PROGNOCIS™
Release Version # 1.8.1
Release Date Oct 1, 2008
Build #38
Bizmatics Inc®.
4020,
Phone: (408) 873 3031/32. Fax: (408) 873 0304
Email: info@bizmaticsinc.com
Home
Appointment Tab
Providers Button to display List of Providers and Resources.
Move the mouse over the Scheduled
Time. If the Property Home Page > home.use.tooltip is set to Y a
tool tip with Patient details is displayed. The Patient details in tool tip can
be configured using the property Home page > home.appt.tooltip.patient and the one for Non patients using Home Page > home.appt.tooltip.others
Open Enc Tab
Providers Button to display List of Providers and Resources.
User can mark an Appointment as Arrived, even if it was scheduled for a Resource. The corresponding Appointment is started with the Attending Doc as Resource. If a Provider clicks on the Patient Name hyperlink on Home page (where the encounter is started), then the Encounter and Appointment Doc is changed from Resource to the Provider.
Appointment >
Schedule
Appointment Overload
If the Overload is checked, a user could overload any number of Appointments in a slot. Now a property Appointment Scheduling > appointments.overload.perslot defines the Max No of Appointments in a slot (of 15 minutes) for a Doctor. If this is set to 0, there is No constraint.
Appointment Reminders
The property Appointment Scheduling > appointment.reminder.2doc can be set to Y, if the Doctor expects an Urgent Message before the scheduled time of the Appointment. It will generate a message for Appointments which are due in the Next few minutes on refresh of a page. The minutes being same as for refresh of urgent message property namely Mail Related Parameters > mail.urgentmessage.refresh_min.
Appointment History
DAS_BOOKED_BY was set to Medic Id instead of Login Id when Appt was taken from Start encounter. As such display in History was wrong. Fixed.
Doctors Alternate Id
New Field TRN_APPOINTMENTS
DAS_DOC_ALT_ID DOM_ID Doctors Alternate Id in PMS
Many PMS programs maintain multiple Ids for a Provider for the purposes of Appointment scheduling. When Appointments are imported in Prognocis, they come in as a Single mapped Provider id. When the Charge is Exported, it can go out for the Single Provider Id in Prognocis. However many a times, users need the same Id used in their Appointment.
On importing Appointments, the incoming Provider Id is maintained in the new Alternate Doc Id field.
New Charge Export property in file
hl7.export.charge.useapptaltdocid If this is set to Y, the Alternate Doc Id send in the encounter Appointment is exported back in the pv1 segment
Resource Scheduling
Appointments need to be scheduled for other than Doctor. It can be an equipment like CT Scan Or USG. In cases where there are multiple specialty Doctors, appointments can be for a type like Injury, Immunization etc. All Doctors will see all the scheduled patients and when one of the Doctor clicks on the appointment patient name to go to the encounter, the Attending Doctor will change.
To provide this feature action needs to be taken at multiple places.
a) Settings > Configuration > Medics > Resources is a new menu option to define all Resources.
b) Appointments > Work Pattern option allows user to define the Work pattern for Resources too besides the Doctors.
c) Appointment Schedule screen Doctors List box and All Docs Radio button, provide for a combined list of Doctors and Resources. Appointments can be taken for any one of them.
d) The same consideration is also available for Block time, Appointment Confirm Pop up, and the Advanced Search link in Appointment Confirm Pop up.
User can mark an Appointment as Arrived, even if it was scheduled for a Resource. The corresponding Appointment is started with the Attending Doc as Resource. If a Provider clicks on the Patient Name hyperlink on Home page (where the encounter is started), then the Encounter and Appointment Doc is changed from Resource to the Provider.
Appointment > Work
Pattern
As explained above, now a Work Pattern can be defined for Resources also, besides Doctors.
Appointment >
Vacation
As explained above, now a Vacation can be defined for Resources also, besides Doctors.
Patient Registration
Patient Registration screen. Add Ref Doc.
If Medics > refdoc.selection.listbox is set to N
Three things are displayed on screen
A search button is to select existing Ref. Docs,
Clear hyper link to clear the selection, and
Add New hyper link to add a new Ref. Doc.
Billing Tab
Responsible Person will be a mandatory field.
As such Billing Tab is enabled for all cases.
If Billing module is switched ON the Patients Outstanding will be displayed.
Patient Insurance
Screen
Displays Insurance Name and Address on Single Line
Insurance name can be Auto Completed OR selected using the Search Button. If a new Insurance company is typed in using the Auto complete feature, the user can click on the + button to add the Insurance company on the fly. However please note the subtle behavior. On auto complete the Insurance name and City is prompted, on Tab out from the field only the Insurance company name is displayed. If a name like Blue Cross is typed in and tabbed out and + button is clicked, the system tries to find insurance records starting with “Blue Cross “. Now there can be Blue Cross of San Francisco, Blue Cross of San Jose etc. if the system find one or more match, it will NOT add the name. If No match is found, only then is the Insurance company added. An appropriate message both on success or failure is given.
Two new fields for Pre Authorization No and Valid upto date have been provided. These get copied to Claims, based on the selected Insurance.
The Insurance Status also provides for Motor Accident, Personal Injury and Workers Compensation. If the Claim is of the corresponding types, it checks for appropriate Insurance Status.
Subscriber Employment Status was hard coded. Now it comes from the Group Master B1 Employment Status. User should ensure that names are not more than 10 characters. If the name is more than 10 Characters, the extra characters will be dropped while building the List Box.
Face Sheet
If count of PMH ailments + Pins + Notes exceeds 100 it would crash on Facesheet. Now it will display only 100 entries on Face sheet.
Face Sheet keywords added.
- MED_STOP Stopped Medication by Date Desc
- MED_PAST Distinct Drugs Prescribed in last 180 days
- ROS Review of System
- ROS_ABN ROS Only Abnormal details
- PHYSICAL Physical Exam
- PHYSICAL_ABN Physical Only Abnormal details
Assessment screen
ENM check box is enabled, so that it can be deleted.
Corresponding fields in TRN_ENCOUNTERS are also reset.
Modifiers
for HCPC.
Modifiers can be assigned to HCPC Code. The screens affected include:
a) Assessment Screen
b) The CPT/HCPC list definition in Settings > Configuration > Tests > Specialty > Template for Mandatory and optional Codes.
c) Settings > Configuration > Tests for Specialty Tests, Lab tests, Radiology Tests.
d) Encounter TOC > Specialty option Optional HCPC Codes button for selected template.
e) Assessment Report Tags
f) Charge Export Logic
g) HL7 Charge Export Message
h) Billing Claims Screen
i) Fee Schedule
j) Calc of Claims
k) EDI 837
Prescription
Past Rx Button displays a Pop up with two new columns for No of refills and Dispense Quantity. The column for Stoppage reason is dropped; instead the reason is displayed as a tool tip in the image of the crossed bottle. Note that if a medication is topped in the current encounter the reason is NOT displayed. The Past Rx screen displays the Drugs in Order of Rx Date in descending order by default.
On the main Rx screen table part, the Dosage column displays the Qty and name of Unit of measure
Earlier Dispense Qty was printed only if Drug Form was each, Not for Liquids and others. Now it is printed in all cases.
RX_SIG was printing Unit Code, now it prints the Unit of Measure name.
RX_SIG_DISPLAY will print proper Unit Name for Dosage as well as for Dispense Qty.
New tags added
RX_DIRECTION
RX_DISPENSE__UNIT
The older tags too display the Unit name.
DEA class 9 is ignored from Dea restriction check (e.g. Calcium)
After a Prescription has been sent, the Select Flag is made Off.
Prescription Parameters > rx.inhouse.drugs.xml
If this is set to Y, on save of Prescription and Doc Form Accept an XML is generated for dispense from In House Drugs Store.
Prescription Parameters > rx.max.prescription.drugs=20
Max Drugs in a Prescription.
Edit Dosage
The Button is available for Prescription drugs (Not the ones entered from Current Medication) after they have been ordered.
This is required so that Provider can change the Dosage on the fly based on patient feedback.
Fields for Dosage Unit and Direction are now available.
Strength is available as a Label.
It is no longer mandatory to edit the Dosage.
Tags in Progress Notes
ENC_RX_STR, ENC_RX_TBL and their child tags print prescription drug details as per fields set in the property Prescription Parameters > rx.drugs.all.fields, rx.drugs.inhouse.fields and rx.drugs.sample.fields
4 new fields are supported
Y Bulk Unit
Z Direction
1 Sig Display old
2 Sig Display with Direction
Refill Prescription
The position of Last Visit Date is changed.
A search button is provided, so that the Attending Doc automatically assigned can be changed.
On print / send of Refill we check if the Attending Doc has become Inactive.
Test Exec
Specialty and Clinic Forms
Preview procedure template report from Test Exec for the selected template. Earlier there was only a print button. Now the template can be viewed before printing.
Specialty
It is now possible to have selective Procedures selected and displayed for an encounter, based on the Medic Type.
Property Specialty > specialty.classifications.DR
Define a comma separated list of Classification codes based on which the templates will be selected.
If this is kept blank, ALL templates are selected.
Similarly add
Specialty > specialty.classifications.MA
Specialty > specialty.classifications.RN
Specialty > specialty.classifications.ST
Specialty > specialty.classifications.BL
Example:
Consider Templates 1,2,3 having Classification field set to MA
Consider Templates 4,5,6 having Classification field set to RN
Consider Templates 7,8 having Classification field NOT set.
Consider that properties are set as:
Specialty > specialty.classifications.DR=MA,RN
Specialty > specialty.classifications.MA=MA
Specialty > specialty.classifications.RN=RN
Specialty > specialty.classifications.ST=
If a Nurse (RN) Logs in, he/she will have access to templates 4,5,6
If a Medical Assistant (RN) Logs in, he/she will have access to templates 1,2,3
If a Doctor (DR) Logs in, he/she will have access to templates 1,2,3,4,5,6
If a Staff (ST) Logs in (assuming he has access), he/she will have access to All the templates 1,2,3,4,5,6,7,8
Formula
Added a Keyword ENCDATE in formula, to consider Encounter Date
Can be typically used to compute elapsed days of injury, pregnancy etc as on encounter date. E.g. LMP – ENCDATE. (Here LMP is assumed to be a valid Test code)
New Tag in formula for PERCENTILE_BMI
This computes the percentile of computed BMI value for Patients Gender in the Age group 2 – 20 years.
Tag
Added a Tag ENC_TEST_GA$XXX to print Gestational Age in Weeks + Days. XXX is the Test Code based on which the Gestational Age will be computed and printed as on Encounter Date. Test XXX must have Result type as Date.
Added a Tag ENC_TEST_TIMEDIFF$XXX User needs to specify two test codes separated by a comma after the $ sign. Both these Tests must be of the Result Type Fraction. User is expected to enter the Time as a fraction, with the part before the decimal indicating hours and the part after the decimal indicating minutes. It is assumed that user is sensible not to enter a time with the post decimal value > 59. This tag will return the time difference between the first and second, represented again as a decimal value with Hours and minutes.
Encounter Close
The property Encounter Close Checks > enc.close.checkifdone .has one more tag OPROC which checks for Open Procedures (i.e. Procedure Templates selected, but Detail Tests not selected) before encounter close.
An encounter cannot be closed if the Attending Doc is still a Resource, and has Not been changed to a regular Doctor.
Lab Order / Radiology
Order
Following Tags which were hidden in earlier version, are once more enabled.
Earlier there used to be only One CPT Code associated with a Lab/Rad Order test. In subsequent version, we started supporting Multiple CPT/HCPC Codes with modifiers and Units, so the tag was no longer valid. Now the tag will consider the first assigned CPT Code and print it.
LOD_CPT__CODE
LOD_CPT__NAME
LOD_CPT__CODENAME
RAD_CPT__CODE
RAD_CPT__NAME
RAD_CPT__CODENAME
Patient > Review >
Lab Matrix
Using the Equivalent Tests which can be defined for similar test, the results of such similar tests can be combined into single Test Rows in the Lab matrix.
Lab / Radiology Order List
The table displays Result Date instead of Sender Name.
Messages > Edit
Patient Messages can be edited on the screen invoked by double clicking on a specific message on the Review > Messages option.
Who can edit it: Sender and Any Provider
Subject can also be edited.
Date, Time and Mail to is that of the original message and cannot be edited.
For a message which is Not edited it displays the label “Add By” followed by the creator. After the message is edited, label changed to “Edited By” followed by name of editor and edited Date Time stamp.
From this screen there would be No response if user clicked on any TOC menu option. Problem is fixed.
Document List
User can define the types of documents which can be displayed here. A typical problem is that Special / Procedure Forms were displayed as part of the list, and the same form details can also be part of Progress notes for the encounter. This confused some users.
The required types are defined in Prognocis Parameters > review.doclist.types
Permitted Values are:
LRB Lab Result Base
RRB Rad Result Base
PMR Patient Medical Records
LIA Letter In Attach
LOB Letter Out Base
PNB Progress Notes Base
LDA Legal Doc Attach
ODA Other Doc Attach
OPA Old Progress Notes Attach
ENC Encounter Doc Attach
SFN Clinic Form
SCN Procedure Notes
The name of Doctor is displayed (in Lab Result / Rad Result) as External if the Lab Order is External and it is NOT created from HL7 import.
Patient > Letters
Out
The Document List displayed is same as in Review Document List.
A Reopen button is provided. This will be enabled when
a) Logged in person has been assigned the role reopenletterout
b) Status of Letter is Sent
c) Property letters.edit.sent is set to N.
This property will be removed shortly.
Patient > Clinic
Forms
Many templates can be created and filled up under Patient Clinic Forms. These templates are related to the patient and not necessarily related to the encounter. These can be used to keep a lot of data related to Workers Comp. If a User needs to fill up such templates for multiple patients, user needs to select a patient, go to his encounter and then select Patient > Clinic Form option for each patient.
Now the Label Name, next to selected Patient on Clinic form is hyperlinked to show the search for Patients. (Search Button would have been more logical, but this had to be done because of real estate constraints) I have a client whoe does lot of workers comp stuff. We have created all templates under clinic form. So they go to pt-clinic form and select the pt.
Messages
Purge
Mail Parameters > mail.purge.type.days property can be set to comma separated values for different types of Mails.e.g
A5 indicates Purge Alert >= 5 days
N4 indicates Purge Notification >= 5 days
Like wise use T for Telephone, M for Normal Mails, D to To Do List.
Deletions are done on Login.
In Box
Click on From to Read the message.
If it is a To Do message both the Action and Duration in Days are displayed. Read message is now displayed with a Reply and a Forward Button.
Using the Forward message, user
can send it to any one, along with his comments. If there are No comments,
there won’t be a Name and Date Time stamp added. The Top Radio buttons for
Out Box
Click on From to Read the message it.
It is now displayed with a Forward Button.
Using the Forward message, user
can send it to any one, along with his comments. If there are No comments,
there won’t be a Name and Date Time stamp added. The Top Radio buttons for
Compose
The following properties are defined, to set a default Message type for each of the Medic type.
Mail Parameters > mail.type4DR=
Mail Parameters > mail.type4RN=
Mail Parameters > mail.type4MA=
Mail Parameters > mail.type4ST=
Mail Parameters > mail.type4BL=
Each can be set to N_normal, U_urgent, T_telephone.
Please Note that none of these defaults will be available for Admin, from Referring Doc portal and from Patient Portal.
Additionally for each of the medic types a default Action can also be defined. Mail Parameters > mail.action4DR=
Mail Parameters > mail.action4RN=
Mail Parameters > mail.action4MA=
Mail Parameters > mail.action4ST=
Mail Parameters > mail.action4BL=
Action by default is None. User can specify the action name if required.
Please note, these default settings are applicable only if the Message Compose option is invoked (NOT the compose from reply as a pop up)
The following properties are defined, to set a default Message type for each of the Medic type.
Mail Parameters > mail.add2pmr.checked4DR=
Mail Parameters > mail.add2pmr.checked4RN=
Mail Parameters > mail.add2pmr.checked4MA=
Mail Parameters > mail.add2pmr.checked4ST=
Attach
Ability to merge the documents into a single PDF document.
Many times the documents are received separately, but users will like to attach them together. Otherwise it unnecessarily increases the length of the documents in the attach center.
A Merge button is provided. User can check and select multiple documents and click on Merge. It will merge them into a single Pdf and delete the individual documents.
If No file is checked, it gives an error “Select file”.
If multiple files are selected, it checks if the extensions as per allowed extension defined in property PDF Parameters > pdf.merge.extns.
our Pdf Application use only these types of files
HTML,TXT,XML,TIFF,TIF,GIF,JPEG,JPG,BMP,PNG
If they don’t match it gives an error “Only Files with specified extensions are supported”
The merged Pdf file is created in the same folder where the selected files were present. The generated filename is of the type MergeYYYYMMDDHHMMSSssss.Pdf
Urgent Message Pop up
This comes up with Reply button. A property Mail Parameters > mail.urgent.msg.sound can be set to Y, to play a sound file whenever an Urgent Message Pops up.
Reports > Tabular
On selecting this option, it first displays the search to select report. Then the pop to fill in other details is displayed.
If the Column Title was wrongly set as with keyword as Time, it would crash in attempting to extract time part from corresponding field. Fixed.
Settings >
Processes > Appointment Mails
User can select specific Lab/Rad Tests (using the search Button now provided) to get list of Patients whose Health Maintenance Tests are Due.
Like wise he can select specific Vaccines (using the search Button now provided) to get a lists of Patients whose Vaccine Doses are Due.
e-Mails will be send to the patients.
Complaints
Duplicate ICD code were accidentally allowed in the Optional ICD codes selection. Now duplicate ICDs with same IDs are not allowed. Note that there can be Duplicate ICD Codes, if such duplicates have been defined in the ICD Master.
Provider Master
A new field DPS# - Department of Public Safety registration number can be defined for Providers.
Correspondingly new Tags are provided for Encounter Reports: ENC_AD_DPS after ENC_AD_NPI
ENC_RD_DPS after ENC_RD_INSTITUTE
ENC_RT_DPS after ENC_RT_INSTITUTE
PT_PCP_DPS after PT_PCP_NPI
PT_PRI_DPS after PT_PRI_NPI
Resource
This is a new medic type, which is used for Scheduling Appointments (besides Providers). This option is available in menu after Providers (in EMR as well as in Billing).
Test Master
Special Text button is re-introduced to define Test Sentence Set for Boolean result Type.
Test Sentence has a new tag < REMARK2>
This prints the prefix “Remarks: “, before printing the remarks for the test.
If the following tags are used, it considers the value in the PTD_READING_DATE field
ENC_TEST_DRESULT$
ENC_TEST_DRESULT__MM$
ENC_TEST_DRESULT__DD$
ENC_TEST_DRESULT__YY$
Lab and Rad Tests Only
A new line is displayed with label “Equivalent To:”
User can select using the search button any other Lab test which is equivalent. Clear hyperlink clears the selection. If there are more than one Labs, each is likely to have a different Tests Code and Name populated automatically from HL7Lab Result Import. This creates a situation where there are two different Tests Codes and Ids for say CBC, RBC, WBC as such they appear as two different rows in the Review > Lab Matrix. Now, with the equivalent concept, this problem will be resolved.
Default value of TST_BASE_ID will be TST_ID (and on clear)
On selection it will have selected TST_ID. The search includes Tests where TST_BASE_ID = TST_ID
Test Template
For Specialty and Clinic Form templates, a “Clear” link is provided after the print template selection button. This clears the assigned print template.
HM result Vs Lab
Result HL7
The connection between Lab Results and the Heath Maintenance (HM) test’s done date is established completely.
The Order No and Order Date in HM when the Lab Order is send.
The Done Date on Lab Result Updates the HM records with the Order No set on Lab Order send.
This had a problem with InHouse Lab, because it is not necessary to send it.
(Unlike other Lab Order, Results can be entered for InHouse Orders without Sending it). There was a problem with Lab Orders Results received in HL7 for which Ordering was done manually. Both these cases have been fixed.
So now we deal with what happens in these scenarios:
a) Enter / Edit Lab Results for Order generated from Prognocis.
b) Enter / Edit Lab Results for Inhouse Order generated from Prognocis.
c) Enter / Edit Lab Results for New External Result.
d) Lab Order Attachment from Attach Center
e) New Lab Order Attachment from Attach Center
f) HL7 Lab Result Import – Existing Order. Note user cannot import results for InHouse Lab if status is NOT Ordered.
g) HL7 Lab Result Import – New Order
h) HL7 Lab Result Import – Result Status is Not Final
HL7LabImport
In case of External Added Lab Results, Status is set to R or C depending on property hl7.status.complete. It was handled for existing Orders.
BILLING
Home Page
Move the mouse over the Scheduled
Time. If the Property Home Page > home.use.tooltip is set to Y a
tool tip with Patient details is displayed. The Patient details in tool tip can
be configured using the property Home page > home.appt.tooltip.patient and the one for Non patients using Home Page > home.appt.tooltip.others
Encounter CoPay
All amounts are right justified.
Claims > Edit
Height of ICD Box reduced.
Visit Location List Box is available. The location is set by default to Appointment Location. Pl note that this is a list of all Locations Active as well as Inactive. User / Biller can change the Location. This location details get printed in Cell 32 of CMS 1500 form.
Preauthorization Number entered in Patient Insurance is copied to the Claim, when it is generated, provided the Valid Upto Date is greater than or equal to Encounter Date. This field is editable on this screen. The changes if made do not reflect back in the Patient Insurance Master.
A notes button is provided to enter details to be printed in Cell 19 Local Use.
Corresponding Tag which can be used in CMS 1500 form printing is BLH_CELL19__LOCALUSE
The Insurance Status also provides for Motor Accident, Personal Injury and Workers Compensation. If the Claim is of the corresponding types, it checks for appropriate Insurance Status.
The change sequence Button like on Assessment ICD Tab, is available to Move up / down Charge codes sequence on the claim.
Click on the Paper Forms Flag button on each Charge Row. It now has a field to define the Patient Discount for that charge. Note that this field will be available only if there is Patient Amount on the charge line and that the discount amount cannot be grater that amount charged to the patient. On Posting this claim, an adjustment voucher is created to set off discount amount against billed charge amount. The same changes are reflected in the Patient Statement too.
On Reopen of Claim, Encounter Bill status was Not getting reset. Fixed.
A button is displayed after the “Auto Accident “ label. It is enabled only in case of Workers Comp / Auto Accident / Other Accident. Clicking on the Button, displays a Pop up to select
Attorney1: Name, A search Button and Clear Hyperlink.
Attorney2: Name, A search Button and Clear Hyperlink.
Insurance Adjuster1: Name, A search Button and Clear Hyperlink
corresponding to Primary / Secondary insurance.
Insurance Adjuster2: Name, A search Button and Clear Hyperlink
corresponding to Primary / Secondary insurance.
User will be able to open the Pop up, but NOT edit the details for Billed Claims.
Business unit list box is provided in the Bottom row. For various considerations Providers at a clinic might need to Bill the visit under separate Corporations / Entities / Business Units. There is a provision to define such Business Units under Settings > configuration. Note that the Business unit List box is displayed Only if there are more than One Business Units defined. There are No Tags for Business units to be used in CMS 1500. However a tabular report can be generated using the assigned Business unit.
Calculation Based on
Property Billing > billing.schedule.rule=ABCD
A Insurance Master
Program checks if the Not Attached Checked Box is checked in Insurance Master. If so it will use the Fee Schedule and Percentage defined in the Insurance Master for Billing. If the flag was NOT checked, then the program will evaluate the next option as per rule.
B Insurance – Doc Master
Some Insurance companies provide special Billing rates for certain Providers. The program will check if there is any Fee Schedule and percentage defined for Insurance and Encounter Attending Provider combination from Settings > Medics > Provider screen using the Insurance Allowable Schedule Button. If such a combination is Not found, then the program will evaluate the next option as per rule.
C Provider specific Fee Schedule
The program will refer to the Billable Schedule on Settings > Medics > Provider screen. If the option selected is Default, then the program will evaluate the next option as per rule.
D U&C
Make sure that this is the last option in the rule. Unlike other options, there is No question of this not being available. This is the Usual and Customary Schedule and ideally All Billing Must be done, as per this schedule. Generating Claims with different rates on a variety of conditions is unnatural and confusing for an average user. While the Claim can be generated at a standard U&C rate, the Insurance companies will always pay as per their contracted schedule, it is not necessarily mandated by them, that the claim have a rate they desire.
Having said this, the fact is that many customers have a genuine need to handle exceptions and this get provided for by using the rules explained. Please note that the property value is logical and does Not need to be changed by the user (unless he is sure he does Not need A, B or C conditions).
ReCalc
On re-calc BLH_INS_SEQN was not set. So on ERA post to generate I2 it used to crash. Fixed.
Validation on save
If Claim is of the type Worker Comp , Auto/Motor Accident, Or Other/Personal Accident then the selected Primary / Secondary Insurance Must be of corresponding type.
Likewise if the Claim type is NOT Worker Comp , Auto/Motor Accident, Or Other/Personal Accident, then the selected Primary / Secondary Insurance Cannot be of the above types.
On Reopen of Claim, Encounter Bill status was Not getting reset. Fixed.
On creation of Claim, the Name for the codes must be set in the Billing Details Table.
Printing
When multiple claims are printed, the claims for the same patient, provider are merged and printed as a single Claim CMS 1500 form. With the new property Billing > billing.cmsperclaim, if it is set to Y, each claim is printed separately.
Claims > New :
Location List Box will have Clinic by default.
On Start Enc it is blank, because the location is identified based on Date, time and Work Pattern. But since this is typically NOT online, one cannot make any assumptions about time and hence about the location.
Claims > Ready to
Send
Check Patient Invoice Printing along with Discount Amount and Visit Adjustment amount.
Hide check Box (like in Patient Invoice) is also available on the PriCMS and SecCMS Tabs.
Claims > Unpaid
Title changed from Unpaid Claims (No Remittance/Receipts) to
Unpaid Claims.
This option now displays Claims which are Fully Or Partially Unpaid.
As such it also displays a Balance Column.
Please Note fully paid Claims will Not be included here.
Since this is likely to have too many rows, a filter is also provided.
Filter By
DOS
Patient
Provider
Type
Insurance
Remittance > Entry
Reopen
Reopen of Remittance is provided. A Remittance when posted, can create a Claim for CoInsurance and a Bill for Patient. If no further transaction (receipt / adjustment) is made against them, then it can be reopened. Any user who has Delete rights And is assigned the reopenclaim role can reopen a Remittance.
Posting
Please Note that the CoInsurance column was disabled, if the Claim did not have a Secondary insurance selected. Now this field is Always enabled. Insurance companies mention some CoIns Amt. If the Patient had a secondary Insurance, this can be Billed to them, and if the Patient did Not have a secondary Insurance it becomes his Responsibility. Accordingly when the Invoice is generated for Patient Responsibility, this coins Amt is included / excluded depending on Secondary Insurance Company if it was selected or not in the Claim.
Remittance > UnAllocated
Hyperlink on Doc No goes to Remittance screen
Remittance >
Processed
Hyperlink on Doc No goes to Remittance screen
Remittance >
Denied
This is used to consider Charges flagged as Denied / Pending in Remittance. Earlier on invoking the Action button one could select the Rebill option. However it would generate a Claim with the single Charge Only and send the CMS 1500 Or Edit for the single entry. Now a Process Button is provided. All selected actions are executed on clicking the Process button. The Button makes an additional consideration of the Charges from the same Remittance pertaining to the same claim and clubs such entries into a single Claim generated for the purpose of Rebill.
Remittance > Patient
Receipts
Reopen functionality provided.
Remittance >
Insurance WriteOff
Reopen functionality provided
Remittance > Patient
WriteOff
Reopen functionality provided
Reports > Statement
The Statement can print Charge Details if the property
Billing > statement.receipt.details is set to Y.
It also print receipt details like Check #.
Patient Statement
This prints the Encounter CoPay collected, even if Claim is NOT raised.
ERA/ Pat Receipt Doc no are also printed on the statement.
Display Multiple names without carrot.
Statement template now has considerations of Discount Amount.
Insurance Statement
One more Radio button is added to select Insurance wise statement.
A search button is provided to select Multiple Insurance Cos.
Insurance Statement templates need Subtype to be STINS.
Reports > Tabular
SQLs for some reports have become shorter and simpler.
Reports > Ledger
Ledger now has considerations of Discount Amount. It also prints details of EOB like Cheque No.
Settings >
Configuration
Business unit
For various considerations Providers at a clinic might need to Bill the visit under separate Corporations / Entities / Business Units. The required Business Units can be defined under this option. Typically there will be only one Business Unit for a Clinic.
Insurance
EDI messages need a EDI Filing Indicator Code to be submitted, which is
Insurance Company dependent. As such a new Group Type E1 is added with the
following values preloaded.
Code Name
09 Self-pay
10 Central Certification
11 Other Non-Federal Programs
12 Preferred Provider Organization (PPO)
13 Point of Service (POS)
14 Exclusive Provider Organization (EPO)
15 Indemnity Insurance
16 Health Maintenance Organization (HMO) Medicare Risk
AM Automobile Medical
BL Blue Cross/Blue Shield
CH Champus
CI Commercial Insurance Co.
DS Disability
HM Health Maintenance Organization
LI Liability
LM Liability Medical
MB Medicare Part B
MC Medicaid
OF Other Federal Program
TV Title V
VA Veteran Administration Plan
WC Workers' Compensation Health Claim
ZZ Mutually Defined
In Edi837, for 2000B SBR segment field No 9, program picks up the code from Insurance Master. If the Code read is Blank Or Null, the program gets it from Edi Partners table.
Attorney
User can create and maintain a list of Attorney Firms, contact person and address. These are typically used in case of Workers Comp / Accident cases.
Insurance Adjuster
User can create and maintain a list of Adjuster for a selected Insurance company, and his address. These are typically used in case of Workers Comp / Accident cases.
Fee Schedule
The code Type List Box is extended with the following options:
CPT Lists all CPT Codes
HCPC Lists all HCPC Codes
SuperBill CPT Lists all CPT Codes which have a Rate defined.
SuperBill HCPC Lists all HCPC Codes which have a Rate defined.
Pref CPT List all Clinic Preferred CPT Codes
Pref HCPC List all Clinic Preferred HCPC Codes
Resend Claim Tracking
The system, now maintains a copy of the earlier send Claim / Edi when ever it is resend. If necessary it is possible to generate a tabular with details of Dates and Charges in all versions send.
Doctor Forms
If the length of Multi Select / Sing le Select List Box options was more than 255, the form would crash on design. Limit raised to 1024 to be in sync with Test Master.
Property
Lab Parameters > labih.from.docform.mailto
For message for Order In House Lab
ICDs also support a dependable field for Side.
This can be set to
N None
L Left
R Right
B Both
Set TEI_NLRB to 0/1/2/3 from Back end.
Affects the following tags
ENC_ASS_ICD_TBL_SNAME
ENC_ASS_ICD_TBL_LNAME
ENC_ASS_ICD_TBL_CODE_SNAME
ENC_ASS_ICD_TBL_CODE_LNAME
ENC_ASS_ICD_TBL_BNAME
ENC_ASS_ICD_TBL_CODE_BNAME
ENC_ASS_ICD_STR_SNAME
ENC_ASS_ICD_STR_LNAME
ENC_ASS_ICD_STR_CODE_SNAME
ENC_ASS_ICD_STR_CODE_LNAME
ENC_ASS_ICD__BILL__STR
ENC_ASS_ICD__BILL__TBL
ENC_ASS_ICD_STR_BNAME
ENC_ASS_ICD_STR_CODE_BNAME
ENC_ASS_ICD_LINE_SNAME
ENC_ASS_ICD_LINE_LNAME
ENC_ASS_ICD_LINE_CODE_SNAME
ENC_ASS_ICD_LINE_CODE_LNAME
ENC_ASS_ICD__BILL__LINE
ENC_ASS_ICD_LINE_BNAME
ENC_ASS_ICD_LINE_CODE_BNAME
Some forms are designed for a specific complaint.
A new Search is provided for invoking Complaint Id specific ICD Codes.
CMPICD:99 where 99 is the Complaint Id.
A process added “PROC” to send mails to a specific role, for all Specialty Procedures Ordered. Property Doc Forms > proc.from.docform.mailto
A Button added to display All Specialty Procedure Notes Template output.
Reset Button click prompts for Confirmation
Processes
Upgrade to B38 Process
This sets the Charge Code Names in all Billing Detail records.
Adds rights for
new menu options.
resendEdi Process
This takes two parameters besides Poolname and Process Id
Parameter 1: Carrot separated Visit Ids
Parameter 2: Insurance Transaction Type I1 or I2.
Based on these two parameters, it regenerates the Edi messages.
CreateClaimsForEnc
This takes three parameters besides Poolname and Process Id
Parameter 1: From Encounter Date
Parameter 2: UptoEncounter Date
Parameter 3: Y to consider all Encounters, N to consider Encounter with CPT Code.
Based on these parameters, it generates Claims for past encounters. Note it does not generate Claims for Encounters whose Billing Status is NOT 0, and it does not consider Dummy and Face Sheet encounters.