Release Notes - Billing
Version No: 2.0
Build No: 6
1. EDI837 Professional and EDI837 Institutional messages are now handled according to 5010 compliance.
2. New TA1 validation error messages are sent through EDI in proper EDI segment as an acknowledgment for claim submission.
3. New 999 validation error messages(replacement for 997 messages)are now supported by PrognoCIS for EDI Claim processing for 5010.
4. Insurance Eligibility Response (270) and Insurance Eligibility Inquiry (271) transaction message meets 5010 compliance.
5. EDI 835 transactions are appropriately handled to meet 5010 compliance.
6. Service Location is not sent when the Service Facility NPI and Billing Provider NPI are same.
7. The Service Facility Address line 1, Address line 2, City, State and Zip cannot be the same as the Billing Provider reported.
II. EDI Support for Chiropractics
10. Patient A/Cà Claims Ledger: Now display of Pri/Sec/Patient responsibility columns on Claims Ledger is property driven.
11. Patient A/C: Now hyperlink ‘Adjustments’ shows the ‘Recouped Amount’ as negative.
12. Button 'Resp. Change' added to display a row on Patient Stmt to show Patient's resp. transferred to Insurance.
13. For better readability of Insurance Eligibility messages, formatting changes are implemented.
14. EDI Partner code required for fetching Insurance Eligibility will now be read from database instead of reading from property.
15. Duplicate Pre Auth Nos. now allowed if one record is open and rest are closed.
16. Capacity of Patient Billing Notes is increased from 5,000 characters to unlimited characters.
19. From EMR--Edit Encounter: Attending Doc changed in an existing claim is updated on claim as well on Billing side.
20. Now restriction is applied that more than Four ICD codes per Charge code row will not be allowed as per 5010 specs.
21. Validation on ‘Ready to Send’ to check all ICD codes added at claim level are associated to at least one Charge Code.
22. Button ‘I’, information about ‘ILLNESS (First Symptom)’ and ‘Same or Similar Illness’ will not be sent by EDI.
23. ‘I’: Billing Provider, Pay To Provider and Submitter Type value will display earlier used value even if blank.
24. ClaimsàSend UB04 Claims: Now UB04 Secondary claims can be processed as EDI 837I claims.
25. New measuring unit (ME-Milligram) is included for ‘units’ drop down list under NDC option.
26. New property for Financial Class assigned to claim to suppress printing of claims on Pat. Stmt from Bulk Billing statement.
27. Additional provision defined to add Billing Address from Location, Provider and Business Unit Screens.
28. Validation to check if amount in ‘Bill_Ins’ for each charge row in claim is less than ‘Min Billable Amount’.
29. Property based validation to check sub category for ICD code is assigned at Charge row level.
30. The ICD / CPT / HCPC / Item / Spl Charge codes cannot be Inactive.
31. Property ‘billing.cell14.leave.blank’ will print blank if set to 'Y' and Date of Illness / Injury / Lmp is not available.
32. Accident related table will be shown in different background color for Worker Comp, Auto Accident, Other Accident.
33. Button Resend: Displays both options ‘EDI/CMS’ to resend claims if Insurance is EDI enabled.
34. A new Property 'billing.lock.period.upto.date' is added to prevent editing/modification of Claims.
35. Whenever the claim is reopened, ‘Patient SOF’ field is set to ‘Generated By Provider (Default)’.
38. Validation applied to check if proper Billing address has been provided with claims being sent electronically.
39. EDI validation Implemented for status ‘129’: ICD Codes between 800 and 995 used, but Date of Injury Not specified.
40. EDI validation Implemented for status ‘130’: To check ‘NOC’ service codes used in claim and comments in ‘NOC’ service code charge row.
41. EDI validation Implemented for status ‘131’: To check ‘Rendering Provider NPI’ is entered in Primary EDI Claims.
42. EDI validation Implemented for status ‘132’: To check ‘Rendering Provider Tax Id’ is entered in Primary EDI Claims.
44. New filter option (Ub04 Yn) is added to select ‘Institutional’ (UB04) or ‘Professional claims.
45. The column ‘Status’ is now hyperlinked to display TA1 and 999 error status code.
XV. Claims>>Outstanding / Claims Center
46. The column ‘ Status’ is now hyperlinked to display TA1 and 999 error status code.
XVI. Remittance>>EOB/ERA Screen.
47. Sequence of selection of claims from Pri/Sec Tab on Claims Search pop up list is retained when displayed on EOB/ERA screen.
48. On EOB posting , Copay will not be processed and moved to Advance if there is any charge row with selective Denied Actions.
49. Claim ‘delete’ button toggles to Claim ‘Edit’ button to allow editing claims without reopening posted claims.
50. Remittance Doc No. is displayed with Yellow background and button ‘Reopen’ is disabled.
51. Now validations carried out on ‘EOB’ Screen is customizable based on property era.validate.conditions= ZEWLCTDNPR.
52. New Denied Reason added in the Group Master will be available in ‘Reason’ autocomplete field of ‘Status’ pop up.
53. Width of ‘Reason’ and ‘Write off’ list box is increased. 20
54. The ‘Prev’ and ‘Next’ labels will be displayed in Red without hyperlinks.
55. In a EOB, where Ist payment is recouped, claim selected again is marked as Normal instead of Duplicate.
56. EOB screen is refreshed on 'Next' link displays next set of four claims with claim selected on prev. as current row. 20
57. Remittance-->EOB/ERA Screen: A new button ‘Pat Ins’ is added next to button ‘Sec Ins’. 21
58. Two new roles added to move remaining amount in EOB TO/FROM Advance’.
59. A new Property 'billing.lock.period.upto.date' is added to prevent editing/modification of Remittances.
60. New Validation condition is introduced in era.validate.condition for Case "S".
61. Now ‘Last Update Details’ pop up is available on hyperlinked ‘Voucher number label’.
62. Button ‘Layout’, buttons ‘Up’ and ‘Down’ are provided to customize the sequence of columns displayed in Reports output.
63. General tags are added to print discrete values based on SQL query written after sign $.
64. Checkbox ‘Hide Fully Balanced Claims’ will not suppress transactions in last 30 days.
66. Reports> Pat Aging: Four ‘Group By’ conditions are introduced to generate Patient Aging Report.
67. Tabular reports now has a provision to add computed fields.
68. Summary output headers for ‘Billed to Insurance’ and ‘Remittances’ hyperlink shows details sorted by Insurance Company.
69. New columns added on summary reports pop-up on hyperlink 'Receipt from Pat - Moved to Advance'.
XXIII. Settings>>Configuration
70. Now hyperlinked Cell titles to display graph in full screen and data with discrete values in pop up table.
71. Dashboard screen will get refreshed at same frequency rate as Billing Home Page is refreshed.
75. Eligibility 'User Id’ and 'Password’ fields are provided per EDI Partner to access clinic’s account.
76. Checkbox ‘Used For Insurance Eligibility’ status indicates if ‘EDI Partner’ to be used for Insurance Eligibility.
77. Ref Qualifier for Billing Provider Type EDI loop 2010AA is sent as 'G2'.
78. Audit Trail feature is now extended to Billing module to track various Billing actions.
79. Settingsà Configuration à Diagnostics: Two new cases are added for diagnostics.
80. Diagnostics: New Case Added in Diagnostics Screen: "74: Fix BU and Provider names with non alpha non digit chars".
81. Diagnostics: New Case Added in Diagnostics Screen: "75: Check for #1 in Patient / Subscriber Address Line 1.".
82. Diagnostics: New Case Added in Diagnostics Screen: "76: List of CP Vouchers without Voucher Date".
83. Diagnostics: New Case Added in Diagnostics Screen: "77: Fix CP Vouchers without Voucher Date".
84. Diagnostics: New Case Added in Diagnostics Screen: "78: List of EOB without Attending doc,Renderring Doc,Location,Business Unit.".
85. Diagnostics: New Case Added in Diagnostics Screen: “79: Fix EOB without Attending doc,Renderring Doc,Location,Business Unit.".
86. Diagnostics: New Case Added in Diagnostics Screen: "80: List EOB with Paid as Pri and Sec for same Claim in same Eob.".
87. Diagnostics: New Case Added in Diagnostics Screen: "81: List of Copay not applied.".
88. Standard set of Self Scheduled Processes and Field can now be copied from Master Database.
89. New calendar with tooltips is added on all applicable screens of Billing module.
90. ReportsNew Billing Tabular Reports are added.
XXIX. New Properties Introduced
None
Numbers of new features related to PrognoCIS Billing have been released in Version 2.0 Build 6.
Following is a list of these new features in brief:
This is the single biggest change, and the Raison d'être for this release. All EDI messages in the Healthcare space need to be in 5010 format from 1st Jan 2012.Bizmatics has become approved vendor for 5010 with all supported Clearing Houses. The following messages will be exchanged in 5010 format.
· 837 Professional, Institutional claims.
· 835 Professional, Institutional – Electronic Remittances.
· TA1 Rejection at Claim level from EDI Partner.
· 999 Success and Failure Messages. This substitutes the earlier 997 messages.
· 277 Claims Enquiry Status Messages from Insurances.
· 270 - Request message for Insurance Eligibility.
· 271- Receipt of Insurance Eligibility Response.
EDI837 Professional and EDI837 Institutional messages related to claims which are generated by PrognoCIS ™ are 5010 compliant.
The TA1 is a transaction that is sent to the claim submitter as an acknowledgement (positive or negative) for their submission. TA1 error messages are sent
at header level in segments ISA and GS to the system. The TA1 report notifies the system about problems encountered in the submitted claims.
TA1 messages are initially stored at server per EDI Partner ( for ex. ‘Gateway’, ‘Office Ally’ etc.).
These messages will be processed when:
• The Scheduled Process is called once a night automatically.
• User goes explicitly to Claims > Returned menu option.
Track status legend is now updated with new entry notifying TA1 error message.
New legend is
24: Header level (TA1) failure
System provides an option to correct these claims on Claimsà Returned screen by clicking hyperlinked 'DOS'. The status of the claims
can be changed by clicking hyperlinked 'Status number' under status column. Hyperlinked 'Edi Error' displays TA1 error message returned
by Clearing House.
Figure:TA1 error messages on Claimsà Returned Screen. 
Now 999 validation error messages are also supported by PrognoCIS for 5010 compliance. The 999 Implementation Acknowledgment transactions is a EDI response message to confirm that a file was received and could be properly read by the translator. The 999 can also report on exactly what syntax-related issue caused the errors on the original document. 999 messages notify the system about success and
failure of the EDI claim processing. All 999 messages will be stored under EDI997FTP and EDI997 folders on server. Rejected claims having 999 error messages will be displayed on ClaimsàReturned Screen. Track status would also capture these validation messages. Two new legends are added to display information about 999 error messages. These legends are:
25: 999 success
26: 999 failure
Note: 999 messages in 5010 will replace 997 messages in 4010.
Gateway is Not yet ready with Ins Eligibility 5010. Hence, there is a property added: billing.ins.eligibility.4010. If this is set to Y, it will query using EDI270IE as per 4010. If it is N, it will query using EDI270IE as per 5010.
Note: It gets called from Patient Insurance screen, as well as Scheduled process for scheduled appointments.
5010 compliant EDI835 Professional and EDI835 Institutional messages related to remittances which are received from Insurances will now be successfully processed by PrognoCIS ™.
6. Service Location is not sent when the Service Facility NPI and Billing Provider NPI are same.
As per 5010 specs, if the Service Facility NPI exists and Billing Provider NPI are same then Service Location should not be sent otherwise EDI claims will be rejected.
7. The Service Facility Address line 1, Service Facility Address 2, Service Facility City, Service Facility State and Service Facility Zip cannot be the same as the Billing Provider reported.
As per 5010 specs, The Service Facility Address line 1, Service Facility Address 2, Service Facility City, Service Facility State and Service Facility Zip cannot be the same as the billing provider reported otherwise EDI claims will be rejected.
Chiropractic related information to be sent on EDI claims can now be captured on EMR side. The chiropractic information to be sent on EDI claims has to be
captured in 4 tests on EMR side. The test codes of these tests have to be mapped to 4 newly introduced properties and on claim generation, the results of
these 4 tests will be a part of EDI claim to be sent to Insurances.
Following are the tests required for Chiropractic service with result type and options:
Test Code |
Result Type |
Last X-Ray Date |
Date Type |
Initial Treatment Date |
Date Type |
Acute Manifestation Date |
Date Type |
Patient Condition |
Set Of Values |
Set of values for Patient Condition are as follows:
A - Acute Condition
C - Chronic Condition
D - Non-acute
E - Non-Life Threatening
F - Routine
G - Symptomatic
M - Acute Manifestation of a Chronic ConditionProperties related to Chiropractic service to map the test codes are:
cms1500.last.xray.testcode
cms1500.initial.treatment.testcode
cms1500.accute.manifestation.testcode
cms1500.patient.condition.testcodeNote: No impact on CMS1500 (CMS1500 does not need this information to be printed.)
Billing Home Page: A hyperlinked text label ' OpeEob xx' in red color is displayed on Home page.' xx' being the count of EOB vouchers where in few claims had been opened for editing but not yet saved using the Single Claim edit feature. Hyperlinked 'OpeEob xx' on click displays pop up ‘List of Eob with Single Claim Edit Open’. This pop up displays details like ‘EhrId’, “Dco No’, ‘Claim Id’, ‘Mod User’, ‘Mod Date’.
Claim Ledger property ‘ledger.claims.detailed’ if property is set to ‘Y’, the claim Ledger will display Pri /Sec/Pat Responsibility columns. If set to ‘N’, it will continue to display only the basic transaction details columns as earlier. In either case print button considers the earlier format only.
A new feature has been introduced to carry out transaction to move responsibility from Patient to insurance for those claims which has Primary/Secondary and Tertiary Insurance AND whose charge balance is not zero along with patient responsibility. Button ‘Resp. Change’ allows moving Patient responsibility against a charge code to Primary/Secondary and Tertiary Insurance. This feature enables to create secondary remittance from the EOB received. Once Patient responsibility is moved using this feature, claims do not get created on ClaimsàSend Claims Screen. Secondary responsibility is automatically created on Patient A/c screen.
Note: Change Responsibility Transaction has been properly handled on Statements. This includes the handling of Additional from Secondary after Change Responsibility Transaction has been done. On Patient Account, statement 'Responsibility changed from Patient to Insurance' is added.
Figure: Patient A/c Screen: Button ‘Resp. Change’ to change Patient Responsibility to Insurance.
Insurance Eligibility Message (271) format is restructured to have better readability of these messages. Basically, formatting is about presentation of the messages, better organization of sections for better understanding and readability etc. These changes are –
· Sections in Insurance Eligibility Message are rearranged. For e.g. All information about Primary Care Physician, Copay, and Deductible are displayed prominently.
· Indentation and dashes added as prefix to denote sections start.
· Subscriber Relations now have Life Partner and Employer as required by 5010
· The existing dropdown option ‘Legal Guardian’ is no more valid. It has been retained for backward compatibility. When selected, instead of Legal Guardian as relation, ‘Parent’ will be sent.
· Appropriate space between sections for better demarcation.
· Additional segments are now processed.
For ex: Info related to ‘Health Care Services Delivery’ (Ex: 20 Visits Remaining) now processed and displayed.
Information about ‘EDI partner code’ is required while Insurance Eligibility is fetched. Now ‘EDI partner code’ is read from database instead of reading from property. It has now become generalized and means system would be supporting multiple clearing houses. Top
Pre Authorization Numbers may be ‘Duplicate’. If only one Pre Auth record is 'open' and others are closed, it will be considered as OK. Earlier it ignored the close check box and gave an error for duplicate Pre Auth Nos.
Limitation: This can still cause a problem on Claims screen I button where we display the Actual No of visits against a Pre Auth No. There is no way for the system to know whether the claim was against first entry of Pre Auth or the second. It will report a total count. On claims ‘I’ button, no. of used visit (total no. of used visit inclusive of the closed Pre Auth as well)/ No. of Pre Auth visit allowed in open Pre Auth.
Patient Billing Notes is now capable of displaying more information/data at a glance as compared to previous versions. Now restriction on number of characters to display Patient Billing Notes is revoked and can display unlimited information on it.
The same Icon can be invoked from
a) Billing > Home Page
b) Billing > Patient A/c Screen
c) Billing > Copay Popup
d) Appointment > Patient
e) Appointment > Schedule
f) Claim > Edit
g) Claim > Charges Center
h) Claim > Claim Center
i) Claim > Outstanding
j) Claim > Unprocessed
k) Remittance > EOB/ ERA
l) Remittance > Disputed
m) Remittance > Denied
n) Remittance > Pat Receipts
o) Remittance > Pat Copay
p) Remittance > AutoWriteOff
Claims--> New: When New Claim is created from Claims à New Screen, default ‘Patient SOF’ value is set to ‘Generated by Provider (default)’ for EDI claims as it is required by 5010.
Warning: User should NOT Use Resend or use it with caution, as old claims will fail 5010 validation Norms.
Note: Now if UB04 claims are created using either of the following options:
· Create a copy of existing claim with New visit ID
· Create a copy of existing claim with Same visit ID
New UB04 claims created using either of the option will copy claim details from ‘U’ button on ClaimsàEdit Screen.
After switching to 5010, before resending the old claim created in 4010, please make sure to reopen the claim, Patient SOF is set to ‘Generated by
Provider(default)’ and then resend it.
Figure: Patient SOF set to ‘Generated by Provider (default)’
When a claim is created, depending on the encounter type and the properties it knows if the claim is to be of Accident Type (Workers Comp, Auto
accident, Other accident). The system tries to assign the corresponding (WorkerComp, MotorAcc,PersonalAcc) Insurances followed by the other Normal
Primary / Sec / Tertiary types. In case of Normal claims (Non Accident), the system tries to assign Normal Primary / Sec / Tertiary types, followed by the rest.
If Encounter associated to a claim which is not yet ‘Billed’ or ‘Reopened’ is edited and ‘Attending Doc’ is changed on Encounter Screen then it will also update Attending /Rendering Doc on associated Claim. Therefore without recreating claims, ‘Attending Doc and Rendering Doc’ can be changed from Encounter Screen.
Claims à Edit screen: Now restriction is applied that more than Four ICD codes per Charge row level will not be allowed. These ICD codes are billed to Insurance along with CPT/HCPC charge codes. These ICD codes are applied using ICD search pop list present on charge row level. ICD search pop up list will display only those ICDs which are selected at Claims level. Whenever user selects more than four ICDs from ICDs search list, a warning message is displayed.
Message - More than 4 ICD codes assignment per charge code is not allowed to associate. Unless and until less 4 ICD codes are selected for a charge code, ICD codes are not allowed to be associated.
Figure: Claimsà Edit Screen: Alert message is displayed if More than 4 ICD codes to a charge row are not allowed.
Claims à Edit Screen: A new validation is applied on ‘Ready to Send’ of claim to check whether ICD codes added at claim level are assigned to charge codes at charge code level. If ICD code added at claim level is not associated to at least one charge code then a warning message is displayed on ‘Ready to Send’ action. It acts as a reminder to the user about non association of ICD codes at claims level to charge codes at charge code row level.
Figure: : Alert message is displayed if an ICD code at Claim Level is not associated to at least to one charge code at charge row level.
On button Claim Additional Info ‘I’, Information about ‘ILLNESS (First Symptom)’ and ‘Same or Similar Illness’ will not be sent in EDI segment anymore as per 5010 compliance. This information about these fields are appropriately changed on 'I' button.
I Button: If in an earlier claim, the Billing Provider Type was 'CL' and now the property does not have it defined (quite likely since now we recommend using BU instead of CL), then the List Box is shown as Blank. Now it will ensure that the earlier used is dynamically added to list Box as is displayed correctly. The same is added for Submitter Type and Pay To Provider Type (Prof and UB04). Top
Now UB04 Secondary Claims for Hospital Billing is allowed to send and processed as EDI837 Claims.
Note: Institutional Payer Id is must for UB04 claims to get created as EDI claims in Pri-EDI and Sec-EDI buckets of Send Claims screen. Otherwise checkbox ‘Paper Ins Form’ remains checked on Claim screen.
New measuring unit is included under NDC option for ‘units’ drop down list. ME-Milligram is now available in the drop down list along with other measuring units like ‘International Unit’, ‘Gram’, ‘Milliliter’, ‘Unit’ and ‘‘Milligram’.
A new property ‘billing.hide.statement.financialclass2’ is added which will be applicable to ‘Financial Class’ on Claims à Edit Screen. Property ‘billing.hide.statement.financialclass2’ can specify the comma separated Financial Class codes. When Financial Class defined in this property is assigned to a Claim then printing of such claims will be suppressed when Patient statement is generated from Bulk Billing Statement. Such claims from these patient statements will still be considered in Account Receivable Reports, Ins. Aging Report, Summary Report etc.
For claims sent by EDI 837 5010, the ‘Billing Provider Type ’ and 'Submitter Type' cannot have a P.O. Box address while sending claims to Insurance companies. It has to be a physical address. ‘Pay to Provider Type ’ can have P.O.Box address.
Therefore, a new field 'Billing' with button as 'address' is provided to add P.O. Box address on following screens:
Settings > Config > Location
Settings > Config > Business Unit
Settings > Config > Providers
This new 'Billing Address' can be used in properties '837.paytoprovider.type' and '837.ub04paytoprovider.type' which will support following values in addition to 'CL','SL','AD','BU':
C2 Billing Address for Clinic
S2 Billing Address for Service Location
A2 Billing Address for Attending / Rendering Provider
B2 Billing Address for Business Unit
Zip-code for Clinic Location, Business Unit, Rendering / Attending Provider from USPS as Billing Provider, Pay To Provider and Submitter Type Address should have 9 digit Zip Code as per 5010. Make sure to update the Zip code appropriately in PrognoCIS.
The Tax ID or Social Security Numbers should be without hyphens for Clinic Location, Business Unit, Rendering / Attending Provider. Make sure to remove them after upgrade, before sending 5010 claims.
Name width limit of 35 characters for Clinic Location, Business Unit, Rendering / Attending Provider has been relaxed for EDI Claims. If abbreviated, you can enter the full Name after upgrade.
Note: 'Billing Address' records for Clinic Param, Locations and Providers would be automatically populated to be same as Normal address on upgrade.
Following property values will also be updated on upgrade:
* Property '837.paytoprovider.type' value will be appended with B2,A2
* Property '837.ub04paytoprovider.type' value will be appended with B2,A2
* Property '837.paytoprovider.type' value will be appended with C2 if CL was present
* Property '837.ub04paytoprovider.type value' will be appended with C2 if CL was present
If 'Billing Provider Type' and 'Service Location' is defined as 'P.O.Box' then appropriate messages would be displayed while sending the claim on ‘Send Claims’ screen. These messages are:
119: Billing Provider Address has PO Box
120: Service Location Address has PO Box
If 'Billing Address' is blank, the appropriate messages would be displayed while sending the claim on ‘Send Claims’ screen. These messages are:
122:Billing Provider Type Address Not Defined
123: Clinic Billing Address Not Defined
124: Service Location Billing Address Not Defined
125: Business Unit Billing Address Not Defined
126: Rendering Provider Billing Address Not Defined
127: Billing Provider Type Address Zip2 Not Defined
128: Service Location Billing Address Zip2 Not Defined
Claims à Edit Screen: An error message is displayed on ‘Ready to Send of a claim after system validates to check if amount in column ‘Bill_Ins’ is less than ‘Min Billable Amount’ specified for Insurance against any charge row. Error message will alert user about correcting amount in column ‘Bill_Ins’ against specific charge code before claim is sent and thereby chances of claim rejections from Insurance Companies are minimized due to this reason. ‘Min Billable Amount’ is set in Insurance Master and field is present on Insurance Masterà Button ‘Extra Info’.
Figure: Claims Edit Screen: Error message is displayed if ‘amount billed to Insurance’ is less than ‘Min Billable Amount’ on ‘Ready to Send’ against charge codes.
Claims Edit Screen: When property ‘billing.icd.subcategories.must' is to ‘Y’ in system then on ‘Ready To Send’, it considers property otherwise not. If set to ‘Y’ then sub category for ICD code must be assigned to Charge code row. For e.g. 787.2 is an ICD code in master. Sub codes 787.20, 787.21, 787.22 … are also present. User is not allowed to select 787.2 in the claim. User is supposed to select 787.20 … sub codes instead.
Inactive ICD/CPT/HCPC/Item/Spl Charge Codes cannot be assigned to claims.
31. Claims --> Edit-->CMS Printing: If property ‘billing.cell14.leave.blank’ is set to ‘Y’, and Date of Illness / Injury / LMP is not available, cell14 is kept blank; otherwise the visit date is printed.
Claims-->Edit-->CMS: Cell 14 of CMS1500 form is kept blank in case property 'billing.cell14.leave.blank' is set to 'Y' and 'Date of Illness/Injury/Lmp is not available.'Visit Date' of Patient would be printed in Cell14 if property 'billing.cell14.leave.blank' is set to 'N'. |
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Figure: Different background color for Worker Comp, Auto Accident , Other Accident .
Claims à Button Resend displays both options ‘EDI/CMS’ to send claims even if claims were earlier sent by EDI so that same claim can now be resend as CMS. This is applicable if Insurance is EDI enabled.
34. Claims --> A new Property 'billing.lock.period.upto.date' is added to prevent editing/modification of Claims.
A new property 'billing.lock.period.upto.date' is added to prevent editing/modification of Claims by not allowing it to be re-opened when Date specified in property is less than Post Date of that entry.
Many times, once the reports are tallied and Audit is done, it is not advisable make any changes to posted entries related to claims. To achieve it, a new property 'billing.lock.period.upto.date' has been added, which allows users to define a specific date and when post date of any entry is less than this date, the entry will not be allowed to be reopened. This is achieved by disabling the 'Reopen' button or not allowing Denied Action "Reopen to Resend". On mouse over of such a disabled 'Reopen' button, the tool tip will display indicating that since Post date is less than the Reopen allowed limit date defined in property 'billing.lock.period.upto.date', the Reopen button is disabled.
On Claims Reopen: Whenever claim is reopened, by default ‘Patient SOF’ field is set to ‘Generated By Provider (Default)’.
Now value in EDI segment will be set as ‘Original’ on click of button ‘Resend’ on ClaimsàEdit Screen instead of ‘corrected’. This is because many times Insurance wants the claim to be resent with the status as Original. Earlier EDI segment was sent as ‘corrected’ status with claims which were reopened and resend. Now this value will always be marked as ‘Original’.
A new filter option (Ub04Yn) is added to view unprocessed ‘Institutional’ (UB04) or professional claims on Unprocessed Screen. Filter has an option ‘Ub04YN’. User can type in ‘Y’ or ‘N’, so as to select Institutional or Professional Claims respectively. It will provide an option to view and analyze unprocessed ‘Institutional’ and ‘Professional’ claims separately.
Send Claims Screen: A new validation '129' is implemented on Send Claims Screen for checking the Injury Date on claims if diagnosis codes
between 800 and 995 are used. Diagnosis Codes (ICD) between 800 and 995 are used for diagnosis for injury and hence if these codes are
used then injury date is necessary on claims. Claims may not necessarily be related to WorkerComp,Auto Accident or Personal Acc type.
Note: On Claims-->Edit Screen: "Place of Accident" is mandatory for Auto Accident Claims only and is sent with EDI if checkbox 'Auto Accident' is
marked.
Status of ‘277 messages are now also shown on Claims>Returned Screen’ in addition to 277 status screen and Track Status for claim rejections.
Claims à Send Claims Screen: Now ‘Billing Provider Type’ should necessarily have physical addresses in claims sent by EDI to Insurance Companies otherwise these claims would get rejected. In order to validate these claims before sending to Insurance Companies, validation has been applied on Send Claims Screen to check if claims have been assigned with physical address or not. New legends have been added to indicate the statuses of these claims for any rejections. The newly added legends related to ‘Physical Address’ validations are as follows:
122: Billing Provider Type Address Not Defined
123: Clinic Billing Address Not Defined
124: Service Location Billing Address Not Defined
125: Business Unit Billing Address Not Defined
126: Rendering Provider Billing Address Not Defined
127: Billing Provider Type Address Zip2 Not Defined
128: Service Location Billing Address Zip2 Not Defined
41. Send Claims Screen: EDI validation Implemented for status ‘129’: ICD Code between 800 and 995 used, Injury Date is mandatory.
Claims --> Send Claims Screen: A validation to verify that ‘Date of Injury’ is mandatory if ICD code between 800 and 995 is associated to a claim. ICD codes between 800 and 995 are injury related diagnosis codes and if these codes are used in a claims then ‘Date of ‘Injury’ is mandatory in that claim. Validation is implemented on Send Claims Screen to check ‘Date of Injury’ when ICD codes between 800 and 995 are used in a claim. Such types of claims are not allowed to send until ‘Date of Injury’ is added to the claims.
Note: On Claims-->Edit Screen: "Place of Accident" is mandatory for Auto Accident Claims only and is sent with EDI if checkbox 'Auto Accident' is marked.
42. A new validation ‘130’ to check 'NOC' service codes used in the claim, description (comments) in charge row and word 'NOC' in 'General Info' on CMS flag is must.
According 5010 specs for EDI claims, for ‘NOC’ (Not Otherwise Classified) service codes, it is mandatory to send description (comments field in charge row) and word ‘NOC’ in General Info on CMS flag otherwise EDI claims with ‘NOC’ service codes will be rejected. User should enter description manually for ‘NOC’ service code using ‘comments’ field on a charge row and word ‘NOC’ is populated automatically in General Info text field. This comment is sent in 'SV101-7' segment with EDI claims. Also word 'NOC' is sent in the 'SUPPLEMENTAL' segment with EDI claims if 'NOC' service codes are present in claims. A validation '130' ('NOC codes without comments)is applied on Claims--> Send Claims Screen to check presence of ‘NOC’ service code and comments for 'NOC' service codes in EDI Claims. If comments are not available for 'NOC' service codes then EDI claims are not sent until comments are filled for 'NOC' service codes.
For 'NOC' code having 'NDC' code associated with it in a charge row, word 'NOC' will not be added in 'General Info' field and will not be sent with EDI claims rather information about 'NDC' codes would be populated in fields like '11-digit Code', 'Unit' and 'Admin. Qty’ from database. The information about 'NDC' code associated to 'NOC' service code in a charge row would be sent with EDI claims. The description from 'Comments' field for 'NOC' service code entered in a charge row will be sent with EDI Claims as it was sent earlier for 'NOC' service code as per 5010 specs.
Claims à 277 Status Screen: A new filter option is added to view ‘institutional’ or Professional claims having ‘277 statuses’ (Claims Status Enquiry Response). Filter has an option ‘Ub04YN’. User can type in ‘Y’ or ‘N’, so as to select Institutional or Professional Claims respectively. It will provide an option to view and analyze ‘Institutional’ and ‘Professional’ claims separately having ‘277 Status’.
Claims à Returned Screen: A new filter option is added to view ‘institutional’ or ‘professional’ claims which are returned from Insurances and are EDI failed claims. Filter has an option ‘Ub04YN’. User can type in ‘Y’ or ‘N’, so as to select Institutional or Professional Claims respectively. It will provide an option to view and analyze the reason failure of ‘Institutional’ and ‘Professional’ claims separately.
The column ‘Status’ is now hyperlinked to open ‘Claim Status’ pop up. The 'Status' option in ‘Claim Status’ pop up are rationalized to include the TA1 and 999 Error Status Codes.
The column 'Status' is now hyperlinked to open a pop up. The 'Status' options in pop up are rationalized to include the TA1 and 999 Error Status Codes.
Note: Non failure Status Codes are Not hyperlinked.
RemittanceàEOB/ERA screen: Same sequence of Claims is retained on EOB screen when included as the sequence in which claims were
selected from Claims Search Pop up list. Earlier those claims added from ‘Pri’ Tab in Claims search pop up list were added first followed by claims added from ‘Sec’ Tab.
Remittance à EOB/ERA screen: On posting of EOB, Copay will not be processed and moved to Advance if there is any charge row with Denied action. If charge row has ‘Denied Status’ either with ‘Write off’ or ‘Rebill’ action then Co-pay associated to charge row is transferred to ‘Advance’ otherwise for rest of the actions like ‘No Action’, ‘Reopen’, ‘Resend’, ‘Agreed’, ‘Resolved’ with ‘Denied’ status, Co-pay is not transferred to Advance.
Summarized list of Copay processing against ‘Denied’ action with status associated with charge row:
Status |
Copay Processing |
NO ACTION |
Do not move Copay to Advance and keep as Copay . |
WO |
Move Copay to Advance |
CHARGE NEXT |
Move Copay to Advance |
REBILL |
SPECIAL Case |
REOPEN |
Do not move Copay to Advance and keep as Copay . |
RESEND |
Do not move Copay to Advance and keep as Copay . |
AGREED |
Do not move Copay to Advance and keep as Copay . |
RESOLVED |
Do not move Copay to Advance and keep as Copay . |
‘Rebill’ Special Case: In case of Denied ‘Rebill’, the system would create an additional claim with same Visit Id and move the Copay to Advance. Now in such a case, the Copay is associated with the newly created Claim, and remains as a copy and is Not moved to Advance.
Earlier on Remittance EOB/ERA screen, claims which were in ‘Entered’ state were allowed to delete using button ‘delete’ under claims table. In order to edit claims which were in ‘posted’ state, claims were required to ‘Reopen’.
Now for posted EOB, same button ‘delete’ toggles/changes to ‘Edit’ claim button and posted claims are allowed to edit without reopening it. Therefore, now with single button two actions can be performed according to state of EOB.
One claim can be reopened at one time. While posting EOB, untouched charge rows get dropped off. When Claim is reopened, those charge rows can be populated on reopening claim to edit. Sec, I and A2 are also be available. It allows changing the Status like Approved, Denied, Pending, etc….and actions as well, like write-off the Patient Responsibility, etc. The Total paid amt via check cannot be changed with this option.
When a claim is opened for edit in a EOB, the Remittance Doc No is displayed in Yellow background and the Reopen button is disabled.
A new property ‘era.validate.conditions’ is added to the system which enables user to customize the validations on ‘EOB’ on ‘Ready to Post’/ ‘Load of EOB Page’ of remittances. This property takes value ‘ZEWLCTDNPR’ and details are as follows:
Value |
Description |
Z |
"Cannot Post with Non - Zero Balance. "Claim:Charge xxxxxxx". |
E |
"Cannot Post. Multiple EOB Found.". Pop up msg "Cannot Post. multiple EOB found. Claim:Code xxxxxxx". |
W |
Write Off limit. |
L |
"Cannot Post. Additional Payment Limit is Exceeded." Pop up msg "Limit Exceeded for Claim:Code xxxxxxx" |
C |
"Cannot Post. Claims Not sent out." Pop up msg "Claims xxxxx not Sent to Primary". |
T |
Trn group invalid. |
D |
'Cannot Post. Denied Status is set For Additional / Duplicate Payment.'. Pop up msg is "Denied Status is set For Additional OR Duplicate Payment. Check Claim:Code - xxxxxxx" |
N |
Negative Balance. |
P |
'Cannot Post. Pri EOB Open'. |
R |
"Cannot resend 5010 Claims with DOS before Jan 2010: Claim". |
Consider a scenario, user does not want to put validation for ‘Zero Bal’ for EOB, just remove letter ‘Z’ from property ‘era.validate.conditions’.. Removal of letter ‘Z’ will ensure that validation for ‘Zero Bal’ is not carried out on ‘Ready to Post’ of remittances.
Hence removal of specific letter(s) from the property will also remove corresponding validations on ‘Ready to Post’/ ‘Load of EOB Page’ of remittances.
New Denied reasons can be added from Settings à Configurationà Group Typesà Non system à Denial Reason Code (DR). These newly added Denied Reason codes are now available with autocomplete feature on ‘Status’ pop up under ‘status’ column on EOB
screen. Earlier those ‘Denied Reason Code’ which were added from back end were only visible and could be used with autocomplete feature.
Remittance EOB Screen: Width of ‘Reason’ and ‘Write Off’ list bo on 'Status' pop up is increased to accommodate lengthy reason for the convenience of the user.
Labels of button ‘Prev’ and ‘Next’ of navigation screen is marked in Red color without hyperlinks if user is respectively on the first/ last page of selected claims.
With change in label’s color and removal of hyperlink when user is at first/last page, adds to the convenience of user that it’s easy to find that user is on first /last page.
Remittance-->EOB/ERA screen: If an EOB for a claim is already received and second EOB is being entered where first payment is recouped and the same claim is selected again to make corrected payment. Earlier the claim would be marked as 'Duplicate'. Now it is marked as 'Normal'. |
Remittance EOB/ERA Screen: Assume that the first 4 claims are displayed in the EOB. If the user clicks on the third row of claim, there is No refresh. Thereafter if he clicks on the Next hyperlink, it displays the next set of 4 claims, with the current selected Row (blue band) being the first one.
Remittance à EOB/ERA screen: A new Button ‘Pat Ins’ is added next to ‘Sec Ins’. Button 'Pat Ins' displays a list of Claims for Patients where in the Claim does Not have a Secondary Isnurance and Primary Insurance is Not the same as that on EOB And there is No Record in Patient Insurance for Insurance on EOB. On selecting any Patient from the search, the Patient Insurance pop up screen is invoked, so that user can add the required Patient Insurance. Once insurance is added, user will be able to click on the button ‘Sec Ins’ and assign the Secondary Insurance to the required claim. Normally it would have been sufficient to show all Patient Names in the search. However since the EOB specifies a claim Id and Patient Name, it will be easier to use the provided search with all its conditions.
58. Remittance--> EOB/ERA screen: A new Property 'billing.lock.period.upto.date' is added to prevent editing/modification of Remittances.
A new property 'billing.lock.period.upto.date' is added to prevent editing/modification of Remittances by not allowing it to be re-opened when Date specified in property is less than Post Date of that entry.
Many times, once the reports are tallied and Audit is done, it is not advisable make any changes to posted entries related to Remittances. To achieve it, a new property 'billing.lock.period.upto.date' has been added, which allows users to define a specific date and when post date of any entry is less than this date, the entry will not be allowed to be reopened. This is achieved by disabling the 'Reopen' button or not allowing Denied Action "Reopen to Resend". On mouse over of such a disabled 'Reopen' button, the tool tip will display indicating that since Post date is less than the Reopen allowed limit date defined in property 'billing.lock.period.upto.date', the Reopen button is disabled.
Added two roles EOB to advance and advance to EOB which will allow user to move remaining amount in EOB To advance Or From advance respectively. This will mean, all normal EOB postings can be done by some person and to post such movements to / from advance, a special person with respective roles will be required.
60. Remittance--> EOB/ERA screen: New Validation condition is introduced in era.validate.condition for Case "S".
Remittance--> EOB/ERA screen: In order to check that remittance vouchers are saved with valid Attending doc,Renderring Doc,Location,Business Unit, a new validation on 'Ready to Post' is applied. It will validate for condition 'S' in property 'era.validate.condition'. Whenever blank Attending doc, Rendering Doc, Location, Business Unit is found on remittance vouchers while posting, an error message - 'Cannot Post. Paid as Primary And Secondary in Same EOB' would be displayed and such remittance vouchers will not be allowed to post until these fields are set.
61. Now ‘Last Update Details’ pop up is available on hyperlinked ‘Voucher number label’ on screens like Ins Credit/ Ins w/off/ Patient WO /Capitation receipt/Pat Misc Credit/Pat Receipt/Pat Item Return Screen with details like Claim Id, Charge code,Last updated by user and Timestamp.
Now latest update history for various vouchers on Remittance screens is available on hyperlinked ‘Voucher number’ as a pop up and it displays details |
like ‘Claim’ (Claim Id), ‘Code’ (Charge code which were updated), ‘User’ (name of user who has updated the remittance/charge code), ‘TimeStamp’ (Date
and time of updation).
Reports à By Claims/By Charges/ Fin. Analysis/Collection Reports: Now sequence of columns which are visible on Reports are customizable. Report layout pop up is customized using button ‘Layout’ present on respective Reports. Button ‘Move Up’ and ‘Move Down’ are added on layout pop up. Highlight the column and click button ‘Move Up’ and ‘Move Down’ to change the sequence which would be ultimately displayed on generated report according to the column sequence customized on layout.
ReportsàTabular: General tags are added to print discrete values on tabular report to make it more generalized. These tags are added in front of sign $ and generated output could be in string, date or amount format depending upon tags passed before sign $.
To print discrete values like ‘Outstanding amount’ for more than 90 days on Tabular Reports, there were no tags. Instead of adding tags for various Dates, Amounts and String outputs, now, limited tags are added, which will work based on SQL query written after $ sign. SQL Tags will use the key word _THISID_ suffixed and prefixed with SPACE in the SQL. The output of the SQL query will be input for the tag and appropriate output will be generated.
For Example: [PT_SQL_STR$select count(*) from TRN_ENCOUNTERS where ENC_PT_ID = _THISID_ ]. This tag will print no. of encounters for the current patient with string o/p. Tag with Date keyword would print o/p in Date format. Same way, tag with AMOUNT keyword would print o/p in Amount format. There are 4 detailed queries written based on whether information is required related to Encounter, Patient, Billing Header level or Billing Detailed level.
There is a check box ‘Hide Fully Balanced Claims’ to suppress Matched Claims on Patient Statement Screen. May be a payment was received yesterday because of which it got fully matched. In such a case user may expect to see the details in the statement. Now in case the claim is fully balanced, it also considers if there is any transaction within the last 30 days. If there was a transaction, the details will NOT be suppressed.
Note: Corresponding changes in CSV Export of Statements program done to support above functionality.
65. New property ‘billing.letters.maxosclaimdurn’=X days is introduced to print letters for Patient/Resp Person/ Insurances only if X days lies between range selected while running the report.
New Property ‘billing.letters.maxosclaimdurn’ is added. If set to ‘Y’, it will consider the Claim with the Max Outstanding Days and see if it applied to selected Range, so as to select the Patient / Resp Person / Insurance. For a patient, it considers the Claim with the Max Outstanding Days and checks if it is applies to the selected Range, only then is the Patient / Resp Person / Insurance selected for the report. For e.g. If a patient had three claims outstanding for 20,40,100 days respectively, earlier a letter was printed for the Patient for each selected Ranges of 0-30, 30-60, 60-90,90-120. Now, since the max outstanding days are 100, a letter will be printed for the patient only when the range 90-120 is selected.
66. Reports-->Pat Aging: Four ‘Group By’ conditions are introduced to generate Patient Aging Report.
Reports --> Pat Aging: Four ‘Group By’ conditions are introduced to generate Patient Aging Report. These ‘Group By’ conditions are:
· None
· Financial Class
· Responsible Person
· Primary Provider
The select clause should specify the field as just 0 and the column title should have a keyword like CALC_2+3 (CALC having a
prefix of space). The numbers 2 and 3 refer to the column serial nos (1 indexed) and the operator can be + - / * %. There can be
multiple operators which will be evaluated left to right e.g. CALC_2+3*4/5.
Note: Add a column name or text before using the formula. e.g. ToTal CALC_2+3
Reports à Summary output headers for ‘Bill to Insurance’ and ‘Remittances’ will now show details sorted by Insurance Company name with Sub totals at the end of group in a pop up for various amounts. Also grand total amount is displayed at the end of the table for various amounts.
ReportsàDashboard: The Cell titles on top row has hyperlinked name and has first name is either ‘Billed Amount’/ ‘Copay Collection’/ ‘Daily Billing’ and second name is ‘data’ for all cells on top row. When hyperlinked ‘first name’ is clicked, the graph is displayed on full screen. The second part of the title is the word Data which is hyperlinked. It displays the discrete values in a pop up table.
Dashboard screen will get refreshed at same frequency rate as Billing Home Page is refreshed. Property 'home.refresh.mins’ governs the refreshing of Billing Home Page and Dashboard screen.
Bulk Billing Statement generation will now have additional validation when property ‘statement.if.additional.transactions’ is set to ‘Y’ to check if there are additional transactions related to ‘Claims’ , ‘Copay’, ‘EOB’ and ‘Patient Receipts’ etc. since last Bulk Billing statement generation. The new Bulk Billing Statement will be generated only when system finds that there are additional transactions related ‘Claims’, ‘Copay’, ‘EOB’ and ‘Patient Receipts’ etc. In case, the property is not set to ‘Y’ then Statements will be generated without any checks.
Note: Validation comes in to effect only if property 'statement.if.additional.transactions' is set to ‘Y’.
Many Clearing Houses, Billing Services, Third Party vendors help the Clinics to send Patient Statements to patients who have any outstanding amount. They also help the clinics to follow up on these statements and collect this outstanding money.
For achieving this, they need the individual patient statement data to be sent to them so that they can then generate the statements, print them and dispatch them to patients / responsible person. ‘Export Patient Statement - CSV’ is a self scheduled process which generates patient statement. Now three new properties are introduced which is read while patient statement is generated. These properties are:
· ‘billing.patient.statement.interface.vendor’ to specify the Edi Partner Code of Vendor.
· ‘billing.patient.statement.interface.remittype’ to specify remit to Address using one of the types CL, C2, SL, S2, BU, B2 and
· ‘billing.patient.statement.interface.remitcode ’to specify remit to Code for the type selected above.
Information fetched from these properties are used and printed on patient statements.
Note : Upgade process will set 'Edi Partner Code' for Insurance Eligibility automatically.
Import Button will now validate the Charge Codes and Modifiers which are being imported from comma separated xls file. Only those Charge codes and Modifiers which are present in Masters will be imported.
Whenever clinic is registered with Clearing House, an account is created for the clinic by clearing house along with ‘Eligibility User Id’ and ‘Eligibility Password’. Now Clinic(s) can access their respective account by entering ‘Eligibility User Id’ and ‘Eligibility Password’ using two fields available on EDI Setup screen. This feature will allow Clinics to access /edit their confidential data using EDI Setup screen interface.
Ref Qualifier for Billing Provider loop 2010AA should be sent as G2 for all Insurances including Medicare (which earlier required 1C) and Medicaid(1D) when EDI Codes and Clinic Codes (Insurance Numbers) are to be as per 5010. Button 'Extra Info' on Insurance Master has a 'Ref---' field. Even if it is set to '1C' or '1D', it will be interpreted by program as 'G2' and is sent as 'G2'. 'EI'and 'SY' Ref Qualifiers will continue to be sent as earlier for Identification, like Tax ID.
Note: Ref. Qualifier is not required for 'Pay to Provider' and 'Submitter' type.
77. Audit Trail feature is now extended to Billing module to track various Billing actions.
Now ‘Audit Trail’ feature has been extended to Billing module to track events/actions on following screen
· ClaimsàEdit Claims Screen
· ClaimsàNew Claims Screen
· ClaimsàUnprocessed Claims Screen
· ClaimsàPenalty Claims Screen
· ClaimsàSend UB04 Screen
· ERAàEdit ERAs
· ERAàPatient Receipts
· ERAà Patient wise Remittance
User can switch on Audit Trail for following:
· Claim Add (from Claim > New): Update, Delete and Reopen
· EOB: Add, Update, Delete, Reopen
· Fee Schedule: Add, Update, Delete.
· Copay: Add, Update, Delete.
ReportàAudit Trail Report pop up (from EMR module) will generate report depending up on the selection of parameters on Audit
Trail pop up. User can generate Audit Trail Report by choosing following parameters on ‘Audit Trail pop up’:
· User Type
· Object
· Menu Option
· Date
· Action
· Sort Order
78. Settings-->Configuration-->Diagnostics: Two new cases are added for diagnostics.
Two new Diagonstics cases have been added as following:
Case no: 68 : List of EOB with Single Claim Edit feature.
Case no: 67 :Make Part ICDs inactive.
80. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "74: Fix BU and Provider names with non alpha non digit chars".
A New Case has been added on screen Settings > Configuration > Diagnostics: "74: Fix BU and Provider names with non alpha non digit chars". This diagnostic case will list out those Business Unit Name/ Provider First Name/Provider Middle Name/Provider Last Name where non alpha/digit characters like hyphen, comma, dot etc. is/are used in respective names. This diagnostic case will to do auto correction in names and will automatically remove 'non alpha non digit characters' from these names. It will also display old names where this correction has been done. This will prevent claims being rejected as per 5010 specs because usage of 'non alpha non digit characters'(like hypen, comma, dotetc.) is not allowed in these names and will lead to EDI claim rejections.
81. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "75: Check for #1 in Patient / Subscriber Address Line 1.".
A New Case has been added on screen Settings > Configuration > Diagnostics: "75: Check for #1 in Patient /Subscriber Address Line 1.". This diagnostic case will list out addresses of those Patients or Subscribers where character'#' has been used in 'Address Line 1'. As per 5010 specs, usage of character '#' is not allowed in 'Address line 1' of Patient's or Subscriber's address and if used then EDI claims will be rejected. Execution of this diagnostic case will notify and help users to correct such addresses in 'Address line 1' of Patients/Subscribers addresses beforehand to prevent any EDI claim rejections.
82. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "76: List of CP Vouchers without Voucher Date".
A New Case has been added on screen Settings > Configuration > Diagnostics: "76: List of CP Vouchers without Voucher Date". This diagnostic case will list out those vouchers from Encounter Copay table where Voucher date for the voucher is not set.
Note: 'CP' stands for 'COPAY'.83. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "77: Fix CP Vouchers without Voucher Date".
A New Case has been added on screen Settings > Configuration > Diagnostics: "77: Fix CP Vouchers without Voucher Date". This diagnostic case will set the voucher date with actual doc. date on those vouchers where voucher date was missing in table table 'TRN_ENC_COPAY', listed out using case: 76.
84. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "78: List of EOB without Attending doc, Rendering
Doc, Location, Business Unit.".A New Case has been added on screen Settings > Configuration > Diagnostics: "78: List of EOB without Attending doc, Rendering Doc, Location, Business Unit.". This diagnostic case will list out those EOB where Attending doc, Rendering Doc, Location, Business Unit are not set/ blank.
85. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "79: Fix EOB without Attending doc, Rendering Doc, Location, Business Unit.".
New Case has been added on screen Settings > Configuration > Diagnostics: "79: Fix EOB without Attending doc, Renderring Doc, Location, Business Unit.". This diagnostic case will fix those EOBs' which would be listed by diagnostic case '78'.
86. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "80: List EOB with Paid as Pri and Sec for same Claim in same Eob.".
A New Case has been added on screen Settings > Configuration > Diagnostics: "80: List EOB with Paid as Pri and Sec for same Claim in same Eob.". This diagnostic case will list out those EOBs' where same Insurance Company has paid for Primary as well as for Secondary for same claim in the same EOB.
87. Settings-->Configuration-->Diagnostics: New Case Added in Diagnostics Screen: "81: List Copay Not Applied.".
A New Case has been added on screen Settings > Configuration > Diagnostics: "81: List Copay Not Applied.". This diagnostic case will list out those EOBs' where Copay collected with claim is adjusted in remittance vouchers but still displays patient balance as pending.
New option in Diagnostics to copy standard set of Self Scheduled Processes and Fields. These are copied from poolname MASTERV2B6.
Calendar is changed throughout Billing module on all applicable screens and now traverse the ‘year/month’ using navigation bar (I<<>>I). Now ‘Tooltips’ are also displayed while button like ‘Move a month ahead’, ‘Move a year ahead’ etc. are used to add to the convenience of the user.
Reports--> Following are the new tabular reports which are added: ‘ZCLAIMDET’, ‘COL03’, ‘ADJ01’, ‘CRD03’ ‘COL01, COL07,
COL08, AR02, MIS01, COL09, ZADJUST, ZINSWO, ZPATWO, ZPATREFUND, ZPATXFER, ZSECRESP, IEPAT, ZINSIPA,
RVUDC, RVUSP, RVUDP, IELPA, IEMIS AR01, CRD01, CRD02, COL05.
837.valid.sof.codes |
billing.hide.statement.financialclass2 |
billing.icd.subcategories.must |
os.writeoff.names |
era.validate.conditions |
cms1500.accute.manifestation.testcode |
cms1500.last.xray.testcode |
cms1500.patient.condition.testcode |
cms1500.initial.treatment.testcode |
billing.cell14.leave.blank |
statement.if.additional.transactions |
billing.patient.statement.interface.vendor |
billing.patient.statement.interface.remittype |
billing.patient.statement.interface.remitcode |
CL_BLADDRESS$
BLH_LOC_BLADDRESS$
BLH_BU_BLADDRESS$
BLH_CELL32_BLADDRESS$
ENC_SQL
ENC_SQL_STR$
ENC_SQL_DATE$
ENC_SQL_AMOUNT$
PT_SQL
PT_SQL_STR$
PT_SQL_DATE$
PT_SQL_AMOUNT$
BLH_SQL
BLH_SQL_STR$
BLH_SQL_DATE$
BLH_SQL_AMOUNT$
BLD_SQL
BLD_SQL_STR$
BLD_SQL_DATE$
BLD_SQL_AMOUNT$
PT_BILLING_OS
PT_BILLING_OS_0030
PT_BILLING_OS_3160
PT_BILLING_OS_6190
PT_BILLING_OS_91120
PT_BILLING_OS_120P
PT_BILLING_OS_90P
PT_BILLING_OS_UNADJUST
RESP_BILLING_OS
RESP_BILLING_OS_0030
RESP_BILLING_OS_3160
PESP_BILLING_OS_6190
RESP_BILLING_OS_91120
RESP_BILLING_OS_120P
RESP_BILLING_OS_90P
RESP_BILLING_OS_UNADJUST
SCHREP_LAST__DIAGNOSES
None