Release Notes (Billing)
Version No: 2.0
Build No: 4

1. Introduction

A number of new features related to PrognoCIS Billing has been released in Version 2.0 Build 4.

Following is a list of these new additions in brief:

2. New Features

Appointments > Schedule

1. Pre authorization number can be associated to an appointment.

From Appointments > Schedule Pre authorization number can be associated to an appointment. This affects the pre-auth number count for Appointment scheduled.

1. Once this appointment is marked "Arrived" and encounter starts, this increases the count of Visits Used and decreases the count of Appointment Scheduled with Pre-auth by 1.
2. When the pre-auth number is associated to an appointment, it is automatically populated on claim when the claim is created from EMR side.
3. Same way, if the Pre-auth number populated above is deleted from claim, the Pre-auth counts change appropriately.

2. Responsible Person can be a minor. Only a warning will be given.

3. Merge Patient process now also includes merging of Billing related table records

    Claims / Remittances and other Billing table records also get merged when two patients are merged.

Patient Insurance

4. Additional Information displayed via Pre-Auth button

    PreAuth button now displays Visits Used, Appt Scheduled and Balance Visits.

1. When the pre-auth number is associated to an appointment, it is automatically populated on claim when the claim is created from EMR side.
2. Same way, if the Pre-auth number populated above is deleted from claim, the Pre-auth counts change appropriately.
3. If pre-auth number associated to appt is changed to other valid pre-auth number from claim, the counts of both pre-auth numbers are changed appropriately.
4. If Pre-auth number is associated to a claim created from Billing side, the counts change appropriately.

5. IPA: Three new "Insurance Types" and associated Fee For Service properties have been introduced: IPA-A, IPA-B and IPA-C are the 3 new Insurance Types and the corresponding 3     properties are billing.ipa-a.fee4service.codes, billing.ipa-b.fee4service.codes, billing.ipa-c.fee4service.codes. The original Insurance Type "IPA" still exists.

Billing > Home

6. On Hold Status now shown on Billing Home Page > Appt Tab > Column Name: Billing Status.
    When Claim Status changes to "On Hold", it will be reflected on Home Page under column "Billing Status".

Claim > Edit

7. Pre-Auth functionality extended on Claim Screen

1. Pre-auth Number now gets populated automatically on claim screen if Appointment associated to it had a Pre-auth number associated.
2. When a claim is posted, all expired Pre-Auth numbers are closed:
   It considers the Primary Patient Insurance Record applicable for claim, and Closes all Pre-Auth entries based on Upto Date AND No of Visits Approved and Used.
3. CLIA Number also shown on "i" button of claim screen in column next to PreAuthorized Visits.

8. The subscriber CAN be a minor. Only a warning will be given

    Now only a warning prompt is displayed alerting the user that the Subscriber is a minor and it will not stop the user from posting the claim.

9. A suffix, 'Minor' is visible along side the name of the Responsible person who also happens to be a minor

    If the Responsible Person is a Minor, his name is suffixed with the word (Minor).

10. The Date of Birth of a patient is displayed along side the Account Number in the Claim

     The Date of Birth of a patient is displayed next to the Account Number on the Claim screen. This will help identify patients with same First and Last name based on DOB. If Patient is a      Minor, his DOB is displayed in red color

11. Changed hard coded Patient Short Name to Display Name

    The Patient name on Claim was hard coded as Last First. Now, it will be customizable through property "patient.name.format". This property is already in use for deciding the format of     Display Name. If Middle Name of Patient has to be displayed, try putting L, F M in the property and it should display complete Middle name as well.

12. Support to manually enter ICD codes directly in the ICD table row provided

       Besides the [+]button for selection, user can enter the ICD Code on each table row. On tab out, it validates the code entered. If it was correct, the name is populated under the next       column, other wise the wrong code is blanked out.

13. UB04 Support for Hospital Claim generation and printing now provided

      U Button for UB04: Hospital Claims generation and printing is now supported from PrognoCIS. For entering additional information on a UB04 claim, U button is provided.
      Note: Claims Paper Form: This checkbox is checked and disabled if UB04 is applicable. This is because currently only UB04 PRINTING is supported. Once Edi 837I is provided, this       constraint will be removed.

14. UB04 Claims creation from Encounter:

      UB04 claims will be created from Encounter if Encounter Type matches the Encounter type codes defined in following property:

      Property: encounters.visittype.ub04

      Note: In such a case the Procedure codes (CPT and HCPC) are not transferred from encounter to the claim, however the Diagnosis (ICD) Codes are transferred. Make sure to select only       Revenue Codes from UB04 Claim once created.

15. The charge code now is displayed as drop-down menu items rather than buttons

      CPT / HCPC / Item / Spl Codes Buttons are dropped. Instead a List Box is provided with options Cpt / Hcpc / Revenue / Special Charge / Item. Revenue Charges are used in case pf UB04,       and the option is available when the U button is enabled. This List box is followed with an edit control to enter 1 Or more than 1 comma separated codes. On tab out the entered codes       are validated and charge lines are added with their applicable rate. The edit control is followed by a search button. This search works for the option selected in the List box.

      If property billing.bypass.hosp.uptodate.check=N, Hospitalization Upto Date on "i" button of claim is not allowed.

17. Support for entering 'Modifiers' on each Charge row provided

      Modifiers can also be entered, besides using the search button on each Charge Line.

18. Modifiers pop-up present on each Charge row now retains the already entered Modifiers

      Modifiers pop up on each charge row now retains the already entered Modifiers

19. Support for editing the assigned ICDs present on each Charge Line provided

      Assigned ICDs can also be similarly edited on each Charge Line.

20. A separate button icon provided to assign a secondary insurance without reopening the Claim

      Assign Secondary Insurance Button: An Icon with ”2nd” written on it is provided on the Claims page to be able to assign the Secondary Insurance without reopening it.

21. Automatic assignment of ICDs to charge codes on 'Ready to Send' (condition based)

      ICD assignment to Charges automatic on Ready to Send if there are no ICDs assigned and No of ICDs are <= 4. If the No of ICDs are more than 4 in a claim, they are not assigned to       charges automatically.

22. Validation when Claim is reposted: If Sec ins = Blank AND earlier there was a Sec Ins in Archive records, an error message will be displayed.

       In case of a claim with 2 insurances, on posting primary remittance, secondary responsibility gets created. After the Secondary responsibility is created, if the claim is reopened and       Secondary insurance associated to claim is removed, and claim is reposted, appropriate error message will be displayed, not allowing removal of Secondary Insurance from claim, thus       avoiding mismatch in Insurance Aging.

23. Another Validation when Claim is reposted: If Sec Insurance is NOT Blank AND earlier there was a different Sec Ins in Archive records, an error message will be displayed.

      In case of a claim with 2 insurances, on posting primary remittance, secondary responsibility gets created. After the Secondary responsibility is created, if the claim is reopened and       Secondary insurance associated to claim is changed to some other Insurance and claim is reposted, appropriate error message will be displayed, not allowing changing Secondary       Insurance from claim, thus avoiding mismatch in Insurance Aging.

24. Support provided to print Tertiary Claims

      Hyperlink "Other Ins" allows associating Tertiary Insurance to a claim and printing it from the "Print" icon.

      Note: Tertiary Claims EDI processing and payment posting currently NOT supported.

Claims > New

25. UB04 Checkbox: Provided to create a claim for UB04. If this is checked, the button "U" on the claim screen will be enabled and option "Revenue Codes" is seen in Charge Codes       dropdown.

26. Autocomplete: The Patient Name, Rendering Provider name, and Referring Provider name can be typed in with Autocomplete facility.

Claims > Unprocessed

27. Filter: On selecting a filter, even if the user goes to some other screen and comes back, the system remembers the last filter applied.

28. Print button: Provided to print ALL rows (of All pages) of Unprocessed entries.

29. Excel button: All rows of unprocessed entries are provided to download as Excel file. "R" Status: The status column displays "R" if the claim was processed earlier and is currently       Reopened.

Claims > Send Claims

30. Overdue: The label for second Radio button "ET" is now changed to 'Overdue'.

31. Pri EDI : Status = 99: All validations should be passed before processing:
      For all claims in Send Claims Pri EDI bucket, button "Validate" will have to be pressed and only after the status has changed to 99, will the Primary EDI claims be sent on click of button       "Process".

32. Printing Issue resolved: When "Process" button is clicked, instead of directly sending the claims to printer, now a "Download File" popup will appear with 2 options to "Open" and       "Save" so that the generated file can be downloaded and saved by the user (and later printed) OR can be opened as a PDF and sent to the printer (will depend on the Adobe version       running on Users PC and its configuration).

33. Download Files: The same file will be also available under the Settings > Configuration > Download files option. This option will be useful when a number of claims are selected for       printing, so that user can go to any other option and Not wait for the download popup to appear.

34. An alert is generated if applicable for CPT in Global Period.

1. On Original Post of a claim (Not when reposted after Reopening), an alert is generated on the name of the user who processed the claim if any CPT billed in that claim has "Global       Period" checkbox checked and "Global Period Days" defined.
   
   The Upto Date of this Alert will be computed based on Global period and the Alert will get closed as soon as Upto Date is crossed.
2. This Alert will be available on Patient Alert Screen accessible from Appointment Scheduler, Encounter and Billing screens.
3. On Appointment Scheduler screen, it will be shown as a pop-up.
4. The message on the Alert will be displayed as follows: "CPT Code XXXXX is in Global Period till (Upto Date Computed)."

CMS 1500

35. Employer's Name or School Name: Box 9C: When Sec or Tertiary claim is printed, it now prints "Other Insurance's Employer Name" using the tag [BLH_INS2_SUBS__EMPLR] and not       [PT_INS2_SUBS__EMPLR].

36. "Other Insured's Sex": Box 9B: When Sec CMS 1500 was printed, following tags had issues printing. Now they are printing.       SB25=[BLH_TICK_INS2SUBSEX_MALE]|SB26=[BLH_TICK_INS2SUBSEX_FEMALE]

Claims >Send UB04

37. Send UB04: A new menu option added:

      For processing UB04 claims, a new menu option "Send UB04" has been added under tab "Claims".
      There are 4 tabs on this screen: Pri EDI, Sec EDI, Pri UB04 and Sec UB04. Tabs "Pri UB04" and "Sec UB04" will show UB04 claims for paper printing for Primary and Secondary Insurances.       These claims can be selected and "Process" button pressed for printing UB04 claims.
      Note: If tabs "Pri EDI" or "Sec EDI" are clicked, it gives a message "Not Implemented". This is because currently only UB04 printing is supported. Once Edi 837I is provided this constraint       will be removed.

Claims > 277 Status

38. Claims > 277 Status

1. A new menu option has been added under Claims called “277 Status”.
2. This Screen would allow users to see the entries of messages related to claims sent to insurances.
3. These messages would have various statuses like Received, Resubmit, Denied, Pending, Rejection, Accepted, etc.
4. The default messages shown on the screen would be filtered by Day to show Today’s received messages.
5. These messages will continue to show on that screen forever and will be seen on applying proper filter.
6. Availity and Office Ally clearing houses do not support 277 messages as of now. So they will continue to show 997 messages in Claims > Returned as per current functionality.
7. Clearing houses like Gateway support 277 types of messages.
8. These 277 messages will be displayed in Track Status pop-up of individual claim as well.

Claims > Outstanding

39. Print button: Provided to print ALL rows (of All pages) of Outstanding entries.

40. Excel button: All rows of outstanding entries are downloaded as Excel file.

Claims > Claims Center

41. Print button: Provided to print ALL rows (of All pages) of Claim entries.

42. Excel button: Provided to download as Excel file, All rows of Claim entries.

Claims > Charge Center

43. Print button: Provided to print ALL rows (of All pages) of Charges entries.

44. Excel button: Provided to download as Excel file, All rows of Charges entries.

Remittance > EOB/ERA

45. Menu Item Name Change: From Entry/ Edit to EOB/ERA to make it more obvious.

      Insurance: Payer Selection made easy: Since Billers prefer to type in rather than use the search, now they can also type in the name of the Insurance Company assisted with an Auto       Complete. If the name typed in is Not a valid Insurance, on tab out, a message is displayed "Not a valid Insurance. Is it a Carrier?". If "Yes" is selected, it will treat the typed name as       Carrier.

46. Primary, Secondary and All Claims selection from a single binocular "Claim":
      Now there is a single Binocular "Claim" for selecting Primary and Secondary Claims. When the binocular "Claim" is clicked, it shows 3 options : Buttons "Pri", 'Sec" and checkbox "All".       Rather than going to various searches, this will be helpful to select all types of claims from a single Search screen at the same time.

47. Ease of claim selection: A new Edit Control has been added between "Claim" Binocular and "Recoup" Binocular on Remittance screen where users can type the comma separated list of       Claim IDs to select the claims rather than selecting the claims from "Claims" binocular for doing remittance

48. Ease of Navigation: In many cases, the number of Claims in a single EOB is quite large and searching claim or saving EOB takes time. This issue has been resolved by introducing       pagination. There are three hyperlinks, "Prev", "Lookup" and "Next" introduced near "Ready to Post" checkbox. Each page will have 4 claims. Hyperlink "Next " will display next 4 claims.       Hyperlink "Prev" will take back to previous 4 claims. To go to a specific Claim, click on "Lookup". This displays a search pop up for all entered Claims and charge rows in EOB. On       Selection of a claim, the EOB screen displays 4 claims starting from the one selected.

49. Claim wise Totals are now displayed in Charges Table instead of showing in a separate table/frame to fix alignment issue: Multi-Resolution support had affected the Remittance       screen because the Totals were not in alignment with Amounts shown in Charges Table. This issue has been fixed now by displaying the Totals in the Charges Table at the end of the       Charge Codes list. The Totals Row is displayed with Green background.
      Note: In cases where there are more charge codes in a claim, the Charges Table will have Vertical Scroll bar and for viewing the Totals, the scrollbar will have to be used.

50. Batch No

      Batch Number is no more required when EOB without Batch No. is reopened.

51. "3 R" Denied actions will get executed only once

      When Remittance is reopened, following Denied - "actions" will not be taken again for any claim having charge codes marked as Denied:

1. Reopen to Resend: Claim will not be reopened unnecessarily.
2. Rebill creating a new claim: A new claim will not be created.
3. Resend without Reopen: Claim will not be sent.

52. Disputed Checkbox: To mark any charge code as Disputed and send to Remittance > Disputed screen when the Allowed amt on EOB is less than the amount signed in contract by       Insurance companies. Used for following up with Insurance companies and for reporting purposes.

53. Disputed Flag will be reset when Additional Payment EOB will be created:
      From Claims where charge codes were marked as Disputed on Remittance screen, if Additional Payment Remittance is created, it will have the "Disputed" checkbox reset. This will       remove the charge code from the screen "Disputed" on posting this remittance

54. New Button: Assign Secondary Insurance To associate a Secondary Insurance on a remittance screen after the claim is sent and EOB from primary is entered and posted, a new button       "Assign Sec" is provided on the bottom row, to be able to assign the Secondary insurance without reopening claim or Primary EOB.

55. Warning on Secondary Responsibility Write-off:
      Now a warning will be given on Secondary Responsibility write-off when Primary Remittance is posted . This warning is to stop Billers from unnecessarily writing off the Secondary       responsibility without trying to receive payments from them.
      In addition, EDI claims will still consider these charge codes for Secondary billing.

56. Pop-up "Status" related Changes on Remittance Screen

*Reason for Denial: On marking a Charge row as Denied / Pending, users had to select the Reason for Denial from List Box, which was too long. Now Autocomplete facility is provided.

*Write-Off Reason: On Status pop-up on Remittance screen, if Denied Action selected is "Write-off, user can and Must select the write off reason from the List Box.

Remittance > Denied

57. Sorting on Denied amounts can now be done by clicking the column Heading "Amount".

58. Print button is provided to print ALL rows (of All pages) of Denied Charges.

59. Excel button is provided to download as Excel file, All rows of Denied Charges.

Remittance > Disputed

60. Disputed:

1. A new menu option added for showing entries of all charge codes where the Insurances allowed fewer amount than what they promised in their contract with the       provider/clinic. Entries are displayed here when any charge code is marked as Disputed by checking the checkbox "Disputed" while posting EOBs. Such entries can then be disputed with Insurance companies by the billers.
2. When the dispute is over, either t he entries will have to be manually removed from this screen OR When the Additional Payment Remittance entry from Insurance is created, it will have "Disputed" checkbox unchecked so that on Post, the entry for that charge code on screen "Remittance > Disputed" is removed. .

Remittance > Insurance Credit

61. Insurance Company name can be now searched by typing assisted by Auto Complete. This screen also has a field "Receipt Batch Number" added now.

Remittance > Ins Refund

62. View Claims Button: Insurance refund screen has a 'View Claims' button. In case of Refund from Insurance Credit, click on that button should display the Claim and Charge details       selected in Insurance Credit for refund.

Remittance > Patient Receipts

63. Auto Complete on Patient Name Field: The User can also type in the patient name assisted with an Auto Complete facility.

Remittance > Pat Item Return

64. Patient Returns option is now renamed as Pat Item Return

Remittance > Patient Refund

65. Auto Complete: The User can now select patient name assisted with Auto Complete facility.

66. Info Button: Users are forced to select the Info Button and associate the appropriate Rendering Provider, Business Unit and Location to the Patient Refund Entry for Reporting purposes.

Remittance > Returned Checks

67. Bounced Checks menu option has been now renamed to Returned Checks. The User can also type in the patient name assisted with an Auto Complete facility. .

Remittance > Patient Xfer Credits

68. Auto Complete: The User can also type in the "From" and "To" patient names assisted with an Auto Complete facility.

Remittance > Capitation Receipts

69. New - Capitation Receipt Screen: A new menu option added to accept contractual amount from Insurance - IPA when the IPA pays at the end of the month / quarter. This amount is not       against any claim or for patient and hence does not affect AR.

70. Info Button: Users are forced to select the Info Button and associate the appropriate Rendering Provider, Business Unit and Location to the Capitation Receipt Entry for reporting       purposes.

71. Auto Complete: The Users can also type in the Insurance Company name assisted with a Auto Complete facility.

Reports > Ins Aging

72. Hyperlinks to show further breakups on Ins Aging O/P reports: If template used for report output is "Insurance wise", the Insurance Name is hyperlinked. When clicked on the       hyperlink, the breakup of Claim wise Aging is seen in pop up. Likewise template chosen for report output is "Insurance wise Claim wise", the Claim details are hyperlinked. Click on the       hyperlink to see the Claim breakup of Charge wise Aging in pop up.

73. Include SelfPay: A new checkbox to include patient responsibility on Ins Aging report output:

1. A new checkbox has been added on Insurance Aging screen. When this checkbox is checked, the last row of the Ins Aging output report will include the row 'Self Pay' which will display total Aging for responsibilities of all Patients.
2. If the Patient Aging has to be included in Ins Aging report everytime, the checkbox 'Include SelfPay' can be kept as checked by default by setting following property: billing.insaging.add.pataging : If this is set to Y, the Patient Aging Check Box 'Include SelfPay' on Ins Aging Selection will be checked by default.

Reports > Patient Aging

74. Hyperlinks to show further breakups on Patient Aging O/P reports:

1. If template used for report output is "Patient wise", the Patient Name is hyperlinked. When clicked on the hyperlink, the breakup of Claim wise Aging is seen in pop up.
2. Likewise if template used for report output is "Patient wise Claim wise", the Claim details are hyperlinked. When clicked on the hyperlink, the Claim breakup of Charge code wise Aging is seen in pop up.

75. Reports > Patient Summary

1. This option now supports Brief And Detailed reports.
2. Period: The report prints a summary of transactions in the selected reporting period.
3. The users can get the Net Effect on AR, and will also get the collections for reconciliation.
4. Secondly the layout is now configurable. With the help of Bizmatics Implementation and Support staff, users can configure it as per the requirements.
5. Claim Date, Remittance Date, Refund Date, Copay Date are the 4 dropdowns available to select appropriate dates while generating reports.
6. Filter By: Details can be filtered on: Location, Business Unit, Rendering Doc, Attending Doc.
7. Group By: Details can be grouped by: Clinic, Location, Business Unit, Rendering Doc, Attending Doc.
8. Select File: Multiple Layouts can be customized as per clinic's requirements and kept in Datafiles in server. 3 file types supported: .xls, .csv, .txt.
9. Filenames in datafiles have to be defined in a property: summary.financial.filenames
10. The Layout names to be shown in dropdown "Select File" can be customized using following property: summary.financial.optionnames
11. On the output report, footer also shows the criteria chosen to run the reports.

76. Reports > Financial Analysis: New Menu Option