, system used to print name as “Bulk Statement” under ‘Comments’ column for any self scheduled process. This was confusing and was difficult to distinguish one bulk statement from other.

 

Now whenever a self scheduled process runs to print Bulk Statement, name for the entry created in SettingsàConfigurationà Clinic àDownload Files is picked up from ‘name’ field on Self Scheduled Process. Now it becomes easy to distinguish between various bulk statements created by different self scheduled process. Also now primary filename of the document generated /printed is displayed under ‘Filename’ column in Download file.

 

Figure 26: Bulk statement entry in SettingsàConfigurationà Clinicà Download files.

 

 

 

65    New Self Scheduled process introduced; ‘Csv Statement’; Clearing house folder is created to store CSV files when Bulk Statement for Patient is generated using Self Scheduled Process to automatically process them.

 

Whenever Patient Statement is generated through Bulk Statement printing using Self Scheduled Process, two comma separated files are created. Comma Separated File named ‘FTP’ and ‘Patient Statement’ are created and are stored in respective sub folder under folder named ‘GATEWAY’ (D:\EDI\GATEWAY\POOLNAME\ EDIPTSTMT). ‘GATEWAY’ folder has following subfolder:

1.      EDIPTSTMT

2.      EDIPTSTMTFTP

3.      EDIPTSTMTLOG

The Self Scheduled Process checks the files stored in EDIPTSTMTFTP whether these files are processed after period of duration or not. If not processed then they are automatically processed and sent to Clearing House (for example: Gateway etc.).

 

Figure 27: New parameter introduced to check Insurance Eligibility for ‘All’ insurance when Scheduled Process is run.

 

Stmt_EXP_CSV

 

66    New Scheduled process is added to the system to check whether Remittance and status messages received from Clearing house i.e. Edi 835 files in 835FTP folder and 277 files in 277FTP folder is pending for processing at FTP server for more than 3 days.

 

 

Scheduled process ‘Check Ftp Working’ is added to the system which will run automatically and check whether remittances and status messages received from clearing house i.e. Edi 835 files in 835FTP folder ( files received from clearing house) and 277 files in 277FTP folder (incoming messages from clearing house) are pending for processing at FTP server for more than 3 days. When this scheduled process runs, it checks for these pending files kept at FTP server for more than 3 days. If Edi 835 files and 277 files are present due to failure of scheduled process then emails are sent to the respective users.

 

67    Two new Scheduled Processes are added to inform patients by email about appointments taken today and a reminder mail to patient about scheduled appointment, ‘X’ days before appointment is scheduled.

 

Scheduled Process ‘Appointments Taken Emails’ is run every night to check for those appointments which were taken during the day and then emails are sent to all patients whose appointments was taken during that day.

 

Similarly another Scheduled Process ‘Appointments Reminder Emails’ is run every night and generates reminder to patients whose appointment is scheduled after ‘X’ days which is set in ‘param..’. ‘X’ days can be set as parameter using ‘params..’ button. Reminder mail is sent to patients whose appointment is scheduled on ‘X’ day. Mail sent to patient has content which is described in template, selected using button ‘params..’.

 

Figure 28: Scheduled ProcessàAppointment Reminder Emails’ Screen

 

Settings >>Configuration>>Clinic>>Receipt Batch No

 

68    ‘Receipt Batch No.’ option is added Billing Module to SettingsàConfigurationà‘Clinic’ Column - Receipt Batch Number.

 

SettingsàConfigurationàClinic Column; ‘Receipt Batch No.’ is moved from EMR module to Billing module. Receipt Batch No. provides detailed view of receipts received against various head (Remittance, Patient Receipt, Capitation Receipt, Co-pay, Misc Credit, Ins Credit) against Posted Amount, Non Posted Amount.

 

69    SettingsàConfigurationàClinic ColumnàReceipts Batch No.; Location label renamed to Collection Location in Receipts Batch No.   

 

SettingsàConfigurationà Clinic Columnà Receipts Batch No.; Location field label is now renamed to Collection Location to make it more obvious and relevant to its usage.

 

 Figure 29: Location label renamed to ‘Collection Location’

 

 

70    New parameter added to Self Scheduled Process for Insurance Eligibility Check for Scheduled Appointment.

 

SettingsàConfigurationàScheduled Process; ‘Get Insurance Eligibility check for Scheduled Appointment’; A new parameter ‘All’ is added in ‘For Insurances’ drop down list. Earlier Insurance eligibility for primary insurance only (first in sequence on Patient Insurance screen) was considered when self scheduled process was run to check the Insurance Eligibility for earlier scheduled appointments.

 

With addition of ‘All’ parameter in ‘For Insurances’ drop down list, Insurance Eligibility of all the insurances can be checked which are assigned to a patient when self scheduled process is run to check the insurance Eligibility for earlier scheduled appointments.

 

Figure 30: Scheduled Process; Get Insurance Eligibility for Scheduled Appointments with ‘All’ option in ‘For Insurances’ drop down list.

 

 

Settings>>Configuration>>Fee Schedule Master

 

71    Fee Schedule Master Screen; ‘From’ date calendar is extended to display next 3 years from current year. Similarly ‘Upto’ date calendar is extended to display next 5 years from current year.

 

Earlier on Fee Schedule Master screen; ‘From’ date calendar used to display next year from current year but now it displays next 3 years also from the current year. Similarly, ‘Upto’ date calendar used to display next 3 years from the current year but now it is extended to display next 5 years from current year. Extension of calendar years display from current year in ‘From’ and ‘Upto’ provides an option to set fee schedule for a charge code for number of years ahead from current year.

 

 

72    Fee Schedule Master Screen; on button ‘calc’ pop up, option ‘All’ added to ‘For Code Type’ dropdown list.

 

Earlier Fee on Fee Schedule Master screen could be calculated for individual code type at a time because from drop down list, it was possible to select single code type (‘CPT’/’HCPC’/’UB04 Revenue Charges’/’Special Charges’/’ITEM’) and calculated fee individually. It was time confusing process as it used to calculate individually for each option in ‘For Code Type’ in drop down list.

Now an option ‘All’ has been added to ‘For Code Type’ dropdown list so that fee is calculated for all code type (‘CPT’/’HCPC’/’UB04 Revenue Charges’/’Special Charges’/’ITEM’) at once.

 

Figure 31: Fee Schedule calculation for ‘All’ code types

 

 

 

73    Fee Schedule Export and Import in CSV format is now supported on Fee Schedule Screen.

 

SettingsàConfigurationàFee Schedule Master; Export and Import of Fee Schedule is now supported in CSV format. Button ‘Export’ and ‘Import’ is provided on Fee Schedule screen. On click of button ‘Export’, ‘download’ pop up is displayed. Internally Fee Schedule is converted in to ‘csv’ file in ‘tmpimpages’ and then it is exported to desired location after choosing path on ‘save’ pop up. By default, ‘FeeSchedule.csv’ is created.

To import Fee Schedule, click button ‘Import’. ‘Upload’ pop up is shown and browse the Fee Schedule CSV format file to import. After browsing the required CSV to import, attach the file to (upload) import to ‘blsummarylayout’ folder.

 

Note: The user is expected to be knowledgeable to edit the file in an editor OR import this file in xls using Import Data from comma delimited text and not forgetting to mark the Code and Modifier columns as TEXT (otherwise the leading Zeros will be lost).

 

Figure 32: Fee Schedule with ‘Export’ and ‘Import’ feature

 

 

 

Settings>>Configuration>>ICD Codes

74    Now custom ICD codes (non-standard) are supported in Claims.

Earlier custom CPT and HCPC codes were supported by PrognoCIS while processing claims. Now custom ICD codes (non-standard) are also supported in claims.
If a ICD code is not found in Std list of ICD codes, it can be added to ICD master by going to screen: Settings>Configuration>ICD. It will be labeled as ‘Custom Non-Standard’. Such a custom, Non-Standard ICD code when added on claim, the claim will be processed with this custom, non-standard ICD code.

 

New Properties Introduced

 

Billing Collect Details wise Report

 

collectiondetails.layout.1.fields

collectiondetails.layout.2.fields

collectiondetails.layout.1.name

collectiondetails.layout.2.colmtitles

collectiondetails.layout.1.summarycols

collectiondetails.layout.2.orderby

collectiondetails.layout.1.colmtitles

collectiondetails.layout.2.name

collectiondetails.layout.1.orderby

collectiondetails.layout.2.summarycols

collectiondetails.layout.3.fields

collectiondetails.layout.4.colmtitles

collectiondetails.layout.3.summarycols

collectiondetails.layout.4.orderby

collectiondetails.layout.3.colmtitles

collectiondetails.layout.4.Fields

collectiondetails.layout.3.name

collectiondetails.layout.4.name

collectiondetails.layout.3.orderby

collectiondetails.layout.4.summarycols

collectiondetails.layout.5.fields

collectiondetails.layout.6.fields

collectiondetails.layout.5.colmtitles

collectiondetails.layout.6.colmtitles

collectiondetails.layout.5.name

collectiondetails.layout.6.name

collectiondetails.layout.5.orderby

collectiondetails.layout.6.orderby

collectiondetails.layout.5.summarycols

collectiondetails.layout.6.summarycols

collectiondetails.layout.7.fields

collectiondetails.layout.8.fields

collectiondetails.layout.7.colmtitles

collectiondetails.layout.8.colmtitles

collectiondetails.layout.7.name

collectiondetails.layout.8.name

collectiondetails.layout.7.orderby

collectiondetails.layout.8.orderby

collectiondetails.layout.7.summarycols

collectiondetails.layout.8.summarycols

 

Billing Guage

guage.1.sql

guage.2.sql

guage.1.maxamt

guage.2.maxamt

guage.1.minamt

guage.2.minamt

guage.1.title

guage.2.title

guage.3.sql

guage.4.sql

guage.3.maxamt

guage.4.maxamt

guage.3.minamt

guage.4.minamt

guage.3.title

guage.4.title

guage.5.sql

guage.6.sql

guage.5.maxamt

guage.6.maxamt

guage.5.minamt

guage.6.minamt

guage.5.title

guage.6.title

guage.7.sql

guage.8.sql

guage.7.maxamt

guage.8.maxamt

guage.7.minamt

guage.8.minamt

guage.7.title

guage.8.title

 

New Tags Introduced

 

PT_INS_ELIGCHK

BLH_P1_VISITAMT__USD

PT_INS_ELIGDATE

BLH_P1_VISITAMT__CENT

PT_INS_ELIGPERSON

BLH_CELL29_TOTPAIDAMT

SCHREP_INSELG__CHECK

BLH_CELL30_TOTBALAMT

SCHREP_INSELG__DATE

SCHREP_INSELG__PERSON

 

 

Browser Settings

 

None