Claim Handling

• Electronic Claims: Combine Same Date...: This rule will affect which claims are combined into a single file, as well as if a matching clinician is required to merge electronic claims.
• Paper Claims: Combine Same...: This rule will affect which paper claims are combined into a single file
• Highlight Out of Balance Claims for Non-Primary Payors: An Out of Balance Claim is one where the sum of payments, balance-affecting adjustments, and non-balance affecting adjustments does not equal the claim charge.
• Auto-Apply Credit Balance Rule: Exact Date/Amount Match: Only auto-apply if a credit balance exists with a payment date matching the appointment date and a payment amount exactly matching the anticipated copay. Any Amount Covering Copay: Auto-apply if there is any credit balance available with at least enough credit to cover the copay. Any Amount: Auto-apply all available credit balances until the balance is satisfied or all credits are exhausted, prioritized by highest amount first, then oldest date.
• 837 EDI File Contents Storage: Save EDI Data: Check this option to save raw EDI data in the database in addition to the file on disk
• CMS-1500 Defaults: Box 12 Signature on File: If this option is checked, box 12 will always show "Signature on File" and the claim date. Otherwise, it will only show this information if "Signature on File" is checked in the Additional Information section on the Financial tab of the Demographic Record.
• CMS-1500 Defaults: Box 13 Signature on File: If this option is checked, box 13 will always show "Signature on File". Otherwise, it will only show this information if "Signature on File" is checked in the Additional Information section on the Financial tab of the Demographic Record.
• CMS-1500 Defaults: Box 27 Accept Assignment: If this option is checked, box 27 will always show "Yes" for Accept Assignment in Box 27. Otherwise, it will only show "Yes" if "Financial Assignment" is checked in the Additional Information section on the Financial tab of the Demographic Record.
• CMS-1500 Receiver Address Position: This setting affects how the receiver information which is displayed on the top of the CMS-1500 printout is positioned.
• UB-04 Printer Calibration: Space Above Box 38
• UB-04 Printer Calibration: Space Above Box 50
• UB-04 Printer Calibration: Space Above Box 58
• UB-04 Printer Calibration: Space Above Box 66
• Generate Unique Payment Reference Number: This setting affects how unique reference numbers will be generated for payment records.
• Default Next Payor for Insurance Payments: Write-off: Write-off the remaining balance Patient: Assign the remaining balance to the Patient Current: Leave balance with current payor Next in Sequence (Patient Default): Primary -> Secondary -> Tertiary -> Patient Next in Sequence (Write-off Default): Primary -> Secondary -> Tertiary -> Write-off
• Collection Service Integration
• Primary Allowed Amount Calculation
• Primary Allowed Amount Calculation: Include Add-Ons: Should service code add-ons be added to the allowed amount
• Claim Level Adjustments (CAS) Method: Simple: Send unpaid balance as OA*2 record Detailed: Show specific recorded Adjustment records
• Service Level Adjustments (CAS) Method: Simple: Send unpaid balance as PR3*2 for claim charge minus primary payments Detailed: Show specific recorded Adjustment records
• Create Adjustment Records For Balance Transfers: This will set the default value of the Create Adjustment Records option on the Balance Assignment form. It will also determine if adjustment records are created in the same fashion when selecting a Next Payor from the Payment Form which is different than the current payor.
• ICD10 Cutover Date: Leave this value at 10/1/2015
• Payment Receipt Custom Footer Message: Patient Receipt
• Payment Receipt Custom Footer Message: Insurer Receipt
• Display on Payment Receipts: Entering Staff: Check this option to display the name of the person entering the payment on receipts
• Display on Payment Receipts: Follow-Up Clinician: Check this option to display the name of the follow-up clinician for patient payment receipts
• Display on Payment Receipts: Credit Balance: Check this option to display credit balance information for payment receipts
• Disable Insurer Mapping: Disable the insurance mapping feature on the 835 ERA Parsing screen so you can manually select the payor.
• Display on Payment Receipts: Open Balance: Check this option to open balance information for payment receipts
• Patient Statement Auto Requeue: Determine if pending Patient Statement transactions should automatically be requeued after the processing date.
• Patient Statement Auto Requeue: Days After Process Date to Requeue: If the "Auto requeue claims" rule is set to "After X Days", this is the number of days after process date to requeue.
• Patient Statement Auto Requeue: The Number of Days that Need to first pass: If the "Auto requeue claims" is set to "On Day X of Each Month", this is the number of days that must have passed since processing before requeuing.
• Patient Statement Auto Requeue: Day of month to requeue on: If the "Auto requeue claims" is set to "On Day X of Each Month", this is the day of the month to requeue on.
• Collection Letter Remit: Line 1: Remit to Address Line 1
• Collection Letter Remit: Line 2: Remit to Address Line 2
• Collection Letter Remit: Line 3: Remit to Address Line 3
• Collection Letter Remit: Line 4: Remit to Address Line 4
• Auto-Assign Balance When Adjusting Service Price: If the service price of an existing claim is adjusted within Claim Details and the balance assignment is currently completely assigned to a single payor, determine if the balance assignment should be adjusted to match the change in the service price.