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To All HAS Clients: Release 1.2.8.41 includes the following regulatory updates:
Version 1.2.8.41 also includes major enhancements for entering COB information on claims. In prior releases, required billing codes were entered via the option set or the Patient Insurance Bill Data tab. There is now a new Billing Codes tab in Payment Entry that allows the user to choose a Process Type to enter the required claim-specific codes.
The A-H series are for MSP billing scenarios and any elements not required for the selected MSP process type will be disabled. In addition, if any required fields are left blank an error message will generate when saving the record. Non-Medicare secondary claims can use the Custom Bill Data Process Type. When Adjustment Reason Codes are selected, the program will check that the claim balances upon saving the record and generate a message. When accessing a claim record in Payment Entry and selecting the Billing Codes tab, if any Patient Insurance Bill Data items are present that are not associated with a Bill Date, the user will be asked if they wish to associate those items with that claim. If the user selects 'No' those items remain in the Bill Data tab without a Bill Date and they will continue to pull to all claims that are generated with option sets specifying their inclusion. If 'Yes' is selected, the items will populate the Billing Codes tab with the Custom Bill Data Process Type and they will only pull for that claim's bill date. This
new functionality also allows the user to pull more bill data items to
the claims than in previous versions and eliminates the need to enter
multiple Adjustment Codes and Amounts in the Notes field of the
Adjustment Reason Bill Data record. It is also no longer necessary to
enter the amount the primary paid in the Insurance Co-Pay field -- the
amount should be entered in the Value Code 1 Amount field for both
Medicare and Non- Medicare payers. In order to take advantage of these new changes, option sets that are currently configured to use the Patient Insurance Bill Data tab will need to be updated. To Merge the new Baseline Option Set: Go to Billing>Electronic Claims In Option Set Selection, choose the Electronic 837 Baseline option set (must be dated 12/04/17 or later) Click the Options button to access the Billing Options Wizard. Click the Merge Button and select the Merge Into Option Set. Only option sets that are pulling data from the Bill Data tab need to be merged (MSP RAP option sets do NOT need to be merged). Click OK.
After merging, choose the option set that was previously selected as the 'Merge Into Option Set' in the Option Set Selection drop-down and click on the Options button. Go to Locator 2320.30. For option sets that were previously configured to pull the Co-Pay Amount, change this to 'Patient Bill Data Value1 Amount'. If the 'Payment Amount from First Other Insurance' option was selected this can remain if desired. If
the Baseline option set is merged into an option set that does NOT require Bill
Data Value Code/Occurrence Code/Condition items (example MSP Initial claims), new option 9000.50 'Include
Pat-Ins-Bill Data" MUST be set to Bypass. For all other merged option sets, this option should be set 'All Patient-Insurance Bill Data Items' (this is the default setting):
Refer to our MSP FAQ or Non-Medicare Secondary Claims with COB loop FAQ for detailed information on these changes. Also in v1.2.8.41, Electronic Claims has been altered so that if Billing Unit Overrides are set to *Hrs Rounded and the option set is consolidated (same rev code/date of service), it totals time for the day and then calculates units (prior it rounded units for each visit, then totaled units for the day). If you are using *Hrs Rounded and consolidating same dates of service on the claim for a payer, confirm with your payer their rounding requirements.
Refer
to Help>Release Notes to review a complete list of current and prior program
changes. |
