Release Notes - Billing

Version No. 2 Build No: 11

Table of Contents

1. Introduction

Numbers of new features related to PrognoCIS Billing have been released in Version 2.0 Build11.

2. ‘Billing’ tab on Patient Portal.

For patients of PrognoCIS Billing Clients a new tab 'BILLING' is added on the Patient Portal to get their Billing details. This tab is divided into 3 Sub Menus as follow.

1. Patient Outstanding: Patient Outstanding when clicked will show only 'Aging' Table in main window. The Aging Table will have following columns: Unapplied $, 0-30 , 31-60, 61-90, 91-120, 120+, Total, Net Due $.



Figure: Patient Outstanding and Patient Payments on the Patient Portal.

2. Patient Payments: Patient Payments when clicked will show all 'Patient Receipts' and 'CoPays' collected from Patient. This table will show the following columns : ID, Date, Paid, Mode .

Figure: Patient Payment on the Patient Portal.

3. Statements :Statements when clicked will show Statements Table with Latest Statement entry on top and with following columns in table: Id, Statement Date, From Date, Upto Date, Outstanding with Hyperlink to Id. When the Hyperlink on is clicked, it will show a pop-up with the statement as shown on Reports > Statement screen.



Figure: Patient Statement on the Patient Portal.

Note: The Billing tab on the patient portal is property based. The property 'pp.tab07.options' has to be set for the Menu title and the sub-menu(s) for this tab in Portal. The User has to enter Menu text, followed by a colon followed by the list of comma seperated sub-menu codes in a required sequence. Foe e.g. 'Billing:PTOS,STMT,PAY'.

3. Multiple Patient Receipts for a Date now accepted from screen 'Appointments>Schedule'.

Multiple Patient Receipts are now accepted from the screen 'Appointments > Schedule'. The Front Desk Staff will not only be able to collect multiple receipts on one day but will also be able to print the corresponding receipts, see current Statements and also view list of all Non-Posted Receipts.

The icon 'Patient Receipt' is moved from the Patient Information block to the global area next to the 'Patient Appointment History' icon. When this icon is clicked the selected Patient's, Patient Receipt is created and shown for the current date by default. The front desk can collect multiple receipts for the same patient for the current date by clicking the 'Add New' button. The multiple receipts created for the patient for the current date will be seen in 'Today's Patient Receipts' drop down box. The Patient Outstanding Amount hyperlink i.e. 'Patient OS' will show the Current Statement for the Patient and Non-Posted Receipt hyperlink i.e. 'Non-Posted Rcpt' will show all the current Receipts which are in 'Entered' status for the patient and have not been posted.

Figure: Patient Receipt pop-up screen.

Here are the Salient Points of this feature:

• Icon 'Patient Receipt' on Appointment Scheduler has been moved on top of page next to Appointment History icon. When this icon is clicked, the patient has to be first selected from Patient list which pops up.
  
  
• From this Patient Receipt, one or multiple Patient Receipts of a patient can be collected for today. There is a 'Add New' icon available once first Patient Receipt of today is saved. Even if selected Calendar Date is of Future or Past, the Receipt will be created for Today. Today’s Date and Patient Name fields are disabled. 'Received From' is a typed in field to type name of the payee if different from Patient.
  
  
• By default, whenever the icon 'Patient Receipt' is clicked and patient is selected, that patient’s latest receipt for that date is selected and displayed. There is a dropdown list given to view multiple Patient Receipt numbers for selected patient for today and when any Patient Receipt is clicked, its details are displayed.
  
  
• Icon ‘Add New’ and dropdown ‘Today’s Patient Receipts’ are disabled till a new Patient Receipt is once saved.
  
  
• New Receipt number is generated on selecting the patient or every time icon ‘Add New’ is clicked.
  
  
• This list does not include Patient Receipt created from Copay Screen when Patient Outstanding Amount is collected. The reason for this is to avoid mess due to changes made to Patient Receipt created from Copay screen.
  
  
• Patient Receipts created from this pop-up are saved as Remittance>Patient Receipt in Entered Status (E) and can be posted only from it.
  
  
• Patient Receipt Pop-up shows Patient Outstanding Amt field with label 'Patient OS' which is same as Patient Net Due = Patient's Total Outstanding Amt - Patient Advance. Patient OS label is a hyperlink now and shows the current Patient Statement in a pop-up for quick reference to the Front Desk while collecting Patient Receipt from Appointment>Schedule screen.
  
  
• Patient Receipt Pop-up also shows a new Amount 'Non-Posted Receipts'. Hyperlink of the label 'Non-Posted Rcpt' shows all the Non-Posted Receipts of the selected patient. Patient OS - Non-Posted Rcpt = Actual Outstanding Amount, which the patient is supposed to pay.
  

Figure; Non-Posted Receipts pop-up when clicked on hyperlink Non-Posted Rcpt.

The details of the Remittance > Patient Receipt screen are as follows:

• 'Paid By' : It will show as 'Patient' for the receipt created from the Patient Receipt pop-up and patient name is shown in the box next to it. The Biller can change the 'Paid By' to 'Guarantor' and the search pop-up when clicked will show all the names for the guarantor. When selected as 'Other' the box next to it is grayed out and the biller can enter the person name in the 'Received From' field.
  
  
• Received From: It will show the Received From name entered in the Patient Receipt pop-up. Any change to Paid By name on Remittance > Patient receipt will be reflected in field 'Received From', over-writing the 'Received From' name from Patient Receipt pop-up. User is free to overwrite this 'Received From' field name.
  
  
• Pay Mode: The payment mode will be check / cash / credit card.

4. 'Patient Outstanding Payment' collection from ‘CoPay’ screen (now renamed as 'Patient Payments').

On the 'Appointments > Schedule' screen when the patient is marked as 'Arrived' there is a '$' icon to collect the 'Copay'. This screen now renamed as 'Patient Payments' is now capable of collecting the 'Copay' as well as 'Patient Outstanding Payment'. The amount entered in the 'Patient Outstanding Payment' field will automatically generate a Patient Receipt 'PTRECxxxxx' which will always be in the 'Entered' status on Billing tab Remittance > Patient Receipt and will be appropriately applied to Patient responsibility by Biller by associating appropriate claim to it and posting the Patient Receipt.

Figure: New field 'Patient Outstanding Payment' on pop-up 'Patient Payments' which generates a Patient Receipt PTRECXXXXX on Save and shows Remarks 'AutoCreated YYYY-MM-DD'

• On Save, if the new field 'Patient Outstanding Payment' has any amount entered, it generates a Patient Receipt. This Patient Receipt number 'PTRECxxxxx' is shown next to field 'Patient Outstanding Payments'.
  
  
• On Save, when Patient receipt is created, field 'Remarks' display text 'AutoCreated YYYY-MM-DD' which isalso shown in field 'Comments' of Patient Receipt created and helps identify Patient Receipt created from pop-up 'Patient Payments'.
  
  
• The fields of Payment Amount i.e. Cash + Check + Credit Card total has to be equal to fields of 'Apportion To' i.e. CoPay + Deductible + Visit + Advance + Patient Outstanding Payment total.
  
  
• Lable of field 'Patient Outstanding' has been changed to 'Pat OS' and it is same as Patient Net Due = Patient's Total Outstanding Amt - Patient Advance.
  
  
• Lable of field 'Pat OS' is now a hyperlink which shows the current Patient Statement when clicked. This will be helpful for Front Desk staff to quickly view the details of outstanding claims while collecting Patient Outstanding Payment from patients.
  
  
• A new field 'Non-Posted Rcpts' has been introduced to show sum total of all Patient Receipts created (In Entered Status) but not yet posted so far. This includes all Receipts of Patient from Remittance>Patient Receipt screen from today or any past date also including Receipt created when Patient Outstanding Amt is collected from this 'Patient Payment' po-up.
  
  
• The Title of the CoPay pop-up has been changed to 'Patient Payments' now that it collects not only CoPay but also Patient Outstanding Payments.
  
  On Remittance > Patient Receipt screen, this Patient Receipt will be created:

• With status 'Entered'.
• Pay Mode as 'On Visit' shown grayed Out and icon 'Show Details' next to it when clicked will pop-up the CoPay pop-up from which this receipt got created.
• The field 'Received Amt' will be grayed out.
• The field 'Receipt Date' will show the Date on Copay pop-up.
• Dropdown Paid By will be selected as 'Patient' and will be grayed out, with Patient Name shown next to it.
• Field Received From will also show Patient's name by default.
• Field 'Post Date' will be shown as 'Batch Creation Date' if Batches are being used, else it will show the Copay Date.
• Lable 'Patient Balance' is now a hyperlink and pops up the current Patient Statement for quick view.
• Icon 'Comments' next to Batch no will show 'Auto Created YYYY-MM-DD' for such Patient Receipts entries created.

5. Case Management Logic Implemented.

Introduction:
Case Management Feature in PrognoCIS has been designed as a multi-purpose screen for tracking various types of cases, emphasizing more on Injury cases.

Injury or accident cases are generally of Workers Comp type or Auto Accident type or Personal Accident type. One Injury or Accident of a patient is generally one Case and needs to be tracked by the clinic, Insurance, Employer, Case Managers, Attorneys, Adjusters, etc. Work Comp Insurances need Progress Notes, Work Status Reports, PR1, PR2, PR4, etc. with every claim sent for a Work Comp Injury patient. Hence, generally, Providers want to track all visits of a patient for a Case very carefully and document progress and status appropriately. Billers want easy access to all documents and transactions related to a Patient Case so that they can send documents along with claims and avoid Claims rejections. The new Case Management feature introduced in PrognoCIS will satisfy all these requirements.
In addition to that, the Case Management feature can be used as a tracking feature for other cases or scenarios for tracking or comparing certain Patient Visits done Vs Approved or Amounts Billed Vs Approved by associating Case number to those visits.
2 Scenarios supported for Case Management:
Till now, to keep data separate for each Case, specially Workers Comp Case, same patient was defined multiple times, one for each injury case. Now, with the Case concept introduced, there will be no need to add same patient again and again just to keep injury wise documents separate.

2 Scenarios:
1. One-to-Many (One Patient-Multiple Cases-Case Wise Visits-Default)
2. One-to-One (One Patient-One Case-New Patient Per Case-Property:Y)

1. One-to-Many : With the ability to assign a case to a visit, users will be able to easily filter the documents per case.  This can be achieved by Scenario 1 below: One-To-Many.
2. One-to-One: If clinics want to continue to define one patient per Injury Case, they will be able to achieve this by Scenario 2: One-to-One. For switching to Scenario 2, one property will have to be turned ON as shown below.

Following property setting decides whether for a clinic, Scenario 1 or 2 will be in effect.
Property: patient.allow.one.case: N
Help: If this property is set to Y, only one Case will be allowed for one patient registered. For every new case, a new patient will have to be added. By default, setting will be N, allowing multiple cases for same Patient.

Property: patient.use.case.management.search: N
Help: If set to Y, additional 3 fields will be shown in Patient Searches: Case No, Date of Injury, Body Part. This will be used only for One-To-One setting i.e where one case for one patient is allowed and same patient has to be defined multiple times.
All major Patient Search screens like Patient Registration, Appointment, Refill Request, Claims, Remittances, Compose, etc. will show these additional 3 columns when above property is set to Y to use scenario 2: One-to-One.
Note: A new button ‘copy’ has been introduced on screen ‘Patient Info’ i.e Patient Registration which will help if scenario One-to-One is enabled. The button ‘copy’ when clicked, will allow copying all the Registration and Encounter details for a patient to a new patient. So for every new injury, when same patient has to be defined again, this button ‘copy’ will come handy.

Case Management Screen:

Case Management Screen shows all the Case related details. A new case can also be added from this screen by default. All Case Numbers are shown in a dropdown list and on click of each Case Number, its details are displayed.
There are total 33 fields on the Case Management pop-up, divided into 3 main sections:

• Case Details
• Insurance/Employer/Patient
• Other Details
  
  Button ‘ledger’ has been provided at the bottom to quickly view the Case related Billing Transactions. Just like the Patient Ledger, it shows all Billing transactions for a Case in the sequence in which they occurred.

The details of each Frames is as follows:

Case Details Frame: It contains fields related to the case. The Case No is unique per patient and is suffixed with Body Areas. The 8 fields Date of Injury, Unable to work From Dt, Unable to work Upto Dt, Hospitalization From Dt, Hospitalization Upto Dt, Place of Accident, First Date of Similar Illness and Initial Treatment Dt are mapped with the Claims > Edit 'i' button fields.

Insurance / Employer / Patient Frame: It contains fields related to the Insurance/Employer/Patient associated to selected case. If the Insurance is associated to the patient it will get auto-populated on th e Insurance field. The fields Status, Insurance Attorney, Insurance Adjuster, Manager and Other Case Contact2 are auto populated if associated to patient or Insurance selected.

Other Details Frame: It contains fields related to Other Misc Case Details.

Case Management screen after entering the data.

Figure: Case Management screen

Note:  The Case Number is unique per Patient with Body Parts suffixed. Data auto populates for selected Insurance.

The Workflow of Case Number is as follows.

• Case can be associated to Appointment.
• When Appointment is Arrived, Case from appointment gets associated to Encounter.
• If Case number is added from Start Encounter or updated from Edit Encounter, it gets added/updated on corresponding appointment.
• When Claim is created from Encounter with Case associated, Case Number will get associated to Claim and will be displayed on button 'i'.
  
  Rules for Pre-auth on Appointment Schedule screen when Case is associated:
  
  
• Pre-auth number cannot be associated to Case. On Case Management screen, there is a Pre-auth icon which takes you to associated Insurance’s all Pre-auths but you cannot select a specific Pre-auth from that list to associate to Case.
• On Appointment Scheduler, both Case and Pre-auth have to be associated separately.
• If Case is associated to Appointment first, the Case Number is displayed. After, that if Pre-auth hyperlink is clicked, it shows all the Pre-auths associated to that Case’s Insurance to select from and associate to Appointment. In other words, it does NOT show Pre-auths of Non-Case Insurance (Insurances other than associated to case.) to select from.
• If Pre-auth is associated first to appointment and then Case is associated to appointment, if the Case Insurance and Pre-auth Insurance are same, the Pre-auth is retained.
• If Pre-auth is associated first to appointment and then Case is associated to appointment, if the Case Insurance and Pre-auth Insurance are different, the Pre-auth gets reset. User has to explicitly click on Pre-auth hyperlink and select Pre-auth from the Case Ins available Pre-auths only.

 

Transfer of fields from Case Management screen to claim

Case Management screen has 8 fields like Date of Injury, Unable to Work, Hospitalization, State of Accident, etc. which are present on Claim as given below.
Data from these fields get transferred to Claim if PrognoCIS Billing is turned ON when the claim with CAse number gets created.

• Date of Injury
• Unable to Work From
• Unable to Work Upto
• Hospitalization From
• Hospitalization Upto
• State of Accident
• First Date of Similar Illness
• Initial Treatment Date

When Data is present on any of these 8 fields on both Encounter as well as Case Management screen, property 'billing.case.fields.preffered.onclaim’ is read for that field to decide whether Encounter Data or Case Management screen data will be picked up. By default, this property is set to 'N'.

• If set as ‘N’, priority will be given to Encounter Test Data while transferring to claim.  Any change to data on claim will update the Encounter Test Data but not the Case Data.
• If set as ‘Y’ Case Data will be preferred over Encounter Test data and claim would always show Data from Case irrespective of the Status of Claim. Any change to data on Claim in this setting will not update Case but will update the Encounter Test Data. Case Data will always override the changed Claim Data on Saving the claim.
  Note: There is a filter for searching Case Number on various Filters on Billing Side. Its a text box and searches any part of the Case Number.

6. Claims >> Edit: 'Change Insurance' pop-up introduced on 'Billed' Claims for Self Pay to Insurance, Insurance to Self Pay or Insurance to Insurance at any stage.

When 'Secondary Change' and 'Tertiary Change' features were introduced, the ability to change Primary once the claim was processed was lost. So was the ability to change Primary Insurance to Self Pay claim or Self Pay to Primary Insurance once the claim was billed. As a result, after the claim was processed, if the Billers realized their mistake, they were required to mark the entire claim as Void and use option to Void and Create a copy of Same Claim. This allowed them to make changes like changing Primary to other Primary, changing Primary to Self Pay or Self Pay to Primary on this new claim and then process the Claim. This was a lengthier process and resulted into too many Voided Claims as many times, as per the Billers, such changes are required for some valid reasons.
Now, a new icon has been introduced on Claim in the row of Primary Insurance by abbreviating the lable 'Primary' to 'Pri'. This icon when clicked, will take the users to Patient Insurance screen to add/edit the Insurances for the Patient. The lables 'Pri', 'Sec' and 'Ter' have been abbreviated and given a hyperlink to go to same screen which is a new Pop-up: 'Change Insurance'. Using this hyperlink, now, on a Billed Claim, Insurance change will be possible.

Figure: Pop-up 'Change insurance' when clicked on hyperlink 'Pri' or 'Sec' or 'Ter' to change Insurance. Claim Ledger also shown. Umbrella icon to now take to Patient Insurance screen.

On 'Change Insurance' pop-up, now, there will be three dropdowns allowing change or assignment of Insurance and a new field 'Reason' to add the Reason for Change. If the Insurance is changed, all transactions posted till then are marked 'Unapplied' and responsibilities are appropriately changed. For Ex: If before Primary Change, the Primary EOB is posted, and current responsibility is with Patient, on Chane of Primary, all the charge codes of the Primary Posting are marked as 'Unapplied' and responsibility gets moved from Patient to new Primary. If the Copay was applied, the Copay amount is moved to Patient Advance. If the Patient Receipt is posted, the Patient Receipt is marked Unapplied and amount is moved to Patient Advance.

Figure: On Insurance Change, Old Primary transactions marked as Unapplied with comments as 'Pri Insurance Changed'. Confirmation message before changing Insurance.

On the pop-up 'Change Insurance', Claims Ledger is also shown with indication of Unapplied transactions clearly shown with word 'Unapplied' marked in red.
There is a new entry created in Track Status when Insurance is changed, indicating Old Insurance Name and New Insurance Name.
Since its important to store Archieved entry of claim with old Insurances before change, an Archieved entry of the claim is created in List of Reopened Claims. On pop-up of this icon click, it also shows the Reason for Insurance change.

On EOB, the automatic charge code marking is done by selecting a new status 'Unapplied'.In addition to earlier 3 statuses i.e Normal, Duplicate and Additional, now there is 4th Radio Button 'Unapplied' which gets automatically marked and is grayed out. The field 'Reason' next to radio button 'Unapplied' also gets automatically populated depending of whether Pri, Sec r Ter is changed. In addition to that, the charge code in bottom frame marked as unapplied is indicated by Blue Color, just like Duplicate is indicated by color Red and Additional is indicated by Yellow.

Figure: Impact of Insurance Change on EOB and Patient account. Grayed out Unapplied Status with Reason, Blue color on Charge code, Ins Name with word Unapplied in middle frame, PtA/C showing Unapplied EOB and Patient Receipt entries and additional To Advance Patient Receipt entry.

The middle frame on EOB shows the Claim with Insurance Name with word 'Unapplied' marked in Red indicating that the Claim's EOB transactions are marked Unapplied due to Insurance Change.

Same way, Patient Receipt also shows middle frame with Patient Name with Word 'Unapplied marked in Red. Not only that, the amount applied to claim is reverted back and is transferred to Patient Advance and is shown as amount 'Moved to Advance'. The Allocated Amount is shown reduced by that amount.

Figure: Patient Receipt with Unapplied transaction and amount Moved to Advance.

Same way, on Patient Account, the EOB table shows word 'Unapplied' in red color in front of the Payor Name indicating that the transactions are marked Unapplied and responsibilites recomputed. Additional Patient Receipt entry with same voucher number and Check No as 0 is shown in EOB table of Patient Account with words 'To Advance' shown in front of Payor Name i.e Patient Name.So there are 2 Patient Receipt Entries displayed: Unapplied, Moved to Advance.

Note: Earlier, due to Sec Change or Tertiary Change, the EOB transaction was marked with Blue color and status was set as 'On Hold'. Now, all transactions because of even Pri Change or Ins change to Self Pay, are marked as 'Unapplied' and shown in Blue color. On upgrade, all 'On Hold' transactions will be marked as Unapplied.

Limitations:

a. No checks will be provided on change of Normal to Accident Ins(WC, AA, PC) or Acc to Normal Ins. The claim will have to be reopened and re-processed instead of directly marking it as Processed for application of checks on Ready to Send.

b.On Ins change, there will be no check provided for Pre-auth. To associate or remove associated pre-auth after insurance change, the claim will have to be reopened and re-processed instead of directly marking it as Processed.

c. Since Ins Change button is available only for Billed claims, Change of Ins will not affect/update the Fees. When claim is resent, (to new ins), it will be sent with old Ins Amounts. Even reopening and reprocessing of claims will not fetch the fees as charge codes are grayed out and no change of fees is allowed after 1st Billed Status.

d. On change of Ins A to Ins B, all transactions of Ins A are marked ‘Unapplied’. The responsibility is brought back to Ins B. Now if again users change Ins B to Ins A, there will not be reversals of Unapplied Transactions. So, new transactions will have to be created again for same amounts for Ins A.

e.Ins Changed from Aetna to BCBS. Payment comes from Aetna. It is marked ‘On Hold’ and posted against new Insurance. When Recoup is done from Remittance>Ins Credit screen:
i) The Insurance has to be selected as New Insurance for doing Recoup of On Hold Payment.
ii) On post, there is no choice to select insurance where this Remaining amount needs to be moved. Hence this amount will be moved to New Insurance Credit Bucket and Refund Entry will be also created for New Insurance instead of old (Correct) Insurance.

f.Change from Ins to Self Pay: If claim had Copay or Visit Fee collected and that copay/visit fee was applied while posting Ins EOB and some remaining amt from that Copay/Visit fee was moved to Advance, a voucher gets created for moved amt to Advance. Now, if Ins is changed to Self Pay from Change Ins pop-up, the Copay/Visit Fee which was applied / moved to Advance is reverted back to Copay /Visit Fee buckets on Copay screen. Now that the Claim is Self Pay claim, these amounts will continue to lie unapplied unless explicitly moved to Advance using Remittance>Advance screen.

7. Claims >> New: Option for creating missing Claims for a specific date’s Encounters in bulk.

‘Create ClaimsDated’, is added on the Claims > New screen, this will allow the Biller to create Claims for all Encounters at the end of the day in a single click. This is useful when Encounters are NOT closed on the same day. This option is dependent on the parameter set in property ‘create.claims.for.encounters.of’.

8. Claims >> Edit screen: ‘Add new’ green icon on Claims >> Edit screen to quickly create a new claim with reference to current selected claim.

A new icon in green ‘Add New’ has been added on Claims>Edit screen next to Claim Search Binocular to quickly add a new claim by taking selected claim as reference. When this icon is clicked, it will pop-up Claims>New screen with 3 Radio buttons and following fields:

• Create New Claim: Date of Service(Today’s Date), UB04(Checked if Ref Claim is UB04), Patient (Same as on selected Claim), Provider (Same as Attending Doc on Selected Claim), Referring Provider (Same as on selected Claim, else blank), Claim Location (Same as on selected Claim), Reason for Visit(Same as on base claim, else blank). On click of button ‘ok’, a new claim with the above details will be populated. Note: No other information will be copied from the reference claim like ICD and Charge details, Batch No, Pre Hosp From and Upto Date, I button details, etc..
• Create a copy of an Existing Claim with New Visit ID: This option when selected would auto-populate the Date as Today’s date and Selected Claim ID as current Claim ID displayed in bold. The search would be enabled to select any other Claim ID to create a copy.
• Create a copy of an Existing Claim with Same Visit ID: This option when selected would auto-populate the selected Claim ID as current Claim ID displayed in bold. The search would be enabled to select any other Claim ID to create a copy. For options 2 and 3, on click of button ‘ok’, a new claim will be created with reference Claim’s details populated.

9. Claims>Edit: Redesign of Charges Table on Claim with DOS From Date and Upto Date moved on main screen from CMS Flag, Modifiers moved at beginning and Totals row changed.

• Removed column ‘Procedures’.
• Instead ‘Code’ and ‘Procedure Name’ are shown on Tooltip of Charge Code.
• Removed Columns ‘Bill_Ins’ and ‘Patient’.
• Instead checkbox ‘Bill Pat’ is used to decide if charge amt is getting billed to Patient or not. It will be default unchecked if Insurance is associated to Claim, Checked if Self Pay. The current logic of Patient Checkbox check and uncheck and related Totals computations remains the same. Changed Label to ‘Bill Emp’ if Employer claim is created.
• From and Upto Date columns are moved before Comments and after CMSFlag. (i.e. these fields from DOS From Date and DOS Upto Date have been moved from CMS Flag of each charge line.)
• Column Modifiers has been moved after Code and before Units to avoid fees getting reset after manual change because of Modifier addition after that.
• Row ‘Total’ has been changed like this: ’Total Billed’: xxx.xx in a grayed out box followed by ‘To Ins’: xxx.xx, followed by ‘To Pat’: xxx.xx Followed by ‘Discount’ xxx.xx Then gap……. ‘Paper’, ‘On Hold’ and ‘Ready to Send’ as is : Aligned to right. Reopen related text continues to show as is – aligned to left. Ex: Total Billed: 3776.00 To Ins: 3276.00 To Pat: 500.00 Followed by Discount 100.00 Paper, On Hold and Ready to Send.

Note: ‘To Emp’ will not go together with ‘To Ins’ and ‘To Pat’. For Employer claim only ‘To Emp’ will be shown but not ‘To Pat’ or ‘To Ins’. Please refer the above figure.

10. Claim Letter: Ability to send letters from Billing side.

An Icon is provided from various screens to invoke a Letter pop-up and write a letter specific to a claim. This feature will help the Billers to compose and send letters to Insurances / Doctors / Patients pertaining to the claim quickly by choosing the predefined templates and attaching Encounter and Claim related Docs from buttons ‘EMR Docs’ and ‘Billing Docs’ respectively. This feature is Claim Centric rather than Patient Centric. If the Biller wants to compose a letter, they have to first highlight the Claim and then click on the ‘Claim Letter’ icon. By default the Claim Id, Patient Name and the Today’s Date get’s displayed automatically. Users can click on the button '+' and select the particular tags for Subscriber Id, Group No, etc., to the claims letters.

Figure: Claim Letter Screen with related ‘Billing Docs’ to attach.

Some predefined templates like 'Medical Necessity, Medical Necessity Appeal, Reconsideration for Procedure Denial and Reconsideration for Timely Denial' are also added to give a jump start to the Billers to start sending Letters. The Letters can be printed, faxed or emailed to one or multiple Contacts associated to the patient of the selected Claim.

Figure: Contacts available to send Claims Letter

As soon as the Letter is saved, an entry get created in the new table ‘Letters’ on Patient Account with hyperlink on Letter ‘Id’. When this hyperlink is clicked Claim Letter is seen in pop-up. An Entered Letter can be edited, deleted, sent from this pop-up from Patient A/c.

Note: Once the Status of the Letter changes to sent the Letter cannot be further edited or deleted but can be sent again if required.

Figure: Patient Account Letter entry in Table ‘Letters’

The icon ‘Claim Letter’ is active when the 'Status' of Claim is ‘Entered (E) / Ready to send(S) / Billed (B) / On Hold (H)'. The Icon is disabled when the 'Status' is 'Archived / Void'. ‘Claim Letter’ icon is available from following screens: Claims > Edit Screen, Claims > Unprocessed, Claims > Returned, Claims > Outstanding, Claims > Claims Center, Claims > Charges Center, Remittance > Denied screen, Remittance > Disputed ,Remittance > EOB, Remittance > Pat Receipt, Remittance > Emp Receipt

11. Claims Entry Batch Enhancement: Claims Entry Batch now editable.

For better tracking of claims and generating End of the Day Reports and End of the Day closure, Batch numbers are recommended in PrognoCIS. There are 2 types of Batches, Claims Entry Batch used on Claims and Receipts Batch used on all payment posting transactions. This Batches functionality has now been enhanced specially for Claims i.e. ‘Claims Entry Batch’. Changes on Settings > Configuration > Claims Entry Batch are as follows:

• Any user can create Claims Entry Batches. Like Receipt Batches, these are still NOT User wise.
• There can be any number of open batches.
• Now, user can change the Batch No so long as it is Unique. User can edit a Batch No so long as it is Not assigned to any claim. Same is true for the Batch Creation Date.
• A Batch can be associated to Location and Business Unit. A location or Business Unit can be changed at any time on Claims Entry Batch screen and that too even if there are claims in any status with that Batch Number.
• A Batch can be deleted Only if there are no Posted Claims Assigned or Reopened Claims Assigned. If a Batch is deleted, the Batch No assigned to Claims (in non-posted or non-reopened status) is reset and Post Date is also reset. If a Batch is deleted, any claim in ‘Ready to Send (S)’ Status with the associated Batch no will change to ‘Ready to Bill (E)’ status and field Batch No will be reset and enabled and Post Date is also reset. Once the Batch is closed, the Batch No assigned to Claim whose status is NOT Billed are reset and enabled and Post Date is also reset but grayed out.
• A table is added on Claims Entry Batch Screen with Count and Amt of claims with this Batch No. One entry for each Claim Status is shown in this table with Statuses like E, S, H, V, B. This table is not shown if there is not a single claims present with the selected Batch No.
• A new button ‘Report’ is added on Claims Entry Batch screen. When clicked, it shows the User Batch Report with list of claims unprocessed and processed seperately with their details.
• Assigned To will be Read Only.

Changes on Claims screen:
The changes on Claims screen are as follows

• Field Batch No is moved from i button of claim in place of Account No on main Claim screen.
• If Batch No is being used, the Post Date field remains disabled and shows Claims Entry Batch creation Date.
• Batch No Dropdown list shows blank by default and following Batch numbers on Claims Screen:
  • Only where Batches Creation Date is equal to or Greater then DOS.
  • Location is ‘All’ or same as Location selected on Claim.
  • Business Unit is ‘All’ or same as selected on Claim.
• Claims Edit screen would show alert message on Ready to Send if there is a mismatch found in Batch Location and Claim Location and/or Batch Business Unit and Claim Business Unit.
• If claim is reopened, the Batch No field becomes disabled. So once the Claim is processed, the Batch no on claim cannot be changed.

Figure: Claim Entry Batch Enhancements.

12. For Institutional Claims (UB04), Revenue Codes will be transferred from EMR side.

Till now, Institutional claims were getting created blank when Encounter with UB04 Enc Type was closed as there was no place holder for Revenue codes on Encounter. Now, Revenue codes can be associated to charge codes at various sources like Inhouse Drugs, Procedures, Labs, Rads, Vaccines, etc. and these charge codes when transferred to Assessment, will have those Revenue codes associated and later transferred to Claim with Code Type as Revenue Code, one Revenue code per Charge line and Charge codes associated as UB04 Procedure codes. A provision to associate a Default Revenue Code has also been provided on CPT and HCPC Master.

13. Send UB04 option dropped: Professional and Institutional Claims processing from ‘Send Claims’ screen.

The ‘Send UB04’ option from Claims menu has been dropped as the submenu is merged with ‘Claims >> Send Claims’ submenu. On the ‘Claims > Send Claims’ screen, the toolbar has a List Box with the list names as Professional and Institutional Claims. By default Professional Claims will be displayed on the list box with all the tabs showing the Professional Claims to be sent for processing. To send the Institutional Claim for the processing, change the list name to ‘Institutional Claim’ in the list box, all the tabs will show the Institutional Claims.

14. ‘Assign To’ feature Enhanced to track assignment history and take action as well.

Now, a task can be assigned to a 'User' or to a 'Role'. After assigning a task, the 'Assignment' panel gets deactivated and the 'Action' panel becomes active for the action to be taken. The 'Assignment Tracking' panel tracks the history of all the tasks for a Claim. An ability to send message, save it in Claim Notes is also provided. The Assignment and Action details get added to Claim Notes when the the Assignment is marked 'Done'. When 'Done' checkbox is checked, it closes the Assignment and button 'add' becomes enabled.

Multiple Assignments can be done by selecting multiple claims and then clicking on the hand icon. If the Assignments are open for some selected claims, a message will pop-up showing their Claim IDs and these claims will be unchecked. The remaining Claim IDs will be shown in the smaller pop-up where assignment is going to be done. This smaller pop-up shows Assignment section only and not Action and History as Multiple assignments are getting done from that screen.

The ‘hand’ icon has been made available on Claims>Edit, Claims>UnProcessed, Remittance>Denied, Remittance >Disputed and Patient A/c in addition to Claims >Outstanding, Claims>Claims Center, Claims>Charges Center and Remittance>Auto Write-Off.

Note: When the 'Status' is 'Archived' and 'Void' the icon 'Assign To' will be 'Disabled'.

Note: Multiple rows can be selected for assigning a task.

Note: If the last Assign Task is marked as 'Done', the 'Status' will get a Prefix of 'DONE'.

15. Favorite Filters can be 'saved' and 'selected'. New Filters added and categorized.

A list Box ‘Select Filters’ shows the List of Defined filters. User can edit an existing Filter Or Save a new Filter. Buttons ‘apply / save filter / save as’ are introduced. Rearranged the sequence of fields and categorized them. The filter icon tooltip will now shows the name of the ‘saved filter’ if selected.

16. Reports>Aging: Merging of Patient, Insurance and Employer Aging Screens

The sub menus ‘Reports > Pat Aging / Ins Aging / Emp Aging’ is been merged together into a single submenu ‘Reports > Aging’. This submenu when invoked opens a pop-up ‘Aging Report’ with three different tabs as follows: Pat Aging, Ins Aging, Emp Aging.

Pat Aging Tab: The Patient Aging tab gives the report for the outstanding amounts due for the patient for each of the specified slots defined in the property 'billing.aging.slot'. The name of the button is changed to ‘Aging Slots’. The field ‘Patients’ is renamed to ‘Patient Financial Class’ since the report generated will be for the different Financial Class. The reports can be generated for all types of claims / claims handed over to ‘Non-Collection Agency’ / claims handed over to ‘Collection Agency’ associated to patient using following radio buttons :

• All
• Non-Collections
• Collections

Figure: Pat Aging with the renamed field ‘Patients Financial Class’.

Note:The Report can have Patient specific columns by setting the properties ‘billing.pataging.fields’, ‘billing.pataging.titles’.

Ins Aging:Insurance Aging report is the 'Account Receivable' Aging Report that displays the longevity of outstanding invoices from the Insurance Companies. The display is insurance-wise and in ascending order (alphabetically). Insurances in the Aging report can be grouped by the ‘Group By’ list box, two next list name ‘Patient Financial Classes’ and ‘Insurance AR Group’ are added in this list. In the ‘Report’ list a new list name ’By Group Total Only’ is added in the list box to print Insurance Aging Report for selected suitable template.

Figure: Ins Aging tab with added list name in ‘Group By’ and ‘Report’.

Note:The Report can have Insurance specific columns by setting the properties ‘billing.insaging.fields’, ‘billing.insaging.titles’.

Earlier the concept of slot selection meant that if only slots 90, 120 were selected, then Patients who DO NOT have any values in these columns should NOT appear in the report. This meant that even if all slots are selected and if patient does not have an aging amount in any of the slots he should not appear in the report. This generated a wrong report in a scenario if a patient is having only an Advance Receipt and No Claim Outstanding (as such no amounts in any of the aging buckets), so the patient was not seen in the report. Now, by default all the Patient will be listed on the report and if the bucket is not having any outstanding then the particular bucket will show the amounts as 0.00. Button ‘Aging Slots’: On clicking the button ‘Aging slots’ a pop-up window ‘Aging Report’ will open. If the Hide checkbox for the particular aging bucket is checked, then that bucket will be suppressed from the report. These changes are applicable for Insurance / Employer Aging tabs also.

Note:The slot selection feature for the button ‘Aging Slots’ is applicable for Insurance / Employer Aging also.

Note:Patient Aging & Insurance Aging will print Grand Total (Patient Count xx) and Grand Total (Insurance Count xx) respectively.

The report can have ‘N’ numbers of records printed by setting the property ‘billing.runbg.recordcount’ with that particular number. By default the property is set to ‘1000 record’. If the number of Patient/ Insurance / Employer selected for the report is beyond this property, the system will execute the process in the background and provide a corresponding alert message. If the process is running in the background a PDF file will be created and will be available under Setting > Configuration > Download Files. A message will be sent to the User on completion of the process. The message in the Users Inbox will have a zoom button to view the generated report. This will be for the currently selected tab.

17. Single Claim Edit without reopening EOB now possible again.

In Single Claim Edit the user can make changes even though an EOB is posted without reopening the Claim. If the posted transaction is changed to Entered transaction by using ‘Single Claim Edit’ or by reopening EOB, the Charge row will be shown the Edit mode, ‘PaidAs’ will be enabled, ‘ABS(A2) will be enabled, Approved to Denied and vice versa will NOT be allowed and the list box will be ‘Disabled’. If ‘NO’ further transactions are found then ‘Write-off’ button on charge row will be available, ‘Disputed’ checkboxes will be available and ‘Bill to Patient’ checkbox will also be available.

18. Retain Responsibility Feature: Responsibility to remain on Payor.

When Insurance pays less than expected and the next responsible amount entered in buckets 'CoIns, CoPay, Deductible and Not Covered' shoould not be created on post of EOB, this new feature 'Retain Responsibility' should be used. Checkbox 'Retain Responsibility' is added under the 'Disputed' Table on EOB screen's 'Approved' pop-up to flag a charge code to retain responsibility with current Insurance. When this checkbox is checked, the next responsibility buckets amounts are kept as same payor responsibility on post of EOB. An entry of this charge code is created in list Remittance>Disputed for the AR Caller to work on all Disputed entries from one single screen. The Patient account shows the alphabet 'R' in Red and Bold in Remittance Table for Claim next to Payor Name where atleast one charge code is marked 'Retain Responsibility'. The Claims Table shows the Responsibility with current Insurance appropriately. When the checkboxes 'Contract / Allowed Amount' Or 'Retain Responsibility' are checked on pop-up 'Approved' of EOB, then 'Dispute Reason' is Mandatory.

This entry remains in Remittance>Disputed screen till:
* The charge code is marked 'Reset - Retain Responsibility' from Remittance>Disputed screen's Yellow flag or
* Claim is selected on EOB either for Additional payment or
* Claim is selected for Secondary payment.

When same Payor pays or next Payor pays, the EOB with posted Retained Responsibility when visited, does not show the word 'Retained' any more and responsibilities are computed and displayed appropriately. There is no way to know that the charge code was originally marked as 'Retain Responsibility'.

19. Payment can be Received / Recouped against a Voided Claim.

The Biller can Receive Payment / Recoup against a Voided Claim. Claim search now displays Voided Claims when checkbox ‘Show Voided Claims’ is checked. If current selected Claim is Voided, VOID label will be displayed in the icons row in RED.

20. Patient A/c: Changes made in buttons 'WoCn' and 'AdjAdv'.

WoCn: It will list all Claims / Charge rows with Balance. The Balance will be shown bifurcated into Primary / Secondary / Tertiary / Employer /Patient Responsibility. The Biller can select charge rows and Write Off the Amounts or can move the responsibility to the Next.

AdjAdv: Earlier the button 'AdjAdv' would adjust the advance amount with charge rows outstanding in chronological order i.e. it would automatically adjust the advance amount with the old charge rows first and then with the new charge rows. Now, it will display the Advance and the Outstanding Charge rows. The Biller can select required charge row and adjust full or part of the advance manually.

21. Billing Home Page

21.1 Icons Added and Rearranged on Various Screens.

New Icons provided on various screen are as follow:

• Assign To , Claim Letter , Refresh Claim Amounts

Representation of Icons:

• (Patient Detail): It takes the User to the ‘Patient Information’ screen.
• (Patient Insurance): It takes the User to the ‘Patient Insurance’ screen.
• (Copay Details): It takes the User to the Encounter ‘Co-Payment’ collected screen.
• (Claim Details): It takes the User to the ‘Claims Edit’ screen provided the Billing Status is at least ‘Ready to Bill’.
• (Track Status): It tracks the claims status, the number of times the claim got sent, rejected, and reopened.
• (Claim Ledger): It gives the ledger details of the claim.
• (Print Sec/Ter CMS/UB04): If the Patient has Secondary/Tertiary Insurance and partial payment is received from the primary/secondary insurance then a claim is built to the secondary/tertiary insurance with the primary/secondary ERA attached.
• (Patient Statement): It takes the User to the payment details of the patient in the form of the statement.
• (Claim Letter): It takes the User to the ‘Claim Letter’ screen. The User can compose letters to Insurances / Doctors / Patients pertaining to the claim quickly.
• (Claim Notes): It opens the ‘Claim Notes’ screen.
• (Patient Billing Notes): It opens the ‘Patient Billing Notes’ screen.
• (Refresh Claim Amounts): It compute and update the Charge Code Bill Amount Column. If the User reopens and edits the Primary Insurance EOB and post it and opens the Secondary Insurance and then clicks on this icon the changes will be reflected on the Secondary Insurance EOB already created.
• (Patient A/c):It takes the User to the ‘Patient Account’ screen.
• (Assign To): It takes the User to ‘Assign To’ screen.
• (Resend Claim): It resends the selected claim.
• (Patient Appointment History): It takes the User to the ‘Patient Appointment History’ screen and displays the patient history of all appointments / their rescheduling / cancellation / deletion on the selected current row.
• (Patient Alert): It opensthe 'Patient Alerts' screen.
• (Encounter Details): It opens the 'Patient Encounter' screen.

The logic of Icons rearranged on various Billing screens is to maintain consistency, be intuitive, and suitable for Billing Workflow starting with Patient, Insurance, Copay, Claim, Claim Related actions, Remittance, and Patient Account.

22. Appointment >> Schedule:

22.1 Time can be blocked for a selected location on Block Time pop-up.

Earlier the block time interval was applicable for all the locations. Now, it is applicable for the selected location only. If the User wants to take an appointment on this block time slot, an error message ‘This slot is Blocked: cannot Take Appointment’ is displayed and it does not allow taking the appointment.

Figure: Message ‘This slot is Blocked: cannot Take Appointment’ is displayed when the slot is blocked.

22.2 Appointment History pop-up displays the status of previous appointments.

On Appointment Confirm Pop-up, if an appointment was rescheduled, the Status would be set to ‘CANCELLED BY PATIENT’. Also, if the scheduled appointment was deleted, the record was deleted from the History. Now, the button ‘history’ when invoked will show the correct Status of previous appointments as scheduled by the Patient. If the scheduled appointment is deleted, a record will be created with Status as DELETED on the ‘Appointment History’ pop-up. The pop-up will also show whether the appointment was been SCHEDULED / RESCHEDULED / CANCELLED / DELETED.

23. Appointment >> Patient:

23.1 All Buttons are converted into icons.

All buttons on the Appointment >> Patient screen have been converted into icons. The look and feel of the icons have been changed and they are designed in such a manner that it represents the name of the icon and gives a user-friendly approach.

24. Patient Insurance.

24.1 New Status 'DMERC' is added for associating to Durable Medical Equipment Carrier.

Medicare does not pay for DMEs. There is a seperate Insurance where only DME charge codes have to be billed. Hence a new Status 'DMERC' is added on Patient Insurance screen for associating it to the Durable Medical Equipment Insurance i.e DMERC. The logic of creating DMERC claims with correct DME charge code is explained in next feature of DMERC supplementary claims.

Figure: 'DMERC' is added in the Status and associated to DME Carrier.

24.2 DMERC Supplementary Claim is auto created when Primary is ‘Medicare’ and DME Equipment is Dispensed.

Medicare does not pay for DMEs. They ask for the DME 'Charge Codes' to be billed to DMERC. Now, if the Primary Insurance is Medicare and there is one more Insurance present with Status ‘DMERC’ and Assessment screen has DMERC marked charge code present, a separate claim will be created with DMERC Insurance as Primary and Non-Medicare Insurance (if present) as Secondary with the DMERC charge code only. Medicare will not be secondary on this DMERC claim. The main claim with Medicare as Primary and Non-DMERC Insurance (if present) as Secondary will be created with Non-DMERC charge codes only.

DME charge codes are identified based on a new checkbox 'DMERC' on CPT and HCPC master. If this checkbox is checked for a charge code, and is selected in Assessment, the Insurances for that patient are checked on creation of claim. If the Primary Insurance is Medicare i.e with Claim Filing Code as Medicare on Insurance Master, it will look if there is any other Insurance with Status marked 'DMERC' associated to Patient. A second claim is created for this DMERC Insurance and charge code for DMERC is moved to this second claim from the Medicare Claim. Medicare is not considered as Secondary for this DMERC claim and viice versa. If other that Medicare and DMERC Insurance if patient has any other active Insurance, it is associated as Secondary for both the claims.

DME claims can be filtered from Filter 'Claim Type' by choosing option DMERC.

25. Claims >> Edit.

25.1 For Institutional Claims (UB04), Revenue Codes will be transferred from EMR side.

Till now, Institutional claims were getting created blank when Encounter with UB04 Enc Type was closed as there was no place holder for Revenue codes on Encounter. Now, Revenue codes can be associated to charge codes at various sources like Inhouse Drugs, Procedures, Labs, Rads, Vaccines, etc. and these charge codes when transferred to Assessment, will have those Revenue codes associated and later transferred to Claim with Code Type as Revenue Code, one Revenue code per Charge line and Charge codes associated as UB04 Procedure codes. A provision to associate a Default Revenue Code has also been provided on CPT and HCPC Master. 

25.2 ‘Add new’ green icon is added to quickly create a new claim with reference to current selected claim.

A new icon in green ‘Add New’ has been added on Claims > Edit screen next to Claim Search Binocular to quickly add a new claim by taking selected claim as reference. When this icon is clicked, it will pop-up Claims > New screen with 3 Radio buttons and following fields:

• Create New Claim: Date of Service(Today’s Date), UB04(Checked if Ref Claim is UB04), Patient (Same as on selected Claim), Provider (Same as Attending Doc on Selected Claim), Referring Provider (Same as on selected Claim, else blank), Claim Location (Same as on selected Claim), Reason for Visit(Same as on base claim, else blank). On click of button ‘ok’, a new claim with the above details will be populated. Note: No other information will be copied from the reference claim like ICD and Charge details, Batch No, Pre Hosp From and Upto Date, I button details, etc..
• Create a copy of an Existing Claim with New Visit ID: This option when selected would auto-populate the Date as Today’s date and Selected Claim ID as current Claim ID displayed in bold. The search would be enabled to select any other Claim ID to create a copy.
• Create a copy of an Existing Claim with Same Visit ID: This option when selected would auto-populate the selected Claim ID as current Claim ID displayed in bold. The search would be enabled to select any other Claim ID to create a copy. For options 2 and 3, on click of button ‘ok’, a new claim will be created with reference Claim’s details populated.

Figure: Redesigned Claims >> Edit screen and ‘New Claim’ pop-up invoked when clicked on icon ‘New Claim’.

25.3 Redesign of Charges Table on Claim with DOS From Date and Upto Date moved on main screen from CMS Flag, Modifiers moved at beginning and Totals row changed

• Removed column ‘Procedures’.
• Instead ‘Code’ and ‘Procedure Name’ are shown on Tooltip of Charge Code.
• Removed Columns ‘Bill_Ins’ and ‘Patient’.
• Instead checkbox ‘Bill Pat’ is used to decide if charge amt is getting billed to Patient or not. It will be default unchecked if Insurance is associated to Claim, Checked if Self Pay. The current logic of Patient Checkbox check and uncheck and related Totals computations remains the same. Changed Label to ‘Bill Emp’ if Employer claim is created.
• From and Upto Date columns are moved before Comments and after CMSFlag. (i.e. these fields from DOS From Date and DOS Upto Date have been moved from CMS Flag of each charge line.)
• Column Modifiers has been moved after Code and before Units to avoid fees getting reset after manual change because of Modifier addition after that.
• Row ‘Total’ has been changed like this: ’Total Billed’: xxx.xx in a grayed out box followed by ‘To Ins’: xxx.xx, followed by ‘To Pat’: xxx.xx Followed by ‘Discount’ xxx.xx Then gap……. ‘Paper’, ‘On Hold’ and ‘Ready to Send’ as is : Aligned to right. Reopen related text continues to show as is – aligned to left. Ex: Total Billed: 3776.00 To Ins: 3276.00 To Pat: 500.00 Followed by Discount 100.00 Paper, On Hold and Ready to Send.

Note: ‘To Emp’ will not go together with ‘To Ins’ and ‘To Pat’. For Employer claim only ‘To Emp’ will be shown but not ‘To Pat’ or ‘To Ins’.
Please refer the above figure.

25.4 New Button ‘Claims Hx’ is added to view the Patient's Billed Claims History

A new button ‘Claims Hx’ is added on the Claims >> Edit screen. This button when clicked will invoke the pop-up 'Claims History' and will show all the Claims with status 'Billed' for the reference Patient and Charge Codes, ICD codes as comma separated list and Hospitalization From and Upto Date. This pop-up will be helpful for knowing what were the claims with Hospitalization and what were the charge codes and ICD codes billed and to use the same codes for consistency for further claims for same hospitalization to avoid rejections.

Note:The ‘Claim Hx’ pop-up information is reference only. It will not copy codes or any data to existing claim. Users will have to memorize the codes and then manually select them on existing claim. Modifiers, Units, NDC Codes etc. associated to individual charge codes will not be shown on ‘Claims Hx’ pop-up.

25.5 New Button ‘EMR Codes’ is added to display the list of CPT / HCPC codes added on Assessment screen.

A new button ‘EMR Codes’ has been added on the Claims > Edit screen. This button when invoked will open a ‘New Assessment Charges’ pop-up. This pop-up will show a list of charge codes which are added to Assessment at a later date, if the encounter is not closed. In a scenario, when a user creates a claim from the Encounter Close screen, the Claims get created on the Claims > Edit screen if the property ‘create.claims.condition’ is set to ‘C’ i.e. if CPT/HCPC is present for encounter. Since the Encounter is open and the user adds the CPT/HCPC codes on the Encounter Close screen. This would create a mismatch between the Assessment and the Claims screens. This button ‘EMR Codes’ on the Claims > Edit screen gives the Biller an opportunity to reconcile both, and make one step simpler by invoking a pop-up ‘New Assessment Charges’, when clicked on button ‘EMR Codes’. This pop-up shows a list of new added charge codes on the Assessment screen. By selecting the charge row and clicking on button ‘ok’ the list of charge rows are added on the Claims > Edit screen.

25.6 Non- Associated ICD codes can now be sent by EDI.

When the Claim was marked as Ready to Send and ther were some ICD codes which were NOT assigned to any charge code, it would give an error(unless they were associated to Voided charge codes). Some clinics need to have multiple ICDs on the claim which have NOT been assigned to any charge rows. Such Claims are expected to be sent by EDI Only and Not as CMS. Now, such Non-Associated ICD codes will be sent by EDI and that too without any warning message by setting the 'billing.claim.nonused.icds.ok' to ‘Y’.

Note: CMS 1500 will not print Non-Associated ICD codes.

25.7 Suppression of message ‘Insurance co-pay applicable but not collected’ when Hosp Claims are marked as Ready to Send.

When a claim is marked as Ready to Send, there is a check comparing Co-pay to be collected with whether Co-pay has really been collected. If the Co-pay is supposed to be collected for a patient, it is saved in Co-pay Field of Patient Insurance screen. So if there is some Positive Amt saved in this field but for a claim, Co-pay has not been collected, a warning is given ‘Insurance co-pay applicable but not collected’. This check is not needed for Hospital Patients because the Hospital collects the Copay and not the individual provider or clinic. Hence, in case of following scenarios, this message has been suppressed on Ready to Send:

• Professional Claims: If ‘Hosp From Date’ is present on ‘I’ button.
• Institutional Claims: If on ‘U’ button, radio button ‘Inpatient’ is selected.

25.8 ‘H’ icon added on ICD Table on Claim next to + button to quickly add ICDs billed in previous claims to current claim.

Icon ‘H’ has been added on ICD Table on Claim screen, next to icon ‘+’ to quickly add ICDs billed in previous claims to current claim. When clicked on it, it will show list of all ICD codes used in this Patients Billed claims. The list would be shown in 3 columns, a checkbox to select multiple ICD Code and its Description.

Note: If the Claims are not present or present but none are in Status ‘Billed’, this list will show blank.

25.9 Batch Processing of Claims now supported for all Payors by setting a property to ‘ALL’.

If existing property ‘837.inswise.payorids4claimsbatch’ is set to ‘ALL’ then a single Batch is considered for all Primary Claims going out and a single EDI837 file is created for Primary. A separate Batch is created for Secondary Claims going out and a single EDI837 file is created for Secondary. If there are multiple Clearing Houses turned on for EDI for a clinic, for each clearing house, single batch for Primary and single batch for Secondary claims is created in respective Clearing House folder.

Note: Tertiary EDI claims are not supported. Hence this feature is not applicable for Tertiary.

25.10 On the ‘Add’ Charge Code list: New list name ‘ALL’ is added.

A new list name ‘ALL’ is added on the field ‘Add’ charge code, to quickly enter all the charge code (CPT/HCPC/Item/Special Charge/ Revenue Codes) related to the claims in comma separated. The Biller can also add the Charge code by clicking on the search binocular. A pop-up will be displayed with the combined codes list for CPT/HCPC/Item/Special Charge/ Revenue Codes.

Note: For Institutional Claims only the ‘Revenue Codes’ will be displayed on the search binocular, when the list name ‘ALL’ is selected.

25.11 Button ‘delete’ is disabled on Claim in 2 scenarios.

The button ‘delete’ is disabled when there is a ‘Claim Letter’ or ‘Assign To’ associated with the claim.

25.12 New Validation added on ‘U’ button.

A new validation ‘Statement Covers From and Upto Date can not be same if Admission HH:MM and Discharge HH:MM is same.’ is added on the ‘U’ button. For an ‘In Patient’ when the Statement Covers From and Statement Covers Upto is same and Statement Covers From and Upto Date can not be same if Admission HH:MM and Discharge HH:MM is same.

25.13 Validation on Address for(Patient / Responsible Person / Insurance / Subscriber)

State Code must be present for all Addresses.

25.14 Subscriber Id must be present for Patient Insurance Subscriber.

Subscriber Id must be present for Patient Insurance Subscriber.

25.15 Subscriber First name / Last name must be present for Patient Insurance Subscriber if relation is Not Self.

If Subscriber is not self but Spouse, Parent, Legal Guardian, etc., both First Name and Last Name are mandatory.

25.16 Copay, Deductible, Visit Fee bucket Amounts related validations while processing claims have been removed.

If Copay / Deductible was collected and No charge was Billed to Insurance, then the Copay / Deductible amount is moved to Advance on Ready to Send. If Visit Amount was collected and Amount was Not Billed to Patient, it is still considered OK, earlier the program gave an error message. This Visit Amount is NOT moved to Advance, it is considered to match the Patient Responsible amount specified in the Insurance EOB.

25.17 The Copay collected amount is moved to Advance when the claim is made Void.

If claim is made Void, the Copay collected amount is moved to Advance.

25.18 Auto 'Recalc' is done when a 'Entered' Status claim's Insurance is changed.

Before the claim is processed, after save if Primary Insurance is changed from 'Insurance' to 'SelfPay', all charges billed to Insurance are billed to Patient. New applicable fee schedule is considered and all charges recomputed accordingly.

If Primary Insurance is changed from 'SelfPay' to 'Insurance', all charges billed to Patient are billed to Insurance. New applicable fee schedule is considered and all charges recomputed accordingly.

If Primary Insurance is changed from 'one' Insurance to 'another', new applicable fee schedule is considered and all charges recomputed accordingly.

25.19 Icon 'Rearrange Claim Details' is added to drag and drop the charge rows.

When the icon 'Rearrange Claim Details' is invoked a pop-up 'Rearrange Claim Details' is opened. The user can click on the charge row and drag and drop the required selected charge row to the required sequence. This provides a simpler way to the Biller to change the sequence rather than using the Move up and Move down buttons.

25.20 A message is displayed when the date of last updation is less than the date of latest updation of Assessment.

On save of the claim if the date of last updation is less than the Date of latest Updation of Assessment Icd / Cpt/ Hcpc, then a message 'Assessment CPT changed after save of claim' is displayed on load of the claim.

25.21 5010 restriction on compulsary assignment of Claim level ICD to atleast one CPT removed.

Earlier on 'Ready to Send' all ICDs associated to the Claim had to be assigned to all the charge codes. If they were not assigned to any of the charge code a message'ICD code xxx.xx is not assigned to any billable charge code.' was displayed on marking the claim 'Ready to Send' stopping further processing of claim. Now, even if a ICD code is not assigned to any charge code, it will be allowed to be present in Claim and while printing CMS 1500 / Sending by EDI all ICD Codes on claim will be considered.

25.22 CMS 1500: The value for the 24H box is set to BLANK by default.

On CMS1500 the Tag [BLD_TICK_EPSDTFP] to print value for box 24H, had a default value 'N', now the default value is set to 'Blank'.

25.23 Compose Message: Zoom Button is shown in the Inbox if it is associated to the Claim.

If the Biller is on the Claim >> Edit screen and composes a message. The Recipient of the message will see a Zoom button in their Inbox to be able to zoom to the claim. Earlier on delete of the Claim, the Zoom button would point to a non-existing claim and would crash. Now, if the Claim is deleted the zoom button is not seen in the inbox of the recipient.

26. Claims >> New:

26.1 Referring Provider auto populates from Patient Register.

On Claims >> New screen, if option ‘Create New Claim’ is selected and the ‘Patient’ name is selected, the name of the 'Referring Provider' gets auto populated from Patient > Registration screen. If the ‘Patient’ name is changed, then the auto populated ‘Referring Provider’ will be retained. If the field ‘Referring Provider’ is made blank and the field ‘Patient’ is changed, then the Referring Provider is refetched for the changed Patient.

Figure: Referring Provider is auto populated.

26.2 Option for creating missing Claims for a specific dates Encounters in bulk.

A new option 'Create Claims for Encounter Dated', has been added on the Claims > New screen, to create Claims for all Encounters at the end of the day. Earlier the Biller had to close the Encounter individually by selecting the checkbox ‘Create Claim’ on the Encounter screen which time consuming. This option is dependent on the parameter set in property ‘create.claims.for.encounters.of.

• If Yesterday’ is set in this property by default Yesterday’s’ date will be displayed on the Claims > New screen.
• If Today is set, by default Toady’s’ date will be displayed on the screen.
• Otherwise, if the property is not set, the default date displayed will be the Yesterday’s’ date.

With this parameter setting on the property, the date will be displayed and the claims will be created accordingly. The Claim creation is also dependent on the property set in ‘create.claims.condition’ as follows:

1. When the property is set to A claims will be created always even if Cpt / Hcpc is not present in the assessment. A message ‘X claims created for X Encounters.’ will be displayed.




Figure: “X claim created with X Encounters” is displayed when the property is set to ‘A’.

2. If set to C, Claims will be created only when the claims is associated with Cpt / Hcpc. A message ‘X claims created for Y Encounters.’ will be displayed.



Figure: “X claim created with Y Encounters” is displayed when the property is set to ‘C’.

3. If set to N, No Claims will be created and a message “0 claims created for X Encounters.” will be displayed.



Figure: “X claim created with Y Encounters” is displayed when the property is set to ‘N’.

• If there are ‘No open Encounters’ then the message “No qualifying Encounters found. Hence, no Claims created.” Will be displayed.



Figure: When ‘No Open Encounter’ is present the message “No qualifying encounters found. Hence, no Claims created” is displayed.

27. Filters icon.

27.1 Favorite Filters can be 'saved' and 'selected'. New Filters added and categorized.

A list Box ‘Select Filters’ shows the List of Defined filters. User can edit an existing Filter Or Save a new Filter. Buttons ‘apply / save filter / save as’ are introduced. Rearranged the sequence of fields and categorized them.

Note: The filter icon tooltip will now shows the name of the ‘saved filter’ if selected.

4 new Filters added with Search binocular icon:

• Insurance Selection
• Insurance AR Group
• Charge Codes
• Charge User Category

New fields are added in the filter pop-up.

Figure: Select Filter, 'apply, save filter, save as' buttons and new fields with search icon are added.

Note: ‘Filter’ icon is available from following screens: Like Claims > Edit / Send Claims / Send UB04 / Outstanding / Claims Center / Charges Center / Reports > By Claims.

Note: The filter icon is added on the following screens: Claims > Unprocessed /

27.2 The Boolean value is changed from NO / YES to BLANK / YES.

The field where boolean values 'NO /YES' were been displayed will now display 'BLANK' as the default value and 'YES' as its 1st value.

Figure: Boolean condition changed to 'BLANK/YES'.

28. Claims >> Send Claims : Enhancements

28.1 On every tab a folder will be displayed.

A folder will be displayed beside the tab name, if the tab will have one or more than one row under the tab.

28.2 'Progress Note' icon is displayed on DOS column.

A ‘Progress Notes’ icon is displayed on the DOS column. The Biller can read the encounter Progress note and makes an assessment, whether the CPT/HCPC codes used are right or it needs to be changed. This is important since many Doctors do not enter any codes, but leave it to the Biller to do so.

28.3 The ‘Track Status’ will show the status as ‘HIDE_SUPRESS’ and the Claim will not be sent.

If the Claim Id checkbox is checked and also the Hide checkbox of the claim is checked, the Claim Status is changed from ‘S(Ready to Send)’ to ‘B(Billed)’. The ‘Track Status’ will show the status as ‘HIDE_SUPRESS’ and the Claim will not be sent.

28.4 A new button ‘print notes’ is provided for the multiselection purpose.

A new button ‘print notes’ is provided for the multiselection purpose. If multiple claims are selected and the button ‘print notes’ is clicked, it will generate all the progress notes using the encounter default progress note template in a single window.

28.5 Claim is removed from the Claims >> Send Claims buckets.

In a scenerio, if a claim is built from the EMR side the Claim Status is set to E(Entered) and on 'Ready to Send' and 'save' the Claim is seen in the Claims >> Send Claims bucket. If the biller edits / adds the assessment from the EMR side. The Claim Status will chang from 'S(Ready to Send)' to 'E(Entered)' and the claim will be removed from the Claims >> Send Claims buckets.

28.6 Sec EDI tab: If none of the Charges have responsibility with Primary then the Claim will be in Sec-EDI tab.

If none of the Charges have responsibility with Primary and the property 'edi.send.sec.ifno.pri.resp' is set to 'Y', then the Claim will be exclusive under Sec Edi tab.

29 Emp Invoice: The Layout of the pop-up is changed to make it more readable.

Claims > Emp Invoice: When Claims > Emp Invoices is clicked, the pop-up ‘Employer Invoice’ is invoked. Some of the fields are rearranged for the ‘User’, for their more readability. The ‘Display Invoice’ and the ‘Create Invoice’ is been separated by a blue line or demarcated.

In this feature, a new provision is provided to select ‘Period’. On selection of the ‘Period’ from the drop down list box the ‘From’ and ‘Upto’ Date changes accordingly. The User can edit these dates further if required. If the dates are ‘edited’ the ‘Period’ drop down list changes to ‘Custom Date’.

Figure: Employer Invoice Report screen with demarcation and field Period having Custom Date selected.

30. Claims >> Outstanding

30.1 Columns ‘Rendering Doc, Loc and Bu’ are moved to right so that ‘Assign To’ can be seen without scrolling to the right.

The columns Rendering Doc, Loc and Bu are moved to the right, so that the Biller can see the Assign To details columns like AssignTo, AssignDate and AssignStatus beside each other.

Note: The Biller can now sort the list by Assign To and Assign Status. If the last Assign Task is marked as ‘Done’, the status gets a Prefix of ‘DONE’, and the cell gets a ‘green’ background color. If there are any ‘Denied’ charge rows for a claim without any ‘Comments’ entered, the ‘Denied’ count is displayed in ‘Red’ color, indicating that work needs to be done.

30.2 More filter criteria introduced in button 'Filter'.

Few more filter conditions are added on pop up ‘Outstanding Filter’ to support the new features like ‘Assign To’, 'Assigned Status' and ‘Open Assignment ’ in PrognoCIS.

Figure: New filter conditions added on pop up ‘Outstanding Filter’.

30.3 Denied Column: The count become RED when all Denied Charge Rows for a Claim are with No Action.

When all the Denied charge rows for a claim are with action as 'No Action', the Denied count is displayed in RED, indicationg that further action needs to be taken for that particular claim. On click of the hyperlinked denied count, a pop-up 'Denied-No Action' is invoked. On clicking on the Notes icon, the Biller can add the comments /action to be taken for that particular charge code of the claim.

If atleast one Denied charge code of the claim having multiple Denials has any other action taken (Other than No Action), the count of Denied - No Action charge codes is displayed in black.

Figure: Denied count in RED indicating that all Denied charge codes of the claim are with 'No Action'. .

31. Claims >> Claims Center

31.1 ‘Billed Amt’ is displayed on RED if Fully UnPaid.

If the Claim Amt is Fully UnPaid then 'Billed Amt' is displayed in RED indicating the Biller that the amount is fully unpaid.

Figure: 'Billed Amt' is Red when Fully Unpaid .

Note: This Feature is also available in Claims >> Charge Center.

32. Remittance >> EOB

32.1 Icon ’View Attachment’ Popup will contain All Documents related to Remittance Voucher.

All documents related to Remittances Voucher can be viewed in the ‘View Attachment’pop-up.

• Remittance Date & Instrument Hyperlink are removed.

The options in the list box are as follows:

• EOB Attachment
• Prognocis Generated Report Html (for ELE)
• EDI 835 (for ELE) (The incoming EDI File can refer to multiple ST segments i.e. multiple Cheques, each of which translates into a different EOB voucher. The program breaks up the EDI file by voucher and attaches the corresponding one) EDI Errors (for ELE)
• EDI Log (for ELE) (One Log file is created per day)

A new property has been added to use Non–ProgoCIS amount feature ‘era.835.use.nonprognocisamts' (Applicable to ELEs). If this is set to Y, and the Claim specified in ELE is NOT part of Prognocis it adds the amount as Non PrognoCIS Amount. Some users prefer to keep the property as N, so that the program will generate and add the ELE error Invalid Claim / Claim is Void etc which is more useful and allows user to take appropriate action.

32.2 Claim Search Popup :  Checkbox is renamed  and added.

The ‘All’ checkbox is renamed to ‘Include Zero Amts’ and a new checkbox ‘Show Void Claims’ is added to view ‘Voided’ Claim.

33.3 Statement Comments: Entry and Addition on Remittance screen.

While posting the EOB for a patient claim, there were denials for Insurance Information insufficient or Pre-Existing condition or some Patient Responsibilities like 'Not Covered' charges. Explanation of this needed to be sent to patient so that Patient understands the Statement better and can take appropriate action if needed. Hence a new field is added to type some comments for patients which should print on the 'Patient Statements'. The most relevant place to enter such ‘Statement Comments’ is EOB screen while posting the EOB. The Biller can also add comments for the Denied Charge Code.

33.4 Payment can be Received / Recoup against a Voided Claim.

The Biller can Receive Payment / Recoup against a Voided Claim. Claim search now displays Voided Claims when checkbox ‘Show Voided Claims’ is checked. If current selected Claim is Voided, VOID label will be displayed in the icons row in RED.

33.5 Icon 'Refresh Claim Amounts' is added to compute and update 'Charge Code' and 'Bill Amount' columns.

The icon ‘Refresh Claim Amounts’ computes and updates the Charge Code Bill Amount Column. In a scenario where two insurances are present, if the User reopens and edits the Primary Insurance EOB and post it and then opens the Secondary Insurance and clicks on icon ‘Refresh Claim Amounts’ the changes which were done on the Primary Insurance will be reflected on the Secondary Insurance EOB which was already created.

33.6 HSA/HRA Payment for Patient Responsibility even after Patient Responsibility is zero.

For ‘HSA/HRA’ Payment the paid amount cannot exceed the ‘Patient Responsibility Amount’. However the Biller can accept Extra Payment by using the (Ex) button. Whatever will be entered as Extra Payment will be moved to the Patient Advance Amount bucket.

34 Remittance > Denied.

It lists the Charge rows from EOBs which were marked as Denied and No further action had been taken.

• New Icons are provided for Claims Letter, Caim Ledger and Assign To.
• A hyperlink R is provided in the column ‘Notes’ if there are any other voucher for the same charge code attached (irrespective whether it was from Primary/ Secondary/ Tertiary/ Patient).

35 Remittance > Unallocated, Processed : A new label ‘Count’ is added before the label ‘Total’ amount.

36 DRG Codes now supported for sending via EDI and Paper on UB04 Claims.

DRG stands for Diagnosis Related Group codes and is used for In-Patient Hospital adjudication. DRG codes have links to Patient Age, Sex, Primary Diagnosis, Secondary Diagnosis, Procedure Codes and determine the weightage using DRG code that is used for reimbursement of claims.

• For In-patient hospital adjudication, this code is used.
• Currently this is applicable only on Billing side.
• In PrognoCIS, it is implemented in U button of the claim.
• If the user has entered any specific ICD code in the claim, then system shows the DRG code for that ICD in the search.
• If the user has not entered any ICD code in the claim, then system shows the complete list of DRG code in the search.
• Only one DRG code can be selected for a claim.
• This DRG code is printed in Cell 71 of UB04 paper claim
• This DRG code goes out by EDI under segment HI*DR:xxx~ where xxx is the 3 digit DRG code selected in the claim.

Note: A request has to be made to Technical Support Team for including DRG codes in PrognoCIS.

37 Reports > Statement, Reports > Ledger, Reports > By Claims related changes.

37.1 Radio buttons ‘Print Ope Bal and Ope Claim Details’ are removed.

Radio buttons ‘Pri Ope Bal’ and ‘Ope Claim Details’ are removed. By default the statement will always print Opening Claim Details.

37.2 Checkbox ‘Hide fully balanced claims’ is changed to ‘Hide Matched Claims’.

If ‘Hide Matched Claim’ is selected then it is suppressed from statement even if it got matched during last 30 days / selected period. The EOB Charge Denied Reason is currently printed in statement depending on a property. No change to this handling. Statement Comments do Not affect current behavior. Assume 3 charge rows are denied, and each has a statement comment which is different. While printing the statement, each of the Charge lines will be printed with their Actual Denial Reason (which the user cannot understand) and then at the end it will again print the Charge Code1: Statement Comment1, Charge Code2: Statement Comment2, Charge Code3: Statement Comment3 This will NOT be confusing for the user. Transaction for Void Claims DO NOT appears in the Statement. All these consideration(changes) are also applicable to the CSV statements generated.

The other changes are as follows.

• Radio button option ‘Layout 2’ is removed.
• The label ‘Outstanding From’ is changed to ‘Oustanding From Resp Date’.
• Label ‘Patients Financial Class’ with 3 options ‘All, Non-Collections, Collection’ are added.
• The checkbox ‘Send Letters’ is renamed to ‘Add to Patient A/c – Letters’
• Group by list box has a new option ‘Ins ARGroup’
• Layout Button: The sequence of the rows/fields can be changed by Drag and Drop.

  User can click on a row in the pop up, drag and Drop to the required sequence of fields. This provides a simpler way to change sequence rather than using the Move up Move down buttons.

38. Reports > Statistics

38.1 The popup has a provision to select a period and a claim filter and New option are added.

The new options added in the list are as follows:

• EOB Denied
• EOB Disputed
• EOB Retain Resp
• EOB Sec On Hold
• EOB Sec On Hold
• Top 10 Charges Billed
• Top 10 Insurances Billed
• Charge Code wise Insurances Billed and Allowed amounts

Note:The Selected filter conditions are printed at the end of the report.

39. Settings > Configuration > Insurance : Default settings are done for 'AR Group' and 'Response Time'

If the list ‘AR Group’ is NOT selected then it is set as ‘UNKNOWN’ by default.

40. Settings > Configuration > Fee Schedule

In Fee Schedule screen the User is able to define Revenue Code wise Charge wise Rates. If the Code Type field is selected as ‘UB04 Revenue Charges’ the buttons ‘AddMod’ and ‘DelMod’ is changed to ‘AddCharge’ and ‘DelCharge’. When the ‘AddCharge’ button is clicked the User can select any CPT/HCPC Code, the selected Revenue Code and CPT/HCPC combination row is created and rate can be defined for the combination.

41. Scrubber Checks Enhancements:

New Fields and Operators are added. The Operand list box will display the code followed by their Name. New Operators are added.

Figure: New fields added on Operand and Operator List box.

42. New Tags Introduced.

[CASE_INJURY_DATE]
[CASE_INJURY_PLACE]
[CASE_INJURY_STATE]
[CASE_BODYPART]
[CASE_STATUS]
[CASE_DATE_1STILLFROM]
[CASE_DATE_1STILLUPTO]
[CASE_DATE_SAMILLNESS]
[CASE_DATE_HOSPFROM]
[CASE_DATE_HOSPUPTO]
[CASE_DATE_NWORKFROM]
[CASE_DATE_NWORKUPTO]
[CASE_DATE_CLOSED]
[CASE_WCAB]
[CASE_QMEPANEL]
[CASE_LIENNOTES]
[CASE_INS_NAME]
[CASE_INS_SUBSCRIBERID]
[CASE_INS_ATTORNEY]
[CASE_INS_ADJUSTER]
[CASE_PAT_ATTORNEY]
[CASE_PAT_ADJUSTER]
[CASE_MANAGER1]
[CASE_MANAGER2]
[CASE_MANAGER3]
[CASE_VISITS_APPROVED]
[CASE_VISITS_ACTUAL]
[CASE_COMMENT]
[CASE_PREAUTH]
[CASE_END]
[CASE_AMOUNT_APPROVED]
[CASE_AMOUNT_ACTUAL]
CASE_INITIAL_TREATMENT_DATE
[ENC_CASEID]
[PT_CASEMGMT_CASENO]
[PT_CASEMGMT_INJURYDT]
[PT_CASEMGMT_INJURYPLACE]
[PT_CASEMGMT_BODYPART]
[PT_CASEMGMT_DISABILITY]
[PT_CASEMGMT_WCAB]
[PT_CASEMGMT_QME]
[PT_CASEMGMT_LIEN]

43. New Properties Added.

Property	Description
prognocis.banner.outsideurlcustom.icon	Giving some value to this property will show PACS Interface icon on banner. On click of which interface will open. Property value is caret (^) separated tool tip and interface URL.(E.g. Digital X-Ray^ http://10.10.1.9/opalweb/IntegrationProcessor.aspx?CMD=OPENSTUDY&ACCESSION=)
pp.reminders.due.days	Enter the number of due days for displaying reminders for HM; Follow Up; and Vaccination on patient portal. If left as blank then by default 15 days is considered. Also, all the older reminders that are still due is displayed.
pp.request.appointment	If the property set to Y then from patient portal if the patient take an appointment then do not take appointment send message to Provider or the rode defined in pp.appointment.mailto
pp.show.disclaimer	Show disclaimer on patient login
eligibility.donotsave.history	If set to Y every time Insurance Eligibility is checked, its record will be saved, else only latest Eligibility record will be saved.
billing.nonbilling.postop.cpt.codes	Enter Comma separated list of CPT and HCPC codes which are used for Post Operative visits and should not be billed. If these charge codes are present on Assessment, they will be dropped while creating claims. Default value Blank.
billing.enrollment.check	Validate if rendering provider has done proper Enrollment and Credentialing.
patient.use.case.management.search	Set to Y to use case management fields on Patient Registration, Encounter, Letter out, Appointment Schedule, CPOE: Refill, Lab & Rad, Message: Compose and Patient: Review search.
patient.allow.one.case	If this property is set to Y, only one Case will be allowed for one patient registered. For every new case, a new patient will have to be added. By default, setting will be N, allowing multiple cases for same Patient
create.claims.for.encounters.of	If set to 'TODAY', the Todays date will be shown on Claims>New menu option Create Claims for Encounters Dated. If set to 'YESTERDAY', yesterday date will be shown.
claim.patresp.on.ready2send	Deposition Claims are Not printed in the statement. As such the Balances could appear to be wrong. Further Depending on a property Claims with status as S and some Bill to Patient are Printed.
billing.cell19.length	This property will decide Maximum length for cell 19
billing.mammography.certnumber	Mammography Certification Number
billing.mammography.chargecodes	Coma separated CPT, HCPC codes like G0202,G0204,G0206,77051,77052,77053,77054,77055,77056,77057
billing.claim.nonused.icds.ok	If this is set to Y, it will allow the non used icds in the claim.
anesthesia.max.overlap.cases	For a DOS, how many overlaps in Anesthesia Time should be allowed while marking the claims with same Attending Doc as Ready to Send is decided by this property. By default, it is set to 0, indicating no check. If set to 1, if 2nd claim with Anesthesia Start Time and End Time overlaps with any other claim already processed for same Attending Doc, this 2nd claim will not be allowed to be processed till Anesthesia Start Time and End Time are changed not to overlap with 1st claim. If set to 2, 3rd claim will be stopped, etc.
patient.allow.one.case	If this property is set to Y, only one Case will be allowed for one patient registered. For every new case, a new patient will have to be added. By default, setting will be N, allowing multiple cases for same Patient
patient.use.case.management.search	Set to Y to use case management fields on Patient Registration, Encounter, Letter out, Appointment Schedule, CPOE: Refill, Lab & Rad, Message: Compose and Patient: Review search.
caseledger.patient.tags	Define Patient and Case Tags to be printed at the start of the Case Ledger.
billing.case.fields.preffered.onclaim	Case Management screen has some fields like Date of Injury, Unable to Work, Hospitalization, State of Accident, etc. which are present on Claim. Same fields on claim are also mapped through properties with Encounter Tests. When this property is set to N, which is default setting, priority will be given to Encounter Test Data while transferring to claim. Any change to data on claim will update the Encounter Test Data but not the Case Data. If set to Y, Case Data will be preferred over Encounter Test data and claim would always show Data from Case irrespective of the Status of Claim. Any change to data on Claim in this setting will not update Case nor Encounter Test Data. Case Data will always override the changed Claim Data on Saving the claim.
billing.nonbilling.postop.cpt.codes	Enter Comma separated list of CPT and HCPC codes which are used for Post Operative visits and should not be billed. If these charge codes are present on Assessment, they will be dropped while creating claims. Default value Blank.
cpthcpcitemsplrev	New search section added.
billing.statementcomments.printtillclaimfullypaid	If set to Y, as soon as Claim is evened out, does not prints Statement comments, continues to show the added comments for the claim on the EOB. If set to N, Statement Comments should get print till explicitly removed from the charge code from EOB screen. Even if removed, the Claims notes will still have a record that Statement Comments were added.
statement.comment.print.tillclmsettled	If set to N, Statement Comments should continue to print till explicitly removed from the charge code from EOB screen. Even if removed, the Claims notes will still have a record that Statement Comments were added
era.835.use.nonprognocisamts	(Applicable to ELEs). If this is set to Y, and the Claim specified in ELE is NOT part of Prognocis it adds the amount as Non Prognocis Amount. Some users prefer to keep the property as N, so that the program will generate and add the ELE error Invalid Claim / Claim is Void etc which is more useful and allows user to take appropriate action.
837.send.billed.charges2sec	If set to Y, consider only those charges which are sec insurance responsibility.
edi.send.sec.ifno.pri.resp	if set to Y, then a claim will be under Sec Edi Only if None of the Charges have responsibility with Primary otherwise means send only if all charge rows are sec insurance responsibility.
837.extra.folder4payerids	Here user can specify the comma separated payer Ids. Now if a EDI is created for an Insurance say Medicare whose PayerId is specified then it will ensure that the EDI is present in EDI837EXTRA only, it wont be present in EDI837.
billing.max.receipt.openbatches	Insurance Aging output can be configured by adding more columns with Insurance Information. SSpecify upper limit of Receipt Batch Numbers allowed to be kept open. After this upper limit is reached, new Receipt Batch numbers are not allowed to be created till some open Batches are closed. If set to Blank, default value of this property is considered as 99.
billing.insaging.titles	Patient Aging output can be configured by adding more columns with Patient Information. Std Patient and Insurance Tags are supported. Default columns: DOB, CHART No, Home Phone.The supported Column Names include PT_DISPLAY_NAME,PT_CHART_NO,PT_DOB and Address tags with prefix.SL,ADDRESS_SL,ML,ADDRESS_ML,LINE1, etc.
billing.pataging.titles	Titles for additional Insurance Fields on Patient Aging Output defined in property billing.pataging.fields have to be added here as comma separated list.
billing.insaging.fields	Insurance Aging output can be configured by adding more columns with Insurance Information. Std Insurance Tags are supported. IM_NAME, etc.
billing.insaging.titles	Titles for additional Insurance Fields on Insurance Aging Output defined in property billing.insaging.fields have to be added here as comma separated list.
statement.csv.clinictags	If the clinic would like to send the patient statements with a different business name, address and telephone other than CL location, user can specify them here with for new lines.
csv.statement.withpdf	Generate a Pdf file for every patient along with the csv file generated.
statement.completion.email.to	Specify comma separated the email IDs who will receive a emails after CSV Patient Statement Process is Complete.
medics.supporting.resource.display	If the property value is set to Y, then on provider master the supporting resource list is available for selection.

44. Browser: IE 10 Settings for Windows 8.

Perform the following steps to enable the compatibility view for IE 10:

1. Open Internet Explorer browser.
2. Click the Tools menu at the top, and then click Compatibility View Settings.
3. Select the checkbox ‘Display all websites in Compatibility View’ in the Compatibility View Settings popup.
4. Click ‘Close’ to save the changes.
5. Access PrognoCIS URL.