2.1 Number of PreAuth entries increased from 10 to 15.

Number of PreAuth entries is increased from 10 to 15, subject to a limit on total length of 1024. It means that if longer comments, dates, etc are added for each PreAuth then allowed number could be possibly smaller.

2.2 Duplicate PreAuth numbers are allowed based on property set.

Some Insurance(s) give the same PreAuth No again and again. To accept duplicate PreAuth number in the system, user is requested to add a Suffix -11, -12 to the PreAuth No. These suffixes will neither be printed in the CMS tags nor will be sent by EDI.

When new Property ‘837.preAuth.withsrno.suffix’ is set to ‘Y’ and system finds dash in the PreAuthNo then content of the suffix is removed. This is used when there are duplicate PreAuth Nos. assigned (by some Insurance companies) for same Patient Insurance.
The modified truncated PreAuth number will be printed on CMS / send by Edi.

Figure2.2 – Duplicate PreAuth numbers are allowed in the system.

3. Claims >> New

3.1 Specialty Template carry forward template's value is recomputed.

When a new Encounter is created which has Specialty Template already attached to it then existing information available with attached specialty template is carried forward with newly created encounter. Specialty Template re-computes the test values for result type XYZ i.e. Formula, Date Calc, Tags accordingly. It ensures that values in Specialty Template are retained as it was entered in the previous encounter and is carried forward with newly created claims. It ensures past reference to Specialty Template information and latest calculation with respect to date, test codes, formula and tags are done afresh by taking past reference of existing information from Specialty Template.

3.2 Sequence of CPT/HCPC charge code in Assessment is maintained in claims with E&M codes always on top.

CPT/ HCPC charge codes from Assessment can be added from various sources from ‘Assessment (Ap)’, ‘Evaluation and Management (Enm)’, ‘Rx inhouse drugs (Rx)’, ‘Vaccination(Vc)’, ‘Labs inhouse(Lb)’ and ‘Radiology inhouse(Rd)’. When a new claim is created from encounter, added CPT/HCPC codes are also transferred with claim. The Table shown below shows the sequence of charge codes on Claims screen as per earlier and new logic. This is just an example. The sequence of CPT charge codes on claims--Edit screen is displayed in table under column ‘Claim – New Logic’. Earlier CPT/HCPC charge codes sequence displayed on Claims—Edit screen is shown under column ‘Claim – Old Logic’. The E&M code would always override other charges and will always be the first charge code on claim and it is followed by CPT charge codes added from Assessment in Assessment and then followed by charge codes from other sources like Rx, Vc, Lb and Rd as seen on Assessment screen.

Sr. No.	CPT/HCPC Code	Entry From	Assessment	Claim – Old Logic	Claim – New Logic
1	CPT1	Addition on Assessment Appointment	CPT1	CPT2	CPT2
2	CPT2	E&m Em	CPT5	CPT1	CPT1
3	CPT3	Rx Inhouse Rx	CPT2	CPT4	CPT5
4	CPT4	Vaccination Vc	CPT3	CPT5	CPT3
5	CPT5	Addition on Assessment Appointment	CPT4	CPT3	CPT4

Note: CPTs from E&M will always override the sequence and it will appear on top.

Figure3.2 – Sequence of charge codes in Assessment and Claim.

3.3 Description of Inhouse drugs dispensed Compound drug automatically copied to Cell 19.

In case of INHOUSE dispensed COMPOUND DRUGS, the COMPOUND Drug Description is automatically copied to Cell 19 of claim on creation of claim. This compound drug code has to be sent with NDC code, Units, Quantity and Description. The Description is displayed on ‘I’ button field ‘Cell 19 Local Use’ of claim and sent through EDI in appropriate loop and printed on CMS1500 in cell 19. Ex: “'Morphine Sulfate XX mg + Fentanyl YY mcg + Clonidine ZZ mcg'”.

4. Claims >> Edit

4.1 ICD code assigned to only ‘DO NOT SEND’ charge code is dropped automatically when Claim is posted.

Charge codes tagged with ‘Do Not Send’ status using CMS flag is treated as ‘Non Billable’ charge codes and are dropped off automatically when the claim is posted.

4.2 All ICD codes marked as ‘Billable or Primary’ from Assessment are now assigned to charge codes with no ICDs associated if claim is created from EMR side.

Whenever claims are created from EMR side with some ICD and some charge codes selected and some charge codes have ICD codes associated in Assessment, the newly created claims from EMR side will carry forward these ICD codes, Charge codes and associated ICD codes at claim level provided they are Primary or Billable. If none of the ICD codes are assigned to a charge row in this claim, all Billable or Primary ICD codes will be assigned to the charge codes in charge row automatically provided the ICD count is less than or equal to 4. If the count of Billable or Primary ICDs is more than 4, no ICD code will be automatically associated to that charge code. Earlier this logic was property based.

Figure4.21 – ICD codes from Encounter associated to claim.

Figure4.22 – ‘Primary & Billable’ ICD codes from Encounter associated to claim.

4.3 Claims can support up to 12 ICD codes based on a property.

The property 'cms1500.max.icds’ can have a max value of 12. In other words, the claim can support up to 12 ICD codes. The default value is set to 8.

4.4 New Validation when claim is saved to check that patient is ‘Established Patient’.

Claims- Edit: A new property ‘billing.newpatient.window’ is introduced to check the period along with same Taxonomy code for a Doctor, within which a patient will be treated as ‘Established Patient’. This property is validated up on saving of the claim. Default value set for this property is ‘1000’. If a patient visit is within this period for a Doctor with same Taxonomy code, it cannot be called as 'New Patient', it is still an 'Established Visit'.

4.5 Handling of ICD code assigned to ONLY ONE charge code billed to Patient is tweaked.

If a Claim uses an ICD Code say 00100 and it is Only assigned to a Charge Code Billed to Patient then
a) It will NOT give any error.
b) While printing CMS this ICD code will NOT be printed. The Charge row billed to Patient is in any case Not printed.
c) While generating the EDI also this ICD code will be ignored.
d) The ICD code will be considered for Sync with EMR.
e) The ICD will be dropped if the Claim needs to be split (more than 4 ICD Codes in a Claim) for CMS printing.

4.6 ‘Reason’ to Re-open claim is now displayed in search of ‘Reopen’.

Claims >> Edit: Button ‘List of Reopened Claims’ displays search pop up for Reopened claims. Pop up ‘Reopened’ has list of claims which were reopened in the past which is currently selected on the claims-->Edit screen. System creates archived entry for those claims which were reopened and these archived claims are displayed on ‘Reopened’ search pop up along with current claim. The pop up has various fields used for filtering out the reopened claims. Whenever claims are reopened, user has to enter ‘Reason’ for reopening a claim. Now field ‘Reason’ is added on pop up ‘Reopened’ so that user can use for searching the reopened claims. The ‘Reason’ for all archived claims is displayed under column ‘Reason’. Whenever archived claim is selected and opened, a yellow band is displayed over upper header of the claims screen to notify that selected claim is archived claim.

Figure4.6 – Field ‘Reason added on pop up ‘Reopened’.

4.7 New button ‘Filter’ is added to apply filter on the screen.

Claims >> Edit Screen: New button ‘Filter’ is added on the screen which will replace button ‘select Filter’ (used to be at bottom) and Tool Bar List Box for ‘All/Unprocessed/Billed’(This toolbar has been also removed from EOB screen). This Filter is indicated by the funnel icon next to Claims search binocular icon. Button ‘Filter’ will invoke pop up ‘Edit Claims Filter’ where user can enter criteria to filter out the claims to be displayed on Claims > Edit screen. Color of the icon turns ‘Green’, when filter is applied to the screen. It indicates that ‘Filter’ is applicable on screen.

Figure4.7 – 'Filter’ icon on Claims-Edit screen.

Note: Filter icon is visible on screens like on Claims >
a) Edit b) Send Claims c) Send UB04 d) Outstanding e) Claims Center f) Charges Center

ii)New Property ’billing.show.toolbar.listbox=N’ has been introduced just in case users would like to add the Tool Box List Boxes for Claims and EOB submenus back. If set to 'Y', the Tool Bar List Box is displayed for Claims and Eob submenus where applicable. It is applicable on screens like a) Claim > Edit b) Remittance > EOB/ERA c) Remittance > Insurance Credit d) Remittance > Ins Woff e) Remittance > Ins Refund f) Remittance > Capitation Receipt g) Remittance > Pat Item Returns h) Remittance > Pat WOff i) Remittance > Pat Refund k) Remittance > Pat Misc Credit

4.8 Place of Accident is mandatory for Auto Accident ONLY.

In accident type claims, now Place of Accident is mandatory for Auto Accident only and not needed for Work Comp and Personal Accidents any more. Accordingly, following are the changes made:
i) The check for Place of Accident has been changed and will be applied when on claim, ‘Auto Accident’ checkbox is checked.
ii) In case of Other Accident/Personal Accident, the patient insurance status can be Primary / Secondary / Tertiary.
iii) The status ‘Personal Accident’ is now redundant.
iv) While printing CMS, tag BLH_CELL10__ACCIDENTPLACE will be printed only in case of Auto Accident.

4.9 Supplementary Claim created when a claim has pre-defined charge code(s).

Sometimes, if an encounter Assessment has a specific charge code in addition to other charge codes, the Insurances expect the specific charge code to be billed in a separate Supplementary claim. This will be now possible with the help of new ‘Supplementary Claim’ feature.

Property Billing Parameters 2 > supplementary.claim.cpt.codes defines comma separated CPT Codes or range like 75956-75984. On creation of Claim, if any CPT Codes fall in this range, then a separate claim is created for these codes. Thus the encounter will have two claims created.

Likewise Property Billing Parameters 2 > supplementary.claim.hcpc.codes defines comma separated HCPC Codes or range like A0100-A0200. On creation of Claim, if any HCPC Codes fall in this range, then a separate claim is created for these codes. Thus the encounter will have two claims created. Consider an Encounter with two codes 99212 and 75957 (X ray). It will create First Default Claim with only 99212 and a Supplementary Claim with 75957.

The Billed Amount, Insurance Amount, Patient Amount and Contract Amount totals will be recomputed for Both Claims. If on Close of Encounter, user tries to recreate the claim, then it recreates the first claim if not Billed. It will also check for Supplementary claim and recreate it, if not billed.

4.10 ‘Sync’ feature related changes.

Feature ‘Sync’ is for synchronization of ICD, CPT and HCPC codes from Claims screen with Assessment screen. Following changes have been made to theSync feature:

If a claim is created from Claims > New, the ICDs are Added to Assessment, but CPTs and HCPCs are NOT added to assessment. They were added on Save Action of Claim screen if the Charge row is modified. Hence if the user creates a claim and marks it as Ready to Send, No addition is done to assessment.

If any ICD is deleted from claim and Sync is turned ON, on Assessment, delete is possible only if the ICD is NOT used in Lab / Rad / Rx of the encounter.

If a Claim is Rebilled, then SyncEmr will not be done.

New Property ’billing.sync.emr.delicds’ if set to Y, unused ICDs from Assessment are deleted. As per 5010, any unallocated ICD code cannot be sent with a claim. Hence they are dropped from the claim. Same way, if Sync property is ON and above property is also ON, unallocated billable or Primary ICDs to any charge row on Assessment will be deleted.

5. Claims >> Send Claims

5.1 Validations ‘120’ and ‘128’ are bypassed when ‘Place of Service’ is ‘12’.

Claims >> Send Claims: Validations for ‘Address’ and ‘Zip’ for Service Location is by passed in case of Place of Service = 12 (Home Visit) on claims. The validations ‘120’ and ‘128’ are bypassed in case ‘Place of Service =12’ (Home Visit) in the claim when it is posted.

5.2 Checks bypassed if validation numbers are set in property.

Added a property ’837.ignore.checks’ for bypassing any check while processing the claim from Claims>>Send Claims screen. For ex: Injury date with Diagnosis code 800 through 995 is not necessarily needed. If the property is set to 129, the check ‘129: If Diagnosis codes 800 to 995 are used, Injury Date is mandatory’ is bypassed. The default value of this property is ‘BLANK’.

Note: This has been applied only for '129'. It will be incorporated for other checks later.

6. Remittance >> EOB/ERA

6.1 Hyperlink ‘Lookup’ displays claim wise details in pop up ‘Claims in EOB’.

Remittanceà EOB/ERA: Claims wise details will be displayed in pop up ‘Claims in EOB’ when hyperlink ‘Lookup’ is clicked. It will show list of claims in a remittance, sorted according to ‘Claim Id’. Pop up ‘Claims in EOB’ displays claim wise details like ‘Claim Id’, ‘Date’, ‘Patient’, ‘Insurance’ and ‘Provider’. The claims in this pop up is sorted in ascending order with respect to ‘Claim Id’. On clicking ‘Claim Id’ displayed on the pop up, the focus moves to Claim Id displayed on the RemittanceàEOB/ERA screen. From this pop up ‘charge code’ column is removed.

Figure6.1– Hyperlinked ‘Lookup’ displaying ‘Claims in EOB’.

6.2 New validation conditions: Char ‘S’ and ‘B’ introduced in property ‘era.validate.condition’.

The property ’era.validate.conditions’ now supports two more characters for checks: ‘S’ and ‘B’.
Add S: There was a case of Insurance making payment as Primary and one more instance of same Claim where same Insurance is making payment as Secondary in the same ELE. This is NOT supported and checked.
Add B: There were cases of multiple payment (Non recouped) entries against same Charge rows. This is Not supported and now validation is implemented on ‘Ready to Post’ action of an EOB. Such EOBs are not allowed to post.

6.3 On Post of EOB, when amount moved to Advance/ used from Advance, defaults are set to same as defaults of 1st claim in that EOB.

On Post of an EOB, if there is an amount which is moved to advance or used from advance, the default values are set in header for Location, Business Unit, Attending Provider, Rendering Provider, based on the values for the first claim id in EOB.

6.4 Attachment windows can be minimized/maximized.

Any attachment when opened opens in a non modal pop-up now. What this means is, this pop-up will have an option to minimize it and maximize it again instead of closing and re-opening it every time to view.

Figure6.4– Non-modal pop up for Attachment window.

6.5 Excess Amount entry possible without Paid Amount entry in ‘Duplicate’ charge codes in claim postings.

Now in case of DUPLICATE charge code entries in EOB (RED), it will allow users to enter Excess Amount without adding Paid amount. (e.g. Interest Paid by Insurance after Claim is fully paid).

Figure6.5– Excess amount entry for ‘Duplicate’ charge codes in EOB allowed.

6.6 Same Claim ID can be selected for recoup multiple times in an EOB.

Earlier user could not select same Claim Id twice in an EOB for recoup. Consider a case that Insurance EOB1 paid for one Charge row of a claim, EOB2 paid for Second Charge row of same claim, and EOB3 paid for Third Charge row for same Claim ID. Now in EOB4, Insurance wants to recoup all three earlier payments. Since user has to select three earlier EOB vouchers with same Claim ID, it was not supported. Now it is supported.

Figure6.6–Same Claim ID selected for recoup multiple times in an EOB.

6.7 Single Claim Edit now supports change of Payment modes like Normal, Duplicate and Additional.

While working on a claim using Single claim Edit, earlier user could not change the Payment modes like Normal, Duplicate and Additional. Now it is supported.

Figure6.7– Single Claim Edit allows payment status to be changed to ‘Normal/Duplicate/Additional’.

7. Remittance >> Disputed

7.1More relevant fields are now displayed on ‘Disputed’ screen.

Remittance >> Disputed: Now on ‘Disputed’ screen, more relevant and feature specific fields are displayed which will help user to view precise information about ‘Disputed’ remittance. Now columns like ‘ERA No.’, ‘RA Date’, ‘Insurance’, ‘Patient’, ClaimId’, ‘DOS’, ‘Code’, ‘Notes’, ‘Bill Amt’, ‘Contract Amt’ and ‘Allow Amt’. Earlier it used to display ‘ClaimId’, ‘DOS’, ‘POS’, ‘Patient’, ‘RA Date’, ‘Insurance’, , ‘Code’, ‘Notes’, ‘Bill Amt’, ‘Exp Amt’ and ‘Allow Amt’.

Figure 7.1: More relevant columns are displayed on screen 'Disputed'.

8. Remittance >> Denied/Pending

8.1 Menu name changed to ‘Denied/Pending’ from ‘Denied’.

Remittance >> Denied/Pending: The menu name under ‘Remittance’ menu is now changed to ‘Denied/Pending’ so that it becomes pretty obvious to users by reading menu name that what screen is all about.

Figure 8.1: Menu name changed to ‘Denied/Pending’ from ‘Denied’.

8.2 Claims with ‘Denied’ status entries will not be displayed on Pat W/O & Ins. W/O’.

Claims entries with payment status as ‘Denied’ on RemittanceàEOB/ERA screen is displayed after saving and posting of EOB. Such claim entries with ‘Denied’ payment status will now be displayed on RemittanceàDenied screen but not on RemittanceàIns. W/O and RemittanceàPat W/O screen. Whenever claim entries with ‘Denied’ payment status is tried to include on
RemittanceàIns. W/O and RemittanceàPat W/O screen, an alert message is displayed. The message ‘Following claims are under Claims>Denied, hence not added claimidxxxx’. Claim entries with ‘Denied’ payment status are not allowed to add / display on RemittanceàIns. W/O and RemittanceàPat W/O screen.

Figure8.2 – Claims with ‘Denied’ action not displayed on RemittanceàIns. W/O & Pat W/O screen.

8.3 More relevant fields are now displayed on ‘Denied/Pending’ screen.

Remittance >> Denied/Pending: Now on ‘Denied/Pending’ screen, more relevant and feature specific fields are displayed which will help user to view precise information about ‘Denied/Pending’ remittance. Now columns like ‘ERA No.’, ‘RA Date’, 'Eob From', ‘Patient’, 'ClaimId’, ‘DOS’, ‘Code’, ‘Status’, 'Reason', ‘Action’, ‘Notes’ and ‘Amount’. Earlier it used to display ‘ClaimId’, ‘DOS’, ‘POS’, ‘Patient’, ‘RA Date’, 'Eob From' ‘Code’, ‘Status’, 'Reason', ‘Action’, ‘Notes’ and ‘Amount’.

Figure8.3 –More relevant columns are displayed on screen 'Denied/Pending'.

9. Remittance >> Unallocated

9.1 ‘Instrument#’ is now displayed under column ‘Check No’ for ELEs only.

Remittance >> Unallocated screen: Now ‘Instrument#’ is also displayed for ELEs received under column ‘Check No’ on ‘Unallocated’ screen.

Figure9.1 – ‘Instrument#’ is now displayed under ‘Check No.’ in ‘Unallocated' Screen.

9.2 List box ‘Voucher’ now supports ‘Capitation Receipt’, ‘Pat Misc Credit’ as well.

Remittance >> Unallocated screen: Now list box ‘Voucher’ supports two more entries like ‘Capitation Receipt’ and ‘Pat Misc Receipt’ which can be eventually used to filter records for respective feature to find ‘Unallocated’ amount.

Figure9.2 – List box ‘voucher’ now supports two more options ‘Capitation Receipt and Pat Misc
Credit’.

9.3 Button ‘export’ is now provided on ‘Unallocated’ screen.

Remittance >> Unallocated screen: Now button ‘export’ is added on ‘Unallocated’ screen which will allow to export respective vouchers in XLS format.

Figure 9.3- Button ‘excel’ provided on ‘Unallocated’ screen.

10. Remittance >> Processed

10.1 ‘Instrument#’ is now displayed under column ‘Check No’ for ELEs only.

Remittance >> Processed screen: Now ‘Instrument#’ is also displayed for ELEs received under column ‘Check No’ on ‘Processed’ screen.

10.2 List box ‘Voucher’ now supports ‘Capitation Receipt’, ‘Pat Misc Credit’ as well.

Remittance >> Processed screen: Now list box ‘Voucher’ supports two more entries like ‘Capitation Receipt’ and ‘Pat Misc Receipt’ which can be eventually used to filter records for respective feature to find ‘Processed’ amount.

10.3 Button ‘export’ is now provided on ‘Processed’ screen.

Remittance >> Processed screen: Now button ‘export’ is added on ‘Processed’ screen which will allow to export respective vouchers in XLS format.

11. Remittance >> EOB/ERA/Pat.Receipts/Cap.Receipts/CoPay/Ins Refund/ Pat Refund/ Pat. Misc. Credit.

11.1 A validation implemented to verify ‘negative check amount’ and ‘check date’ in EOB.

Remittance >> EOB/ERA / Pat. Receipts/ Cap. Receipts /CoPay /Ins. Refund / Pat. Refund / Pat. Misc. Credit screen:

A check has been introduced to verify that entered ‘check date’ is not future date in EOB but date prior to current date is allowed as ‘check date’. Whenever ‘check date’ is found greater than today’s date, an alert message is displayed- ‘Check Date cannot be greater than today.’

Another validation is introduced to check ‘negative check amount’ in EOB. An alert message is displayed – ‘Please enter positive numeric value’. Both validations are implemented on action ‘save’ of EOB. Whenever either of the validation turns valid, the EOB is not allowed to save till appropriate changes are incorporated in EOB.

Figure11.1 – Validations about ‘check date and negative amount’ in EOB on EOB/Pat Receipts/ CoPay/Cap Receipts/ Ins. Refund/ Pat. Refund / Pat. Misc. Credit screen.

11.2 Field ‘Instrument #’ is added on EOB Screen for ELEs’.

In case of ELE, the screen will now display the Instrument #. This Instrument number will fulfill two purposes:

This Instrument number will be helpful for Billers to track the ELE on Clearing house’s website. The Instrument Number is nothing but the check number for that ELE.

This Label ‘Instrument#’ will be hyper linked if there was an error while processing the 835 request. For ex: Hyperlinked ‘Instrument #’ will display ‘835’ errors received against claims in EOB (e.g. Claims which are received in EOB but from outside of PrognoCIS could not be processed).

Another important change where this Instrument Number hyperlink will be effectively used is: Till now, if the ELE had only Non PrognoCIS Claims, or for some reason none of the claims in an ELE could be processed by the system, then the ELE created would get deleted. Now it will remain and when clicked, will display (only Header without details) with the specified claim details in Instrument# hyperlink.

Figure11.2 – ‘Instrument#’ on Remittance screen for ELE received.

12. Remittance >> Patient Receipts

12.1 Tooltip over field 'Patient' displays Patient name and Chart number.

RemittanceàPatient Receipts screen: A tooltip is displayed when mouse moves field ‘Patient’. It will display the patient name and chart number of the selected patient. This tooltip will provide quick information about chart number of the selected patient.

Figure12.1 – Tooltip displaying patient name and chart number.

13. Messages >> Attach Center /Scan Center

13.1 Feature added to Attach/ Scan Billing Doc and EOB from Billing side.

Messages--Attach Center/ Scan Center: Both these menu option were earlier accessible from EMR side only. Now they can be invoked from Billing side. When invoked from Billing side shows Only Billing and EOB options. If EOB option is selected, the default order No. is ‘NEW’. This indicates that a new EOB voucher will be created and the document attached to it. Also note that from changes to Others and the label “Name” in the next line changes to Carrier. Use has to mandatoryly enter the name of the Carrier / Insurance from whom the EOB document is received. The EOB gets created with this name of Carrier. The same functionality is also applicable under scan menu option. Note: Carrier is ‘Not’ required when EOB order No. is Not ‘NEW’.

Figure13.1 – Attach / Scan Center feature from Billing Module.

14. Reports >> Statement

14.1 A new property introduced to print ‘Denied’ reason in EOB on statement.

Reports--Statement: In order to add to the flexibility to printing of information on reports generated, a new property ‘statement2.print.denied.reason’ is introduced. If it is set to ‘Y’ then statement will print ‘Denied’ reason in EOB.

Figure14.1 – ‘Denied’ reason in EOB printed on Statement.

14.2 A new property introduced to customize background color in patient statement.

Reports--> Statement: A new property ‘statement.patcolm.bgcolor’ is introduced so that user
can customize the background color ‘Patient Bill’ and ‘Patient Receipt’ column in the generated statement. When it is set to a color code then background color of the ‘Patient Bill’ and ‘Patient Receipt’ column is set accordingly when statement is generated. By default, it is set to ‘#999999’ (Gray color). If it is to ‘#FFFFFF’ then background color will not be printed. The color code is set in property as ‘bgColor=#99FC99’.

Figure14.2 – Customized background for ‘Patient Bill’ and ‘Patient Receipt’.

14.3 Now ‘check number’ for CoPay collected is also printed on statement.

ReportsàStatement: When Copay is collected from patient by ‘check’, the check number for copay collected is also printed on generated statement. Information about ‘check number’ for copay collected will be helpful to user whenever check bounces back. Earlier suffix ‘BOUNCED’ was only printed in case check against Copay collected had bounced back.

14.4 Now consolidated statement is printed for several patients having same ‘Resp. Person’.

Reports--Statement: A single person might be ‘Responsible Person’ for several patients. Whenever report is generated for ‘A Responsible Person’ criteria in statement pop up, single statement would be printed for all patients having same ‘Responsible Person’. The generated statement will be grouped by ‘Patient’ and data pertaining to each patient will be shown separately on that single statement.

Note: The same changes are made for Statements Exported as CSV to Gateway. Same way, CSV Statements now support ‘Dunning Messages’.

14.5 Set the period to print details of patient using property 'statement.patientac.days’.

A new property ‘statement.patientac.days’ which determines how many days in the past should it consider printing the details of all Patient Claims. The default value is 365. The same property is also used by Ledger to print the Ope Balance Date. The default Ledger dates are considered to be by Document Date (earlier it used to consider Mod timestamp).

15. Reports >> Collection

15.1 Credit Card Type Name field removed from collection reports.

ReportsàCollection: Whenever a report is printed, a layout is selected so that reports are generated according to the placement of fields on the selected layout. PrognoCIS provides flexibility to customize layouts in reports using button ‘layout’. Now field ‘Credit Card Type Name’ is removed from the list of fields displayed on Layout and it is not available for printing on collection report.

16. Reports >> Summary

16.1 ‘CoPay- Move to Advance’ is now hyperlinked to show details.

Reports >> Summary: Now summary reports generated will display hyperlinked ‘Copay- Move To Advance’ (tabular report based on Pt Id/Chart No). This pre-defined amount ‘Copay- Move To Advance’ is defined in Financial Amounts.xls file. When hyperlinked ‘Copay- Move To Advance’ is clicked, it will display breakup of Copay moved to Advance.

17. Reports >> Fin Analysis

17.1 Options included for calculating and printing yearly / monthly /Daily/Category charge wise ‘Totals’ for Financial Analysis.

Reports-- Fin Analysis: On pop up ‘Financial Analysis Monthly’, three radio buttons are added to facilitate the user to calculate and print ‘Totals By’ on Financial Analysis report for:

Year-Month

Day wise (only if period is less than a month)

Category (Charge wise category)

These options on Financial Analysis pop up will add to flexibility to analyze the financial report.

Figure17.1 – Options to calculate and print ‘Totals By’ for year-month/ Days/Category on Financial Analysis Report.

18. Reports >> Fin Analysis/By Charges/By Claims/ Summary

18.1 Feature added to export reports to Excel spreadsheet.

Reports-- Fin Analysis/ By Charges/By Claims/Summary screen: Reports generated from various screens can now be exported in CSV format to MS Excel spreadsheet. This feature will allow analyzing generated output and also sharing with other users who are not internal users.

Figure18.1 – Feature to export the reports in Excel format.

18.2 Button Layout: by default, now Layout #1 is non editable.Layouts can be made non-editable.

Reports-- Fin Analysis/ By Charges/By Claims/Summary screen: There are 8 layouts on each screen. Each Layout can be customized as per requirements. One or more Layouts can be standard layouts designed by Bizmatics and will not be allowed to be edited by end users with the help of properties introduced for each of these screens. Layout #1 has been made non-editable by default.

Following are the properties for each screen. It accepts comma separated list of layout numbers between 1 to 8 for which no modification is allowed. Default value set is 1.
fa.layouts.noedit
claimrep.layouts.noedit
chargerep.layouts.noedit
collectiondetails.layouts.noedit
collectionheader.layouts.noedit

18.3 Button Layout:Changes related to Category, Order By, Summary columns and Move Up and Move Down.

Layouts: Reports >> Fin Analysis/ By Charges/By Claims/Collection screen: Additional changes done on Layout screens are as follows:

In case of composite amounts set in properties, instead of displaying it as Blank it displays Field No as “Unknown” and Category as “User Specified”.

Plus button is moved before buttons ‘Move Up’ and ‘Move Down’.

Summary Columns are displayed in Yellow Background.

Order By checkmark is shown if some criteria are chosen.

19. Reports >> Output Templates

19.1 New tags introduced to print modified ‘Date’, ‘Time’, and ‘User’ for patient.

Reports >> Templates >> Billing: To print modified ‘Date’, ‘Time’ and ‘User’ name, now arguments after ‘$’ can be passed after tags in the selected template. In selected template, insert the tag with argument in front of ‘$’ sign. It extends the feature to customize the templates with the help of new tags which will print required information at desired location.

20. Reports >> Letters

20.1 Page breaks in letters is allowed to insert at desired location.

Reportsà Letters: Page breaks at desired places in a letter can be inserted for better formatting of the letter which when generated is sent Patient/ Responsible Person/ Insurance Company. The page break is inserted in the template which will be selected for printing the letter. Wherever page breaks are inserted, the text below ‘Page break’ is moved to new page in the letter.

21. Settings >> CPT Master

21.1 Now ‘NDC’ codes to the CPT charge codes are allowed to associate.

A provision has been made to associate ‘NDC’ codes to the CPT charge codes. If a CPT/HCPC is selected in a Claim, after ‘Save’ it adds the NDC Code to those charge codes where NDC code was associated on CPT/HCPC Master. The ‘NDC’ status is also automatically updated on ‘CMS’ flag for that charge code. If a CPT/HCPC is selected on EMR side, on copying it to Billing it adds the NDC Code and is automatically updated on ‘CMS’ flag for that charge code if ‘NDC’ code was already associated to that charge code.

Figure21.1 – Provision to associate ‘NDC’ code to the CPT charge codes.

21.2 Checkbox for ‘NOC’ code added to the CPT/HCPC charge codes Master.

Figure21.2 – Checkbox for ‘NOC’ codes on CPT/HCPC Master.

22. Settings >> Location Master

22.1 When location is created, default value of ‘Place of Service’ is set to ’11-Office’.

Default ‘Place of Service’ when create ‘New’ location is displayed is set to ’11-Office’. But according to need, the user can change the ‘Place of Service ’.

Figure22.1 – Default value for newly created ‘Location’ is set to ’11-Office’.

23. Settings >> Billing

23.1 Back up HTML file is saved with modified time stamp when Template is edited.

On edit of a template, many a times the wrong codes are added and messed up. There was No way to know the original. Up on saving, for say Id ‘1135’, it creates a template file 1135.html. Now if the change was made on 12 Jan 2012, it will save the original as 1135_2012-01-12.bak If a change is made once more, then it won’t overwrite the backup created. If change is made the next day, one more file 1135_2012-01-13.bak will be created.

24. Settings >> Conf.>> Scheduled Process

24.1 New feature implemented to import Charge Codes from other software to PrognoCIS.

Settings>> Conf. >> Scheduled Process: A new self scheduled process has been introduced to import charge codes from encounter of other practice management software to PrognoCIS. These charge codes are sent by cleints in HL7 format.

24.2 Text box length is increased when label text ‘Template’ is found.

Settings >> Conf. >> Scheduled Process: In the Params popup, if the label contains the word “Template” the program will accept a long text.

25. Fee Schedule

25.1 New Button 'Add Mod' allows adding multiple modifiers to a charge code in a fee schedule.

Button ‘Add Mod’ allows user can associate multiple modifiers to current charge code selected on a fee schedule. When button ‘Add Mod’ is clicked, a pop up ‘Assign Modifier’ is displayed. User can select multiple modifiers from the list displayed on pop up. The selected modifier will get associated to currently selected charge code on the Fee schedule. When button ‘Ok’ is selected, various combinations with entry of charge code along with selected modifiers are added to the Fee Schedule.
If a combination already existed then that combination will not be disturbed. Now user can set fix Fee rate for that combination and will be pulled in claim or remittance when a specific combination of charge code and modifier used in claim or remittance according to Fee Schedule selected.

Figure25.1 – Button ‘Add Mod’ on Fee Schedule.

25.2 Functionality of button ‘Delete Mod’ is changed.

Fee Schedule: Button ‘Delete Mod’: If the Current row did not have any modifier, then all rows with combination of Charge row and modifiers will be deleted. If the current row had a modifier, only then the current row will be deleted.

25.3 New functionality added to ensure that new CPT/HCPC code in Master is available in current Fee Schedule.

A button ‘New Codes’ has been added before button ‘Add Mod’. This button ensures that new CPT/HCPC codes which have been added to the master will be available in the current Fee Schedule. This is basically helps to achieve synchronization between Master and Current Fee Schedule. If any rates or codes are missing from Fee Schedule then entered new rates and codes will be saved using button ‘New Codes’. This feature now adds to the flexibility to automatically save and update Fee Schedule with new rates and codes up on save.

Figure25.3 – Button ‘New Codes’ on Fee Schedule.

New Properties Introduced

Property

Description

era.chngresp.prefix
Prefix to be Used for Resposiblity change doc No. Special characters in prefix are : YY for calendar year, MM for month number.

era.chngresp.length
Number of digits of Generated Serial Number used in PResposiblity change doc No. This does not include the Prefix. The total length including the prefix should not exceed 20 characters.

ledger.with.charge.comments
If Set to 'Y', print Charge with Comments too.

ledger.datesby
'D' for Document Date, 'P' for Post Date, 'T' for Mod Timestamp.

837.ignore.checks
Specify the Error Nos. to be bypassed.

fa.layouts.noedit

Comma separated List of Layout Numbers for which no modification is allowed.

claimrep.layouts.noedit
Comma separated List of Layout Numbers for which no modification is allowed.

chargerep.layouts.noedit
Comma separated List of Layout Numbers for which no modification is allowed.

collectionheader.layouts.noedit
Comma separated List of Layout Numbers for which no modification is allowed.

collectiondetails.layouts.noedit
Comma separated List of Layout Numbers for which no modification is allowed.

billing.sync.emr.delicds
If set to 'Y', unused ICDs from Assessment are deleted.

837.preAuth.withsrno.suffix
If set to 'Y', finds dash in the PreAuth No and removes the suffix. This is used when there are duplicate PreAuth Nos assigned (by some Insurance companies) for same Patient Insurance.

billing.newpatient.window
If a patient visit is within this period for a Doctor with same Taxonomy code, it cannot be called as New Patient, it is still an Established Visit. Hence New Patient codes 99201 to 99205 will not be allowed to be billed again if billed during that window. Please enter this window in number of days.Default value is 1000.

billing Show.toolbar.listbox
If set to 'Y', the Tool Bar List Box is displayed for Claims and EOB submenus where applicable.

supplementary.claim.cpt.codes
Define comma separated CPT Codes or range like 75956-75984. On creation of Claim from EMR, if any CPT Codes fall in this range, then a separate claim is created for these codes. Thus the encounter will have two claims created.

supplementary.claim.hcpc.codes
Define comma separated HCPC Codes or range like A0100-A0200. On creation of Claim from EMR, if any HCPC Codes fall in this range, then a separate claim is created for these codes. Thus the encounter will have two claims created.

New Tags Introduced

PT_MOD
PT_MOD_USER$
PT_MOD_DATE
PT_MOD_TIME

Browser Settings

None

1. Introduction

2. Patient Insurance

2.1 Number of PreAuth entries increased from 10 to 15.

3. Claims >> New

3.1 Specialty Template carry forward template's value is recomputed.

4. Claims >> Edit

4.4 New Validation when claim is saved to check that patient is ‘Established Patient’.

4.10 ‘Sync’ feature related changes.

6.4 Attachment windows can be minimized/maximized.

6.5 Excess Amount entry possible without Paid Amount entry in ‘Duplicate’ charge codes in claim postings.

6.7 Single Claim Edit now supports change of Payment modes like Normal, Duplicate and Additional.

7.1More relevant fields are now displayed on ‘Disputed’ screen.

8. Remittance >> Denied/Pending

8.1 Menu name changed to ‘Denied/Pending’ from ‘Denied’.

9.1 ‘Instrument#’ is now displayed under column ‘Check No’ for ELEs only.

9.2 List box ‘Voucher’ now supports ‘Capitation Receipt’, ‘Pat Misc Credit’ as well.

9.3 Button ‘export’ is now provided on ‘Unallocated’ screen.

10.1 ‘Instrument#’ is now displayed under column ‘Check No’ for ELEs only.

10.2 List box ‘Voucher’ now supports ‘Capitation Receipt’, ‘Pat Misc Credit’ as well.

10.3 Button ‘export’ is now provided on ‘Processed’ screen.

18.2 Button Layout: by default, now Layout #1 is non editable.Layouts can be made non-editable.

18.3 Button Layout:Changes related to Category, Order By, Summary columns and Move Up and Move Down.

24.2 Text box length is increased when label text ‘Template’ is found.