CareLogic System Administration User Guide, Part 1 -...

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CareLogic

System Administration

User Guide, Part 1

CareLogic User Manual

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Table of Contents

CareLogic .................................................................................................................................................................................... 1

System Administration .............................................................................................................................................................. 1

User Guide, Part 1 ...................................................................................................................................................................... 1

Table of Contents ...................................................................................................................................................................... 2

Billing Administration............................................................................................................................................................... 8

Organizations ............................................................................................................................................................................ 8 Access Organizations 8

Set Up a Multi-Tier Organizational Structure 9 Add Organizations 10 Update Organizations 13

Remote Access ....................................................................................................................................................................... 13 Restrict IP Addresses Administration 13

Setting Up Billing Categories ................................................................................................................................................ 14 Adding Billing Categories 14 Updating Billing Categories 15 Deleting Billing Categories 16

Setting Up Procedure Codes ................................................................................................................................................. 16 Adding Procedure Codes 17

Reviewing Activity/Procedure Mappings 18 Updating Procedure Codes 19 Creating a New Standard Fee for an Existing Procedure Code 20 Deleting Procedure Codes 22

Setting Up Revenue Codes.................................................................................................................................................... 22 Claim Engine Logic for Revenue Codes 22

Setting System Configuration to Enable Revenue Codes 23 Setting Up Procedure/Revenue Codes 24 Setting Up Payer Plan Fee Matrices 25

Setting Up Modifiers ............................................................................................................................................................... 27 Adding Modifiers 28 Associating Modifiers with Organizations 29 Updating Modifiers 30 Creating a New Percentage Fee Change for an Existing Modifier 31 Deleting Modifiers 33

Setting Up Activity Codes ...................................................................................................................................................... 33 Adding Activity Codes 34 Associating Activities with Organizations 38

Updating Activity Codes 38 Setting Up Activity/Procedure Mappings 39 Setting Up Activity/Program Mappings 44


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Set Up Treatment Programs .................................................................................................................................................. 46 Add Treatment Programs 47 Associate Programs with Organizations 48

Update Treatment Programs 50 Set Up an Activity Program Matrix 50 Set Up Activities for Per Diem Programs 51

Payer Panels ............................................................................................................................................................................ 54 Add Payer Panels 55 Assign Staff Members to Payer Panels 55 Associate Payer Panels with Organizations 58 Update Payer Panels 58 Delete Payer Panels 59

Maintaining HCFA and UB04 Configurations ...................................................................................................................... 59 Configuring Dynamic HCFAs 60 Copying Dynamic HCFA Configurations 67 Deleting Dynamic HCFA Configurations 67

Configuring UB04s 67 Copying UB04 Configurations 71 Deleting UB04 Configurations 72

Payer Administration .............................................................................................................................................................. 72 Setting Up Payers 72 Set Up Payer Plans 76 Setting Up a Payer Plan’s Fee Matrix 88

Auditing Payers ....................................................................................................................................................................... 96

Checking Client Eligibility in Batch Mode ........................................................................................................................... 99 Maintaining 270 Eligibility Batch Files 101 Reviewing 271 Eligibility Response Files 106

Check a Client’s Payer Eligibility in Real Time ................................................................................................................. 110 Real-time Eligibility Configuration 110

Setting Up Referral Sources 110 Adding Referral Sources 111 Updating Referral Sources 113 Adding Staff Visits to Referral Sources 114 Adding Notes about Referral Visits 115 Deleting Referral Sources 116

Setting Up Service Locations by Organization ................................................................................................................. 117

Setting Up Type of Bill by Organization ............................................................................................................................. 118

Setting Up Point of Entry Mappings ................................................................................................................................... 119 Adding Point of Entry Mappings 119 Updating Point of Entry Mappings 120 Deleting Point of Entry Mappings 121

Set Up Claim Rollup Rules .................................................................................................................................................. 121 Add a Rollup Record 122 Add Billable Units for Rollup Records 124


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Maintain Rollup Rules 126 Updating a Rollup Record 128

Deleting a Rollup Record 128

Setting Up Sliding Fee Scales ............................................................................................................................................. 128 Adding Sliding Fee Scales 129 Adding a Fee Matrix to a Sliding Fee Scale 131 Updating Sliding Fee Scales 132 Deleting Sliding Fee Scales 133

Setting Up Dynamic Sliding Fee Scales ............................................................................................................................ 133 Setting Up Bill Next Procedure Mappings 135

Configuring the Supervising Physician to Appear on Claims ........................................................................................ 138 Making Collection Assignments 140

Accessing Existing Collection Assignments 141 Creating New Collection Assignments 142

Clinical Administration ......................................................................................................................................................... 144

Episode of Care Types ......................................................................................................................................................... 144 Add Episode of Care Types 145 Update Episode of Care Types Names 146 Update Programs Associated With Episode of Care Types 146 Delete Episode of Care Types 149

Medications ........................................................................................................................................................................... 149 Add Medications 150

Associate Medications with Organizations 150 Update Medications 151

Medication Reconciliation 152

Medication Consent .............................................................................................................................................................. 152 Create a Medication Consent Service Document 152

Supervisor Groups ............................................................................................................................................................... 154 Add New Supervisor Groups 156 Update Supervisor Groups 157 Update the Members in a Supervisor Group 158

Service Documents............................................................................................................................................................... 159 Add Service Documents 160

Add Instances to Service Documents 161 Configure Service Documents 165 Add an Instance to Service Document Groups 166

Add Signature Filters to Service Documents 167 Associate Service Documents with Organizations 169

Configurable Forms .............................................................................................................................................................. 170 Build Clinical Module Forms 170 Previewing Clinical Module Forms 178 Editing Clinical Module Forms 179 Copying Clinical Module Forms 180 Deleting Clinical Module Forms 180


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Service Document Crosswalks ........................................................................................................................................... 181 Add Service Document Crosswalks 182

Update Service Document Crosswalks 186 Delete Service Document Crosswalks 187

Unsign Service Documents ................................................................................................................................................. 187

Order Statuses ...................................................................................................................................................................... 190

Clinical Orders....................................................................................................................................................................... 191 Configuring Billable Orders 192 Configuring Orders to Generate Claims 193 Configuring Clinical Orders 193 Setting Up Order/Procedure Mappings 207

Defining Order Privilege Levels 217

Standing Order Protocols .................................................................................................................................................... 218 Creating Standing Order Protocols 219 Adding Instances to Standing Orders Protocol 219 Defining Standing Orders Protocol Privilege Levels 221 Deleting Standing Orders Protocol 222

Client Groups ........................................................................................................................................................................ 222 Adding New Groups 223 Updating Groups 225 Defining Group Rosters 226 Copying Group Rosters 227 Deleting Groups 227

Beds ........................................................................................................................................................................................ 228 Adding Beds 229 Setting Up Programs for Beds 230 Updating Beds 231 Deleting Beds 231

Treatment Plan Grids ............................................................................................................................................................ 232 Associating Treatment Plan Grids with Organizations 233 Adding Diagnosis Codes 234 Adding Sub Problems 235 Setting Up Treatment Goals 236 Setting Up Treatment Objectives 237 Setting Up Treatment Interventions 237

Diagnosis Categories ........................................................................................................................................................... 238 Set Up the Diagnosis Category Module 238 Assign Diagnosis Categories to Programs 240

Call Logs ................................................................................................................................................................................ 242

DRG Codes Administration ................................................................................................................................................. 243 3rd Party Sources 244

Add 3rd Party Sources 245 Associate 3rd Party Sources with Organizations 248 Update 3rd Party Sources 248


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Delete 3rd Party Sources 248 Referring Physician Configurations 248

Add Referring Physician Configurations 249 Update Referring Physicians Configurations 250 Delete Referring Physicians Configurations 251

Business Rules 251 Add Scheduling Rules 252 Add Clinical Decision Rules 254 Add Employee Document Rules 256 Add Treatment Plan Rules 256

Patient Portal ......................................................................................................................................................................... 258

Clinical Quality Measures .................................................................................................................................................... 259 Report Clinical Quality Measures 259

System Administration ......................................................................................................................................................... 263 Menu Management System 263

Adding Menu Systems 264 Select Menu Items 266 Add Menu Items 267 Editing Menu Items 268 Setting Up Menu Items by Organization 269 Defining Privilege Levels for Menu Items 270 Changing the Order of Menu Items 271 Deleting Menu Items 272

List Modifier ........................................................................................................................................................................... 272 Select a List Modifier Type 273 Add a New List Modifier Type 274 Add New List Modifier Descriptors 274 Set a List Modifier Descriptor as the Default 276 Copy a List Modifier 276 Editing a List Modifier Descriptor 277 Deleting a List Modifier Descriptor 278

Setting Up Privilege Groups ................................................................................................................................................ 278

Dashboard Administration................................................................................................................................................... 279

Setting Up the Dashboard ................................................................................................................................................... 280

Face Sheet Administration .................................................................................................................................................. 282 Use the Face Sheet 291

Adding System Messages 292 Accessing a Service Process Quality Management File 293

Retrieving SPQM Files 293 Adding an SPQM Extract File 294 Deleting an SPQM Extract File 294

Setting Up Group Bonus Configurations 295 Adding Group Bonus Configurations 295

Updating Group Bonus Configurations 296 Deleting Group Bonus Configurations 296

Setting Up Fee For Service Mapping 297 Adding Fee For Service Mappings 297


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Updating Fee For Service Mappings 298 Deleting Fee For Service Mappings 299

Setting Up Unit Cost Management 299 Adding Unit Cost Management Records 299 Updating Unit Cost Management Records 300

Deleting Unit Cost Management Records 300 Mapping DRG Codes 301

Creating HL-7 Batches ......................................................................................................................................................... 302 Adding HL-7 Automated Job Configuration 302

Manually Creating HL-7 Batches 304 Accessing Records Included in HL-7 Batches 305 Downloading HL-7 Batches 305 Deleting HL-7 Batches 306

Using the Clinical Audit Log ................................................................................................................................................ 306

Setting Up Source of Payment Instances .......................................................................................................................... 308 Adding Source of Payment Records 309 Updating Source of Payment Records 309 Adding Matrix to a Source of Payment Record 310 Deleting Source of Payment Records 311

Using Session Management ................................................................................................................................................ 312

Setting Up a Co-Pay Matrix.................................................................................................................................................. 312 Adding Co-Pay Matrices 313 Updating Co-Pay Matrices 314 Associating Payer Plans with Co-Pay Matrices 315 Deleting Co-Pay Matrices 316

Setting Up Per Diem Schedules 316 Adding Per Diem Schedules 317

End Dating Per Diem Schedules and Removing Non-Billed Days 318 Adding Non-Billed Days to a Per Diem Schedule 319

Deleting Per Diem Schedules 320 Setting Up iCalendar Feeds 320


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Billing Administration This chapter is used to set up the billing-related administration modules. The following topics are included in this chapter: Organizations Setting Up Billing Categories Setting Up Procedure Codes Setting Up Revenue Codes Setting Up Modifiers Setting Up Activity Codes Set Up Treatment Programs Setting Up Payer Panels Maintaining HCFA and UB04 Configurations Payer Administration Auditing Payers Checking Client Eligibility in Batch Mode Check a Client’s Payer Eligibility in Real Time Setting Up Referral Sources Setting Up Service Locations by Organization Setting Up Type of Bill by Organization Setting Up Point of Entry Mappings Set Up Claim Rollup Rules Setting Up Sliding Fee Scales Setting Up Dynamic Sliding Fee Scales Setting Up Bill Next Procedure Mappings Configuring the Supervising Physician to Appear on Claims Making Collection Assignments Important: See the General Ledger Guide for detailed instructions about setting up GL administration.

Organizations The Organizations module is used to set up all of the organizations in your business unit that are licensed to use CareLogic. Whether your business unit consists of a single organization (a flat organization structure) or multiple organizations (a multi-tier organization structure), the Organizations module allows you to set up an organizational structure to meet your specific needs. See page 13 for information about setting up a multi-tier organization structure.

Access Organizations 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Organizations.

The Organization List page appears. This page, and the organization tree in the left pane, lists the organization you are currently logged into and all child organizations.


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This page is used to perform the following tasks: Add Organizations Update Organizations

Set Up a Multi-Tier Organizational Structure Note: CareLogic provides a great deal of flexibility in setting up organizations. This section is intended to

provide general guidelines that will assist you in setting up a multi-tier organizational structure.

The Organizations module can be used to configure a multi-tier (Parent-Child) organizational structure. Using the multi-tier model, your business unit will be able to share data across organizations. You should be aware of the following information when setting up multi-tier organizational structures. Each implementation can have only one top-tier organization. A top-tier organization is one that does

not have a parent organization defined. When a child organization is created, it automatically inherits the menu management system that is

defined for the parent organization. Once the child organization is created, the menu management system can be modified to meet the specific needs of the child organization.

All system data is filtered at the organization level, which means that every drop-down list in the system is specific to an organization.

Staff members in a parent organization will automatically have access to the data in the child organizations. This includes activities, procedures, activity/procedure mappings, programs, groups, medications, payer panels, POE mappings, bed administration, service locations, order/procedure mappings, failed activities, failed claims, claim maintenance, claim batch, payment maintenance, cash sheets, cash sheet approval, GL codes, and account numbers.

Client searches allow you to access only the clinical records that are in your current organizational branch (this includes the clients in your current organization as well as the clients in organizations directly above and below your current organization). If the client episode was created in a different organizational branch, you cannot access it through a client search.

Staff searches are used to search for staff members across all organizations. However, you can only access the staff records that are in your current organization or a child organization. If a staff record is above your current organization, or in a different organizational branch, you cannot access the staff record.

The following example shows a multi-tier organizational structure. In this example, the top-tier organization is Qualifacts Systems, Inc. Under this organization, there are two mid-level organizations: Northeastern Central Office and Southeastern Central Office. Each of the two mid-level organizations has three child organizations.


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By default, all staff members have access to the data in their current organization level and all child organizations. In the previous example, staff members in the Qualifacts Systems, Inc. organization will have access to all child organizations. Staff members in the Northeastern Central Office will have access to Boston, New York, and Philadelphia facilities only. Staff members in the Southeastern Central Office will have access to the Atlanta, Miami, and Nashville facilities only.

Client searches are limited to the particular branch where the client’s episode was created. For example, if a client was admitted to the Nashville Facility, the client’s clinical record would be accessible by staff members in the Qualifacts Systems, Inc., Southeastern Central Office, and Nashville Facility organizations.

Add Organizations This task includes instructions for adding organizations. Each organization that is licensed to use CareLogic must be set up in the system. See page 13 for information about setting up a multi-tier organizational structure.

Note: Once an organization is added to the system, you can use the Select button on the Organization List page to update it (see page 13).

To add organizations: 1 Access the Organization List page (see Access Organizations). 2 Click the Add an Organization button.

The Organization Information page appears. All required fields are highlighted. 3 In the Organization Name field, enter the complete name of the organization you are

adding. Important: Your business unit can have only one top-tier organization. A top-tier organization is one

that does not have a parent organization defined.

4 If this is a child organization, use the drop-down list in the Parent Organization field to select the name of the parent organization. If this is the highest level parent organization in your business unit, do not select parent organization in this field.

5 The Admit to Organization field is used to define at which organization new clients will have their episodes created. This drop-down list includes only the organization you are currently logged into and all child organizations. This field works in conjunction with the ‘Organization’ field in the POE Client Demographics module (see page 14 the Point of Entry Guide). For example, suppose you are creating an organization record for Southeastern Central Office and you select Nashville Facility in this field. In this scenario, when you enter new clients into the system at the Southeastern Central Office, the system automatically creates their episodes at the Nashville Facility organization.


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6 For agencies in the state of Oregon, the CPMS - CMHP Number and CPMS - Provider Number fields allow you to enter your community mental health provider ID and your state provider number which will be used for CPMS state reporting.

7 For agencies in the state of Tennessee, the CMHC ID field allows you to enter your community mental health care ID which will be used for CMHC state reporting.

8 In the Short Name field, enter an abbreviated name of the organization. This entry can be up to 20 characters.

9 The Code field is used to enter a unique code to identify the organization. This entry can be up to 10 characters.

10In the Prefix field, enter a prefix for the organization. 11In the Region field, use the drop-down list to select the geographical region in which

the organization is located. 12In the Federal ID field, enter the organization’s federal tax ID number. 13In the Organization NPI field, enter the unique National Provider Identifier (NPI)

number for the organization. The NPI number must contain 10 numeric characters. The first nine numbers are used as unique identifiers and the tenth number is used as a check digit to detect invalid NPIs.

Note: A unique NPI number must be assigned to each organization and staff member (see page 57 the Employee User Guide for assigning NPI numbers to staff members). NPI numbers can also be assigned to payer panels (see Assign Staff Members to Payer Panels). The NPI numbers, for both organizations and staff members, appear on both electronic and paper claims.

14Taxonomy codes are nationally standardized codes that can be assigned to both organizations and staff members (see page 56 the Employee User Guide). Taxonomy codes can also be assigned to payer panels (see Add Payer Panels). Your organization is responsible for selecting the taxonomy code that most closely represent the services your organization provides. The taxonomy code is a sub-category of the NPI which appears on claims. In the Taxonomy Code field, enter the 10-digit alphanumeric taxonomy code that you want to assign to the organization. The taxonomy codes, for both organizations and staff members, appear on claims.

Important: The Hospital Data ID and Medicaid Provider Number fields may not display on your system. It is a configurable field that is activated based on organizational needs. It is used only for in-patient agencies in Arkansas.

15The County Code field is used in Minnesota to identify to the state the county where services were provided.

16The Hospital Data ID field is used to capture your facility’s hospital ID for state reporting in Arkansas.

17The Medicaid Provider Number field is used to capture your facility’s Medicaid Provider ID for state reporting in Arkansas.

18The CRS Agency Group Code field is used only for agencies located in Philadelphia and is used to identify your organization when reporting to the Consumer Reporting System of Philadelphia.

Note: This field may not display on your system. It is a configurable field that is activated based on organizational needs. It is used only for agencies in Philadelphia.

19Value option IDs, which are organization IDs, are used when submitting electronic claims to clearing houses. In the Value Options ID field, use the drop-down list to select the clearing house ID you want to define for the organization.

20In the CCAR Agency Code field, use the drop-down list to select the appropriate organization code used for Colorado Client Assessment Records.


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Note: This field may not display on your system. It is a configurable field that is activated based on organizational needs. It is used only for organizations in Colorado.

21In the Uses Cash Sheet field, indicate if the organization will create daily cash sheets. Typically, cash sheets are used to collect client co-payments for outpatient services.

22In the Contract Organization field, indicate if the is a contract organization. 23In the EEOC Organization field, indicate if the organization is in compliance with Equal

Employment Opportunity Commission regulations. 24In the Service Location field, use the drop-down list to select a default service

location that will be used when scheduling activities at this organization (see page 18 the Scheduling Guide). When setting up an organization, this drop-down list contains every service location available in the system (it is not restricted by organization). Once the organization record is saved, the organization/service location mapping is automatically updated.

25In the Educational Organization field, indicate if this organization provides educational services.

26In the Organization Facility Bills field, indicate if this organization bills by facility. 27In the Billing Organization field, indicate if this organization will generate claims. If

you select Yes, the Claim Engine will attempt to run for this organization. If you select No, the Claim Engine will ignore this organization.

28in the BHO Location Code field, enter the Behavioral Health Organization code used when reporting CRG/TPG assessments to the state of Tennessee.

Note: This field may not display on your system. It is a configurable field that is activated based on organizational needs. It is used only for organizations in Tennessee which are TennCare members.

29When setting up an organization, you can enter both a physical and billing address, if appropriate. The billing address is the address to which payers remit payments that were submitted by the organization. All of the information entered in this section appears on the bills that are sent to payers.

a In the Country field, use the drop-down list to select the country in which the organization is located. Important: If you select the USA, or one of its territories, this page allows you to enter a domestic

address (Steps b through e). If the organization is located outside the USA, you must enter an international address. Once you select a country other than the USA, the page is refreshed to display all of the address fields (Steps b through e) as text entry fields. This means that when you enter an international address, you must manually enter the city, state/province, postal code, and county.

b In the Street fields, enter the organization’s street address. c If the street address contains an apartment or suite number, enter it in the Apt/Suite field. d For addresses located within the USA, or one of its territories, use one of the following methods to

enter the city, state/province, and postal code (zip code). To use the Postal Code Lookup feature, select the Do City/State lookup using Postal Code check

box, enter the postal code (and postal code extension, if known), and press Tab. The system performs a postal code lookup and automatically populates the City and State fields. The city that is preceded by an asterisk is the postal service’s preferred city for the postal code entered.

To manually enter the city, state, and postal code, uncheck the Do City/State lookup using Postal Code check box, enter the city, use the drop-down list to select the state, and enter the postal code (and postal code extension, if known).


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e Before you can select the county in which the organization is located, you must select a state (by either method described in the previous step). The County field is automatically filtered to include only the counties that are located within the selected state. Use the drop-down list to select the appropriate county.

30In the Phone Number field, enter the 10-digit telephone number for the organization. If the organization has an international phone number, select the International Number check box (to modify the Phone Number field), and then enter the country code and international number. This entry can be up to 40 characters.

31In the Fax Number field, enter the 10-digit telephone number for the organization’s billing address. If the organization has an international fax number, select the International Number check box (to modify the Fax Number field), and then enter the country code and international number. This entry can be up to 40 characters.

32The Display Client Balance field is used to indicate if you want to include client balances on client receipts printed from the Front Desk Cash Sheet.

33If you want to includes any comments or special instructions on the bills that are sent from the organization, make an entry in the Statement Comments field. Your entry can be up to 500 characters. Your entry appears on all client statements.

34Click Submit in the status bar. The organization record is saved and listed on the Organization List page.

Update Organizations After an organization is entered into the system, you must use the instructions in this task to update it.

To update organizations: 1 Access the Organization List page (see Access Organizations).

2 Click the Select button that corresponds with the organization you want to update. The Organization Information page appears. You can edit any of the fields on this page. All required fields are highlighted. See Add Organizations for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated organization is saved and listed on the Organization List page.

Remote Access Some agencies have the need to restrict access to their system based on the IP address the user is originating from. Administrators have the ability to restrict the IP addresses.

Note: Staff with the remote access override set to Yes will not be affected by IP restrictions.

Restrict IP Addresses Administration


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Note: If no IP addresses are entered here or no restriction records are active, remote access restrictions will not be in effect.

1 Navigate to Administration → Remote Access. 2 Click the Add an IP Address button.

3 Fill out required fields. Add the IP address. Important: If the initial entry is entered incorrectly in the table, it could cause the entire system to be

inaccessible.

4 Click Submit.

Setting Up Billing Categories This task is used to set up and maintain all of the billing categories or licensures that are used throughout the system. Once the billing categories are set up, you can use them to create a fee matrix for your payer plans (see Setting Up a Payer Plan’s Fee Matrix).

To access billing categories: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Billing Categories.

The Billing Category List page appears. This page lists all of the billing categories that are set up in the system.

This page is used to perform the following tasks: Adding Billing Categories Updating Billing Categories Deleting Billing Categories

Adding Billing Categories


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This task is used to add billing categories to the system. Billing categories are used in various parts of the system. When setting up staff credentials in the Employee module (see page 49 the Employee User Guide), you must associate the credential with a billing category. When creating service document crosswalk records (see Setting Up Service Document Crosswalks), you can associate each record with a billing category.

Note: Once a billing category is added to the system, you can use the Select button on the Billing Category List page to update it (see page 65).

To add billing categories: 1 Access the Billing Category List page (see Setting Up Billing Categories) 2 Click the Add Billing Category button

The Billing Category page appears. As indicated by the red highlight in the text entry fields, both of the fields on this page are required.

3 In the Code field, enter the code for the billing category 4 In the Description field, enter the name of the billing category 5 In the EDI Code field, enter a value to map to an EDI file 6 Click Submit in the status bar

The billing category is saved and listed on the Billing Category List page.

Updating Billing Categories Once a billing category is created, you must use must this task to update its code or description.

To update billing categories: 1 Access the Billing Category List page (see Setting Up Billing Categories)

2 Select the billing category you want to update The Billing Category page appears.


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3 If you want to update the code associated with the billing category, enter a new code in the Code field

4 If you want to update the name of the billing category, enter a new name in the Description field

5 If you want to update the EDI code associated with the billing category, enter a new code in the EDI Code field

6 Click Submit in the status bar The selected billing category is updated and listed on the Billing Category List page.

Deleting Billing Categories This task is used to delete billing categories from the system.

To delete staff credentials: 1 Access the Billing Category List page (see Setting Up Billing Categories).

2 Click the Delete button that corresponds with the billing category you want to delete. The Delete Billing Category Entry page appears.

3 Select Yes to confirm you want to delete the selected billing category. 4 Click Submit in the status bar.

The selected billing category is deleted from the system.

Setting Up Procedure Codes Procedure codes are nationally standardized codes that describe the type of service provided by your organization. When you submit a bill to a third-party payer, a procedure code must be included on the claim. The procedure code tells the payer about the type of service for which you are billing. During the billing process, activity codes are automatically converted to procedure codes (see Matching Activity Codes to Procedure Codes).

Note: Procedures in this section assume the revenue code feature is disabled. Refer to Setting Up Revenue Codes to use revenue code features.

Important: If your organization wants to use facility billing, see Setting Up Facility Billing for instructions about setting it up. Facility billing is a system configuration that is accessible to your system administrator.

To access procedure codes: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Procedures.


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The Procedure/Revenue Code Administration page appears.

This page is used to perform the following tasks: Adding Procedure Codes Reviewing Activity/Procedure Mappings Updating Procedure Codes Creating a New Standard Fee for an Existing Procedure Code Deleting Procedure Codes

Adding Procedure Codes When entering procedure codes in the system, it is important to understand that the actual procedure code and the description must be the same across all of your organizations. However, if desired, you can set up a unique standard fee for each organization. This means the same procedure code and description can have a different standard fees in different organizations.

Note: Once a procedure code is added to the system, you can use the Select button on the Procedure Code Administration page to update it (see page 102).

To add procedure codes: 1 Access the Procedure Code Administration page (see Setting Up Procedure Codes). 2 Click the Add a Procedure button.

The Procedure Code Entry page appears. All required fields are highlighted.

3 In the Procedure Code field, enter a code to designate the procedure code. The code you enter in this field represents a service or activity that is delivered to clients by your organization. Your entry can be up to 12 characters.


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Note: Once the procedure code is used to create a claim, the procedure code number cannot be modified. You can only modify the procedure code number if it is not attached to a claim.

4 In the Description field, enter a description of the procedure code. Your entry can be up to 60 characters.

5 The Organization field is used to select the organization to which the procedure code standard fee applies. This drop-down list includes only the organization you are currently logged into and all child organizations.

6 In the Begin Date field, enter the date the procedure code becomes active in the system. This is the date the standard fee (step 7) is charged for the procedure. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

7 In the End Date field, enter the date the procedure code becomes inactive in the system. This is the date the standard fee (step 7) is no longer charged for the procedure. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

8 In the Procedure Standard Fee field, enter the amount to charge for services related to the procedure code. The standard fee that is entered in this field appears on claims as the Billed amount. In addition to setting up a standard fee, you must also define a contracted rate (based on a fee matrix) for each payer plan (see Setting Up a Payer Plan’s Fee Matrix). For each procedure code, the contracted rate (which appears on claims as the Expected amount) must be equal to or greater than the standard fee. If the standard fee is less than the contracted rate, the Claim Engine generates an error.

Note: Once the procedure code is used to create a claim, you should not modify the standard fee. Instead, you should use the instructions on Creating a New Standard Fee for an Existing Procedure Code to create a new standard fee/date range record.

9 Click Submit in the status bar. The procedure code is saved and listed on the Procedure Code Administration page.

Reviewing Activity/Procedure Mappings The Matrix button is used to review the procedure mappings that are setup for an activity. All activity/procedure mappings are setup through the Procedure module (see Reviewing Activity/Procedure Mappings).

To review activity/procedure mappings: 1 Access the Procedure Code Administration page (see Setting Up Procedure Codes) 2 Locate the activity you want to review the procedure mappings for and click the

Matrix button The Procedure Code Matrix page appears for the selected activity

3 Select a record to view the record details The selected record appears on the Activity Procedure Matrix data entry page (see Adding Activity/Procedure Mappings) in the Activities module. You can modify the record, as needed. Note: In order to return to the Procedure Code Administration list page, you must select Show

Menu>Procedures.


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Updating Procedure Codes This task includes instructions for modifying procedure code records. It is important to understand that a single procedure code record consists of two parts: 1) the parent level, which includes the procedure code number and description, and 2) the child level, which includes the standard fee and date range. There can be many child records associated with a single parent level. Each time you access a procedure code in edit mode, the standard fee/date range history is listed.

If the procedure code’s standard fee changes, it is recommended that you follow the instructions on Creating a New Standard Fee for an Existing Procedure Code to create a new standard fee/date range record for the procedure code. By doing this, you will ensure that the procedure code remains backward compatible.

Note: If a procedure code has been used to generate a claim, the procedure code number cannot be modified. You can only modify a procedure code number if it is not attached to a claim.

To update procedure codes: 1 Access the Procedure Code Administration page (see Setting Up Procedure Codes) 2 Select the record that should be updated

The procedure code appears in edit mode. This page is divided into two sections. Procedure Fee History. This section lists a history of the procedure code’s standard fee. By default, the

most recent standard fee/date range is selected, which means it is displayed in the Procedure Code Entry section. If multiple standard fee/date range records exist, you can click the corresponding Select button to display the desired record in the Procedure Code Entry section If the standard fee/date range record has not been used to generate a claim, then a Delete button appears in the Procedure Fee History section. If a standard fee/date range record has been used to create a claim, then you cannot delete it. Also, you cannot delete the most current standard fee/date range record.

Note: For information about using the Create a New Standard Fee/Date Range button, see Creating a New Standard Fee for an Existing Procedure Code.

Procedure Code Entry. This section is used to modify the selected procedure code record. By default, the most recent procedure code record is displayed in this section

Note: Each Procedure code record must have a unique combination of organization and date range. If you modify either item for a record, it cannot overlap with an existing record listed in the Procedure Fee History section.


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3 Make the desired edits in the Procedure Code Entry section. See Adding Procedure Codes for field descriptions

Note: If the procedure code has been used to create a claim, the Procedure Code field appears in view-only mode and cannot be modified.

4 Click Submit in the status bar The selected procedure code is updated and listed on the Procedure Code Administration page.

Creating a New Standard Fee for an Existing Procedure Code When the standard fee associated with a procedure code changes, it is recommended that you use this task to create a new standard fee/date range from the existing procedure code record. This method is preferable to simply updating the existing standard fee because it ensures that the procedure code will remain backward compatible.

The standard fee/date range records associated with a procedure code cannot overlap. This means before you can create a new standard fee/date range record, you must end date the existing standard fee/date range record. For example, if the standard fee changes on an annual basis, you can use this task to end date the existing standard fee and create a new record for the new standard fee and date range. As a result, the procedure code record will have two standard fee/date range records associated with it. Both of these records will be listed in the Procedure Fee History section.

To create a new standard fee for an existing procedure code: 1 Access the Procedure Code Administration page (see Setting Up Procedure Codes). 2 Click the Select button that corresponds with the procedure code you want to define a

new standard fee for. The Procedure Code Entry page appears.


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3 In the End Date field, enter today’s date in mm/dd/yyyy format. This indicates that the existing standard fee (Step 10) will become inactive today.

4 Click Submit in the status bar. The record is updated and listed in the Inactive Procedure Codes section of the Procedure Code Administration page.

5 Click the Select button to access the record you just end dated. The Procedure Code Entry page appears.

6 Click the Create a New Standard Fee/Date Range button. The Procedure Code Entry page is refreshed. The existing values remain in the Procedure Code and Description fields. The values are cleared from the date range and Standard Fee fields.

Note: If the procedure code has been used to create a claim, the Procedure Code field appears in view-only mode and cannot be modified. If the procedure code is not attached to a claim, you can modify the Procedure Code field, if desired.

7 If desired, you can enter a new Description for the procedure code. This entry can be up to 60 characters.

8 The Organization field is used to select the organization the procedure code fee applies to. This drop-down list includes only the organization you are currently logged into and all child organizations.

9 In the Begin Date field, enter the date the procedure code becomes active in the system. This is the date the new standard fee (Step 10) will be charged for the procedure. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.


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10In the End Date field, enter the date the procedure code becomes inactive in the system. This is the date the new standard fee (Step 10) will no longer be charged for the procedure. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

11In the Procedure Standard Fee field, enter the amount to charge for treatment related to the procedure code. The standard fee that is entered in this field is the default standard fee associated with the procedure code. If you define a standard fee for the activity/procedure matrix (see Adding Activity/Procedure Mappings), it overrides this default standard fee. In addition to setting up default standard fees, you must also define a contracted rate (based on a fee matrix) for each payer plan (see Setting Up a Payer Plan’s Fee Matrix). For each procedure code, the contracted rate must be equal to or greater than the standard fee. If the standard fee is less than the contracted rate, the Claim Engine generates an error.

12Click Submit in the status bar. The new standard fee/date range record is created for the selected procedure code.

Deleting Procedure Codes Once a procedure code has been used to generate a claim, it cannot be deleted. You can only delete the procedure codes that are not attached to claims.

To delete procedure codes: 1 Access the Procedure Code Administration page (see Setting Up Procedure Codes). 2 Click the Delete button that corresponds with the procedure code you want to delete.

The Delete Procedure Code page appears. 3 Select Yes to confirm you want to delete the selected procedure code. 4 Click Submit in the status bar.

The selected procedure code is deleted from the system.

Setting Up Revenue Codes Revenue codes and fees are used to generate Institutional claims. When the revenue code configuration is enabled, the revenue codes and standard fees are set up in the Procedures module, and the contracted rates are set up in the payer plan fee matrices.

Note: If you want to use revenue codes for facility billing, you must enable the facility billing configuration (see Setting System Configuration for Facility Billing).

By default, the system is not set up to allow revenue codes and fees. If you want to use revenue codes, you must use the following outline to set it up:

Step 1Setting System Configuration to Enable Revenue Codes

Step 2Setting Up Procedure/Revenue Codes

Step 3Setting Up Payer Plan Fee Matrices

Claim Engine Logic for Revenue Codes


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The following diagram explains the logic used by the Claim Engine when processing revenue and procedure codes.

Note: In the following illustration, revenue codes are used without the facility billing feature enabled. If your organization uses revenue codes for facility billing, see Claim Engine Logic for Facility Billing.

1 Once the status of an activity is marked as Kept, it is automatically processed by the nightly run of the Claim Engine.

2 The first check by the Claim Engine is to determine the type of facility (outpatient or inpatient) that provided the service. In order to do this, the system uses the service location associated with the activity. Each service location is designated as either outpatient or inpatient (see Setting Up Service Locations by Organization).

For outpatient services, a Professional claim is created based on the procedure code and fee. For inpatient services, the Claim Engine must determine the type of service being processed.

3 The final check by the Claim Engine is to determine the type of inpatient service being processed. The following options are possible.

Professional services include such things as Individual Therapy and Office Visits. For professional services, a Professional claim is generated based on the procedure code and fee.

Observation services occur during pre-admission. Organizations use observation services to assess clients for less than 24 hours to determine if they should be admitted for treatment. For observation services, an Institutional claim is generated based on the procedure and revenue codes and fees.

Institutional services include per diem services, such as Room & Board and Food. For institutional services, an Institutional claim is generated based on the revenue code and fee.

Setting System Configuration to Enable Revenue Codes


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By default, the revenue codes/fees configuration is disabled, which means your organization can produce Professional claims only. When this configuration is enabled, your organization can use revenue codes and fees. This organization configuration, along with all other organization configurations, must be enabled. Contact Qualifacts for assistance.

Setting Up Procedure/Revenue Codes The Procedures module is used to set up procedure codes and revenue codes, and the standard fees for each. The procedure code and fee is used to generate Professional claims. The revenue fee and the code format defined for the payer plan (Procedure only, Revenue only, Procedure-Revenue, or Revenue-Procedure) is used to generate Institutional claims.

To set up procedure/revenue codes: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Procedures.

The Procedure/Revenue Code Administration page appears.

3 Click Add a Procedure/Revenue in the status bar. The Procedure/Revenue Fee History page appears. All required fields are highlighted.

4 In the Procedure Code field, enter a code to designate the procedure code. The code you enter in this field represents a service or activity that is delivered to clients by your organization. This entry can be of up to 10 characters.


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5 In the Revenue Code field, enter the revenue code you want to associate with the procedure code. This code will be used to generate Institutional claims. This entry cannot exceed four characters. If you enter a revenue code in this field, you must enter a Revenue Standard Fee in Step 10.

Note: Once the procedure code or revenue code are used to create a claim, they cannot be modified. You can only modify the procedure code and revenue code numbers if they are not attached to a claim.

6 In the Description field, enter a description of the procedure code. Your entry can be up to 60 characters.

7 In the Begin Date field, enter the date the procedure code and revenue code becomes active in the system. This is the date the codes can be used for facility billing.

8 If you want to enter an end date for this record, enter it in the End Date field. This is the last date the codes can be used for facility billing.

9 In the Procedure/Revenue Standard Fee Entry matrix, define a contracted rate (based on a fee matrix) for each payer plan (see Setting Up Payer Plan Fee Matrices). The contracted rate is the expected amount (or allowed amount) that appears on claims. For each procedure/revenue code, the contracted rate must be equal to or less than the standard fee. If the standard fee is less than the contracted rate, the Claim Engine generates an error.

Note: Once the procedure code is used to create a claim, you should not modify the standard fee. Instead, you should use the instructions on Creating a New Standard Fee for an Existing Procedure Code to create a new standard fee/date range record.

10Click Submit in the status bar. The procedure/revenue code is saved and listed on the Procedure/Revenue Code Administration page.

Setting Up Payer Plan Fee Matrices For each payer plan, you must set up a corresponding fee matrix. The fee matrix defines the contracted rates the payer plan will pay for each procedure code and revenue code, based on the credential of the staff member who provides the service.

Note: In addition to the contracted rates set up for payer plans, you can also set up a standard fee for each procedure code and revenue code (see Setting Up Procedure/Revenue Codes). For each procedure code and revenue code, the contracted rate must be equal to or less than the standard fee. If the standard fee is less than the contracted rate, the Claim Engine generates an error.

To set up payer plan fee matrices for facility billing: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Payers.

The Payers list page appears. 3 Identify the payer you want to set up a payer plan for and click the corresponding

Payer Plans button. The Payer Plans list page appears for the selected payer.


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4 Click the Fees button that corresponds with the payer plan for which you want to add a fee matrix.

The Fee Matrix page appears for the selected payer plan. 5 Click Add Fee Matrix in the status bar.

The Payer Plan Date Range Entry page appears. All required fields are highlighted.

Note: The begin date for the fee matrix must be equal to or later than the begin date for the payer plan. The begin date for the fee matrix cannot precede the begin date for the payer plan.

6 In the Begin Date field, enter the first date the fee matrix becomes active in the system. This is the first date that the fee matrix will be used to calculate fees for the selected payer plan.

7 If you want to enter an end date for the fee matrix record, enter the desired date in the End Date field. This is the last date that the fee matrix will be used to calculate fees for the selected payer plan.

8 If this fee matrix record will only apply to the clients over a certain age, enter the minimum age requirement for this record in the Min Age field.

9 If this fee matrix record will only apply to the clients under a certain age, enter the maximum age requirement for this record in the Max Age field.

10In the Begin Visit field, enter the beginning number of client visits allowed by the payer plan.

11In the End Visit field, enter the ending number of client visits allowed by the payer plan.

12If this fee matrix record is specific to a particular location, use the drop-down list in the Location field to select a location. If this record will apply to all locations, do not select an option in this field.

13If this fee matrix record is specific to a particular treatment program, use the drop-down list in the Program field to select an option. If this record will apply to all treatment programs, do not select an option in this field.

14Click Submit in the status bar. The payer plan date range record is saved and listed on the Fee Matrix page.


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15Click the Fee Matrix button of the record you just created. The Fee Matrix page appears. This page lists all of the procedure codes that are set up in the system (see Setting Up Procedure Codes). For each procedure code, you can define a fee for each billing category that is set up in the system (see Setting Up Billing Categories). In the following example, billing categories have been set up for medical doctors (MD), registered nurses (RN), and licensed clinical social workers (LCSW).

16Click the Select button that corresponds with the procedure code you want to define a fee matrix for.

The Fee Entry page appears for the selected procedure code. Important: In order to increase the likelihood of receiving payments from the payer plan, you

must define a fee for every billing category in your organization. If a fee is not defined for a billing category, and a staff member associated with that billing category treats a client for the selected procedure, the payer plan will not pay for the service.

17For each billing category, you can enter a procedure fee and a revenue fee. The procedure fee will be used to generate Professional claims and the revenue fee will be used to generate Institutional claims.

18If the payer plan will not pay for the selected procedure code and revenue code, click the Not Paid check box.

19Click Submit in the status bar. The fee matrix is saved for the selected procedure code. Note: To define a fee matrix for additional procedure codes and revenue codes, repeat Steps 16 through

19. In order to increase the likelihood of receiving payments, you must create a fee matrix for every procedure code/revenue code your organization uses.

Setting Up Modifiers


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Modifiers are nationally standardized codes that are attached to procedure codes to provide additional information about the billed procedure. For example, if you are billing for an office visit, you could use the procedure code 99213 and the modifier HE to indicate that it was related to a mental health program.

This section includes instructions for setting up the master modifiers list that is used throughout the system. In some cases, a modifier can affect the fee calculation for services. In these situations, it is important to remember that modifiers affect the contracted rate (the expected amount) rather than the standard fee (the billed amount).

To access modifiers: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Modifiers.

The Modifiers page appears. The top half of the page lists all of the active modifiers. A modifier is categorized as active if the current system date falls within the modifier’s begin and end date. The bottom half of the page lists all of the inactive modifiers. A modifier is categorized as inactive if the current system date meets or exceeds the modifier’s end date.

This page is used to perform the following tasks: Adding Modifiers Associating Modifiers with Organizations Updating Modifiers Creating a New Percentage Fee Change for an Existing Modifier Deleting Modifiers

Adding Modifiers Modifiers are nationally standardized codes that are attached to procedure codes to provide additional information about the billed procedure. This task includes instructions for adding modifiers.

Note: Once a modifier is added to the system, you can use the Select button on the Modifier Administration page to update it (see page 42).

To add modifier: 1 Access the Modifiers page (see Setting Up Modifiers). 2 Click Add Modifier in the status bar.

The Master Modifier Entry page appears. In addition to the highlighted fields, the Affects Fee field is also required.


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3 In the Modifier Code field, enter the two-digit code to designate the modifier. This is the modifier that will be attached to procedure codes.

Note: Once the modifier is used to create a claim, the modifier number cannot be updated. You can only update the modifier number if it is not attached to a claim.

4 In the Description field, enter a description of the modifier. This entry can be up to 100 characters.

5 In the Begin Date field, enter the date the modifier becomes active in the system. This is the first date the modifier can be attached to a procedure code. Your entry must be in the following format: mm/dd/yyyy.

6 In the End Date field, enter the date the modifier becomes inactive in the system. This is the last date the modifier can be attached to a procedure code. Your entry must be in the following format: mm/dd/yyyy.

7 In the Affects Fee field, indicate if the modifier changes the contracted rate that is used by the procedure code. If you select Yes, you must enter a percentage fee change in the following field.

8 In the Default Percent Fee Change field, enter the percentage amount the contracted rate must be adjusted when this modifier is attached. For example, if the modifier increases the rate by 5 percent, enter 5.

Note: Once the modifier is used to create a claim, you should not update the default percentage fee change. Instead, you should use the instructions on Creating a New Percentage Fee Change for an Existing Modifier to create a new percentage fee change/date range record.

9 Click Submit in the status bar. The modifier is saved and listed on the Modifier Administration page.

Associating Modifiers with Organizations When a new modifier is added (see Adding Modifiers), it is only available at the organization of the staff member who added it. This task includes instructions for making activities available to child organizations.

To associate modifiers with organizations: 1 Access the Modifiers page (see Setting Up Modifiers) 2 Locate the modifier you want to associate with organizations and click the

Organization button The Organization List page appears for the selected modifier. This list includes the organization you are currently logged into and all its child organizations.


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3 To associate the selected modifier with an organization, select the checkbox next to each organization that it should be associated with

Note: To associate the selected modifier with all organizations, select the checkbox in the table header at the top of the checkbox column. To exclude the selected modifier from all organizations, deselect the checkbox in the table header at the top of the checkbox column.

4 Click Submit in the status bar. The modifier organization matrix record is saved.

Updating Modifiers This task includes instructions for updating modifier records. It is important to understand that a single modifier record consists of two parts: 1) the parent level, which includes the modifier code number and description, and 2) the child level, which includes the percentage fee change and date range. Each time you access a modifier in edit mode, the percentage fee change/date range history is listed.

If the modifier’s percentage fee changes, it is recommended that you follow the instructions on page 49 to create a new percentage fee change/date range record for the modifier. By doing this, you will ensure that the modifier remains backward compatible.

Note: If a modifier has been used to generate a claim, the modifier code cannot be updated. You can only update a modifier code if it is not attached to a claim.

To update modifiers: 1 Access the Modifiers page (see Setting Up Modifiers). 2 Click the Select button that corresponds with the modifier you want to update.

The modifier appears in edit mode. This page is divided into two sections. Master Modifier History. This section lists a history of the modifier’s percentage fee change. By

default, the most recent percentage fee change/date range is selected, which means it is displayed in the Master Modifier Entry section. If multiple percentage fee change/date range records exist, you can click the corresponding Select button to display the desired record in the Master Modifier Entry section. If multiple records exist, a Delete button will appear under the following conditions: if the record has not been used to generate a claim or if the date range of the record is in the past. A Delete button will not appear if there is only one record or if the record has been used to create a claim.

Note: For information about using the Create a New Master Modifier Percent Fee/Date Range button, see Creating a New Percentage Fee Change for an Existing Modifier.

Master Modifier Entry. This section is used to update the selected modifier record. By default, the most recent modifier record is displayed in this section.


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Note: Each modifier record must have a unique date range. If you update the date range for a record, it cannot overlap with an existing record listed in the Master Modifier Entry section.

3 Make the desired edits in the Master Modifier Entry section. See Adding Modifiers for field descriptions.

Note: If the modifier has been used to create a claim, the Modifier Code field appears in view-only mode and cannot be updated.

4 Click Submit in the status bar. The selected modifier is updated and listed on the Modifiers page.

Creating a New Percentage Fee Change for an Existing Modifier When the percentage fee associated with a modifier changes, it is recommended that you use this task to create a new percentage fee change/date range from the existing modifier record. This method is preferable to simply updating the existing percentage fee change because it ensures that the modifier will remain backward compatible.

The percentage fee change/date range records associated with a modifier cannot overlap. This means before you can create a new percentage fee change/date range record, you must end date the existing percentage fee change/date range record. For example, if the percentage fee changes on an annual basis, you can use this task to end date the existing percentage fee change and create a new record for the new percentage fee change and date range. As a result, the modifier record will have two percentage fee change/date range records associated with it. Both of these records will be listed in the Master Modifier History section.

To create a new percentage fee change for an existing modifier: 1 Access the Modifiers page (see Setting Up Modifiers). 2 Click the Select button that corresponds with the modifier you want to define a new

percentage fee change for. The Master Modifier Entry page appears.


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3 In the End Date field, enter today’s date in mm/dd/yyyy format. This indicates that the existing percentage fee change (Step 11) will become inactive today.

4 Click Submit in the status bar. The record is updated and listed as an Inactive Modifier.

5 Click the Select button to access the record you just end dated. The Master Modifier Entry page appears.

6 Click the Create a New Master Modifier Percent Fee/Date Range button. The Master Modifier Entry page is refreshed. The existing values remain in the Modifier Code and Description fields. The values are cleared from the date range, Affects Fee, and Default Percent Fee Change fields.

Note: If the modifier code has been used to create a claim, the Modifier Code field appears in view-only mode and cannot be modified. If the modifier code is not attached to a claim, you can modify the Modifier Code field, if desired.

7 If desired, you can enter a new Description of the modifier. This entry can be up to 100 characters.

8 In the Begin Date field, enter the date the modifier becomes active in the system. This is the first date the modifier, with the new percentage fee change (Step 11), can be attached to a procedure code. Your entry must be in the following format: mm/dd/yyyy.


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9 In the End Date field, enter the date the modifier becomes inactive in the system. This is the last date the modifier, with the new percentage fee change (Step 11), can be attached to a procedure code. Your entry must be in the following format: mm/dd/yyyy.

10In the Affects Fee field, indicate if the modifier changes the contracted rate that is used by the procedure code. If you select Yes, you must enter a percentage change in the following field.

11In the Default Percent Fee Change field, enter the percentage amount the contracted rate must be adjusted when this modifier is attached. For example, if the modifier increases the fee by 5 percent, enter 5.

12Click Submit in the status bar. The new percentage fee change/date range record is created for the selected modifier.

Deleting Modifiers Once a modifier has been used to generate a claim, it cannot be deleted. You can only delete the modifiers that are not attached to claims.

To delete modifiers: 1 Access the Modifiers page (see Setting Up Modifiers). 2 Click the Delete button that corresponds with the modifier you want to delete.

The Delete Modifier page appears. 3 Select Yes to confirm you want to delete the selected modifier. 4 Click Submit in the status bar.

The selected modifier is deleted from the system.

Setting Up Activity Codes Activity codes are used to define how your organization internally records services. An activity code must be set up for every billable event your organization provides. This includes services provided to individual clients and client groups, as well as billable orders.

Note: Billable order activities require a different set up than client and group activities. When you are creating an order activity, you do not have to set up a corresponding activity/procedure mapping or service document crosswalk. See Configuring Billable Orders for instructions about setting up billable orders.

With the exception of billable order activities, you must set up an activity/procedure mapping (see Setting Up Activity/Procedure Mappings) and a service document crosswalk (see Setting Up Service Document Crosswalks) for each billable activity. This includes all client additives and all group activities. Once a billable activity is marked with a status of Kept, it is automatically processed by the nightly run of the Claim Engine. If the activity/procedure mapping record or the service document crosswalk record is missing, an error occurs which prevents the system from converting the activity into a claim.

Note: Typically, staff activities are not billable.

Important: If your system is not configured to use the Activity-Program Matrix, the Program Matrix button does not appear in the Activities list by default. To update your activity-program mappings, you must first click the Update Program Mappings button in the status bar. This button displays the Program Matrix button and also filters the Activities list to only display the activities mapped to the organization you are currently logged into.


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To access activity codes: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Activities.

The Activity Codes page appears. The top half of the page lists all of the active activity codes. An activity code is categorized as active if the current system date falls within the activity code’s begin and end date. The bottom half of the page lists all of the inactive activity codes. An activity code is categorized as inactive if the current system date meets or exceeds the activity code’s end date.

This page is used to perform the following tasks: Adding Activity Codes Associating Activities with Organizations Updating Activity Codes Setting Up Activity/Procedure Mappings Setting Up Activity/Program Mappings Deleting Activity Codes

Adding Activity Codes This task includes instructions for entering activities into the system. Every activity that is provided by your organization must be entered into the system. Once an activity is added (see Adding Activity Codes), it is available at the organization you are currently logged into only. If you want to make an activity available to child organizations, see Associating Activities with Organizations.

Note: Once an activity code is added to the system, you can use the Select button on the Activity Codes page to update it (see page 106).

To add activity codes: 1 Access the Activity Codes page (see Setting Up Activity Codes). 2 Click the Add Activity button.

The Activity Entry page appears. All required fields are highlighted.


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3 In the Begin Date field, enter the date the activity code becomes active. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

4 In the End Date field, enter the date the activity code becomes inactive. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 In the Code field, enter a unique code for the activity. This entry can be up to 10 characters.

6 In the Name field, enter the name of the activity as it will be known in the system. The activity name you enter in this field appears in the Activity drop-down list when you schedule an appointment. Your entry can be up to 60 characters.

7 In the Billable field, indicate if the activity is billable. If you select Yes, the activity is billable under any circumstance, which means the payer is billed based on the procedure code once the activity has been scheduled and marked as Kept. If you select No, the activity is not billable, which means the payer is not charged for the activity under any circumstance.

8 If you are setting up a block activity, use the drop-down list in the Block Type field to select the type of block activity. Block activities allow staff members to block off time on their schedules to work with unscheduled clients. For example, a staff member may block off a period of time on his schedule to perform intake assessments for clients.

9 In NDC Code field, enter the National Drug Code associated with the activity.


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10In the Overlap field, indicate if this activity, whether billable or non-billable, can overlap with another activity on the schedule.

11The Type field is used to identify the type of activity. The following options are available:

Client. Select this option if the activity can be scheduled as a client activity only, which means it can be scheduled from the Schedule a Client Activity page only.

Staff. Select this option if the activity can be scheduled as a staff activity only, which means it can be scheduled from the Schedule a Staff Activity page only.

Both. Select this option if the activity can be scheduled as either a client or staff activity, which means it can be scheduled from either the Schedule a Client Activity page or the Schedule a Staff Activity page.

Group. Select this option if the activity can be scheduled as a group activity only, which means it can be scheduled from the Schedule a Group Activity page only.

Order. If your organization bills for orders (see Configuring Billable Orders), select this option to create an order activity. Depending on your environment, you can either set up individual activity records for each billable order type or a generic activity record that can be used for all billable order types. Once the order is converted to an activity, it will be processed by the Claim Engine.

12In the Display Non-Billable Minutes field, indicate if you want the non-billable minutes textbox to appear when statusing client or group appointments. This allows you to designate some time from a Kept activity to non-billable status.

13In the Activity Classification field, use the drop-down list to select the way in which the activity is classified. When building configurable forms (see Build Clinical Module Forms), this field is used in conjunction with the Activity Counter field type (the field types are selected on the Field Codes page (see Build Clinical Module Forms).

14The CRS Program Activity Code field is used only by agencies in Philadelphia, and this field is used to associate the activity with the appropriate CRS code when create reporting to Consumer Reporting System of Philadelphia.

Note: This field may not display on your system. It is a configurable field that is activated based on organizational needs. It is used only for organizations in Philadelphia.

15When processing inpatient services, the Claim Engine uses the Type of Service field to determine the type of service being processed. The following options are available:

Professional services include such things as Office Visits and Individual Therapy. For professional services, a Professional claim is generated based on the procedure code and fee.

Institutional services include per diem services, such as Room and Board. For institutional services, an Institutional claim is generated based on the revenue code and fee.

Observation services occur during pre-admission. Organizations use observation services to assess clients for less than 24 hours to determine if they should be admitted for treatment. For observation services, an Institutional claim is generated based on the procedure and revenue codes and fees.

16In the Core Service Code, use the drop-down list to select the core service code for state reporting in Colorado.

Note: This field may not display on your system. It is a configurable field that is activated based on organizational needs.

17In the Modality Code field, use the drop-down list to select the activity’s modality code for state reporting in Colorado.



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18The Move to Timesheet field is used to indicate if you want the system to automatically move the activity to your timesheet once it is marked as Kept.

19If you selected Yes in the previous step, use the drop-down list in the Timesheet Category field to select the category on your timesheet to which the activity is posted.

20By default, the status of an activity cannot be marked as Kept in the Scheduler until the activity date and time arrives. If you want to override this feature and mark the activity as Kept before the activity date and time arrives, select the Yes radio button in the Can be marked Kept in the future field.

21The Billable Unit Is field is used to define what constitutes a billable unit for the activity. If the billable unit is based on Minutes or Hours, you must also define the unit calculation method to use for partial units. If the billable unit is based on Sessions, a unit calculation method is not needed because there will be no partial units.

In the text field, enter the number of units to base the billable unit on. In the second field, use the drop-down list to select the type of billable unit you want to use. The options are Minutes and Hours. For example, if you want to base the billable units on one hour sessions, you would enter 60 in the text field and select Minutes in the drop-down list.

Note: CareLogic supports both whole and decimal numbers.

The next drop-down list is used to select the unit calculation method to use for partial units. The following options are available. Fraction. Select this option if you want to bill the unit exactly as it occurred, without any

calculations applied. For example, if the session lasted for one hour and fifteen minutes, the billable unit would be one hour and fifteen minutes.

Round Nearest. Select this option if you want all units to be rounded to the nearest defined unit. If you select this option, you must select a value in the Nearest Unit Size field. For example, suppose the billable unit is 1. If the session lasts one hour and 15 minutes, the billable unit is rounded down to 1 unit. If the session lasts for one hour and a half, the billable unit is rounded up to 2 units. Suppose the billable unit is 0.25. If the session lasts for 1.1 units, the billable units are rounded down to 1 unit. If the session lasts for 1.2 units, the billable unit is rounded up to 1.25 units.

Round Up. Select this option if you want all units to be rounded up to the nearest defined unit. If you select this option, you must select a value in the Nearest Unit Size field. If the nearest unit size is 1 or blank, the system rounds up to a whole unit. If the nearest unit size is a fraction, the system rounds up to that fraction. For example, suppose the billable unit is set as 1 hour and nearest unit size is set to 1/4. In this scenario, 1-15 minutes will be billed as 1/4 unit; 16-30 minutes will be billed as 1/2 unit; 31-45 minutes will be billed as 3/4 units; and 46-60 minutes will be billed as 1 unit.

Truncate. Select this option if you want to remove all fractions of a unit and bill the whole number associated with the unit only. For example, if the session lasts for one hour and a half, the billable unit would be one hour.

Nearest Unit Size. Use the drop-down list to select the fraction to round the billable unit to. You must select a value in this field if you selected Round Nearest or Round Up as the unit calculation method. If you selected another unit calculation method, do not select a value in this field.

22For each activity, you can use the Staff Unit field to define the number of units to use when calculating staff productivity for reporting purposes. In the first field, enter a numeric value. In the second field, use the drop-down list to select the type of unit, such as Session, Minutes, Hours, Days, or Months.

23The Fee for Service Bonus Minutes field is used when an activity requires use of bonus minutes. Your entry can be up to 4 digits.

24Click Submit in the status bar. The activity code is saved and listed on the Activity Codes page.


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Associating Activities with Organizations When a new activity is added (see Adding Activity Codes), it is only available at the organization of the staff member who added it. This task includes instructions for making activities available to child organizations.

To associate activities with organizations: 1 Access the Activity Codes page (see Setting Up Activity Codes). 2 Locate the activity you want to associate with organizations and click the Organization

button. The Organization List page appears for the selected activity. This list, which is sorted by Parent Organization name, includes the organization you are currently logged into and all its child organizations.

3 To associate the selected activity with an organization, select the checkbox next to each organization that it should be associated with

Note: To associate the selected activity with all organizations, select the checkbox in the table header at the top of the checkbox column. To exclude the selected activity from all organizations, deselect the checkbox in the table header at the top of the checkbox column.

4 Click Submit in the status bar. The activity organization matrix record is saved.

Updating Activity Codes Once an activity code is entered into the system, you can edit any of the information associated with the activity code record.

To update activity codes: 1 Access the Activity Codes page (see Setting Up Activity Codes).

2 Click the Select button that corresponds with the activity you want to update.


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The Activity Entry page appears. You can edit any of the fields on this page. All required fields are highlighted. See Adding Activity Codes for field descriptions.

3 After making the desired edits, click Submit in the status bar. The activity code is updated and listed on the Activity Codes page.

Setting Up Activity/Procedure Mappings An activity/procedure mapping contains a set of user-defined parameters that tell the system which procedure code to use for a particular activity. An activity/procedure mapping links an activity code to procedure codes. See page 66 for information about how activity codes are linked to procedure codes.

To access the Activity Procedure Matrix page: 1 Access the Activity Codes page (see Setting Up Activity Codes).

2 Click the Matrix button that corresponds with the activity code you want to set up an activity/procedure mapping for.

The Activity Procedure Matrix page appears for the selected activity.

This page is used to perform the following tasks: Adding Activity/Procedure Mappings Updating Activity/Procedure Mappings Deleting Activity/Procedure Mappings

Adding Activity/Procedure Mappings Activity/procedure mappings are used by the Claim Engine to convert your internal activity codes to nationally standardized procedure codes that are used to generate claims. In order to be adjudicated by payers, every claim you send out must have a procedure code on it. When setting up your mappings, you should remember that a single activity code can be mapped to multiple procedure codes. Once the mappings are established, the standard fee that is set up for the procedure code is used as the basis for calculating a charge for the activity.


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For each activity/procedure mapping, you can define what constitutes a billable unit. If the billable unit is based on Minutes, Hours, Days, or Months, you can also define the unit calculation method to use for partial units. If the billable unit is based on Sessions, a unit calculation method is not needed because there will be no partial units.

Note: Once an activity/procedure mapping is added to the system, you can use the Select button on the Activity Procedure Matrix page to update it (see page 110).

To add activity/procedure mappings: 1 Access the Activity Procedure Matrix page (see Setting Up Activity/Procedure

Mappings). 2 Click the Add Mapping Entry button.

The Activity Procedure Matrix page changes to add mode. All required fields are highlighted.

3 In the Begin Date field, enter the date the activity/procedure mapping becomes active in the system. This is the first date the Claim Engine will convert the selected activity into a procedure code and use the procedure’s standard fee to create a claim.

4 If you want the activity/procedure mapping to be active for a particular date range only, enter the end date for the mapping in the End Date field. This is the last date the Claim Engine will use this mapping record.

Note: The procedure code drop-down will filter procedure codes based on begin and end dates. For example, procedure code 90801 has one record in Administration with a begin date of 01/01/2010 and an end date of 12/31/2010 and a second record in Administration with a begin date of 01/01/2011 and no end date.


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When the user adds an activity mapping with a begin date of 01/01/2011 with no end date, procedure code 90801 will appear in the drop-down.

When the user adds an activity mapping with a begin date of 04/01/2010 and no end date, procedure code 90801 will not appear in the drop-down.

When the user adds an activity mapping with a begin date of 04/01/2010 and an end date of 12/31/2010, procedure code 90801 will appear in the drop-down.

5 In the Is This a Non-Billable Mapping field, indicate if the activity/procedure mapping will create a billable service. If you select Yes, the activities matching this mapping will not be billed. If you select No, the activities matching this mapping will be billed and you must complete Step 14.

6 In the Procedure Code field, use the drop-down list to select the procedure code you want the selected activity to map to. The Claim Engine will use the standard fee associated with this procedure code to generate a claim for the selected activity.

7 In the Standard Fee field, Enter the standard fee to use instead of the fee associated with the procedure code. The Claim Engine will use the entered fee to generate a claim for the selected activity.

8 By default, the Claim Engine considers all activities, regardless of the staff credentials associated with them, when applying this mapping record. If you want to narrow the credential criteria associated with this mapping record, use the drop-down list in the Billing Category field to select the desired credential. Once you select a credential in this field, the Claim Engine will consider only the activities associated with the selected credential when applying this mapping record.

9 By default, the Claim Engine considers all activities, regardless of their duration, when applying this mapping record. If you want to narrow the minute range criteria associated with this mapping record, enter the desired duration in the Minute Range field. The minimum and maximum minute range allowed in this field is 1 and 9999. Once you enter a minute range, the Claim Engine will consider only the activities that fall within the defined minute range when applying this mapping record.

10The Organization field is used to select the organization you want to associate with this mapping record. This drop-down list includes only the organization you are currently logged into and all child organizations.

11In the Program field, use the drop-down list to select the program to which this activity-procedure matrix applies.

12For some payers, you may need the ability to map activities to procedure codes based upon the location at which the service was provided. To associate the activity-procedure matrix with a service location, enter the partial or full name of the service location, and use the drop-down list to select the desired location in the Service Location field.

13For some payers, you may need the ability to map activities to procedure codes based upon the age of the client. To associate the activity-procedure matrix with a certain age range, enter the beginning and ending ages to which this activity-procedure matrix applies in the Age Range field.

14If you want to define a specific billing type for the activity/procedure mapping, use the drop-down list to select an option in the Billing Type field.

15By default, the Claim Engine considers all activities, regardless of the payer plans associated with them, when applying this mapping record. If you want to narrow the payer plan criteria associated with this mapping record, use the drop-down list in the Payer Name field to select the desired payer plan. Once you select a payer plan in this field, the Claim Engine will consider only the activities associated with the selected payer plan when applying this mapping record.


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16By default, the Claim Engine considers all activities, regardless of the payer type associated with them, when applying this mapping record. If you want to narrow the payer type criteria associated with this mapping record, use the drop-down list in the Payer Type field to select the desired payer type. Once you select a payer type in this field, the Claim Engine will consider only the activities associated with the selected payer type when applying this mapping record.

17The Billable Unit Is field is used to define what constitutes a billable unit for the activity/procedure mapping. If the billable unit is based on Minutes, Hours, Days, or Months, you must also define the unit calculation method to use for partial units. If the billable unit is based on Sessions, a unit calculation method is not needed because there will be no partial units.

In the text field, enter the number of units to base the billable unit on. In the second field, use the drop-down list to select the type of billable unit you want to use. The options are Sessions, Minutes, Hours, Days, and Months. For example, if you want to base the billable units on one hour sessions, you would enter 60 in the text field and select Minutes in the drop-down list.






Nearest Unit Size. Use the drop-down list to select the fraction to round the billable unit to. You must select a value in this field if you selected Round Nearest or Round Up as the unit calculation method. If you selected another unit calculation method, do not select a value in this field.

18The Modifier fields allow you to select up to four modifiers that the Claim Engine will attach to the procedure code when using this mapping record. The drop-down lists in these fields are populated by the Modifiers module (see Setting Up Modifiers).

Important: If you select multiple modifiers in these fields, it is important to know that only one of the modifiers can affect the fee calculation. If you select more than one modifier that affects the fee calculation, the Claim Engine will generate an error and move the service into Failed Claims.

19Click Submit in the status bar. The activity/procedure mapping is saved and listed on the Activity Procedure Matrix page. See Matching Activity Codes to Procedure Codes for information about how an activity/procedure mapping is used to match activity codes to procedure codes.


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Updating Activity/Procedure Mappings Once an activity/procedure mapping is entered into the system, you must use this task to edit it.

To update activity/procedure mappings: 1 Access the Activity Procedure Matrix page (see Setting Up Activity/Procedure

Mappings).

2 Click the Select button that corresponds with the activity/procedure mapping you want to update.

The Activity Procedure Matrix page changes to edit mode. You can edit any of the fields on this page. All required fields are highlighted. See Adding Activity/Procedure Mappings for field descriptions.

3 After making the desired edits, click Submit in the status bar. The activity/procedure mapping is updated and listed on the Activity Procedure Matrix page.

Deleting Activity/Procedure Mappings Once an activity/procedure mapping has been used in some part of the system, it cannot be deleted. You can only delete an activity/procedure mapping that have never been used by the system.

To delete activity/procedure mappings: 1 Access the Activity Procedure Matrix page (see Setting Up Activity/Procedure

Mappings).

2 Click the Delete button that corresponds with the activity/procedure mapping you want to delete.

The Delete Activity Matrix Entry page appears. 3 Select Yes to confirm you want to delete the selected activity/procedure mapping. 4 Click Submit in the status bar.

The activity/procedure mapping is deleted from the system.

Matching Activity Codes to Procedure Codes Activity codes are used to define how your organization internally records services. Procedure codes are nationally standardized codes that describe the type of service provided. During the nightly run of the Claim Engine, the system uses activity/procedure mapping records to convert your activities codes to procedure codes. The following logic is used during this process.

The Claim Engine identifies the activity code associated with the service and attempts to match it to an activity/procedure mapping record.


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If the activity is successfully matched to an activity/procedure mapping, the procedure code is identified, a standard fee is attached, and a claim is produced.

If the activity cannot be matched to an activity/procedure mapping, it is moved into Failed Activities (and marked with the status ‘No Activity Procedure Crosswalk Exists’) and a claim is not produced.

The following chart shows the checks the Claim Engine performs when attempting to match an activity code to an activity/procedure mapping.

Note: In order for an activity to match an activity procedure mapping, it must match all of the criteria. For example, when performing the first check, the activity must match the payer, the licensure, AND the program of the activity/procedure mapping. If an activity fails on any of the criteria in the first check, the Claim Engine attempts to match it against the criteria in the second check. The Claim Engine continues to compare the activity to all 12 of the checks until a match is found.

Payer Payer Type

Licensure Program

1 Check Check Check

2 Check Check

3 Check Check

4 Check

5 Check Check Check

6 Check Check

7 Check Check

8 Check

9 Check Check

10 Check

11 Check

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Setting Up Activity/Program Mappings An activity/program mapping links an activity to a treatment program. Once the mapping is set up, the Activity drop-down list on the Schedule page is filtered based on the program selected (see page 18 the Scheduling Guide).


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Important: If your system is not configured to use the Activity-Program Matrix, the Program Matrix button does not appear in the Activities list by default. To update your activity-program mappings, you must first click the Update Program Mappings button in the status bar. This button displays the Program Matrix button and also filters the Activities list to only display the activities mapped to the organization you are currently logged into.

To set up activity/program mappings: 1 Access the Activity Codes page (see Setting Up Activity Codes).

2 Click the Program Matrix button that corresponds with the activity you want to set up an activity/program mapping for.

The Program List page appears for the selected activity. This page lists all of the treatment programs that are set up for the current organization, plus all child organizations (unless you click the Update Program Mappings button, as you only see the programs and activities set up at the organization you are currently logged into). By default, all of the program are excluded, which means they the activity is not associated with them.

3 To associate a program with the selected activity, click the Include checkbox. Selecting the Included checkbox means the activity can be scheduled for the selected program. You can include as many programs as desired for the selected activity.

4 Click Submit in the status bar. The activity/program mapping is saved.

Deleting Activity Codes Once an activity code has been used in some part of the system, it cannot be deleted. You can only delete the activity codes that have never been used by the system.

To delete activity codes: 1 Access the Activity Codes page (see Setting Up Activity Codes).


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2 Click the Delete button that corresponds with the activity code you want to delete. The Delete Activity page appears.

3 Select Yes to confirm you want to delete the selected activity code. 4 Click Submit in the status bar.

The selected activity code is deleted from the system.

Set Up Treatment Programs The Programs module is used to maintain a list of all the treatment programs your organization offers. Once the treatment programs are set up, you can enroll clients into them through the ECR (see page 38 the Clinical Record Guide). When you schedule an activity, you must identify the treatment program. The billing frequency is based on the type of program in which the client is enrolled. For example, residential programs do not generate claims until the client is discharged from the program.

Important: If your system is not configured to use the Activity-Program Matrix, the Activities button does not appear in the Program list by default. To update your activity-program mappings, you must first click the Update Activity Mappings button in the status bar. This button displays the Activities button and also filters the Program list to only display the programs mapped to the organization you are currently logged into.

To access treatment programs: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Programs.

The Program Administration page appears.

This page is used to perform the following tasks: Add Treatment Programs Associate Programs with Organizations Update Treatment Programs Set Up an Activity Program Matrix


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Set Up Activities for Per Diem Programs

Add Treatment Programs This task includes instructions for entering treatment programs into the system. Every program provided by your organization must be entered into the system. Once a treatment program is added, it is available at the organization you are currently logged into only. If you want to make a program available to child organizations, see Associate Programs with Organizations.

Important: After adding a treatment program, you must add the program to an episode type in order to admit a client into the program (see Setting Up Episode of Care Types).

Note: Once a client program is added to the system, you can use the Select button on the Program Administration page to update it (see page 130).

To add treatment programs: 1 Access the Program Administration page (see Set Up Treatment Programs). 2 Click the Add a Program button.

The Program Administration page changes to add mode. All required fields are highlighted.

3 In the Program Code field, enter a code to represent the program. Your entry can be up to six characters.

4 In the Program Name field, enter a description of the program. 5 In the Begin Date field, enter the date the program becomes active in the system. Your

entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

6 In the End Date field, enter the date the program becomes inactive in the system. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

7 In the Recording Code field, enter the MICP state reporting code for this program. This field is used in Georgia state reporting.


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8 In the HCPF Program Code field, enter the Health Care Financing and Policy code for the program. This field is used in Colorado state reporting.


9 In the EBP Service Category field, use the drop-down list to select the Evidence Based Practice service category for the state-defined program. This field is used in Colorado state reporting.


10In the DPAS Program ID, enter your DMHAS Provider Access System Program ID number for the state of Connecticut.


11If you want to classify the program, use the drop-down list in the Program Classification field to select an option.

12In the Per Diem field, indicate if this is a per diem treatment program. If you select Yes, you must set up the per diem activities you want to associate with the program (see page 76).

13The CRS Site Facility Code field is used only for agencies located in Philadelphia and is used as a program-level code to identify the program in which the client is being served.


14In the Requires Diagnosis field, indicate if the treatment program requires a diagnosis to file claims.

15In the Capacity field, enter the client capacity for this program. Note: This field may or may not appear in your system based on how your system is configured. For

questions about this configuration, please contact QSI Support. Once the client admission capacity has been reached for the program, each subsequent attempt to admit a new client to the program will result in a scheduling validation issue alerting the person scheduling the service that the program capacity has been reached.

16In the Budgeted field, enter the number of budgeted enrollments for this program. Note: This field may not display on your system. It is a configurable field that is activated based on

organizational needs.

17Click Submit in the status bar. The new program is saved and listed on the Program Administration page. The new program is available at the organization you are currently logged into only.

Associate Programs with Organizations When a new treatment program is added (see Add Treatment Programs), it is only available at the organization of the staff member who added it. This task includes instructions for making treatment programs available to child organizations.

To associate programs with organizations:


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1 Access the Program Administration page (see Set Up Treatment Programs). 2 Locate the program you want to associate with organizations and click the

Organization button. The Organization List page appears for the selected program. This list, which is sorted by Parent Organization name, includes the organization you are currently logged into and all its child organizations.

3 To associate the selected program with an organization, select the checkbox next to each organization that it should be associated with

Note: To associate the selected program with all organizations, select the checkbox in the table header at the top of the checkbox column. To exclude the selected program from all organizations, deselect the checkbox in the table header at the top of the checkbox column.

4 Click Submit in the status bar. The program organization matrix record is saved.

Simultaneous Program Exclusions Programs that should not be active at the same time can be mutually excluded.

1 Navigate to the Administration → Show Menu → Programs

2 Click the Exclusion button next to the desired program The Program Exclusions entry page will allow users to exclude programs that should not be active at the same time using a checkbox. The entry page will display the Active and Inactive Programs which will include the Program Code, Program Name, Begin Date and End Date.

3 Identify any program that should not be active at the same time as the selected program to exclude by clicking on the checkbox next to the Program Name.


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4 Click Submit

Update Treatment Programs Once a program is added to the system, you can use the instructions in this task to update any of the fields associated with the program.

To update treatment programs: 1 Access the Program Administration page (see Set Up Treatment Programs). 2 Click the Select button that corresponds with the program you want to update.

The Program Administration page appears. You can edit any of the fields on this page. All required fields are highlighted. See Add Treatment Programs for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated program is saved and listed on the Program Administration page.

Set Up an Activity Program Matrix For each treatment program, you can set up an activity program matrix that defines which activities can be associated with the program. Once the matrix is set up, it is used by the Schedule. When scheduling activities, the Activity drop-down list is filtered once a program is selected (see page 18 the Scheduling Guide).

Important: If your system is not configured to use the Activity-Program Matrix, the Activities button does not appear in the Program list by default. To update your activity-program mappings, you must first click the Update Activity Mappings button in the status bar. This button displays the Activities button and also filters the Program list to only display the programs mapped to the organization you are currently logged into.

To set up an activity program matrix: 1 Access the Program Administration page (see Set Up Treatment Programs).


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2 Click the Activities button. The Activity Code List appears for the selected program. This list includes all of the activities that have been set up in the current organization, plus all child organizations (unless you click the Update Activity Mappings button, as you only see the programs and activities set up at the organization you are currently logged into). The Type column indicates if the activity is for clients, groups, or both. By default, all of the activities are excluded, which means they can not be scheduled for the program.

3 To associate an activity with the program, click the Include checkbox. Selecting the Included checkbox means the activity can be scheduled for the selected program. You can include as many activities as desired for the selected program.

4 Click Submit in the status bar. The activity program matrix record is saved.

Set Up Activities for Per Diem Programs For each per diem treatment program, you can define the activities you want to associate with it. Once the activities are set up, the system automatically generates the services each day clients are enrolled in the program. This feature allows you to bill multiple services for per diem programs. For example, suppose you set up two services (room/board and food) for an Inpatient Detox program. In addition to billing for the detox sessions attended by the clients, you can also bill for room/board and food each day clients are enrolled in the program. You can also have the ability to indicate that certain per diem activities bill out under a certain staff member.

To access per diem activities: 1 Access the Program Administration page (see Set Up Treatment Programs).

2 Click the Per Diem button. The Per Diem Activities list page appears for the selected program.

This page is used to perform the following tasks:


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Adding Activities to a Per Diem Program Updating the Activities Associated With a Per Diem Program Deleting the Activities Associated With a Per Diem Program

Adding Activities to a Per Diem Program This task is used to define the services you want to be generated for a per diem program. Each night the Claim Engine generates the services if it finds a match for the combination of client, program, and date.

Note: For each program, there can be only one active per diem activity record during a given date range.

To add activities to a per diem program: 1 Access the Per Diem Activities page (see Set Up Activities for Per Diem Programs).

2 Click the Add Per Diem Activities button in the status bar. The Per Diem Activity Setup page appears for the selected program. The following fields are required: Begin Date and Per Diem Activities.

Note: The date range of the per diem activity record must fall within the date range of the related per diem program.

3 In the Begin Date field, enter the date the per diem activity record becomes active in the system. This is the first date the system attempts to generate services for the combination of client, program, and date. By default, the current system date is entered. If desired, you can click the Calendar icon to select a different date.


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4 In the End Date field, enter the date the per diem activity record becomes inactive in the system. This is the last date the system attempts to generate services for the combination of client, program, and date.

5 In the Organization field, use the drop-down list to select the organization to which this per diem activity applies.

6 The Create Services on Program Admission Date field is used to indicate if you want to generate the services on the date clients are admitted into the treatment program.

7 The Create Services on Program Discharge Date field is used to indicate if you want to generate the services on the date clients are discharged from the treatment program.

8 The Create Services for 1-day Stays field is used to indicate if you want to generate services for clients whose admission and discharge dates are the same date.

9 The Billing Staff field is used to indicate that a particular per diem activity bills out under a certain staff member.

10The Per Diem Activities field is used to select the activities you want to be generated for the selected per diem program. This field allows you to select any activity that is set up for your current organization and all child organizations. You must select at least one activity in this field.

Note: This field is used to search for the client activities that are active during the date range of this record (as defined in Steps 3 and 4). Group, staff, and order activities are not included in this search.

a In the text entry field, enter the full or partial activity name or activity code you want to be generated for the selected per diem program.

b Click the Tab key. The drop-down list is filtered based on your search criteria.

c Use the drop-down list to select the desired activity. d Click the Add button.

The selected activity appears in the list, which means it will be generated for the selected per diem program. You can add as many activities as desired by repeating this step.

Note: To remove a per diem activity from the list, highlight it and click the Remove button.

11In the Per Diem Schedule field, use the drop-down list to select the per diem schedule that applies to this per diem activity.

Note: If you select a per diem schedule, a list of the non-billed days appear in read-only format for your review.

12After adding all the desired activities, click Submit in the status bar. The per diem activity record is saved and listed on the Per Diem Activities page. Once the record becomes active, it will be processed by the nightly run of the Claim Engine. If the system finds a successful match for the combination of client, program, and date, the Claim Engine will generate the services for all clients enrolled in the program. The services appear as one-minute activities on the Schedule and their status is automatically set to Kept so they are processed by the Claim Engine.

Updating the Activities Associated With a Per Diem Program This task includes instructions for updating the activities record associated with a per diem program. You can update any of the data in the per diem activities record until the record is used to create services. Once a per diem activity record is used to create services, the only fields that can be modified are the Begin Date and End Date.

To update the activities associated with a per diem program: 1 Access the Per Diem Activities list page (see Set Up Activities for Per Diem Programs).


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2 Click the Select button of the record you want to update. The Per Diem Activity Setup page appears. You can modify any of the fields on this page. See Set Up Activities for Per Diem Programs for field descriptions. Note: The Begin Date and End Date fields cannot be modified if the new date range will create orphan

records.

3 After making the desired edits, click Submit in the status bar. The record is updated and listed on the Per Diem Activities page.

Deleting the Activities Associated With a Per Diem Program This task is used to delete per diem activity records.

Note: Once a per diem activity record is used to create services, the record cannot be deleted.

To delete the activities associated with a per diem program: 1 Access the Per Diem Activities list page (see Set Up Activities for Per Diem Programs).

2 Click the Delete button of the record you want to delete. The Delete Per Diem Activity Setup page appears.

3 Select Yes to confirm you want to delete the record. 4 Click Submit in the status bar.

The selected record is deleted.

Payer Panels Payer panels are used to assign staff members to groups that can be attached to specific payers. All of the staff members who are part of the payer panel are authorized to perform services for the payer. Payer panels are useful when you have a staff member who is authorized to perform services for multiple payers.

When establishing payer panels, you should be aware of the following information. A staff member can be a member of more than one payer panel. A staff member can be authorized to perform services for two different programs for the same payer.

To do this, add the staff member to the same payer panel twice, once for each program. Staff members are always assigned to payer panels, which are then attached to specific payers.

To access payer panels: 1 Click Administration in the navigation bar.

The Administration menu system is loaded.


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2 Click the Show Menu arrow in the shortcut bar and select Payer Panels. The Payer Panel Administration page appears. This page lists all of the payer panels that are set up in the system.

This page is used to perform the following tasks: Add Payer Panels Assign Staff Members to Payer Panels Associate Payer Panels with Organizations Update Payer Panels Delete Payer Panels

Add Payer Panels This task includes instructions for creating payer panels. The payer panels you create are associated with specific payer plans (see Set Up Payer Plans). After a payer panel is created, you must assign staff members to it (see Assign Staff Members to Payer Panels).

Note: Once a payer panel is added to the system, you can use the Select button on the Payer Panel Administration page to update it (see page 75).

To add payer panels: 1 Access the Payer Panel Administration page (see Payer Panels). 2 Click the Add Panel button.

The Panel Entry page appears.

3 In the Panel Name field, enter the name of the payer panel you want to create. Your entry can be up to 30 characters. This is a required field, as indicated by a red highlight in the user entry section.

4 Click Submit in the status bar. The payer panel record is saved and listed on the Payer Panel Administration page.

Assign Staff Members to Payer Panels Once a payer panel is created (see Add Payer Panels), you must assign staff members to it. See Payer Panels for general information about payer panels.

To assign staff members to payer panels:


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1 Access the Payer Panel Administration page (see Payer Panels).

2 Click the Members button that corresponds with the payer panel you want to assign staff members to.

The Panel Member List page appears. This page lists all of the staff members who have been assigned to the selected payer panel.

3 Click the Add Panel Member button. The Panel Member Entry page appears. All required fields are highlighted.

4 In the Begin Date field, enter the date the payer panel becomes active in the system. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 In the End Date field, enter the date the payer panel becomes inactive in the system. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

Important: An entry is required in either the Staff Name field or the Organization field. If desired, you can select an option in both fields. If you select a staff member and an organization, the payer panel includes all of the services provided by the selected staff member at the selected organization.

6 If you want to assign a specific staff member to the payer panel, use the drop-down list in the Staff field to select the desired staff member. This drop-down list only includes the staff members associated with the current organization and all child organizations. All staff members listed in the Staff drop-down are active employees during the selected date range.


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7 In the Organization field, use the drop-down list to select the organization you want to associate with the payer panel. This drop-down list includes only the organization you are currently logged into and all child organizations.

8 The Program field is used to associate the payer panel with a particular program. If you selected a staff member and a program, the payer panel authorizes the staff member to treat

clients in the selected program only, at any location. If you selected a location and a program, the payer panel authorizes the treatment of all services

provided at the selected location for the selected program only. If you selected a staff member, a location, and a program, the payer panel authorizes the staff

member to treat clients for the selected program only at the selected location only. 9 The Activity field is used to associate the payer panel with a particular activity.

If you selected a staff member and an activity, the payer panel authorizes the staff member to treat clients for the selected activity only, at any location.

If you selected a location and an activity, the payer panel authorizes the treatment of all services provided for the selected location for the selected activity only.

If you selected a staff member, a location, and an activity, the payer panel authorizes the staff member to treat clients for the selected activity only at the selected location only.

10In the EDI Provider Number field, enter the provider number used to submit EDI transactions.

Note: This field only appears if your system is configured to submit EDI transactions.

11The Blanket Authorization Number field is used to collect a blanket authorization for a payer based on the specified organization, program, and activity combination.

Note: This field only appears if your organization has this configuration turned on. See an administrator or QSI Support for more information on this configuration.

12The Specialty Code field is used to collect the specialty codes used by Pennsylvania Medical Assistance and all Pennsylvania Managed Medicaid Payers.

Note: This field only appears if your system is configured to submit to the state of Pennsylvania.

13In the TennCare Provider ID field, enter the provider ID used to submit transactions to TennCare.

Note: This field only appears if your system is configured to submit to TennCare.

14Use the drop-down list to select the Pin Number Qualifier that is associated with the Pin Number field below.

Note: This field only appears if your system has been configured to display it.

15The Pin Number field is used to associate the payer panel with the particular PIN number that is used by the staff member who is providing the service. The PIN entered in this field prints on the HCFA and UB-92 claims when a client has a payer with this payer panel attached.

16Use the drop-down list to select the Group Number Qualifier that is associated with the Group Number field below.

Note: This field only appears if your system has been configured to display it.

17The Group Number field is used to associate the payer panel with a particular group number.

Note: NPI Numbers and taxonomy codes can also be assigned through the Organization module (see Add Organizations) and the Employee Menu (see page 59 the Employee User Guide).


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18In the NPI Number field, enter the unique National Provider Identifier (NPI) number for the organization. The NPI number must contain 10 numeric characters. The first nine numbers are used as unique identifiers and the tenth number is used as a check digit to detect invalid NPIs.

19Taxonomy codes are nationally standardized codes that can be assigned to both organizations and staff members. Your organization is responsible for selecting the taxonomy code that most closely represent the services your organization provides. The taxonomy code is a sub-category of the NPI which appears on claims. In the Taxonomy Code field, enter the 10-digit alphanumeric taxonomy code that you want to assign to the organization. The taxonomy codes, for both organizations and staff members, appear on claims.

20The fields Payer Specific Code -1, Payer Specific Code -2, and Payer Specific Code -3 are used for payer specific requirements when generating EDI claims. Values need only be entered as instructed by Qualifacts personnel to support a specific payer’s custom requirements

21Click Submit in the status bar. The staff member is added to the payer panel and is listed on the Panel Member List page. To assign additional staff members to the payer panel, repeat this task.

Associate Payer Panels with Organizations When a new payer panel is added (see Add Payer Panels), it is only available at the organization of the staff member who added it. This task includes instructions for making payer panels available to child organizations.

To associate payer panels with organizations: 1 Access the Payer Panel Administration page (see Payer Panels). 2 Locate the payer panel you want to associate with additional organizations and click

the Organization button. The Organization List page appears for the selected payer panel. This list includes the organization you are currently logged into and all its child organizations.

3 To associate the selected payer panel with an organization, select the checkbox next to each organization that it should be associated with

Note: To associate the selected payer panel with all organizations, select the checkbox in the table header at the top of the checkbox column. To exclude the selected payer panel from all organizations, deselect the checkbox in the table header at the top of the checkbox column.

4 Click Submit in the status bar. The payer panel organization matrix record is saved.

Update Payer Panels Once a payer panel is created, you must use this task to modify its name.


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To update payer panels: 1 Access the Payer Panel Administration page (see Payer Panels). 2 Click the Select button that corresponds with the payer panel you want to update.

The Panel Entry page appears. 3 In the Panel Name field, edit the name of the payer panel. Your entry can be up to 30

characters. 4 Click Submit in the status bar.

The payer panel record is updated and listed on the Payer Panel Administration page.

Delete Payer Panels This task is used to delete payer panels. If there are payer provider records attached to a payer panel, it cannot be deleted.

To delete payer panels: 1 Access the Payer Panel Administration page (see Payer Panels).

2 Click the Delete button that corresponds with the payer panel you want to delete. The Delete Panel Entry page appears.

3 Select Yes to confirm you want to delete the selected payer panel. 4 Click Submit in the status bar.

The selected payer panel is deleted from the system.

Maintaining HCFA and UB04 Configurations The HCFA/UB04 Configuration module allows your organization to control the information that is printed on HCFA and UB04 claims forms. You can create as many dynamic HCFA or UB04 records as needed. If necessary, you can create a unique dynamic HCFA or UB04 record for each payer plan to which your organization submits claims.

Note: The Dynamic HCFA module supports the CMS 1500 (08/05) form only.

To access the HCFA/UB04 Configuration list page: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select HCFA/UB04 Configuration. 3 The HCFA Configurations list page appears, which lists all of the dynamic HCFA records

that have been set up.


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This page is used to complete the following tasks: Configuring Dynamic HCFAs Copying Dynamic HCFA Configurations Deleting Dynamic HCFA Configurations Configuring UB04s Copying UB04 Configurations Deleting UB04 Configurations

Configuring Dynamic HCFAs This task is used to configure dynamic HCFA records in the system.

To configure dynamic HCFAs: 1 Access the HCFA/UB04 Configuration list page (see Maintaining HCFA and UB04

Configurations). 2 Click Add HCFA Config in the status bar.

The HCFA Configuration Setup page appears. All required fields are highlighted. Note: Not every box on the CMS 1500 form can be configured through the Dynamic HCFA module. If a

box cannot be configured, ‘N/A’ appears beside the box number on the HCFA Configuration Setup page.

3 In the Configuration Name field, enter a name for the dynamic HCFA record you are creating. This entry can be up to 60 characters.

4 If you want to pad the left margin alignment of the HCFA claims with blank spaces, enter the number of blank spaces you want to insert in the Alignment - Left Padding field. For example, if you enter 2, two blank spaces will be inserted in the left margin when the HCFA claims print.

5 If you want to insert spacing between pages of the form, enter the number of carriage returns you want to insert in the Alignment - Page Spacing field. For example, if you enter 1, a single carriage return will be inserted in between pages of the form.

6 In the 1- Carrier Type field, use the drop-down list to identify the type of carrier that will be associated with this dynamic HCFA record.

If you select Medicare, Medicaid, Tricare, CHAMPVA, Group Health Plan, FECA, or Other, the corresponding check box will be automatically selected in box 1.

If you select Dynamic, one of the following check boxes will be automatically selected in box 1.


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Medicare. If the payer plan has a payer type of Medicare, then the Medicare check box is selected in box 1.

Medicaid. If the payer plan has a payer type of Medicare, then the Medicare check box is selected in box 1.

Group Health Plan. If the payer plan has a payer type of anything other than Medicare and Medicaid, then the Group Health Plan check box is selected in box 1.

7 By default, the client’s Practice Management system-generated ID number is printed in box 1(a) as the insured’s ID number. If you want to print a different ID number in box 1(a), you must select a different option in the 1(a) - Insured’s ID Number field.

The following ID number options are set up in the Client Payer module: Plan Number, Policy Number, or Group Number.

If you do not want to print an ID number in box 1(a), select Always Leave Blank. 8 By default, the patient’s birth date is printed in box 3. If you do not want to print the

patient’s birth date on claims, select No in the 3 - Patient’s Birth Date field. 9 By default, the insured’s name is always printed in box 4. If you do not want to print

the insured’s name in box 4, you can select one of the following options in the 4 - Insured’s Name field:

No. If you select this option, the insured’s name is printed in box 4 only if the insured is a different person than the patient. If the insured and the patient are the same person, then nothing is printed in box 4.

Always Leave Blank. If you select this option, box 4 always remains empty. 10By default, the patient’s address and phone number are printed in box 5. If you do

not want to print this information in box 5, you can select one of the following options in the 5 - Patient’s Address field:

Print Address Without Phone Number. Select this option if you want to print the patient’s address only in box 5. If you select this option, the patient’s phone number is not printed, even though it is known.

Always Leave Blank. Select this option if you do not want to print either the patient’s address or phone number in box 5.

11By default, the patient’s relationship to the insured is indicated in box 6. If you do not want to include this information, select the Always Leave Blank option in the 6 - Patient’s Relationship to Insured field.

Note: If the insured’s name is not printed in box 4 (Step 10), then the insured’s address and phone number are not printed in box 7 (Step 13), regardless of the option you select in the 7 - Insured’s Address field.

12By default, if the insured’s name is printed in box 4 (Step 10), then the insured’s address and phone number are printed in box 7. If you do not want to print this information in box 7, you can select one of the following options in the 7 - Insured’s Address field:

Print Address Without Phone Number. Select this option if you want to print the insured’s address only in box 7. If you select this option, the insured’s phone number is not printed, even though it is known.

Always Leave Blank. Select this option if you do not want to print either the insured’s address or phone number in box 5.

13By default, the patient’s marital and employment statuses are indicated in box 8. If you do not want to include this information, select Always Leave Blank in the 8 - Patient Status field.


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14By default, if the patient is covered by a secondary insurance plan, information about that secondary insurance plan is printed in boxes 9 and 9(a) - 9(d). If you do not want to print information about the patient’s secondary insurance, select Always Leave Blank in the 9 and 9(a)-(d) - Other Insured field.

Note: Currently, the 10 - Is Patient’s Condition Related To is not used. If you enter text in this field, it is not printed on the HCFA.

15By default, the insured’s group number is printed in box 11 (Insured’s Policy Group or FECA Number). If you want to print a different ID number in box 11, you must select one of the following options in the 11 - Insured’s Policy Group or FECA Number field: ID Number, Plan Number, or Policy Number.

16By default, the insured’s birth date, sex, employer name, and insurance plan name are printed in boxes 11(a) - 11(c). If you do not want to print this information in boxes 11(a) - 11(c), select Always Leave Blank in the 11(a)-(c) - Insured’s Date of Birth and Sex, Employer’s Name, and Insurance Plan Name field.

17By default, if the patient is covered by a secondary insurance plan, information about that secondary insurance plan is printed in boxes 9(a) - 9(d). If you do not want to print information about the patient’s secondary insurance, select No in the 11(d) - Is There Another Health Benefit Plan field.

18By default, the value Signature on File is printed in box 12. If you do not want this value to print in box 12, you can select one of the following options in the 12- Patient’s or Authorized Person’s Signature field:

SOF. This is an abbreviation for Signature on File. Select this option if the patient or an authorized person for the patient has a signature on file. If you select this option, the value SOF is printed in box 12.

No Signature on File. Select this option if the patient or an authorized person for the patient does not have a signature on file. If you select this option, the value ‘No Signature on File’ is printed in box 12.

Leave Blank - Indicates No Signature. Select this option if you do not want to print anything in box 12. When you select this option, it indicates that the patient or an authorized person does not have a signature on file.

19By default, the value Signature on File is printed in box 13. If you do not want this value to print in box 13, you can select one of the following options in the 13 - Insured’s or Authorized Person’s Signature field:

SOF. This is an abbreviation for Signature on File. Select this option if the insured or an authorized person for the insured has a signature on file.

No Signature on File. Select this option if the insured or an authorized person for the insured has a signature on file.

Leave Blank - Indicates No Signature. Select this option if you do not want to print anything in box 13. When you select this option, it indicates that the insured or an authorized person does not have a signature on file.

20By default, box 17 (Name of Referring Provider or Other Source) is left blank by default. If you want to print a value in box 17, you must select one of the following option in the 17 - Name of Referring Provider or Other Source field.

Use Referring Physician. If you select this option, the name of the active provider selected from the Referring Physician Configuration prints in box 17. (see Setting Up Referring Physician Configurations)

Use Bill-To Staff (Only if Different from Provider). If you select this option, the supervisor (bill-to staff) of the staff member who provided the service prints in box 17. If the staff member who provided the service does not have a bill-to staff, then box 17 is blank.


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Use Bill-To Staff (Even if Same as Provider). If you select this option, the supervisor (bill-to staff) of the staff member who provided the service prints in box 17. If the staff member who provided the service does not have a bill-to staff, then the provider is printed in box 17.

Dynamic. Select this option if you want the Qualifacts Professional Services group to write a dynamic query in order to pull the referring provider from another part of the system. When you select this option, a text area field appears.

Note: If the referring provider is not printed in box 17 (Step 21), then the referring provider’s PIN information is not printed in box 17(a) (Step 22), regardless of the option selected in the 17(a) - Name of Referring Provider or Other Source field.

21Box 17(a) is used to print an ID qualifier and an identifier for the referring provider. By default, the referring provider’s ID qualifier is dynamically selected and printed in box 17(a). If you

want to print a static ID qualifier in box 17(a), you must select one of the options in the drop-down list in the 17(a) - Name of Referring Provider or Other Source field. If you do not want to print an ID qualifier in box 17(a), select Always Leave Blank.

By default, the PIN number that was set up in the Payer Panels module is printed in box 17(a) as the referring provider’s identifier. If you do not want to use this PIN number, you can select a different option from the Identifier drop-down list. Use Referring Taxonomy Code. Select this option to print the provider taxonomy code that was

set up as part of the 3rd Party Source configuration (see Setting Up 3rd Party Sources) in box 17(a). Use Referring Federal ID. Select this option to print the provider federal tax ID that was set up as

part of the 3rd Party Source configuration (see page 330) in box 17(a). Use Referring SSN. Select this option to print the provider social security number that was set up

as part of the 3rd Party Source configuration (see Setting Up 3rd Party Sources) in box 17(a). Use Provider PIN from Payer Panel. Select this option to print the provider PIN number that was

set up in the Payer Panels module as the referring provider’s identifier. Use Location PIN from Payer Panel. Select this option to print the location PIN number that was set

up in the Payer Panels module as the referring provider’s identifier. Use Provider Group from Payer Panel. Select this option to print the provider group number that

was set up in the Payer Panels module as the referring provider’s identifier. Use Location Group from Payer Panel. Select this option to print the location group number that

was set up in the Payer Panels module as the referring provider’s identifier. Use Taxonomy Code. Select this option to print the taxonomy code that was set up in the Payer

Panels module. Use a Query (Qualifacts Only). Select this option if you want the Qualifacts Professional Services

group to write a query in order to pull the referring provider’s identifier from another part of the system. If this option is selected, the query must be entered in the field provided.

Use Static Value (Enter Below). Select this option if you want print a static referring provider identifier in box 17(a). If this option is selected, you must enter the static identifier in the field provided.

Note: If the referring provider is not printed in box 17 (Step 21), then the referring provider’s NPI information is not printed in box 17(b) (Step 23), regardless of the option selected in the 17(b) - Ref. Provider NPI Information field.

22By default, the NPI number that was set up in the Employee Credentials module is printed in box 17(b). If you want to use a different NPI number for the referring provider, you can select one of the following options in the 17(b) - Ref. Provider NPI Information field.

Use Referring NPI. Select this option to print the provider national provider ID that was set up as part of the 3rd Party Source configuration (see page 330) in box 17(b).


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Use Provider NPI. Select this option to print the provider NPI that was assigned to the organization in box 17(b).

Use Service Location NPI. Select this option to print the NPI number that was assigned to the organization in box 17(b).

Use a Query (Qualifacts Only). Select this option if you want the Qualifacts Professional Services group to write a query in order to pull an NPI from another part of the system. When you select this option, a teat area field appears.

Use Static Value (Enter Below). Select this option to print a static NPI in box 17(b). When you select this option, a text area field appears, which must be used to enter the static NPI number.

23The 18 - Hospitalization Dates Related to Current Services field is used to display the client’s admission and discharge dates (begin and end dates) for inpatient programs. By default, this field is set to No, use the drop-down list to change the select to Yes if you want to print the begin and end dates of the inpatient program on the HCFA.

24The 19 - Reserved for Local Use field is used by some payers for additional information such as payer panel, taxonomy code, and others. By default, this field is set to Always Leave Blank, as it is only used for certain payers.

Note: If your organization submits claims to a payer which requires this field, contact QSI Support about configurations for this field.

25The Diagnosis code(s) is entered in HCFA Field 21. The HCFA configuration form provides a drop down for Field 21 so the user can specify the diagnosis code output option: Disallow V codes or Print All Codes. The selection defaults to Disallow V Codes, but the customer can change this to Print all codes to include V-Codes.

26By default, the prior payer authorization number is not printed in box 23. If you want to print the prior payer authorization number in box 23, select Yes in the 23 - Prior Authorization Number field.

27By default, if a service is delivered on a single day, an ending date is not printed in box 24(a). If you want to print both a beginning and ending date for services that are delivered on the same date, select Yes in the 24(a) - Dates of Service field.

28By default, box 24(c) indicates if this is an emergency service. If your organization does not want to indicate this information in box 24(c), select No in the 24(c) - Emergency field.

29Box 24(i) is used to print an ID qualifier and an identifier for the provider. By default, the provider’s ID qualifier is dynamically selected and printed in box 24(i). If you want to

print a static ID qualifier in box 24(i), you must select one of the options in the drop-down list in the 24(i) - Provider PIN Information field. If you do not want to print an ID qualifier in box 24(i), select Always Leave Blank.

By default, the PIN number that was set up in the Payer Panels module is printed in box 24(i) as the provider’s identifier. If you do not want to use this PIN number, you can select a different option from the Identifier drop-down list. Use Location PIN from Payer Panel. Select this option to print the location PIN number that was set

up in the Payer Panels module as the provider’s identifier. Use Provider Group from Payer Panel. Select this option to print the provider group number that

was set up in the Payer Panels module as the provider’s identifier. Use Location Group from Payer Panel. Select this option to print the location group number that

was set up in the Payer Panels module as the provider’s identifier. Use Taxonomy Code. Select this option to print the taxonomy code that was set up in the Payer

Panels module.


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Use a Query (Qualifacts Only). Select this option if you want the Qualifacts Professional Services group to write a query in order to pull the provider’s identifier from another part of the system. If this option is selected, the query must be entered in the field provided.

Use Static Value (Enter Below). Select this option if you want print a static provider identifier in box 24(i). If this option is selected, you must enter the static identifier in the field provided.

30By default, the NPI number that was set up in the Employee Credentials module is printed in box 24(j). If you want to use a different NPI number for the provider, you can select one of the following options in the 24(i) - Provider NPI Information field.

Use Service Location NPI. Select this option to print the NPI number that was assigned to the organization in box 24(j).

Use a Query (Qualifacts Only). Select this option if you want the Qualifacts Professional Services group to write a query in order to pull an NPI from another part of the system. When you select this option, a text area field appears.

Use Static Value (Enter Below). Select this option to print a static NPI in box 24(j). When you select this option, a text area field appears, which must be used to enter the static NPI number.

Leave Blank. Select this option if you do not want to print anything in box 24(j). 31By default, the federal tax ID of the organization that provided the service is printed

in box 25. If you do not want to print the organization’s federal tax ID, select Always Leave Blank in the 25 - Federal Tax ID field.

32By default, the patient’s client ID number is used as the account number and printed in box 26. If you want to select a different format for the account number, you can select one of the following options in the 26 - Patient’s Account Number field.

Claim ID. Select this option if you want the claim ID to print in box 26. Client ID-Claim ID. Select this option if you want to use the format [Client ID]-[Claim ID] to print in box

26. 33By default, the name of the physician who delivered the service and the physician’s

primary licensure code are printed in box 31. If you do not want to print this information, you can select different values in the two drop-down lists in the 31 - Signature of Physician or Supplier field.

The following options are available in the first drop-down list (Signature). Signature on File. Select this option if the physician’s signature is on file. If you select this option,

the text ‘Signature on File’ is printed in box 31. SOF. This is an abbreviation for Signature on File. Select this option if the physician’s signature is on

file. If you select this option, the text ‘SOF’ is printed in box 31. Always Leave Blank. Select this option if you do not want to print anything in box 31. When you

select this option, it indicates that the physician does not have a signature on file. The following options are available in the second drop-down list (Licensure). Print Credential from Primary Licensure. Select this option if you want to print the physician’s

credential from the primary licensure. Always Leave Blank. Select this option if you do not want to print anything in box 31.

34The service location refers to the organization that provided the service. By default, the full organization name that provided the services is printed in box 32. If you want to print the organization’s short name (as entered in the Organizations module), select the Use Organization Short Name in the 32 - Service Facility field.

35By default, the NPI number that was set up in the Organization module is printed in box 32(a). If you want to use a different NPI number for the service facility, you can select one of the following options in the 32(a) - Service Facility NPI field.


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Use Billing Provider NPI. Select this option to print the NPI number that was set up for the provider (in the Employee Credentials module) in box 32(a).


Use Static Value (Enter Below). Select this option to print a static NPI in box 32(a). When you select this option, a text area field appears, which is used to enter the static NPI number.

36Box 32(b) is used to print an ID qualifier and an identifier for the service facility. By default, the service provider’s ID qualifier is dynamically selected and printed in box 32(b). If you

want to print a static ID qualifier in box 32(b), you must select one of the options in the drop-down list in the 32(b) - Service Facility ID Number field. If you do not want to print an ID qualifier in box 32(b), select Always Leave Blank.

By default, the location PIN number that was set up in the Payer Panels module is printed in box 32(b) as the service facility’s identifier. If you do not want to use this PIN number, you can select a different option from the Identifier drop-down list. Use Location Group from Payer Panel. Select this option to print the location group number that

was set up in the Payer Panels module as the service facility’s identifier. Use Taxonomy Code. Select this option to print the taxonomy code that was set up in the Payer

Panels module. Use a Query (Qualifacts Only). Select this option if you want the Qualifacts Professional Services

group to write a query in order to pull the service facility’s identifier from another part of the system. If this option is selected, the query must be entered in the field provided.

Use Static Value (Enter Below). Select this option if you want print a static provider identifier in box 32(b). If this option is selected, you must enter the static identifier in the field provided.

37The billing facility refers to the organization that printed the HCFA claim. By default, the full organization name of the billing facility is printed in box 33. If you want to print the organization’s short name (as entered in the Organizations module), select the Use Organization Short Name in the 33 - Billing Facility field.

38By default, the NPI number that was set up in the Organization module is printed in box 33(a). If you want to use a different NPI number for the billing facility, you can select one of the following options in the 33(a) - Billing Facility NPI field.

Use Billing Provider NPI. Select this option to print the NPI number that was set up for the provider (in the Employee Credentials module) in box 33(a).


Use Static Value (Enter Below). Select this option to print a static NPI in box 33(a). When you select this field, a text area field appears, which is used to enter the static NPI number.

39Box 33(b) is used to print an ID qualifier and an identifier for the billing facility. By default, the billing facility’s ID qualifier is dynamically selected and printed in box 33(b). If you want

to print a static ID qualifier in box 33(b), you must select one of the options in the drop-down list in the 33(b) - Billing Facility ID Number field. If you do not want to print an ID qualifier in box 33(b), select Always Leave Blank.

By default, the location PIN number that was set up in the Payer Panels module is printed in box 33(b) as the billing facility’s identifier. If you do not want to use this PIN number, you can select a different option from the Identifier drop-down list. Use Location Group from Payer Panel. Select this option to print the location group number that

was set up in the Payer Panels module as the billing facility’s identifier.


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Use Taxonomy Code. Select this option to print the taxonomy code that was set up in the Payer Panels module.

Use a Query (Qualifacts Only). Select this option if you want the Qualifacts Professional Services group to write a query in order to pull the billing facility’s identifier from another part of the system. If this option is selected, the query must be entered in the field provided.

Use Static Value (Enter Below). Select this option if you want print a static identifier in box 33(b). If this option is selected, you must enter the static identifier in the field provided.

40Click Submit in the status bar. The dynamic HCFA configuration file is saved and listed on the Available HCFA Configurations list page.

Copying Dynamic HCFA Configurations This task is used to create a new HCFA configuration record by copying an existing record. When you use the Copy feature, the entire record is copied. When you copy a HCFA configuration record, the new HCFA configuration record contains the same details as the copied record.

1 Access the HCFA/UB04 Configuration list page (see Maintaining HCFA and UB04 Configurations).

2 Click the Copy button that corresponds with the HCFA configuration you want to copy. 3 The Dynamic Claim Config Copy page appears.

4 In the Copy To field, enter the name of the new HCFA configuration you are creating. 5 Click Submit in the status bar. 6 The copied dynamic HCFA record is saved to the system and listed on the HCFA/UB04

Configuration list page.

Deleting Dynamic HCFA Configurations After a dynamic HCFA configuration has been set up in the system, you must use this task to remove the configuration from the system.


2 Click the Delete button that corresponds with the HCFA configuration you want to delete.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected record. 4 Click Submit in the status bar.

The selected HCFA configuration record is deleted.

Configuring UB04s This task is used to configure UB04 records in the system for creating claims forms.


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To configure setup for UB04s: 1 Access the HCFA/UB04 Configuration list page (see Maintaining HCFA and UB04

Configurations). 2 Click Add UB04 Config in the status bar.

The UB04 Configuration Setup page appears. Note: Not every box on the UB04 claim form can be configured through the UB04 Configuration module.

If a box cannot be configured, a note appears beside the box number explaining what data populates that field on the UB04 Configuration Setup page.

3 In the Configuration Name field, enter a name for the UB04 record you are creating. This entry can be up to 60 characters.

4 If you want to pad the left margin alignment of the UB04 claims with blank spaces, enter the number of blank spaces you want to insert in the Alignment - Left Padding field. For example, if you enter 2, two blank spaces will be inserted in the left margin when the UB04 claims print.

5 If you want to pad the top margin alignment of the claims form with blank spaces, enter the number of blank spaces you want to insert in the Alignment - Top Padding field. For example, if you enter 1, a single blank space will be inserted in top margin of the form.

6 The Federal Tax Number field refers to your organization’s Federal Tax ID. Use the drop-down list to select the format of the tax ID based on the payer requirements.

7 By default, the system-generated ID number is printed in box 8(a) as the patient ID number. If you want to print a different ID number in box 8(a), you must select a different option in the Patient ID - 8A field.

The following ID number options are set up in the Client Payer module: Plan Number or Policy Number.

If you do not want to print an ID number in box 1(a), select Always Leave Blank. 8 By default, the Admission Hour - 13 field pulls the client’s admission time from the

client program admission record. If you do not want this value to print in box 13, you can select one of the following options:

Use a static value (enter below). Select this option if you want print a static admission time in box 13. If this option is selected, you must enter the static identifier in the field provided. This entry can be up to 2 characters.

Always Leave Blank. Select this option if you do not want to print anything in box 13. 9 By default, the Priority (Type) of Visit - 14 field pulls the client’s visit type from the

client program admission record. If you want to manually enter the priority (type) of visit code, you can select the Use a static value (enter below) option, and enter the visit type code in the field provided. This entry may be up to 2 characters.

10By default, the Discharge Hour - 16 field pulls the client’s discharge time from the client program discharge record. If you do not want this value to print in box 16, you can select one of the following options:

Use a static value (enter below). Select this option if you want print a static discharge time in box 16. If this option is selected, you must enter the static identifier in the field provided. This entry can be up to 2 characters.

Always Leave Blank. Select this option if you do not want to print anything in box 16. 11By default, the Responsible Party Name and Address - 38 field pulls the client’s

guarantor information from the client’s Point of Entry record. If you do not want to print anything in box 38, you can select Always Leave Blank.


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12By default, the Prior Payments - Payer - 54 field pulls the prior payment amounts from the claim adjudication information after billing the primary payer. If you do not want to print anything in box 54, you can select Always Leave Blank.

Note: This field is only used when filing secondary claims to show the primary payer’s payment amount.

13By default, the Estimated Amount Due - 55 field is set to Always Leave Blank. If you want to include the estimated amount due, you can select Claim Expected Amount, which will pull the expected claim amount due from system.

14By default, the Other Provider Qualifier - 57-QUAL field is set to Always Leave Blank. If you want to include another provider qualifier and ID, you can select one of the following options:

Payer Panel PIN Qualifier. Select this option to print the provider PIN number qualifier that was set up in the Payer Panels module as the provider’s identifier.

Payer Panel Group Qualifier. Select this option to print the provider group number qualifier that was set up in the Payer Panels module as the provider’s identifier.

Use a static value (enter below). Select this option if you want print a static provider qualifier in box 57. If this option is selected, you must enter the static identifier in the field provided.

Always Leave Blank. Select this option if you do not want to print anything in box 57. 15By default, the Other Provider ID- 57-ID field is set to Always Leave Blank. If you

want to include another provider qualifier and ID, you can select one of the following options: Payer Panel PIN Number. Select this option to print the provider PIN number that was set up in the

Payer Panels module as the provider’s identifier. Payer Panel Group Number. Select this option to print the provider group number that was set up in

the Payer Panels module as the provider’s identifier. Use a static value (enter below). Select this option if you want print a static provider in box 57. If this

option is selected, you must enter the static identifier in the field provided. Always Leave Blank. Select this option if you do not want to print anything in box 57. Note: The Other Provider ID you select must match the Other Provider ID Qualifier you selected in the

field above.

16By default, the system-generated ID number is printed in box 60 as the insured’s ID number. If you want to print a different ID number in box 60, you must select a different option in the Insured’s Unique Identifier - 60 field.

The following ID number options are set up in the Client Payer module: Plan Number or Policy Number.

17By default, the Insured’s Group Number - 62 field uses the payer panel group number that was set up in the Payer Panels module. If you do not want to print anything in box 62, you can select Always Leave Blank.

18By default, the Treatment Authorization Codes - 63 field prints any prior authorizations codes related to the client treatment that is being billed for. If you do not want to print anything in box 63, you can select Always Leave Blank.

19By default, the Prospective Payment System Code - 71 field is set to Always Leave Blank. If you want to include DRG codes on the claim, you can select the DRG Code option.

Note: For more information about setting up DRG codes, see the System Administration Guide.

20By default, the Billing Provider Name, Address and Telephone Number - 1 field uses the billing address set up for your current organization. If you want to use the physical address that was set up for your organization, you can select the Organization Physical Address option in the drop-down list.


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21By default, the Billing Provider’s Designated Pay-to-Address - 2 field is set to Always Leave Blank. If you want to include a provider’s billing address, you can select one of the following options:

Organization Billing Address. Select this option to include the billing address that was set up for your organization.

Organization Physical Address. Select this option to include the physical address that was set up for your organization.

22By default, the Billing Provider NPI - 56 field uses the Organization NPI set up at the organization level. If you want to include a different value in box 56, you can select one of the following options:

Payer Panel NPI. Select this option if you have an NPI set up at the payer panel level that you want to include on the claim form instead of the organization NPI.

Use a static value (enter below). Select this option if you want print a static billing provider NPI in box 56. If this option is selected, you must enter the static identifier in the field provided. This entry must be 10 digits.

23By default, the Attending Provider Name - 76 field uses the Attending Physician information from the client record. If you want to include a different person in box 76. you can select one of the following options:

Staff Name. Select this option if the client was only admitted for outpatient treatment and no attending physician was assigned to the client.

Always Leave Blank. Select this option if you do not want to print anything in box 76. 24By default, the Attending Provider NPI - 76-NPI field uses the Staff/Attending NPI

that has been set up at the organization level. If you want to include a different value in box 76, you can select from one of the following options:

Use a static value (enter below). Select this option if you want print a static attending provider NPI in box 76. If this option is selected, you must enter the static identifier in the field provided. This entry must be 10 digits.

Always Leave Blank. Select this option if you do not want to print anything in box 76. 25By default, the Attending Provider Qualifier - 76-QUAL field is set to Always Leave

Blank. If you want to include a different attending provider qualifier and ID, you can select one of the following options:

Payer Panel PIN Qualifier. Select this option to print the attending provider PIN number qualifier that was set up in the Payer Panels module as the attending provider’s identifier.

Payer Panel Group Qualifier. Select this option to print the attending provider group number qualifier that was set up in the Payer Panels module as the attending provider’s identifier.

Use a static value (enter below). Select this option if you want print a static attending provider qualifier in box 76. If this option is selected, you must enter the static identifier in the field provided.

Always Leave Blank. Select this option if you do not want to print anything in box 76. 26By default, the Attending Provider ID- 76-ID field is set to Always Leave Blank. If you

want to include a different attending provider qualifier and ID, you can select one of the following options:

Payer Panel PIN Number. Select this option to print the attending provider PIN number that was set up in the Payer Panels module as the attending provider’s identifier.

Payer Panel Group Number. Select this option to print the attending provider group number that was set up in the Payer Panels module as the attending provider’s identifier.

Use a static value (enter below). Select this option if you want print a static attending provider in box 76. If this option is selected, you must enter the static identifier in the field provided.


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Always Leave Blank. Select this option if you do not want to print anything in box 76. Note: The Attending Provider ID you select must match the Attending Provider ID Qualifier you selected

in the field above.

27By default, the Other Provider Name and ID - 78 field is left blank. If you want to include a different person in box 78. you can select one of the following options:

Referring Physician. If you select this option, the name of the active provider selected from the Referring Physician Configuration prints in box 78 (see Setting Up Referring Physician Configurations).

Always Leave Blank. Select this option if you do not want to print anything in box 78. 28By default, the Other Provider Name NPI - 78-NPI field is blank. If you want to include

a different value in box 78-NPI, you can select from one of the following options: Referring Physician NPI. Select this option to print the provider national provider ID that was set up

as part of the 3rd Party Source configuration (see Setting Up 3rd Party Sources) in box 78-NPI. Use a static value (enter below). Select this option if you want print a static attending provider NPI in

box 78-NPI. If this option is selected, you must enter the static identifier in the field provided. This entry must be 10 digits.

Always Leave Blank. Select this option if you do not want to print anything in box 78-NPI. 29By default, the Other Provider ID- 78-ID field is set to Always Leave Blank. If you

want to include a different other provider qualifier and ID, you can select one of the following options:

Referring Physician Taxonomy Code. Select this option to print the provider taxonomy code that was set up as part of the 3rd Party Source configuration (see Setting Up 3rd Party Sources) in box 78-ID.

Referring Physician Federal ID. Select this option to print the provider federal tax ID that was set up as part of the 3rd Party Source configuration (see Setting Up 3rd Party Sources) in box 78-ID.

Referring Physician SSN. Select this option to print the provider social security number that was set up as part of the 3rd Party Source configuration (see Setting Up 3rd Party Sources) in box 78-ID.

Always Leave Blank. Select this option if you do not want to print anything in box 78-ID. 30By default, the Remarks - 80 field is set to Always Leave Blank. If you want to include

the payer name and address in box 80, you can select Payer Name and Address from the drop-down list.

31By default, the Code Field - 81A field is set to Always Leave Blank. If you want to include a taxonomy code in box 81A, you can select one of the following options:

Claim Org Taxonomy Code. Select this option to use the taxonomy code set up at the organization level in your system.

Payer Panel Taxonomy Code. Select this option to use the taxonomy code set up at the payer panel level in your system.

Use a static value (enter below). Select this option if you want print a static taxonomy code in box 81A. If this option is selected, you must enter the static identifier in the field provided.

Copying UB04 Configurations This task is used to create a new UB04 configuration record by copying an existing record. When you use the Copy feature, the entire record is copied. When you copy a UB04 configuration record, the new UB04 configuration record contains the same details as the copied record.


2 Click the Copy button that corresponds with the UB04 configuration you want to copy.


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3 The Dynamic Claim Config Copy page appears.

4 In the Copy To field, enter the name of the new UB04 configuration you are creating. 5 Click Submit in the status bar.

The copied dynamic UB04 record is saved to the system and listed on the HCFA/UB04 Configuration list page.

Deleting UB04 Configurations After a UB04 configuration has been set up in the system, you must use this task to remove the configuration from the system.


2 Click the Delete button that corresponds with the UB04 configuration you want to delete.


The selected UB04 configuration record is deleted.

Payer Administration For each third-party payer you plan to bill for services, you must set up a record in the system. The Payers module is used to maintain all of the information that is necessary for you to successfully bill your third-party payers. The process of setting up payers involves the following steps.

Step 1Setting Up Payers. You must include detailed information about each payer, such as the payer name, the active date range, and a general ledger code. See Setting Up Payers.

Step 2Setting Up Payer Plans. For each payer that is set up, you must set up at least one payer plan. See Set Up Payer Plans.

Step 3Setting Up Fee Matrices. For each payer plan that is set up, you must set up a corresponding fee matrix. See Setting Up a Payer Plan’s Fee Matrix.

Setting Up Payers For each third-party payer you plan to bill for services, you must set up a record in the system. The Payers module is used to maintain all of the information that is necessary for you to successfully bill your third-party payers.

To access the Payers page: 1 Click Administration in the navigation bar.


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The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Payers.

The Payers page appears. The top half of the page lists all of the active payers. A payer is categorized as active if the current system date falls within the payer’s begin and end date. The bottom half of the page lists all of the inactive payers. A payer is categorized as inactive if the current system date meets or exceeds the payer’s end date.

This page is used to perform the following tasks: Adding Payers Configuring Payer Billing Information Updating Payers Printing the Clients in a Payer Plan Deleting Payers Set Up Payer Plans

Adding Payers Every third-party payer that you intend to bill must have a record set up in the system. This task includes instructions for adding payers.

Note: Once a payer is added to the system, you can use the Select button on the Payers page to update it (see page 71).

To add payers: 1 Access the Payers page (see Setting Up Payers). 2 Click the Add Payer button.

The Payer Entry page appears. All required fields are highlighted.

3 In the Name field, enter the complete name of the payer. This entry can be up to 30 characters.

4 In the Begin Date field, enter the first day the payer becomes active in the system. Once a payer is active, you can submit bills to the payer. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

Note: An end date cannot be set until a payer plan has been set up for the payer (see Add Payer Plans).


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5 Click Submit in the status bar. The payer record is saved and the system prompts you to add payer plans for the payer. If you select OK, the Payer Plan Entry page appears (see Add Payer Plans). If you select Cancel, the Payers page appears.

Configuring Payer Billing Information If your organization will be submitting electronic claims to the selected payer, you must use the Billing Config feature to set up your organization’s sender code and general ledger account.

To configure payer billing information: 1 Access the Payers page (see Setting Up Payers).

2 Click the Billing Config button. The Billing Configurations list page appears. This page lists all of the billing configuration records that have been set up for the selected payer.

3 Click Add Billing Config in the status bar. The Billing Configuration Entry page appears. Both fields on this page are required.

4 In the Organization field, use the drop-down list to select the organization associated with the sender code (entered in the next step).

5 In the Sender Code field, enter the ID number for your organization that was assigned by the payer. Each time your organization submits an electronic claim to the selected payer, this sender code will be included. This entry can be up to 15 characters.

6 In the Payer GL Account field, use the drop-down list to select the general ledger account you want to assign to the payer plan. When you assign a GL account, all of the related GL codes that were set up for revenue, receivables, and write offs are automatically assigned to the payer plan. The payer GL accounts are set up in the GL Code Admin module (see page 1 the General Ledger Guide).

7 Click Submit in the status bar. The billing configuration record for the selected payer is saved and listed on the Billing Configurations list page.

Updating Payers


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Once a payer is added to the system, you must use this task to update it.

To update payers: 1 Access the Payers page (see Setting Up Payers).

2 Click the Select button that corresponds to the payer you want to update. The Payer Entry page appears. You can edit any of the fields on this page. All required fields are highlighted. See Adding Payers for field descriptions.

3 After making the desired edits, click Submit in the status bar. The payer record is saved and listed on the Payers page.

Printing the Clients in a Payer Plan This task is used to print the clients associated with a particular payer plan to an Excel spreadsheet.

To print the clients in a payer plan: 1 Access the Payers page (see Setting Up Payers).

2 Click the Client Report button. The Payer Report to Excel page appears for the selected payer.

3 In the Payer Plan field, use the drop-down list to select the payer plan you want to print.

4 Click Submit in the status bar. The system generates an Excel spreadsheet that contains all of the clients associated with the selected payer plan. After the file is created, the File Download window appears.

5 Click the Open button to view the file from the server. Or, click the Download button to save the file to your local desktop.

The payer plan file opens as an Excel worksheet.

Deleting Payers You cannot delete payers that have payer plans associated with them. You can only delete payers that do not have payer plans associated with them.

To delete payers: 1 Access the Payers page (see Setting Up Payers).


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2 Click the Delete button that corresponds to the payer you want to delete. The Delete Payer page appears.

3 Select Yes to confirm you want to delete the selected payer. 4 Click Submit in the status bar.

The selected payer is deleted from the system.

Set Up Payer Plans For each third-party payer you set up (see Setting Up Payers), you must set up at least one payer plan. A payer plan is a particular plan that is provided by the payer.

Note: After setting up a payer plan, you must also set up a corresponding fee matrix for the payer plan (see Setting Up a Payer Plan’s Fee Matrix).

To access payer plans: 1 Access the Payers page (see Setting Up Payers). 2 Click the Payer Plans button for the payer you want to access.

The Payer Plans page appears for the selected payer. The top half of the page lists all of the active payer plans. A payer plan is categorized as active if the current system date falls within the payer plan’s begin and end date. The bottom half of the page lists all of the inactive payer plans. A payer plan is categorized as inactive if the current system date meets or exceeds the payer plan’s end date.

This page is used to perform the following task: Add Payer Plans Entering Payer Plan Addresses Setting Up a Payer Plan’s Fee Matrix Viewing the Clients Associated with Payer Plans Overriding the Point of Service for Payer Plans Overriding the Point of Service for Payer Plans Setting Up Insurance Codes for a Payer Plan Setting Up Procedures That Require Authorizations Configuring Payer Plan Billing Information Updating Payer Plans Deleting Payer Plans


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Add Payer Plans For each third-party payer you set up (see Setting Up Payers), you must set up at least one payer plan. A payer plan is a particular plan that is provided by the payer.

Note: Once a payer plan is added to the system, you can use the Select button on the Payer Plans page to update it (see page 85).

To add payer plans: 1 Access the Payer Plans page (see Set Up Payer Plans). 2 Click the Add Payer Plan button.

The Payer Plan Entry page appears. All required fields are highlighted. Note: The begin date for the payer plan must be equal to or later than the begin date for the payer. The

begin date for the payer plan cannot precede the begin date for the payer.

3 In the Begin Date field, enter the first date the payer plan becomes active in the system. Once a payer plan is active, you can bill for services and submit bills to the payer plan. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

4 If the payer plan is to be active for a defined date range only, enter the end date in the End Date field. This is the last date the payer plan can be billed for services. If the payer plan is to remain active indefinitely, leave this field blank.

Note: If claims have been created for this payer plan, the Payer field cannot be modified. If claims have not been created for this payer plan, a drop-down list appears in the Payer field which allows you to move the payer plan to a different payer.

5 In the Payer field, use the drop-down list to select another payer to move this plan to if no claims have been generated for the plan yet.

6 In the Fee Code field, enter the fee code you want to associate with the payer plan. The fee code, which can be up to 30 alphanumeric characters, is used to uniquely identify the payer plan.

7 In the Name field, enter the full name of the payer plan. A payer plan is a particular plan that is provided by the payer.

8 In the Print Name field, enter the payer plan name as you want it to appear on the bill. 9 In the Payer Type field, use the drop-down list to select the type of payer you want to

associate with the payer plan. The payer type is used to group payers together for reporting purposes.

10In the Is this a Medicare Secondary Payer field, indicate if the payer is a medicare secondary payer or not.

Note: Selecting Yes in this field displays an MSP Code field when adding a payer plan to the client record through the Point of Entry wizard or the client ECR.

11In the Is this a Medicaid Payer field, indicate if the payer is a medicaid payer or not. Note: This field may not display on your system. It is a configurable field that is activated based on


12In the Is this a Medicaid Capitated Payer field, indicate if the payer is a medicaid payer or not for Colorado reporting.

13In the Use Expected Amount for Billed field, indicate if the Billed Amount on the claim should change to the Expected Amount


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14In the Reimburses Facility Fees field, indicate if the payer repays billable facility fees or not.

15In the Institutional Code Set field, select the code set to report on Institutional claims that are generated by facility fees.

16In the Requires COB Code field, indicate if the payer requires a Coordination of Benefits code or not.

Note: This field may not display on your system. It is a configurable field that is activated based on organizational needs when Medicaid is billed as a secondary payer.

17In the Institutional Code Set field, use the drop-down list to select the code set to report on institutional claims generated by facility fees.

18In the CCAR BHO ID field, use the drop-down list to select the appropriate Behavioral Health Organization ID.

Note: The CCAR BHO ID field is used only by Colorado payer plans that submit claims to the State of Colorado using the Colorado Client Assessment Record.

19In the CCAR Enrollment Payer Type field, use the drop-down list to select the appropriate payer type for this payer plan.

Note: The CCAR Enrollment Payer Type field is used only by Colorado payer plans that submit claims to the State of Colorado using the Colorado Client Assessment Record.

20In the BHO ID field, enter the 3-digit identification code for the payer plan. This code is required when submitting CRG/TPG assessments to BHOs. When a staff member begins a new CRG/TPG assessment, the system automatically displays this BHO ID on the Identifying Information page (see page 131 the Clinical Record Guide).

Note: The BHO ID field is used only by Tennessee payer plans that submit claims to TennCare. If the payer plan you are adding does not submit claims to TennCare, ignore this field.

21If the payer uses a Proxymed Payer ID, enter the payer ID in this field. 22If used, enter a Medigap Insurer ID code. 23The CRS Funding Type field is used only by agencies in Philadelphia and is only

needed if the payer is reported to the Philadelphia Consumer Reporting System. Note: This field may not display on your system. It is a configurable field that is activated based on

organizational needs. It is used only for organizations in Philadelphia.

24Select a region. 25Enter the region code for the selected region.

Important: If you are setting up a HAP (Hoosier Assurance Plan) payer plan, you must set the Always Generate a Claim field to Yes. See State Reporting Configuration for information about HAP.


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26By default, the Always Generate a Claim field is set to No, which means the Claim Engine uses the standard ‘waterfall’ approach to generating claims (see page 68 the Clinical Record Guide). Under the ‘waterfall’ approach, the payer plan only receives a bill if it is the highest priority payer plan (as defined in the Client Payer module) that reimburses for the service. If you want this payer plan to override the waterfall billing process, change this setting to Yes. When you do this, the Claim Engine will always consider this payer plan a priority one payer when a service is provided, which means that a claim will be generated for every service that is reimbursed by the payer plan. When this option is set to Yes, it does not exclude other payer plans from being marked as priority one payers in the ECR (the Client Payer module). In a situation where the Claim Engine encounters multiple payer plans that are marked as priority one payers, each payer will have a claim generated and sent to Claim Approval.

27In the Book to G/L field, indicate if you want to post the services that are charged to the payer plan to a general ledger account code.

28In the Unkept Appt Charge field, indicate if the payer plan will be charged when a client does not keep an appointment.

29If the payer plan is charged for unkept appointments, enter the charge amount in the Amount to Charge Unkept Appointment field.

30In the Send Statement field, indicate if a statement must be sent to the payer plan each time a bill is processed.

31In the Needs Authorization field, indicate if the client must have authorization in order to use the payer plan. Authorizations are assigned to the client in the Client Record module (see page 64 the Clinical Record Guide). If you select Yes in this field and an authorization is not provided for a service, the Claim Engine process generates an error and the activity is moved into Failed Activities (see page 18 the Billing and Accounts Receivable Guide).

Note: If you set this field to Yes, then all services provided by your organization and billed to this payer plan will require an authorization. If the payer plan only requires specific procedure codes to be authorized, you can use the Procedure Auths feature to set them up (see Setting Up Procedures That Require Authorizations).

32Indicate if a primary claim failing for No Authorization should waterfall automatically to a secondary payer in the Waterfall for “No Authorization” field

Note: .This field may not display on your system. It is a configurable field that is activated based on organizational needs when primary claims should automatically waterfall to secondary payers instead of using the Bill Next functionality.

33If the payer plan requires an authorization, describe the type of authorization needed in the If Authorization is Needed, Please Explain field. Your entry can be up to 500 characters.

34In the Need Group Number field, indicate if the client must have a group number in order to use the payer plan. Group numbers are assigned to the client in the Client Record module (see page 43 the Clinical Record Guide). If you select Yes in this field and a group number is not provided for a service, the Claim Engine process generates an error and the activity is moved into Failed Activities (see page 18 the Billing and Accounts Receivable Guide).

35In the Need ID Number field, indicate if the client must have an ID number in order to use the payer plan. ID numbers are assigned to the client in the Client Record module (see page 58 the Clinical Record Guide). If you select Yes in this field and an ID number is not provided for a service, the Claim Engine process generates an error and the activity is moved into Failed Activities (see page 18 the Billing and Accounts Receivable Guide).

36In the Need PIN Number field, indicate if the client must have a PIN number in order to use the payer plan.


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37In the Default ID Number to SSN field, indicate if the payer plan accepts a client’s social security number as the ID number.

38If the payer requires claims be submitted within a certain amount of time, enter the amount in the Timely Filing Limit field, and use the drop-down list to select the appropriate timely filing length type.

39In the Is this Payer an EAP Payer field, indicate if the payer participates in EAP. 40In the V-Code Diagnosis Allowed field, indicate if the payer plan allows V-Codes on

claim as a primary Axis I diagnosis. 41In the Alert Insurance Verifier, indicate if an alert should be sent to verify the

insurance plan. 42In the Process Non-Primary Payments as Primary field, indicate if when payments

come back in the 835 that are flagged as secondary or tertiary, but there is no bill next function associated with the claim, CareLogic should re-match the payment to the original claim.

43Click Submit in the status bar. The payer plan is saved and listed on the Payer Plans page. Note: After setting up the payer plans, you must set up a corresponding fee matrix (see Setting Up a

Payer Plan’s Fee Matrix).

Entering Payer Plan Addresses This task is used to enter the payer plan’s address. If necessary, you can enter multiple addresses for a payer plan.

To enter a payer plan address: 1 Access the Payer Plans page (see Set Up Payer Plans).

2 Click the Address button that corresponds with the payer plan for which you want to track multiple addresses.

The Payer Plan Addresses page appears. 3 Click the Add Address button.

The Payer Address Entry page appears. All required fields are highlighted.


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4 In the Name field, enter the name of the payer plan. 5 In the Country field, use the drop-down list to select the country in which the payer

plan is located. Important: If you select the USA, or one of its territories, this page allows you to enter a domestic

address (Steps 6 through 9). If the payer plan is located outside the USA, you must enter an international address. Once you select a country other than the USA, the page is refreshed to display all of the address fields (Steps 6 through 9) as text entry fields. This means that when you enter an international address, you must manually enter the city, state/province, postal code, and county.

6 In the Street fields, enter the physical address of the payer plan. 7 If the payer plan’s address contains an apartment or suite number, enter it in the

Apt/Suite field. 8 For addresses located within the USA, or one of its territories, use one of the following

methods to enter the payer plan’s city, state/province, and postal code (zip code). To use the Postal Code Lookup feature, select the Do City/State lookup using Postal Code check box,

enter the payer plan’s postal code (and postal code extension, if known), and press Tab. The system performs a postal code lookup and automatically populates the City and State fields. The city that is preceded by an asterisk is the postal service’s preferred city for the postal code entered.


9 Before you can select the county in which the payer plan is located, you must select a state (by either method described in the previous step). The County field is automatically filtered to include only the counties that are located within the selected state. Use the drop-down list to select the appropriate county.

10In the Phone Number field, enter the payer plan’s 10-digit telephone number. If the payer plan has an international phone number, select the International Number check box (to modify the Phone Number field), and then enter the country code and international number. This entry can be up to 40 characters.


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11In the Fax Number field, enter the payer plan’s 10-digit fax number. If the payer plan has an international fax number, select the International Number check box (to modify the Fax Number field), and then enter the country code and international number. This entry can be up to 40 characters.

12Click Submit in the status bar. The address record is saved. To add additional address records for the selected payer plan, repeat Steps 3 through 10.

Viewing the Clients Associated with Payer Plans This task includes instructions for viewing the clients who are associated with a particular payer plan.

To view the clients associated with payer plans: 1 Access the Payer Plans page (see Set Up Payer Plans).

2 Click the Clients button that corresponds with the payer plan for which you want to view clients.

The following page appears. This The page lists all of the active and inactive clients who are associated with the selected payer plan.

3 After reviewing this page, click the Return to Payer List button. The Payer Plans page appears.

Overriding the Point of Service for Payer Plans The Override POS (Point of Service) feature allows organizations to override the scheduled point of service (service location) with the specific service location that is required by the selected payer plan. This functionality is helpful when billing payer plans that require a specific service location on the claim. For example, if the clients in a group activity are covered by different payer plans that require different service locations, you can use the Override POS feature to set up the appropriate service location overrides for each payer plan.

To override the point of service for payer plans: 1 Access the Payer Plans page (see Set Up Payer Plans).


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2 Click the Override POS button that corresponds with the payer plan for which you want to set up a point of service override.

The Payer Plan Override list page appears for the selected payer plan. 3 Click Add Payer Plan Override in the status bar.

The Override POS entry page appears. All required fields are highlighted.

4 In the Begin Date field, enter the first date this POS override record will be active in the system. This is the first date the Claim Engine will use this record to override the service location for the selected payer plan.

5 If you want to define an end date for this POS override record, enter the desired date in the End Date field. The end date is the date this record becomes inactive in the system.

6 In the Place of Service field, select the service location that will be overridden for this payer plan. This is the service location associated with the scheduled activity. In the text entry field, enter the full code or full/partial service location and press <Tab> to filter the drop-down list. Use the drop-down list to select the desired service location.

7 In the Override POS field, select the service location that will override the service location of the scheduled activity (selected in the previous step) for the selected payer plan. This is the service location that appears on the claims sent to the selected payer plan. In the text entry field, enter the full code or full/partial service location and press <Tab> to filter the drop-down list. Use the drop-down list to select the desired service location.

8 Click Submit in the status bar. The POS override record is saved and listed on the Payer Plan Override list page.

Setting Up Insurance Codes for a Payer Plan When filing electronic bills (837 files), some payers require you to include insurance codes. Insurance codes are service location codes that are used to determine the location and program that provided the service. The insurance codes are attached to the provider ID on the electronic bills.

To set up insurance codes for a payer plan: 1 Access the Payer Plans page (see Set Up Payer Plans).


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2 Click the Insurance Codes button that corresponds with the payer plan for which you want to add insurance codes.

The Insurance Codes list page appears for the selected payer plan. 3 Click the Add Code button.

The Insurance Code Entry page appears. All required fields are highlighted.

4 In the Insurance Code field, enter the insurance code you want to create. Your entry can be up to 10 characters.

5 In the Program field, use the drop-down list to select the program to which the specialized code applies.

6 The Organization field is used to select the organization to which the specialized code applies. This drop-down list includes only the organization you are currently logged into and all child organizations.

7 Click Submit in the status bar. The insurance code is saved and listed on the Insurance Codes list page.

Setting Up Procedures That Require Authorizations Note: The Procedure Auths column is displayed on the Payer Plans list page only if the Uses

Procedure/Authorization Lockdown configuration is enabled. If this configuration is disabled, the Procedure Auths column is not displayed. Contact the Technical Support department for assistance enabling this configuration.

By default, when a payer plan is flagged as requiring an authorization (see the Need Authorization field on the Payer Plan Entry page (see Add Payer Plans), all of the services provided by your organization and billed to the payer plan will require an authorization. In some cases, the payer plan only requires an authorization for certain procedure codes or after a certain number of units have been used for a procedure code. If your organization works with this payer plan requirement, you must use the Procedure Auth feature to define which procedures require an authorization.

To set up procedures that require authorizations: 1 Access the Payer Plans page (see Set Up Payer Plans).

2 Click the Procedure Auths button. Note: The Procedure Auths button is available only if the Need Authorization field is set to Yes on the

Payer Plan Entry page (see Add Payer Plans). If this field is set to No, the text ‘No Auth Needed’ appears in the Procedure Auths column.

The Procedure Codes Needing Authorizations list page appears for the selected payer plan.


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3 Click Add Procedure Authorization in the status bar. The Procedure Code Needing Authorization Entry page appears. All required fields are highlighted.

4 In the Begin Date field, enter the first date this record will be active in the system. This is the first date the Claim Engine requires an authorization for the services related to the combination of payer plan and procedure code.

5 If you want to define an end date for this procedure authorization record, enter the desired date in the End Date field. The end date is the date this record becomes inactive in the system.

6 In the Procedure Code field, use the search-and-select field to select the procedure code on which this authorization record will be based. In the text entry field, enter the full or partial procedure code or description, press Tab to filter the drop-down list, and then use the drop-down list to select the desired procedure code.

7 By default, the selected procedure code can be associated with up to four modifiers. If you want to allow the selected procedure code to be attached to any modifier, select the All Modifier Combinations check box. If you select this check box, the four Modifier fields are instantly removed from the page.

8 The Modifier fields allow you to select up to four modifiers to attach to the procedure code. Use the drop-down lists to select the desired modifiers. The drop-down lists in these fields are populated by the Modifiers module (see Setting Up Modifiers).

9 In the Number Units Authorized field, enter the maximum number of units that will trigger the authorization check. For example, if the payer plan requires an authorization after 10 sessions, enter 10 in this field. If the payer plan requires an authorization for all sessions, enter 0.

10If you want to add another procedure authorization requirement record, select the Add Another Record check box.

11Click Submit in the status bar. The record is saved and listed on the Procedure Codes Needing Authorizations list page. If you selected the Add Another Record check box, the record is saved but the Procedure Code Needing Authorization Entry page is refreshed.

Configuring Payer Plan Billing Information If your organization submits electronic claims to the selected payer plan, you must use the Billing Config feature to configure the billing information.


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To configure payer plan billing information: 1 Access the Payer Plans page (see Set Up Payer Plans).

2 Click the Billing Config button. The Billing Configurations list page appears. This page lists all of the billing configuration records for the selected payer plan.

3 Click Add Billing Config in the status bar. The Billing Configuration Entry page appears. All required fields are highlighted.

4 In the Organization field, use the drop-down list to select the organization that will be submitting claims to the selected payer plan.

5 If you want to associate the payer plan with a payer panel, use the drop-down list in the Panel field to select an option. If you select an option in this field, all of the staff members who provide services that will be billed to this payer plan must be set up in the payer panel. All of the panels that are available in this field are set up in Panel Administration (see 0Setting Up Payer Panels).

6 By default, this payer plan is set up to use the GL account that was assigned at the payer level (see Adding Payers). If you want to assign a different GL account to this payer plan, use the drop-down list in the Payer GL Account field to select an option. When you assign a GL account, all of the related GL codes that were set up for revenue, receivables, and write offs are automatically assigned to the payer plan. The payer GL accounts are set up in the GL Code Admin module (See page 1 the General Ledger Guide).

7 In the Interim Billing field, indicate is the payer plan allows interim billing.


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Note: This field only appears if your system is configured to use interim billing. Contact QSI Support for more information about this configuration.

8 If your organization sends and receives electronic eligibility batch files, use the 270/271 EDI Type field to select the desired EDI type that will be used for the 270 and 271 files. All of the options in this drop-down list are set up by Qualifacts.

Note: If your system is set up to use Real-Time Eligibility, select Emdeon Eligibility from the 270/271 EDI Type drop-down.

9 If your system is configured to use Real-Time Eligibility, you must search for the payer and use the drop-down list to select the payer to which any eligibility transactions should be submitted in the 270/271 Emdeon Payer field.

Note: What you select in this field drives which payer Emdeon submits the eligibility request to. You can search by payer name or payer ID to find the correct payer to which you want to submit eligibility transactions for the selected CareLogic payer plan.

10If your organization sends electronic claims for outpatient services to the selected payer plan, use the drop-down list in the Outpatient EDI Type field to select the desired file format.

11If your organization sends paper claims for outpatient services to the selected payer plan, use the drop-down list in the Outpatient Billing Type field to select the claim format. Some example claim formats are HCFA and UB04. If you used the HCFA Configuration module (see Configuring Dynamic HCFAs) to set up a dynamic HCFA that will be used by this payer plan, select it in the list. The options that appear in this drop-down list are set up in the Descriptors module by your system administrator. If you select the Dynamic HCFA option and you have set up a Dynamic HCFA Configuration in the system, a new Outpatient Dynamic Claim Configuration field will appear with all dynamic HCFA configurations you have set up in the drop-down list. You must select one of those HCFA configurations to use for billing the selected payer.

Note: By default, CareLogic supports the creation and batching of electronic and paper claims. If your organization needs to send a payer plan a custom invoice, CareLogic can be configured to accommodate this need. Contact a Technical Support Representative for assistance.

12Use the Outpatient Payer ID field when submitting EDI claims to a clearinghouse that utilizes different payer IDs for outpatient claims.

13If your organization sends electronic claims for inpatient services to the selected payer plan, use the drop-down list in the Inpatient EDI Type field to select the desired file format.

14If your organization sends paper claims for inpatient services to the selected payer plan, use the drop-down list in the Inpatient Billing Type field to select the claim format. Some example claim formats are HCFA and UB04. If you used the UB04 Configuration module (see Configuring UB04s) to set up a dynamic UB04 that will be used by this payer plan, select it in the list. The options that appear in this drop-down list are setup in the Descriptors module by your system administrator. If you select the Dynamic UB04 option and you have set up a Dynamic UB04 Configuration in the system, a new Inpatient Dynamic Claim Configuration field will appear with all dynamic UB04 configurations you have set up in the drop-down list. You must select one of those UB04 configurations to use for billing the selected payer.

15Use the Inpatient Payer ID field when submitting EDI claims to a clearinghouse that utilizes different payer IDs for inpatient claims.

16In the Payer ID field, enter the payer’s identification, as it should appear in an 837 file.

17In the Claim Office Number field, enter the claim office number that is used to further identify the payer in an 837 file.


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18In the Claim Filing Indicator field, use the drop-down list to select the claim type code used for this payer.

19Click Submit in the status bar. The billing configuration record for the selected payer plan is saved and listed on the Billing Configurations list page.

Updating Payer Plans Once a payer plan is added to the system, you can edit any of the information associated with the payer plan record.

Note: When you select a payer plan record, the payer plan’s contact information appears in view-only mode. If you want to update the contact information, you must use the Addresses button.

To update payer plans: 1 Access the Payer Plans page (see Set Up Payer Plans).

2 Click the Select button that corresponds with the payer plan you want to update. The Payer Plan Entry page appears. You can edit any of the fields on this page. All required fields are highlighted. See Add Payer Plans for field descriptions.

3 After making the desired edits, click Submit in the status bar. The payer plan record is saved and listed on the Payer Plans page.

Deleting Payer Plans You cannot delete payer plans that have clients associated with them. You can only delete payer plans that do not have clients associated with them.

To delete payer plans: 1 Access the Payer Plans page (see Set Up Payer Plans).

2 Click the Delete button that corresponds with the payer plan you want to delete. The Delete Payer Plan page appears.

3 Select Yes to confirm you want to delete the selected payer plan. 4 Click Submit in the status bar.

The selected payer plan is deleted from the system.

Setting Up a Payer Plan’s Fee Matrix


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For each payer plan (see Add Payer Plans), you must set up a corresponding fee matrix. The fee matrix defines the contracted rates the payer plan will pay for each procedure code, based on the credential of the staff member who provides the service. The contracted rate appears on claims as the Expected amount. The contracted rate must be less than or equal to the standard fee (see Adding Procedure Codes) that is defined for the procedure code.

To access a payer plan’s fee matrix: 1 Access the Payer Plans page (see Set Up Payer Plans).

2 Click the Fees button that corresponds with the payer plan for which you want to add a fee matrix.

The Fee Matrix page appears.

This page is used to perform the following tasks: Defining the Date Range for a Payer Plan Fee Matrix Defining a Payer Plan Fee Matrix Creating a New Payer Plan Fee Matrix from an Existing Record Copying a Fee Matrix from One Payer Plan to Another Updating the Date Range for a Payer Plan Fee Matrix Updating a Payer Plan Fee Matrix Deleting a Payer Plan Fee Matrix

Defining the Date Range for a Payer Plan Fee Matrix Prior to defining a fee matrix, you must define the date range and number of client visits allowed by the payer plan. Once you complete this task, you can define the fee matrix (see Defining a Payer Plan Fee Matrix).

Note: Once a fee matrix date range is defined, you can use the Select button on the Fee Matrix page to update it (see page 93).

To define the date range for a payer plan fee matrix: 1 Access the Fee Matrix page (see Setting Up a Payer Plan’s Fee Matrix).

2 Click the Add Fee Matrix button.


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The Payer Plan Date Range Entry page appears. All required fields are highlighted.


3 In the Begin Date field, enter the first date the fee matrix becomes active in the system. This is the first date that the fee matrix will be used to calculate fees for the selected payer plan.

4 If you want to enter an end date for the fee matrix record, enter the desired date in the End Date field. This is the last date that the fee matrix will be used to calculate fees for the selected payer plan.



7 In the Begin Visit field, enter the beginning number of client visits allowed by the payer plan.

8 In the End Visit field, enter the ending number of client visits allowed by the payer plan.

9 The Organization field is used to select the organization this fee matrix record applies to. This drop-down list includes only the organization you are currently logged into and all child organizations.


11If this fee matrix record is specific to particular service locations, enter the partial or full name of the service location, and hit the Tab key. Use the drop-down list in the Service Location list to select the desired service location, and click the Add link to associate this fee matrix record with the selected service locations. Repeat as needed to add multiple service locations to the Service Location list.

12If this fee matrix is specific to a particular staff member, search for the staff, and use the drop-down list in the Staff field to select a staff member. If this record will apply to all staff, do not select an option in this field.


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Note: The Staff field only appears if your organization has been configured to assign a fee matrix to a specific staff member.

13Click Submit in the status bar. The payer plan date range record is saved and listed on the Fee Matrix page.

Defining a Payer Plan Fee Matrix After defining the date range for the fee matrix (see Defining the Date Range for a Payer Plan Fee Matrix), you must define a fee matrix. The payer plan’s fee matrix is the contracted rate that has been negotiated for the payer plan. The amount entered in the payer plan’s fee matrix appears on claims as the Expected amount. The Billed amount that appears on claims is standard fee that is set up for the procedure code (see Adding Procedure Codes).

To define a fee matrix: 1 Access the Fee Matrix page (see Setting Up a Payer Plan’s Fee Matrix).

2 Click the Fee Matrix button that corresponds with the record you want to define a fee matrix for.

The Fee Matrix list page appears for the selected payer plan. For each procedure code/modifier combination you select, this page allows you to define a fee for each licensure that is set up in the system (see Setting Up Billing Categories).

3 Click Add New Fees in the status bar. The Fee Matrix page changes to add mode. Important: In order to increase the likelihood of receiving payments from the payer plan, you

must define a fee for every licensure in your organization. If a fee is not defined for a licensure, and staff members with that licensure treats a client for the selected procedure, the payer plan will not pay for the service.


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4 In the Procedure column, enter the full or partial procedure code number in the text field and press Tab to filter the drop-down list. Use the drop-down list to select the desired procedure code.

5 The Modifier column is used to associate the procedure code with up to four modifiers. This allows your organization to enter fees based on licensure and procedure code/modifiers combinations. Use the drop-down list to select the desired modifiers.

6 For each licensure, enter the contracted rate that has been negotiated with the payer plan. When staff members with this licensure provides services to clients related to this procedure/modifier combination, the payer plan will be billed the amount you enter. In the previous example, the payer plan will pay $65 when the procedure code 90801 is provided by an MD and $55 when it is provided by a RN.

7 If the payer plan will not pay for the selected procedure/modifier combination when it is provided by staff members with a particular licensure, click the Not Paid check box. In the previous example, the payer plan will not pay for the procedure code 90801 when it provided by a LCSW.

8 Repeat Steps 4 through 7 to enter additional records in the payer plan’s fee matrix. 9 Click Submit in the status bar.

The fee matrix is saved and listed on the Fee Matrix list page.

Creating a New Payer Plan Fee Matrix from an Existing Record


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This task is used to create a new fee matrix record by copying an existing record. When you use the Copy feature, the entire record is copied, except for the date range. Once the new record is created, the copied record is automatically end dated. The end date for the copied fee matrix record is set to one day before the begin date of the new fee matrix record. For example, if the begin date for the new record is 3/10/2009, then the end date for the copied record is set to 3/9/2009. When you copy a fee matrix record, the new fee matrix contains the same fee matrix details as the copied fee matrix record.

To create a payer plan fee matrix from an existing record: 1 Access the Fee Matrix page (see Setting Up a Payer Plan’s Fee Matrix).

2 Click the Copy button that corresponds with the fee matrix you want to copy. The Copy Fee Matrix page appears. The top half of the page lists the date range and the number of visits defined for the fee matrix record you are copying.

3 The New Begin Date field is used to define the begin date for the new fee matrix record you are creating. By default, the current system date is entered. If desired, you can either manually enter a different date or click the Calendar icon to select a date from the popup window. Your entry must be in the following format: mm/dd/yyyy.

4 In the New End Date field, enter the end date for the new fee matrix record. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 Click Submit in the status bar. The new fee matrix record is created and listed on the Fee Matrix page. The end date for the copied fee matrix record is set to one day before the begin date of the new fee matrix record.

Copying a Fee Matrix from One Payer Plan to Another This task is used to create a new fee matrix record by copying the fees that are set up for an existing payer plan. When you use the Copy Fee Matrix feature, only the fees associated with the selected plan are copied. Once the new record is created, you must define the date range and you have the ability to associate the fee matrix with an age range, visit range, location, and program.

To copy a fee matrix from one payer plan to another: 1 Access the Fee Matrix page (see Setting Up a Payer Plan’s Fee Matrix).


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2 Click Copy Fee Matrix in the status bar. The Copy Default or Existing Plan Fees page appears.

3 In the Select Existing Plan field, use the drop-down list to select the payer plan you want to copy.


4 In the New Begin Date field, enter the first date the fee matrix becomes active in the system. This is the first date that the fee matrix will be used to calculate fees for the selected payer plan.

5 If you want to enter an end date for the fee matrix record, enter the desired date in the New End Date field. This is the last date that the fee matrix will be used to calculate fees for the selected payer plan.



8 In the Begin Visit field, enter the beginning number of client visits allowed by the payer plan.

9 In the End Visit field, enter the ending number of client visits allowed by the payer plan.

10The Organization field is used to select the organization this fee matrix record applies to. This drop-down list includes only the organization you are currently logged into and all child organizations.



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12If this fee matrix record is specific to particular service locations, enter the partial or full name of the service location, and hit the Tab key. Use the drop-down list in the Service Location list to select the desired service location, and click the Add link to associate this fee matrix record with the selected service locations. Repeat as needed to add multiple service locations to the Service Location list.

13If this fee matrix is specific to a particular staff member, search for the staff, and use the drop-down list in the Staff field to select a staff member. If this record will apply to all staff, do not select an option in this field.

Note: The Staff field only appears if your organization has been configured to assign a fee matrix to a specific staff member.

14Click Submit in the status bar. The new fee matrix record is saved and listed on the Fee Matrix list page for the selected payer plan.

Updating the Date Range for a Payer Plan Fee Matrix This task includes instructions for editing the date range and number of client visits authorized by a payer plan.

To update the date range for a payer plan fee matrix: 1 Access the Fee Matrix page (see Setting Up a Payer Plan’s Fee Matrix).

2 Select the Select button that corresponds with the record you want to update. The Payer Plan Date Range appears. You can edit any of the fields on this page. All required fields are highlighted. See Defining the Date Range for a Payer Plan Fee Matrix for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated record is saved and listed on the Fee Matrix page.

Updating a Payer Plan Fee Matrix This task includes instructions for updating a payer plan fee matrix. In addition to updating individual fee matrix record, this task also includes instructions for performing a mass update on all of the fee matrices that are set up for the selected payer plan.

To update a payer plan fee matrix: 1 Access the Fee Matrix page (see Setting Up a Payer Plan’s Fee Matrix).

2 Click the Fee Matrix button that corresponds with the record you want to update. The Fee Matrix page appears for the selected payer plan.


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3 To update an individual fee matrix record, click the corresponding Select button. The Fee Entry page appears for the selected procedure code. You can modify any of the fees associated with the procedure code. See Defining a Payer Plan Fee Matrix for information about assigning a fee to a procedure code/licensure combination.

4 To update multiple fee matrix records at once, click Mass Update in the status bar. The Fee Matrix page appears in mass update mode. This page lists all of the procedure codes, and their corresponding fee matrices, that are set up in the system. You can modify the fee matrix records as desired. See Defining a Payer Plan Fee Matrix for information about assigning a fee to a procedure code/licensure combination.

5 After making the desired edits, click Submit in the status bar. The fee matrix records are saved and listed on the Fee Matrix page.

Deleting a Payer Plan Fee Matrix This task includes instructions for deleting a payer plan’s fee matrix.

To delete a payer plan fee matrix: 1 Access the Fee Matrix page (see Setting Up a Payer Plan’s Fee Matrix).

2 Click the Delete button that corresponds with the fee matrix you want to delete. The Delete Fee Matrix page appears for the selected payer plan.

3 Select Yes to confirm you want to delete the selected record. 4 Click Submit in the status bar.

The selected record is deleted.

Auditing Payers


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The Payer Audit module is used to verify your payer-related data is set up correctly. After selecting a payer plan, this module allows you to view the associated payer panels (as well as the individual panel members), the procedure codes set up in the fee matrix, and the activity codes that are mapped to the procedure codes.

By clicking the various hyperlinks within the Payer Audit module, you can update the data setup for the payer plans. Hyperlinks are available for payer panels, procedure codes, and activity codes.

To audit payers: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Payer Audit.

The Payer Audit search page appears. This page is used to enter the search criteria that will be used to access a payer plan. All required fields are highlighted.

3 In the Organization field, use the drop-down list to select the organization where the payer plan you want to access is setup. This drop-down list contains the organization you are currently logged into and all of its child organizations.

4 In the Payer Name field, use the second drop-down list to select the payer plan you want to audit. If desired, you can select a payer in the first drop-down list to filter the payer plans in the second list.

5 By default, the Report as of Date field is set to the current system date, which means the search will only consider the payer plans that are active in the system as of this date. If desired, you can change the search criteria by changing the date in this field.

Note: When you select a payer plan in the Payer Name field, the active date range for the payer plan is displayed (in read-only mode) in the Begin Date and End Date fields. If the selected payer plan is currently active, the End Date field will be blank.

6 Click Submit in the status bar. The Payer Audit Screen appears for the selected payer plan. By default, the payer panel members associated with the selected payer plan are displayed. If you want to modify any of the payer panel information, you can click the following hyperlinks. Panel Members Hyperlink. This hyperlink is located above the panel members list page. When you

click the Panel Members hyperlink, the Panel Member list page appears for the selected payer plan (see 0Setting Up Payer Panels). After making the desired edits, click the Panel Members link in the left pane to return to the Payer Audit Screen.

Staff Member Hyperlinks. Each staff member name in the panel member list page is a hyperlink. When you click these hyperlinks, the Panel Member Entry page appears for the selected staff member (see Assign Staff Members to Payer Panels). If desired, you can modify these records. After making the desired edits, click the Panel Members link in the left pane to return to the Payer Audit Screen.

Note: To view information about the procedures set up in the payer plan’s fee matrix, continue with Step 7.


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7 In the left pane, click the procedure code you want to audit. All of the procedure codes that are set up in the selected payer plan’s fee matrix are listed in the left pane. The procedures in black text are mapped to an activity. The procedures in red text are not mapped to an activity.

The following lists page appear in the right pane. Fee Matrix Date Range. This list contains the date range/number of visits record associated with the

fee matrix. To modify this record, click the value in the Begin Visit column to access the Payer Plan Date Range Entry page (see Defining the Date Range for a Payer Plan Fee Matrix). After making the desired edits, click the procedure code link in the left pane to return to the Payer Audit Screen.

Fee Matrix Record. This list contains the contracted rates setup for the selected procedure code. To modify this record, click the procedure code value in the Procedure column to access the Fee Entry page for the selected procedure code (see Defining a Payer Plan Fee Matrix). After making the desired edits, click the procedure code link in the left pane to return to the Payer Audit Screen.

Activity Mappings. This list contains all of the activity mappings that are setup for the selected procedure. To modify these records, click an activity name in the Activity Code column to access the activity/procedure matrix record (see Setting Up Activity/Procedure Mappings). After making the desired edits, click the procedure code link in the left pane to return to the Payer Audit Screen.

Note: If you want to generate an audit report for the selected payer plan, continue with Step 8.


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8 Within the Payer Audit module, click the Report button in the status bar to generate a Payer Audit Report for the selected payer plan.

A new browser window opens, displaying the Payer Audit Report for the selected payer plan. This report contains all of the information that is visible through the Payer Audit module.

Checking Client Eligibility in Batch Mode In addition to checking client eligibility in real-time (see the Point of Entry Guide), CareLogic enables your organization to electronically verify client insurance coverage in batch mode. This process involves creating a 270 eligibility request batch file, sending it to either a clearing house or payer, and then uploading a 271 eligibility response file. The electronic client eligibility verification process helps your organization reduce the number of claims that fail due to no verifiable coverage or expired coverage.

The following diagram shows the batch eligibility process flow. An outline describing the process follows the diagram.


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1 QSI Sets Up 270/271 EDI Types. If your organization wants to send and receive electronic eligibility batch files, Qualifacts will set up the necessary EDI types during the Implementation phase.

2 Set 270/271 EDI Type for Payer Plans. For each payer plan you want to verify client eligibility, you must select the appropriate EDI type in the payer plan’s billing configuration (see Configuring Payer Plan Billing Information).

3 Create Eligibility Batch File. The Eligibility Batch module is used to create 270 eligibility batch files (see Creating Eligibility Batch Files). This process involves defining the parameters that are used to create the batch file.

4 Review Eligibility Batch File. Once the 270 batch file is created, you can review the clients included in the file (see Reviewing Batch File Details). If the batch file was not created as you intended, you can back it out. After the file is backed out, you must recreate it by defining new batching parameters (see Backing Out Eligibility Batch Files).


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5 Download/Submit Eligibility Batch File. When you are satisfied with the batch file contents, it must be download to your organization’s network (see Downloading Eligibility Batch Files). When downloading the batch file, the system creates the file in the 270 standard format.

6 Send Batch File to Clearing House/Payer. At this point, the 270 batch file must be electronically sent to either a clearing house or payer for eligibility verification.

7 Receive Eligibility Response File. After the clearing house or payer processes the file, they will return a 271 eligibility response file to your organization. Take note of where this file is stored on your organization’s network.

8 Upload Eligibility Response File. The EDI Upload module is used navigate to the network location of the 271 file and upload it into the system (see page 100 the Billing and Accounts Receivable Guide).

9 Review Client Eligibility Status. Once the 271 eligibility response file is uploaded, you can review the eligibility responses through two different modules.

To review the eligibility statuses and reject reasons for all clients in the file, use the Administration>Eligibility Response module (see Reviewing 271 Eligibility Response Files).

To review the eligibility status of an individual client, use the ECR>Eligibility Status module (see page 97 the Clinical Record Guide).

Maintaining 270 Eligibility Batch Files The Eligibility Batch module is used to create 270 eligibility request batch files. When creating an eligibility batch file, you must define the parameters (EDI type, date range, organization, etc.) that the system uses to create the file. Once the file is created, you can review it. If the batch file was created as you intended, it can be downloaded and then submitted to a clearing house or payer. If the batch file was not created as you intended, it can be backed out and then a new batch file can be created by defining different batch parameters.

To access the Eligibility Batch module: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Eligibility Batch.

The Eligibility Batch page appears. By default, the Eligibility Batch List displays all of the batch files that have been created. For each batch file, this section lists the system-generated batch ID number, the number of clients in the batch file, the date the batch file was created, the staff member who created the batch file, and the organization where the batch file was created. If you want to filter the batch file list, you must enter the desired search criteria in the Eligibility Batch Search section.


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This page is used to perform the following tasks: Creating Eligibility Batch Files Searching for Existing Eligibility Batch Files Reviewing Batch File Details Backing Out Eligibility Batch Files Regenerating Eligibility Batch Files Downloading Eligibility Batch Files Submitting Eligibility Batch Files

Creating Eligibility Batch Files This task includes instructions for creating 270 eligibility request batch files. This process involves defining the parameters the system will use to create the file. When creating an eligibility batch file, the system only considers the clients who are assigned to payer plans that have a 270/271 EDI type selected in the payer plan Billing Configuration module (see Configuring Payer Plan Billing Information).

To create eligibility batch files: 1 Access the Eligibility Batch page (see Maintaining 270 Eligibility Batch Files). 2 Click Create Batch in the status bar.

The Create Batch page appears. All required fields are highlighted.

3 The Eligibility EDI Type field contains all of the 270 EDI types that have been set up by Qualifacts. Use the drop-down list to select the EDI type that will be used for this eligibility request record. The batching process only considers the clients who are assigned to payer plans with the selected EDI type.

4 By default, the batching process only considers the clients who are scheduled to receive services during the current month. If you want to check the eligibility of clients who are scheduled to receive services during a different date range, enter the desired dates in the Scheduled Date Range field.

5 By default, the system indicates that eligibility should be checked only for the submitted date, but you want to check eligibility for a date range, select Yes in the Check Eligibility across date range field.

Note: If you select Yes in this field, an Eligibility Date Range field appears dynamically.

6 If you indicated in the Check Eligibility across date range field that you wanted to check eligibility for a date range, you must enter a date range for which to check a client’s eligibility.

Note: This field defaults to span the entire current month when checking eligibility, but it can be modified.


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7 By default, the batching process only considers the clients who are scheduled to receive services at the current organization and its child organizations. If you want to check the eligibility of clients who are scheduled at a different organization, use the drop-down list in the Organization field to select the desired organization.

8 By default, the batching process only considers the clients who have not had their eligibility checked within the past 30 days. This means the clients who had their eligibility checked within the past 30 days will be automatically excluded from the batch. If you want to change this time frame, enter the desired value in the Number of Days Since Last Client Check field.

9 By default, the batching process considers all of the clients who match the other batching criteria. If you want to limit the batching process to a single client, use the Client field to select the desired client. To select an individual client, enter the full or partial client name in the text entry field, press Tab, and then use the drop-down list to select the desired client.

10Click Submit in the status bar. The eligibility batch file is created and listed on the Eligibility Batch list page.

Searching for Existing Eligibility Batch Files By default, the Eligibility Batch List displays all of the 270 batch files that have been created. This task includes instructions for filtering the Eligibility Batch List by entering user-defined search criteria.

To access existing eligibility batch files: 1 Access the Eligibility Batch page (see Maintaining 270 Eligibility Batch Files).

2 If you want to access the batch files associated with a particular 270 EDI type, use the drop-down list in the Eligibility EDI Type field to select the desired option.

3 If you want to access the batch files created within a particular date range, enter the beginning and ending dates in the Created Date field.

4 If you want to access the batch files within a particular batch number range, enter the beginning and ending numbers in the Batch Numbers field.

5 If you want to access the batch files created at a particular organization, use the drop-down list in the Organization field to select the desired organization.

6 Click Submit in the status bar. The page is refreshed and the batch files that match your search criteria are displayed in the Eligibility Batch List.

Reviewing Batch File Details


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This task includes instructions for viewing the details of a 270 eligibility batch file.

To review batch file details: 1 Access the Eligibility Batch page (see Maintaining 270 Eligibility Batch Files). 2 Locate the batch file you want to review and click the Client List button.

The Eligibility Detail List appears, which displays all of the clients in the 270 batch file. For each client, this page lists the date the selected batch file was created, the client’s payer plan, and the date the client’s eligibility was last checked or the date range of eligibility last checked.

Backing Out Eligibility Batch Files While reviewing the batch file details (see page 118), you may decide that the batch file was not created as you intended. In this scenario, you must use this task to backout the batch file. Once the file is backed out, you must create a new one by defining different parameters (see Creating Eligibility Batch Files).

To backout eligibility batch files: 1 Access the Eligibility Batch page (see Maintaining 270 Eligibility Batch Files).

2 Locate the batch file you want to backout and click the Backout button. The Backout Eligibility Batch page appears.

3 Select Yes to confirm you want to backout the selected batch file. 4 Click Submit in the status bar.


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The selected batch is removed from the system and no longer displayed in the Eligibility Batch List.

Regenerating Eligibility Batch Files When the system regenerates an eligibility batch file, it gathers any new subscriber data that did not exist at the time the original batch file was created. For example, suppose you notice that a client’s provider ID is missing at the time the batch file is created. In this scenario, you could add the provider ID and then regenerate the batch file to include the client’s provider ID. By using the Regenerate feature, you can refresh the batch file data without having to backout the file and then recreate it by defining the batch parameters again.

To regenerate eligibility batch files: 1 Access the Eligibility Batch page (see Maintaining 270 Eligibility Batch Files).

2 Locate the batch file you want to regenerate and click the Regenerate button. The page is refreshed and the selected batch file is regenerated.

Downloading Eligibility Batch Files This task includes instructions for downloading eligibility batch files. When downloading a batch file, the system displays the file in the 270 standard format. After the file is downloaded, it can be sent to a clearing house or payer for eligibility verification.

To download eligibility batch files: 1 Access the Eligibility Batch page (see Maintaining 270 Eligibility Batch Files).


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2 Locate the batch file you want to download and click the Download button. The system displays the 270 file, containing all of the client eligibility requests. This file will open in a text editor.

3 Within the text editor, save the file to your organization’s network. Note: At this point, the 270 file can be sent to either a clearing house or payer.

Submitting Eligibility Batch Files After the 270 eligibility batch file has been sent to either a clearing house or payer, it is recommended that you change the status of the file in the system. This task is optional and serves as a visual indication that the batch file has been submitted.

Note: If you follow the steps in this task to submit the batch file, the system automatically locks the file, which means it can no longer be backed out.

To submit eligibility batch files: 1 Access the Eligibility Batch page (see Maintaining 270 Eligibility Batch Files).

2 Locate the eligibility batch file that has been sent and click the Submit Batch button. The Mark Eligibility Batch as Submitted page appears.

3 Select Yes to confirm the selected batch file has been sent to either a clearing house or payer plan.

4 Click Submit in the status bar. The Eligibility Batch List appears and the Submit Batch button is updated with the text ‘Submitted’.

Reviewing 271 Eligibility Response Files Once the clearing house or payer receives a 270 eligibility request batch file, they will process it and then return a 271 eligibility response file to your organization. After your organization uploads the 271 file (see page 100 the Billing and Accounts Receivable Guide), you must use the Eligibility Response module to review the client eligibility statuses and reject reasons in the file.

Note: You can also use the ECR>Eligibility Status module to check the eligibility status of individual clients (see page 97 the Clinical Record Guide).

To access the Eligibility Response module: 1 Click Administration in the navigation bar.


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The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Eligibility Response.

The Eligibility Response page appears. By default, the Eligibility Response list displays all of the 271 files that have been uploaded. For each response file, this section lists the name of the 271 file, the date it was uploaded into the system, the date it was created, and the payer who provided the eligibility response. If you want to filter the 271 files in this list, you must enter the desired search criteria in the Eligibility Response Search section.

This page is used to perform the following tasks: Searching for Existing Response Files Reviewing a Response File’s Subscriber List Reviewing a Response File’s Reject Reasons Backing Out Response Files

Searching for Existing Response Files By default, the Eligibility Response list displays all of the 271 files that have been uploaded into the system. This task includes instructions for filtering this list by entering search parameters.

To search for existing response files: 1 Access the Eligibility Response page (see Reviewing 271 Eligibility Response Files).

2 If you only want to display the 271 files that were uploaded into the system during a particular date range, enter the beginning and ending dates in the Loaded Date Range field.

3 If you only want to display the 271 files that fall within a particular client eligibility date range, enter the beginning and ending dates in the Eligibility Date Range field.


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4 Click Submit in the status bar. The page is refreshed and the 271 files that match your search criteria are displayed in the Eligibility Response list.

Reviewing a Response File’s Subscriber List This task includes instructions for reviewing the eligibility status of the clients in a 271 response file. In addition to reviewing the eligibility statuses for all the clients in the file, you can also use the ECR>Eligibility Status module to review the eligibility status of individual clients (see page 97 the Clinical Record Guide).

To review a response file’s subscriber list: 1 Access the Eligibility Response page (see page 149). 2 Locate the response file you want to review and click the Subscriber List button.

Note: If the 271 file contains all rejections because there was not enough information provided in the 270 file to check eligibility, then the Subscriber List button is replaced with the text, ‘No Subscribers’.

The Subscriber List page appears. By default, the Eligibility section lists all of the clients whose eligibility was verified. For each client, this section lists the client’s name, the eligibility status, the category of service that describes the eligibility, the level of coverage, the insurance type, the entity applicable to the information source, the insurance coverage begin and end dates, and any client-specific messages included in the response file. If you want to filter the clients in this list, you must enter search criteria in the Eligibility Search section.

3 To view detailed information about a particular client, click the Eligibility Detail button for the desired client.

The Eligibility Detail page appears. Note: The client information that appears on this page is pulled directly from the 271 response file. This

means the amount of information that appears on this page is determined by the clearing house or payer who created the 271 file. The following screen capture provides an example of the type of information that may be displayed on the Eligibility Detail page.


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Reviewing a Response File’s Reject Reasons This task includes instructions for reviewing the reject reasons in the 271 file.

To review a response file’s reject reasons: 1 Access the Eligibility Response page (see Reviewing 271 Eligibility Response Files). 2 Locate the response file you want to review the reject reasons for and click the Reject

Reasons button. Note: If the response file does not contain any rejections, then the Reject Reasons button will be

replaced with the text, ‘No Rejections’.

The Reject Reasons page appears. This page lists all of the reject reasons included in the selected file. This page lists the client whose eligibility status check was rejected, whether the eligibility request was valid, the reject reason, and the recommended follow-up action. Note: If ‘N/A’ is displayed in the Client Name column, it means that necessary provider information was

missing in the 270 request file.

Backing Out Response Files This task includes instructions for backing out a 271 response file. This process may be necessary if your organization decides to rerun the entire eligibility process again. In this scenario, you could backout the current 271 file, create a new 270 request batch file, submit it to a clearing house or payer, and then upload the new 271 response file once it is received.

To backout response files: 1 Access the Eligibility Response page (see Reviewing 271 Eligibility Response Files).


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2 Locate the response file you want to back out and click the Backout button. The Backout Eligibility Batch page appears.

3 Select Yes to confirm you want to backout the selected 271 file. 4 Click Submit in the status bar.

The selected 271 response file is backed out and removed from the Eligibility Response page.

Check a Client’s Payer Eligibility in Real Time This task is used to verify a client’s eligibility with the primary payer in real time.

Real-time Eligibility Configuration Important: Emdeon charges a per transaction fee for the eligibility functionality. Agencies must sign a

contractual agreement in order to have Qualifacts enable this functionality.

Note: The Check Eligibility button can be displayed on any or all of POE, Front Desk and Claim information by configuration. Clicking the Check Eligibility button in any location will submit an Emdeon eligibility request. Contact Qualifacts for assistance in enabling the desired button display(s).

The Real-time Eligibility Verification configuration must be enabled to use. Contact Qualifacts for assistance.

You must be submitting and receiving 270/271 files or using Emdeon to gather real-time information.

Setting Up Referral Sources The Referral Sources module is used to maintain a list of the referral sources your organization uses. This list includes the sources that have referred clients to your organization and the sources that your organization has referred clients to. When a staff member admits a client through the Point of Entry module, the options you set up here are used to populate the Referral Source drop-down list.

To access referral sources: 1 Click Administration in the navigation bar.



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2 Click the Show Menu arrow in the shortcut bar and select Referral Sources. The Search Source Search page appears. This page is used to access referral sources by entering search criteria. The more search criteria entered, the more accurate the search results will be. If you want to access all referral source records, click Submit in the status bar without entering any search criteria.

3 In the Name field, enter the full or partial name of the referral source you want to access.

4 In the Referral Source Type field, use the drop-down list to select the type of referral source record you want to access. The options available in this field are set up by your system administrator.

5 In the Type field, enter the full or partial type of referral source record you want to access.

6 Click Submit in the status bar. The page is refreshed and the search results are listed in the Search List for Referral Sources list.

This page is used to perform the following tasks: Adding Referral Sources Updating Referral Sources Adding Staff Visits to Referral Sources Adding Notes about Referral Visits Deleting Referral Sources

Adding Referral Sources This task includes instructions for adding a referral source record for the sources that refer clients to your organization and the sources that your organization refers clients to. When a staff member admits a client through the Point of Entry module, the options you set up here are used to populate the Referral Source drop-down list.

Note: Once a referral source is added to the system, you can use the Select button on the Search List for Referral Sources page to update it (see page 124).


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To add referral sources: 1 Access the Search List for Referral Sources page (see Setting Up Referral Sources).

2 Click the Add Referral Source button in the status bar. The Referral Source Information page appears. This page is used to create a record for the contact organization. All required fields are highlighted.

3 In the Begin Date field, enter the date the referral source becomes active. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

4 If the referral source is to be active for a defined date range only, enter the end date in the End Date field. This is the last date the referral source can be used in the system. If the referral source is to remain active indefinitely, leave this field blank.

5 In the Name field, enter the complete name of the referral source. This entry can be up to 100 characters.


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6 In the Referral Source Type field, use the drop-down list to select the type of referral source you are creating. The options in this field are set up by your system administrator.

7 The Type field is used to enter information about the type of referral source you are adding. Your entry can be up to 50 characters.

8 In the Country field, use the drop-down list to select the country in which the referral source is located.

Important: If you select the USA, or one of its territories, this page allows you to enter a domestic address (Steps 9 through 12). If the referral source is located outside the USA, you must enter an international address. Once you select a country other than the USA, the page is refreshed to display all of the address fields (Steps 9 through 12) as text entry fields. This means that when you enter an international address, you must manually enter the city, state/province, postal code, and county.

9 In the Street fields, enter the physical address of the referral source. 10If the referral source’s address contains an apartment or suite number, enter it in the

Apt/Suite field. 11For addresses located within the USA, or one of its territories, use one of the

following methods to enter the referral source’s city, state/province, and postal code (zip code). To use the Postal Code Lookup feature, select the Do City/State lookup using Postal Code check box,

enter the referral source’s postal code (and postal code extension, if known), and press Tab. The system performs a postal code lookup and automatically populates the City and State fields. The city that is preceded by an asterisk is the postal service’s preferred city for the postal code entered.


12Before you can select the county in which the referral source is located, you must select a state (by either method described in the previous step). The County field is automatically filtered to include only the counties that are located within the selected state. Use the drop-down list to select the appropriate county.

13In the Phone Number field, enter the referral source’s 10-digit telephone number. If the referral source has an international phone number, select the International Number check box (to modify the Phone Number field), and then enter the country code and international number. This entry can be up to 40 characters.

14In the Fax Number field, enter the referral source’s 10-digit fax number. If the referral source has an international fax number, select the International Number check box (to modify the Fax Number field), and then enter the country code and international number. This entry can be up to 40 characters.

15The Family Details field is used to enter details about the contact person’s family. This entry can be up to 500 characters.

16The Likes and Dislikes field is used to enter the likes and dislikes of the contact person at the referral source. This entry can be up to 500 characters.

17The Miscellaneous field is used to enter any additional notes or comments about the contact person at the referral source. This entry can be up to 500 characters.

18Click Submit in the status bar. The new referral source record is saved and listed on the Search List for Referral Sources page.

Updating Referral Sources


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After a referral source record is added to the system, you must use the instructions in this task to keep it up to date.

To update referral sources: 1 Access the Search List for Referral Sources page (see Setting Up Referral Sources).

2 Click the Select button that corresponds with the referral source you want to update. The Referral Source Entry page appears. You can edit any of the fields on this page. All required fields are highlighted. See Adding Referral Sources for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated referral source is saved.

Adding Staff Visits to Referral Sources For each referral source that is entered into the system, you can enter a record each time a staff member visits the referral source. Staff visits enable your organization to keep referral source records up to date.

To add staff visits to referral sources: 1 Access the Search List for Referral Sources page (see Setting Up Referral Sources).

2 Click the Staff Referral button that corresponds with the referral source who received a visit from a staff member.

The Referral Visits page appears. This page contains a record for each time a staff member visited the referral source.

3 Click the Add Staff Visit button in the status bar. The Referral Source Staff Entry page appears. All required fields are highlighted.


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4 In the Staff Name field, use the drop-down list to select the staff member you want to assign to the referral source.

5 In the Primary field, specify if the staff member will be the primary contact person for the referral source.

6 In the Begin Date field, enter the date the staff member will become an active contact person for the referral source. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

7 In the End Date field, enter the date the staff member will no longer be a contact person for the referral source. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

8 Click Submit in the status bar. The staff member is added to the Referral Source Staff page.

Adding Notes about Referral Visits When the designated contact person meets with the referral source, he can use the instructions in this task to add notes about the meeting. By using the Referral Visit button, the contact person can record the date and time of the visit, as well as the topics discussed and the topics to discuss for future meetings.

To add notes about referral visits: 1 Access the Search List for Referral Sources page (see Setting Up Referral Sources).

2 Click the Referral Visit button that corresponds with the referral source for which you want to a add note about a visit.

The Referral Visits page appears. This page lists all of the visit records that have been added for the selected referral source.

3 Click the Add Visit button in the status bar. The Referral Source Visit page appears. All required fields are highlighted.


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4 In the Visit Type field, use the drop-down list to select the type of visit you are documenting.

5 In the Topics Discussed field, enter a description of the topics discussed with the referral source. This entry can be up to 2,000 characters.

6 In the Visit Date/Time field, enter the date of the visit in the first field. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window. Enter the time of the visit in the second field and select either AM or PM.

7 In the End Date/Time field, enter the date the visit ended in the first field. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window. Enter the time the visit ended in the second field and select either AM or PM.

8 In the Topics to Discuss field, enter a description of the topics you would like to discuss with the referral source during a future visit. This entry can be up to 2,000 characters.

9 Click Submit in the status bar. The referral visit record is saved and listed on the Referral Visits page.

Deleting Referral Sources This task is used to delete referral source records.

To delete referral sources: 1 Access the Search List for Referral Sources page (see Setting Up Referral Sources).

2 Click the Delete button that corresponds with the referral source you want to delete.


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The Delete Referral Source page appears. 3 Select Yes to confirm you want to delete the selected referral source. 4 Click Submit in the status bar.

The selected referral source record is deleted from the system.

Setting Up Service Locations by Organization The Service Locations module contains a nationally standardized list of service locations. Every activity that is billed in the system must occur at a service location. When you schedule an activity, a service location must be selected (see page 18 the Scheduling Guide). The service location is the actual location where the staff member meets with the client to provide a service.

To set up service locations by organization: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Service Locations.

The Service Location list page appears.

3 Locate the service location record you want to associate with organizations and click the Organization button.

The Organization List page appears for the selected service location. This list includes the organization you are currently logged into and all its child organizations. Note: When the button appears in the Included column, the service location is available at that

organization. When the button appears in the Excluded column, the service location is not available at that organization.

4 To associate the selected service location with an organization, click the Excluded button.


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The page is refreshed and the button is moved to the Included column, which means the service location is available at the selected organization. You can associate the service location with as many organizations as desired.

5 Click Submit in the status bar. The service location organization matrix record is saved.

Setting Up Type of Bill by Organization The Type of Bill module contains a nationally standardized list of HIPAA-compliant type of bill codes and descriptions. The type of bill must be included on every institutional bill (UB-04 and 837I) your organization generates. When your organization is discharging a client for inpatient services, the type of bill must be selected on the discharge order (see page 251 the Clinical Record Guide).

To set up type of bill by organization: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Type of Bill.

The Type of Bill list page appears.

3 Locate the type of bill record you want to set up and click the Organization button. The Organization List page appears for the selected type of bill. This list includes the organization you are currently logged into and all its child organizations.


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Note: When the button appears in the Included column, the type of bill can be generated at that organization. When the button appears in the Excluded column, the type of bill cannot be generated at that organization.

4 To associate the selected type of bill with an organization, click the Excluded button. The page is refreshed and the button is moved to the Included column, which means the type of bill can be generated at the selected organization. You can associate the type of bill with as many organizations as desired.

5 Click Submit in the status bar. The type of bill organization matrix record is saved.

Setting Up Point of Entry Mappings This task is used to link activities to programs, which are used in the Point of Entry module. When a POE client is assigned to a program, the Point of Entry mapping is used to automatically schedule the client for the related activity. For example, suppose you create a Point of Entry mapping that links the activity ‘Intake Assessment’ to the program ‘Inpatient Detox - Level I’. In this scenario, when you assign the POE client to the Inpatient Detox - Level I program, the client is automatically scheduled for an Intake Assessment activity.

To access point of entry mappings: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Point of Entry Mapping.

The Point of Entry Mappings page appears.

This page is used to perform the following tasks: Adding Point of Entry Mappings Updating Point of Entry Mappings Deleting Point of Entry Mappings

Adding Point of Entry Mappings


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This task is used to add Point of Entry mapping records. When a POE client is assigned to a program, the Point of Entry mapping is used to automatically schedule the client for the related activity. For example, suppose you create a Point of Entry mapping that links the activity ‘Intake Assessment’ to the program ‘Inpatient Detox - Level I’. In this scenario, when you assign the POE client to the Inpatient Detox - Level I program, the client is automatically scheduled for an Intake Assessment activity.

Note: Once a Point of Entry mapping is added to the system, you can use the Select button on the Point of Entry Mappings page to update it (see page 118).

To add point of entry mappings: 1 Access the Point of Entry Mappings page (see Setting Up Point of Entry Mappings). 2 Click the Add Mapping button in the status bar.

The Point of Entry Mapping Entry page appears.

3 The Organization field is used to select the organization the POE mapping applies to. This drop-down list includes only the organization you are currently logged into and all child organizations.

4 When scheduling a client for an intake assessment through the POE wizard, the system checks to see which POE mapping record to use, based on the treatment program the client is being enrolled in.

If you select a treatment program in the Program field, the system will automatically use the corresponding activity (selected in the next step) for the intake assessment.

If you do not select a treatment program in this field, the system will use the activities associated with default POE mapping records. A default POE mapping record is one that is not specific to a particular treatment program.

5 In the Activity field, use the drop-down list to select the activity that you want to associate with the program.

6 Click Submit in the status bar. The point of entry mapping record is saved and listed on the Point of Entry Mappings page.

Updating Point of Entry Mappings Once a Point of Entry record is created, you can use this task to update it.

To update point of entry mappings: 1 Access the Point of Entry Mappings page (see Setting Up Point of Entry Mappings).


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2 Click the Select button that corresponds with the Point of Entry mapping record you want to update.

The Point of Entry Mapping Entry page appears. You can edit any of the fields on this page. All required fields are highlighted. See Adding Point of Entry Mappings for field descriptions.

3 After making the desired edits, click Submit in the status bar. The selected Point of Entry record is updated and listed on the Point of Entry Mappings page.

Deleting Point of Entry Mappings This task is used to delete Point of Entry mapping records.

To delete point of entry mappings: 1 Access the Point of Entry Mappings page (see Setting Up Point of Entry Mappings).

2 Click the Delete button that corresponds with the Point of Entry mapping record you want to delete.

The Delete Point of Entry Mapping page appears. 3 Click Yes to confirm you want to delete the record. 4 Click Submit in the status bar.

The selected Point of Entry mapping record is deleted from the system.

Set Up Claim Rollup Rules The Claim Rollup Rules module is used to define the criteria by which individual services are rolled up into a single claim. The purpose of this module is to allow your administrators to determine how a collection of related services are claimed. Each night when the Claim Engine runs it checks to see if you have set up any claim rollup rules that are specific to your environment.

Claim rollup rules are used primarily in the following situations: To collect multiple services on a single claim, as in per diem charges. To rollup several different services into a single billable procedure. To satisfy payer requirements for the minimum and maximum number of billable services in a given

time period.

There are two steps involved in setting up claim rollup rules: Creating a rollup record (see Add a Rollup Record). This is the parent-level record that defines the type

of claims the rule will apply to. Every rollup record must apply to either a specific payer or payer type, or it must be specific to self-pay claims.


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Creating the rollup rules (see Add a Rollup Rule). This is the child-level record that defines which services will be rolled up. When defining a rule, you must specify if the services will be rolled up by procedure code, activity code, or activity group. Every rollup record must have at least one related rollup rule. If a rollup rule does not exist, the rollup record is ignored by the Claim Engine.

To access claim rollup rules: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Claim Rollup Rules.

The Rollups page appears. The top half of the page lists all of the active rollup records in the system. A rollup record is considered active if the current system date falls within the date range of the rollup record. The bottom half of the page lists all of the inactive rollup records in the system. A rollup record is considered inactive if the current system date falls outside the date range of the rollup record.

This page is used to perform the following tasks: Add a Rollup Record. Add Billable Units for Rollup Records. Maintain Rollup Rules. Updating a Rollup Record. Deleting a Rollup Record.

Add a Rollup Record The first step in creating claim rollup rules is to create a rollup record. The rollup record defines the type of claims the rule will apply to. Every rollup record must apply to either a specific payer or payer type, or it must be specific to self-pay claims.

Note: After creating a rollup record, you must create the rollup rules (see Add a Rollup Rule). Every rollup record must have at least one related rollup rule. If a rollup rule does not exist, the rollup record is ignored by the Claim Engine.

To add a rollup record: 1 Access the Rollups page (see Set Up Claim Rollup Rules). 2 Click Add a Rollup in the status bar.

The Claim Rollup Setup page appears. In addition to the highlighted fields, one of the following fields are required: Player Plan, Payer Type, or Self-Pay.


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3 In the Description field, enter the name you want to use to identify this rollup record. This is the name that will also identify the rollup rules associated with the record. The name you enter in this field should be representative of the type of rule you are creating. For example, if the rollup record is specific to commercial payers, the description should reflect this with a name such as Commercial Payer Rollup.

Note: When the claims are rolled up and listed in Claim Approval (see page 31 the Billing and Accounts Receivable Guide), you can hover over the procedure code to view the rollup rule name, which is the description listed in this field.

4 In the Begin Date field, enter the date this record becomes active in the system. This is the first date the rollup record and the associated rules will be processed by the Claim Engine. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 In the End Date field, enter the date this record becomes inactive in the system. This is the last date the rollup record and the associated rules will be processed by the Claim Engine. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

Important: When creating the rollup record, you must identify the type of claims the rule will apply to by selecting an option in either the Payer Plan or Payer Type fields, or by indicating that the record is for Self-Pay claims.

6 If the rollup record is for a particular payer, use the drop-down lists in the Payer Plan field to select the payer name and/or payer plan. The first drop-down list is used to select the payer name, and the second drop-down list is used to select the payer plan. You can select a value in either or both of these fields.

7 If the rollup record is for a particular payer type, use the drop-down list in the Payer Type field to select the desired option.

8 If the rollup record is for self-pay claims, select Yes in the Self-Pay field. This option allows you to create a rollup rule for self pay claims only.


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9 The Periodic Limit field is used to define the time frame within which the services must occur in order to be considered by the related rollup rules. Enter a numeric value in the text field and use the drop-down list to select a limit unit. For example, if you want to roll up all of the services that occur within one week, you would enter 1 in the text field and select Weeks in the drop-down list.

Note: When setting the periodic limit, it is important to understand the difference between “7 Days” and “1 Week.” “1 Week” indicates a calendar week (Sunday through Saturday) while “7 days” indicates any seven consecutive days.

10The Rollup Combination field is used to indicate either that a certain payer accepts all services, regardless of staff or program, rolled up to one organization or that a certain payer accepts all services, regardless of staff or program, rolled up to a specific organization.

Note: This field only appears if your system is configured to rollup claims to organizations.

11The Rollup Across Months field provides a convenient way for your organization to rollup inpatient services. When this option is set to Yes, all of the claims generated for the duration of a client’s treatment (from admission to discharge) are automatically rollup into a single claim once the client is discharged. If a client’s treatment spans multiple months, the following workflow is recommended so your organization can recognize the revenue in the appropriate months: 1) Rollup all the claims at the end of the month, but do not batch the claim. 2) As additional claims are generated for subsequent months, rollup these claims at the end of each month into the original claim, but do not batch the claim. 3) Once treatment is complete and the client is discharged, rollup all remaining claims into the original claim and then batch it and send it out for billing.

12In the Recalculate Units After a Rollup field, indicate if you want to recalculate the units associated with the individual services after they are rolled up. If you select Yes, you must specify the billable unit to use for the recalculation using the Billable Unity function (see Add Billable Units for Rollup Records). If you select No, then the billable units will be the sum of the units for the individual services.

13The Max Units field is used to define the maximum number of units that will be used to calculate fees for the claim after the rollup.

14In some cases, the individual services that are being rolled up are related to different procedure codes. If your payer requires you to report them under a single procedure code, you can use the drop-down list in the Rollup to Procedure field to select the desired procedure code. Once the individual services are rolled up, the fee associated with the selected procedure code is listed on the claim.

15Click Submit in the status bar. The rollup record is saved and listed on the Rollups page. Note: When there are multiple authorizations for the same payer for different services, the Claim Rollup

Rule will only roll up services that use the same authorization number. If a service does not require an authorization, it can still roll into a claim with an authorization.

Add Billable Units for Rollup Records This task includes instructions for adding billable units for claim rollup records designated to recalculate units after a rollup.

To add billable units to rollup records: 1 Access the Rollups page (see Set Up Claim Rollup Rules). 2 Click the Billable Units button that corresponds with the rollup record you want to add

billable units to.


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The Billable Units list page appears, displaying all active billable units added to this claim rollup record.

3 Click the Add a Billable Unity button in the status bar. The Billable Units entry page appears.

4 In the Minute Range field, enter the beginning and end number of total minutes associated with this billable unit. For example, if your billable unit is different for 0 to 15 minutes of service vs. 15 to 30 minutes of service, you would enter two billable unit rules for your rollup record to accurately reflect these two different billable units.

5 The Billable Unit Is field is used to define what constitutes a billable unit for the rollup record. If the billable unit is based on Minutes, Hours, Days, or Months, you must also define the unit calculation method to use for partial units. If the billable unit is based on Sessions, a unit calculation method is not needed because there will be no partial units.

In the text field, enter the number of units to base the billable unit on. In the second field, use the drop-down list to select the frequency of the billable unit you want to use. The options are Units or Minutes. For example, if you want to base the billable units on one hour sessions, you would enter 60 in the text field and select Minutes in the drop-down list.

Note: CareLogic supports both whole and decimal numbers.






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6 In the Nearest Unit Size field, use the drop-down list to select the fraction to round the billable unit to. You must select a value in this field if you selected Round Nearest or Round Up as the unit calculation method. If you selected another unit calculation method, do not select a value in this field.

7 Click Submit in the status bar. The billable unit entry is saved and listed on the Billable Unit list page.

Maintain Rollup Rules Rollup rules define the types of services that will be rolled up. When defining a rollup rule, you can identify the services to rollup by procedure code, activity code, or activity group.

To access rollup rules: 1 Access the Rollups page (see Set Up Claim Rollup Rules). 2 Click the Rules button that corresponds with the rollup record you want to create a

rule for. The Rollup Rules page appears for the selected rollup record.

This page is used to perform the following tasks: Add a Rollup Rule Updating a Rollup Rule Deleting a Rollup Rule

Add a Rollup Rule Once a rollup record is created (see Add a Rollup Record), you must use this task to create at least one rollup rule. The rollup rule defines which types of services will be rolled up. When defining the rollup rule, you can identify the services to rollup by procedure code, activity code, or activity group.

You can create as many rollup rules as desired for the selected rollup record. Although the rollup will start when the first service satisfies the rule, the claim cannot be approved or billed until it contains the number of services that fall within the minimum and maximum range.

Note: You should be careful when configuring claim rollup rules. If you create a rollup rule that is not what you intended, you will have to backout the claims in Claim Approval (see page 32 the Billing and Accounts Receivable Guide).

To add a rollup rule: 1 Access the Rollup Rules page (see Maintain Rollup Rules). 2 Click Add a Rollup Rule in the status bar.

The Rollup Rule page appears for the selected rollup record.


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Note: When defining a rollup rule, you must base the rule on either an activity code, activity classification, or procedure code. This means you must select an option in only one of the following fields: Activity, Activity Classification, or Procedure.

3 If you want to base the rollup rule on a particular activity code, use the drop-down list in the Activity field to select an option. If you select an activity in this field, then all of the services related to this activity will be considered during the rollup.

4 If you want to base the rollup rule on a particular activity classification 5 , use the drop-down list in the Activity Classification field to select an option. If you

select an activity classification in this field, then all of the services related to this activity classification will be considered during the rollup.

6 If you want to base the rollup rule on a particular procedure code (or procedure code-revenue code combination), use the drop-down list in the Procedure field to select an option. If you select an option in this field, then all of the services related to this procedure (or procedure-revenue combination) will be considered during the rollup.

7 The Activity Units field is used to define the minimum and maximum number of units that are required to satisfy the rule. Although the rollup will start when the first service satisfies the rule, the claim cannot be approved or billed until it contains the number of services that fall within the minimum and maximum range.

8 If you selected a procedure code in Step 5, indicate if you want the services to be rolled up into the same claim in the Rollup onto the Same Claim Item field. If you select No in this field, then this rollup rule is designed to satisfy a payer’s minimum number of services before sending the claims.

9 By default, all rollup rules are based on continuous services. This means in order to be part of the rollup, services have to be delivered on continuous days. If you want the ability to rollup services that do not occur on continuous days, select Yes in the Rollup Discontinuous Service field.

10Click Submit in the status bar. The rollup rule is saved and listed on the Rollup Rule page for the selected rollup record.

Updating a Rollup Rule Once a rollup rule is created, you must use this task to update it.

To update a rollup rule: 1 Access the Rollup Rules page (see Maintain Rollup Rules). 2 Click the Select button that corresponds with the rule you want to update.

The Rollup Rule page appears for the selected rollup record. You can edit any of the fields on this page. Refer to Add a Rollup Rule for field descriptions.

3 After making the desired edits, click Submit in the status bar.


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The selected rule is updated and listed on the Rollup Rule page for the selected rollup record.

Deleting a Rollup Rule This task includes instructions for deleting a rollup rule.

To delete a rollup rule: 1 Access the Rollup Rules page (see Maintain Rollup Rules). 2 Click the Delete button that corresponds with the rule you want to delete.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected rule. 4 Click Submit in the status bar.

The selected rule is deleted and is no longer a part of the rollup record.

Updating a Rollup Record Once a rollup record is created, you must use this task to update it.

To update a rollup record: 1 Access the Rollups page (see Set Up Claim Rollup Rules). 2 Click the Select button that corresponds with the rollup record you want to update.

The Claim Rollup Setup page appears. You can edit any of the fields on this page. See Add a Rollup Record for field descriptions.

3 After making the desired updates, click Submit in the status bar. The selected record is updated and listed on the Rollups page.

Deleting a Rollup Record This task includes instructions for deleting rollup records that have not been used to create claims. Once a rollup record is used by the system, it cannot be deleted.

To delete a rollup record: 1 Access the Rollups page (see Set Up Claim Rollup Rules). 2 Click the Delete button that corresponds with the rollup record you want to delete.


The selected record is removed from the system. When the rollup record is deleted, all of its related rollup rules are also deleted.

Setting Up Sliding Fee Scales The Sliding Fee Scale module is used to define a fee schedule for guarantor claims and co-pay amounts, based on number of people in the client’s family and the family income level. Because there are no industry standards in relation to calculating sliding scales, this module gives your organization the ability to define the fee scales to meet its particular needs.


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Note: In addition to defining sliding fee scales based on the number of people in the client’s family and client’s family income level, your organization can also use the Dynamic Sliding Fee Scale module (see Setting Up Dynamic Sliding Fee Scales) to define sliding fee scales based on custom, user-defined formulas.

To access the Sliding Fee Scale module: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Sliding Fee Scale.

The Fee Scale List page appears. For each sliding scale record, this page lists the record type (guarantor claim or client co-pay), the effective date range, the payer plan (if the record is specific to a payer plan), and the minimum and maximum family members a client can have in order to qualify for the sliding scale adjustment.

This module is used to perform the following tasks. Adding Sliding Fee Scales Adding a Fee Matrix to a Sliding Fee Scale Updating Sliding Fee Scales Deleting Sliding Fee Scales

Adding Sliding Fee Scales This task is used to define the criteria the system will use to determine if a client qualifies for a sliding fee scale adjustment. In addition to defining the sliding fee scale’s effective date, you must also specify the client’s family size, the admitting organization, and whether the sliding fee scale applies to guarantor claims or client co-pay amounts.

To add sliding fee scales: 1 Access the Fee Scale List page (see Setting Up Sliding Fee Scales).

2 Click Add Fee Scale in the status bar. The Sliding Fee Scale Setup page appears. All required fields are highlighted.


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3 In the Begin Date field, enter the first date this sliding fee scale record will be active in the system. This is the first date the system will attempt to apply this sliding fee scale record to guarantor claims and co-pays for clients who meet the required criteria.

4 If this record is to be active for a defined date range only, enter the end date in the End Date field. If the record is to be active indefinitely, do not make an entry in this field.

5 By default, when calculating guarantor claims and co-pay amounts, the system does not consider the client’s payer plan. If you want this record to apply to the clients who have a particular payer plan only, use the Payer Name search-and-select field to select the desired payer plan.

Important: The system only applies sliding fee scale records to primary payer plans. Therefore, if a client has two payer plans set up in the system, and you create a sliding fee scale for the priority two payer plan, then the sliding fee scale will not be applied for that client.

6 In the Minimum Family Size field, enter the minimum number of family members a client can have in order to qualify for the sliding fee scale adjustment. The options are 1 through 99.

7 In the Maximum Family Size field, enter the maximum number of family members a client can have in order to qualify for the sliding fee scale adjustment. The options are 1 through 99.

Note: The number you enter in this field determines the number of columns available on the Fee Scale list page (see Adding a Fee Matrix to a Sliding Fee Scale).

8 By default, when calculating guarantor claims and co-pay amounts, the system attempts to apply this record to clients admitted to the current organization and all of its child organizations. If you want to apply this sliding fee scale record to a different organization, use the drop-down list in the Organization field to select the desired organization.

9 By default, when calculating guarantor claims and co-pay amounts, the system does not consider the client’s treatment program. If you want to apply this record to the clients in a particular treatment program only, use the drop-down list in the Program field to select the desired program.

10By default, when calculating guarantor claims and co-pay amounts, the system does not consider the procedure code associated with the service. If you want to apply this record to a particular procedure code only, use the drop-down list in the Procedure field to select the desired procedure.

11In the Type field, select the type of charge to which this sliding scale record will apply. If you select Claim, this record is used to calculate guarantor claims. If you select Co-Pay, this record is used to calculate client co-pay amounts.

12Click Submit in the status bar. The sliding fee scale record is saved and listed on the Fee Scale List page.


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Adding a Fee Matrix to a Sliding Fee Scale Once the sliding fee scale record is created (see page 137), you must define a fee matrix for it. This task enables your organization to define the percentage of the bill a client will be charged, based on his family’s size and monthly income level. The sliding scale percentages defined in the Sliding Scale Fee Matrix module apply to the current organization and all of its child organizations.

To add a fee matrix to a sliding fee scale: 1 Access the Fee Scale List page (see Setting Up Sliding Fee Scales).

2 Locate the sliding fee scale record for which you want to set up a fee matrix and click the Fee Matrix button.

The Sliding Fee Scale list page appears. This page is a grid that contains rows and columns. Each row contains a user-defined button that defines the monthly income levels. Each column contains a number which represents the client’s family size. The number of columns that appear on this list page is determined by the Maximum Family Size field on the Sliding Fee Scale Setup page (see Adding Sliding Fee Scales).

3 Click Add Adjusted Annual Income in the status bar. The Adjusted Annual Income page appears.

4 In the Low Income field, enter the minimum annual family income a client can have and still qualify for the sliding fee scale adjustment. This entry must be a whole number, and can contain a decimal point, if desired. An entry in this field is required.

5 In the High Income field, enter the maximum annual family income a client can have and still qualify for the sliding fee scale adjustment. This entry must be a whole number, and can contain a decimal point, if desired. If a number is not entered in this field, the sliding scale adjustment will apply to all clients with a monthly family income that exceeds the amount entered in the Low Income field.

6 Click Submit in the status bar. The low and high income values entered are saved and listed as buttons in the grid on the Fee Scale list page. For example, if you entered a low annual income of $1 and a high annual income of $1,000, then the button in the grid on the Fee Scale list page will contain the label: $1 to $1,000. Repeat Steps 3 through 6 until you have created all necessary monthly income levels to satisfy the needs of your organization.


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7 Locate the first button that contains an annual income level, and enter the sliding scale percentage that will be charged, based on the client’s family size. For example, suppose the annual income level on the first button is $1 to $1,000 and your organization has determined that the sliding scale will be 50% for a family of 5, 40% for a family of 4, 30% for a family of 3, 20% for a family of 2, and 10% for a family of 1. In this scenario, you would enter 10 in the 1 column, 20 in the 2 column, 30 in the 3 column, 20 in the 2 column, and 10 in the 1 column.

Note: You must repeat this step for each annual income level button that is set up.

8 Click Submit in the status bar. The sliding scale values are saved and listed on the Fee Scale list page.

Updating Sliding Fee Scales This task is used to modify the sliding scale fee matrix by updating the monthly income levels and the sliding scale percentages based on family size.

To update sliding fee scales: 1 Access the Fee Scale List page (see Setting Up Sliding Fee Scales).

2 Locate the sliding fee scale record you want to update and click the Select button. The Sliding Fee Scale Setup page appears. All required fields are highlighted.

3 Update the values on this page as desired. See Adding Sliding Fee Scales for field descriptions.

4 Click Submit in the status bar. The updated record is saved and listed on the Fee Scale List page.


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Deleting Sliding Fee Scales This task is used to delete a sliding fee scale record.

To delete sliding fee scales: 1 Access the Fee Scale List page (see Setting Up Sliding Fee Scales).

2 Locate the sliding fee scale record you want to delete and click the Delete button. A delete confirmation page appears.


The sliding fee scale record is deleted and removed from the Fee Scale List page.

Setting Up Dynamic Sliding Fee Scales If the Sliding Fee Scale module (see Setting Up Sliding Fee Scales) does not provide enough flexibility to meet your organization’s needs, you can use the Dynamic Sliding Fee Scale module to create custom formulas for sliding fee scales. These formulas can be based on a variety of criteria, such as household income, family size, standard fees, contracted rates, and sliding fee scale records (created through the Sliding fee Scale module).

To set up dynamic sliding fee scales: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Dynamic Fee Scale.

The Dynamic Sliding Fee Scale list page appears. For each dynamic fee scale record, this page lists the record type (guarantor claim or co-pay), the effective date range, the formula, the payer plan associated with the record, if applicable, and the organization, program, and procedure associated with the dynamic fee scale.

3 Click Add Formula in the status bar. The Dynamic Formula Entry page appears. All required fields are highlighted.


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4 In the Begin Date field, enter the first date this dynamic fee scale record will be active in the system. This is the first date the system will attempt to apply this record to guarantor claims and co-pays for clients who meet the required criteria.

5 If this record is to be active for a defined date range only, enter the end date in the End Date field. If the record is to be active indefinitely, do not make an entry in this field.

6 By default, when calculating guarantor claims and co-pay amounts, the system does not consider the client’s payer plan. If you want to apply this record to the clients who have a particular payer plan only, use the search-and-select element in the Payer Name field to select the desired payer plan.

Important: The system only applies dynamic fee scale records to primary payer plans. Therefore, if a client has two payer plans set up in the system, and you create a dynamic fee scale for the priority two payer plan, then the sliding fee scale will not be applied for that client.

7 By default, when calculating guarantor claims and co-pay amounts, the system attempts to apply this record to clients admitted to the current organization and all of its child organizations. If you want to apply this dynamic fee scale record to a different organization, use the drop-down list in the Organization field to select the desired organization.

8 By default, when calculating guarantor claims and co-pay amounts, the system does not consider the client’s treatment program. If you want to apply this record to the clients in a particular treatment program only, use the drop-down list in the Program field to select the desired program.

9 By default, when calculating guarantor claims and co-pay amounts, the system does not consider the procedure code associated with the service. If you want to apply this record to a particular procedure code only, use the drop-down list in the Procedure field to select the desired procedure.

10The Formula field is used to define the variables for this dynamic fee scale record. When combining the placeholders listed at the bottom of the page, you must use two colons (::) as a separator. In addition the placeholders described below, the formula can consist of any of the following: *, -, (,), ., /, +, -, and any number.


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Important: When defining a dynamic fee scale formula, you must include either the STANDARD_FEE or CONTRACTED_RATE placeholder, and the formula must contain an equal number of open and closed parenthesis.

SLIDING_SCALE. Use this placeholder to include sliding fee scale records in the dynamic fee scale formula. This placeholder maps to the records created in the Sliding Fee Scale module (see Setting Up Sliding Fee Scales).

INCOME. Use this placeholder to include the client’s householder income in the dynamic fee scale formula. This placeholder maps to the Household Income field in the Client Demographics module.

STANDARD_FEE. Use this placeholder to include a procedure code’s standard fee in the dynamic fee scale formula. This placeholder maps to the standard fee amount defined in the Procedures module.

CONTRACTED_RATE. Use this placeholder to include a payer plan’s contracted rates in the dynamic fee scale formula. This placeholder maps to the contracted rates set up in the payer plan’s fee matrix.

FAMILY_SIZE. Use this placeholder to include the client’s family size in the dynamic fee scale formula. This placeholder maps to the Individuals in Your Household field in the Client Demographics module.

11By default, the system uses this record to calculate the co-pay amount for qualified clients. If you want to use this record to calculate guarantor claims, select the Claim radio button in the Type field.

12Click Submit in the status bar. The dynamic fee scale record is saved and listed on the Dynamic Sliding Fee Scale list page.

Setting Up Bill Next Procedure Mappings The Bill Next Procedure Mappings module allows you to establish bill next mappings that are tied to the creation of bill next claims. The created mappings allow the modification of procedure codes, revenue codes, and modifiers when the primary code or modifier combination waterfalls to the next payer.

To set up bill next procedure mappings: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Bill Next Procedure

Mappings. The Bill Next Procedure Mappings list page appears, displaying all active and inactive mappings in the system. If you have access to multiple organizations, you will see all bill next mappings at any organization at or below the one you are currently logged into.

Note: You can hover over the Bill Next Payer Name to display additional information about the payer.

3 Click Add Mapping in the status bar. The Bill Next Procedure Mapping Entry page appears.


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4 In the Begin Date field, enter the date at which the mapping becomes active in the system.

5 If you want the mapping to only be active for a certain period of time, enter the date at which the mapping becomes inactive in the system in the End Date field.

6 In the Incoming Codes section, enter the following fields to complete the form: a Incoming Procedure Code. Use the drop-down list to select the desired incoming procedure code you

want mapped to another procedure code for bill next claims. b Incoming Modifiers. Use the drop-down list to select the desired modifier(s) that accompany the

desired incoming procedure code you want mapped to another procedure code for bill next claims. 7 In the Outgoing Codes section, enter the following fields to complete the form:

a Outgoing Procedure Code. Use the drop-down list to select the desired outgoing procedure code you want submitted for bill next claims based on the selected incoming procedure code.

b Outgoing Modifiers. Use the drop-down list to select the desired modifier(s) that should accompany the desired outgoing procedure code you want submitted for bill next claims.

c Do you want to recalculate units? Indicate if you want to recalculate units for your bill next mapping. If you select Yes, more fields appear.

d Billable Unit is. Define what constitutes a billable unit for the bill next mapping. In the text field, enter the number of units to base the billable unit on. In the second field, use the

drop-down list to select the type of billable unit you want to use. The options are Sessions, Minutes, or Hours. For example, if you want to base the billable units on one hour sessions, you would enter 60 in the text field and select Minutes in the drop-down list.

The next drop-down list is used to select the unit calculation method to use for partial units. The following options are available.


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Fraction. Select this option if you want to bill the unit exactly as it occurred, without any calculations applied. For example, if the session lasted for one hour and fifteen minutes, the billable unit would be one hour and fifteen minutes.


Round Up. Select this option if you want all units to be rounded up to the nearest defined unit. If you select this option, you must select a value in the Nearest Unit Size field. If the nearest unit size is 1 or blank, the system rounds up to a whole unit. If the nearest unit size is a fraction, the system rounds up to that fraction. For example, suppose the billable unit is set as 1 hour and nearest unit size is set to 1/4. In this scenario, 1-15 minutes will be billed as 1/ 4 unit; 16-30 minutes will be billed as 1/2 unit; 31-45 minutes will be billed as 3/4 units; and 46-60 minutes will be billed as 1 unit.


Note: If the billable unit is based on Minutes or Hours, you must also define the unit calculation method to use for partial units. If the billable unit is based on Sessions, a unit calculation method is not needed because there will be no partial units.

e Nearest Unit Size. Use the drop-down list to select the fraction to round the billable unit to. You must select a value in this field if you selected Round Nearest or Round Up as the unit calculation method. If you selected another unit calculation method, do not select a value in this field.

8 In the Bill Next Claims Criteria section, enter the following fields to complete the form:

a Billing Category. If you want this bill next procedure mapping to apply only to certain billing categories, use the drop-down menu to select the desired licensure.

b Organization. If you want this bill next procedure mapping to apply only to a certain organization, use the drop-down menu to select the desired organization.

c Program. If you want this bill next procedure mapping to apply only to a certain program, use the drop-down menu to select the desired program.

Important: You can only select a payer name or payer type to determine when a bill next procedure mapping should be used on bill next claims. You cannot select both.

d Payer Name. If you want this bill next procedure mapping to apply only to a certain payer plan, use the first drop-down menu to select the desired payer name, and use the second drop-down list to select the desired payer plan.

e Payer Type. If you want this bill next procedure mapping to apply only to a certain payer type, use the drop-down menu to select the desired payer type.

f Minute Range. If you only want the bill next mapping to apply to a certain minute range, enter the begin and end minute range to which this mapping applies.

g Age Range. If you only want the bill next mapping to apply to a certain age range, enter the begin and end ages to which this mapping applies.

Note: The Age Range criteria apply to the client’s age on the date of service, so if the age range is 13-18, and a client received services the day before his 19th birthday, the bill next mapping would still apply to the client even if the claim did not go out until after he was already 19.


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h Service Location. The Service Location drop-down is populated with an organization-specific list of nationally standardized service locations your system administrators have determined will be used by your organization to send out on claims.

9 Click Submit in the status bar. The bill next procedure mapping is saved to the system and listed on the Bill Next Procedure Mappings list page.

Configuring the Supervising Physician to Appear on Claims Important: The instructions in this section apply only to the Medicaid payer plan in the state of Indiana.

If your organization does not bill Medicaid for services in Indiana, you can ignore this section.

In some cases, payer plans dictate which PIN Number to include on claims, based on the credential of the rendering staff member. For example, in the state of Indiana, Medicaid allows the rendering staff with a particular credential, such as HSPP, to use their own PIN Number on claims. However, staff members with all other credentials must bill under the PIN Number of their supervisor.

The Supervising Physician Configuration module allows your organization to report the rendering staff member’s supervisor on claims instead of the rendering staff.

To configure the supervising physician to appear on claims: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Supervising Physician

Config. The Supervising Physician Configurations list page appears.

3 Click the Add Configuration button in the status bar. The Create Supervising Physician Configuration page appears. Note: If a supervising physician configuration record already exists, the Copy Existing Configuration field

appears. This field is used to create a new record that is based on an existing record. After using the drop-down list to select the existing record you want to copy, the system automatically creates a new record. By default, the new record contains the same payer, payer plan, and selected licensures as the copied record. At this point, you can modify the new record to meet your specific needs (Steps 5 through 9).


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4 Click the Create New Configuration button. The Supervising Physician Configuration Entry page appears. In addition to the highlighted fields, at least one licensure selection is required.

5 In the Begin Date field, enter the date this record will be active in the system. This is the date the system will use this record to put the PIN number of the rendering staff member’s supervisor on the claims that match the combination of payer plan (Step 7) and licensure (Step 8).

6 If this record is to be active for a defined date range only, enter the end date in the End Date field. If this record will be used indefinitely, do not make an entry in this field.

7 The Payer Plan field is used to select the payer plan to which this record will apply. Use the second drop-down list to select the desired payer plan. If desired, you can select a payer in the first drop-down list to filter the payer plan list.

8 The Licensure field contains all of the licensures that are set up in the system. You must select at least one licensure in this field. Select all of the licensures that the payer plan requires the PIN number of the rendering staff member’s supervisor.

9 Click Submit in the status bar. The record is saved and listed on the Supervising Physician Configurations list page.

Note: The remaining steps include instructions for creating supervising physician configuration override records. All override records take precedent over the supervising physician configuration records.

10Click Add Override in the status bar. The Create Supervising Physician Override page appears.


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Note: If an override record already exists, the Copy Existing Override field appears. This field is used to create a new record that is based on an existing record. After using the drop-down list to select the existing record you want to copy, the system automatically creates a new record. By default, the new record contains the same payer, payer plan, and licensure, and procedures as the copied record. At this point, you can modify the new record to meet your specific needs (Steps 12 through 17).

11Click the Create New Override button. The Supervising Physician Override Entry page appears. In addition to the highlighted fields, at least one procedure selection is required.

12In the Begin Date field, enter the date this record will be active in the system. This is the date the system will put the rendering staff member’s PIN Number on claims associated with the combination of payer plan, credential, and procedure.

13If this record is to be active for a defined date range only, enter the end date in the End Date field. If this record will be used indefinitely, do not make an entry in this field.

14The Payer Plan field is used to select the payer plan to which this record will apply. Use the second drop-down list to select the desired payer plan. If desired, you can select a payer in the first drop-down list to filter the payer plan list.

15In the Licensure field, use the drop-down list to select the rendering staff member’s licensure that will be used by this record.

16You can use the Procedure fields to associate this record with up to six procedure codes. At least one procedure code must be selected in the Procedure fields.

17Click Submit in the status bar. The override record is saved and listed on the Supervising Physician Configurations list page.

Making Collection Assignments The Collections module is used to perform the following tasks: Accessing Existing Collection Assignments


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Creating New Collection Assignments

Accessing Existing Collection Assignments This task includes instructions for accessing existing collection assignments by entering search criteria.

To access collection assignments: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Collections.

The Collection Assignment Search page appears. Note: You can enter as much search criteria as desired. The more criteria you enter, the more narrow the

search results will be. If you want to access all of the collection assignments in the system, click Submit without entering any search criteria.

3 If you want to access the collection assignments associated with a particular staff member, use the drop-down list in the Staff field to select an option. If you do not select a staff member in this field, the search considers the collection assignments for all staff members.

Note: The Self Pay field is set to No and cannot be changed. This is because collection assignments exist for payer claims only. There are no collection assignments in the system for self-pay claims.

4 If you want to access the collection assignments associated with a particular payer plan, use the drop-down list in the Payer Plan field to select an option. If you do not select a payer plan in this field, the search considers the collection assignments associated with all payer plans.

5 If you want to access the collection assignments associated with a particular payer type, use the drop-down list in the Payer Type field to select an option. If you do not select a payer type in this field, the search considers the collection assignments associated with all payer types.

6 Click Submit in the status bar. The Payer Plan Collection Assignments page appears, which lists all of the collection assignments that match your search criteria. For each collection assignment, this page lists the payer plan, payer type, begin and end date of the assignment, the staff member assigned to the unpaid claim, the last name range of the clients associated with the unpaid claim, and the balance amount. Note: You can use the Select button to modify the collection assignment. You can use the Delete button

to remove the collection assignment from the system.


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Creating New Collection Assignments This task includes instructions for assigning unpaid claims to staff members. Once the collection assignments are made, the staff member is responsible for following up with the payer.

To create new collection assignments: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Collections.

The Collection Assignment Search page appears. 3 Click Add New Assignment in the status bar.

The Staff Collections Assignment Form appears. All required fields are highlighted.

4 In the Begin Date field, enter the first date the collection record will be assigned to the staff member. This is the first date the collection assignment appears in the My Collections module of the Billing/AR menu system (see page 64 the Billing and Accounts Receivable Guide) for the specified staff member. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

5 In the End Date field, enter the last date the collection record will be assigned to the staff member. This is the last date the collection assignment appears in the My Collections module of the Billing/AR menu system (see page 64 the Billing and Accounts Receivable Guide) for the specified staff member. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

6 In the Staff field, use the drop-down list to select the staff member the collection record is being assigned to.

7 In the Day Range field, Note: The Self Pay field is set to No and cannot be changed. This is because collection assignments can be

created for payer claims only.

8 If you want to assign the unpaid claims for a particular payer plan, use the drop-down list in the Payer Plan field to select an option. If you do not select a payer plan in this field, the collection assignment considers all payer plans.

9 If you want to assign the unpaid claims for a particular payer type, use the drop-down list in the Payer Type field to select an option. If you do not select a payer type in this field, the collection assignment considers all payer types.


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10If you want to assign unpaid claims based on the client’s last name range, use the drop-down lists in the Client Last Name Range fields to select the range. If you do not define a client last name range, the collection assignment considers all client last names.

11If you want to assign unpaid claims based on a balance amount range, enter the amount range in the Balance Range field. If you do not define a balance range, the collection assignment considers all balance amounts.

12Click Submit in the status bar. The system assigns all of the unpaid claims that meet your search criteria to the selected staff member. The staff member can follow-up on the collection assignments by using the My Collections module in the Billing/AR menu system (see page 64 the Billing and Accounts Receivable Guide).


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Clinical Administration This chapter is used to set up the clinical-related administration modules. The following topics are included in this chapter:

• Episode of Care Types • Medications • Medication Consent • Supervisor Groups • Service Documents • Configurable Forms • Service Document Crosswalks • Unsign Service Documents • Order Statuses • Clinical Orders • Standing Order Protocols • Client Groups • Beds • Treatment Plan Grids • Diagnosis Categories • Call Logs • DRG Codes Administration • 3rd Party Sources • Referring Physician Configurations • Business Rules • Patient Portal • Clinical Quality Measures

Episode of Care Types The Episode Type option is used to assign programs and their begin and end dates to episode types, which enables you to see a client record for a specific episode of care as opposed to the entire clinical record of the client. Each episode type can also be associated with a menu system so each type has its own menu links specific to its need. For more information on setting up treatment programs, see Set Up Treatment Programs. See page Adding Menu Systems for more information on menu management.

To access the episode type list: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Episode Types.

The Episode Type administration page appears.


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Note: The Delete button only appears if no client has been admitted to a program within the episode type. Once a client is admitted to one or more of these programs, the episode type can no longer be deleted.

This page is used to perform the following tasks: • Add Episode of Care Types • Update Episode of Care Types Names • Delete Episode of Care Types

Add Episode of Care Types This task includes instructions for adding episode types and associating programs with the episode of care types.

To add an episode type: 1 Access the Episode Type administration page (see Episode of Care Types). 2 Click the Add Episode Type button.

The Episode Type data entry page appears. All required fields are highlighted.

3 The Begin Date field is used to set the begin date automatically for all programs added to the selected episode type at the time the episode type is created in the system.

4 If your episode type has a definitive end date, enter the last day on which clients can be admitted to programs associated with the selected episode type in your system in the End Date field.

Note: Entering an end date sets end dates for all programs added to the episode during the episode setup.

5 The Organization field is used to select the organization to which the episode type applies. This drop-down list includes only the organization you are currently logged into and all child organizations.

6 In the Name field, enter the name of the episode type. This entry can be up to 60 characters.


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Important: Each program you have set up in your system can only be added to one Episode Type for each organization because the Episode Type is driven off of the admission program. For more information on setting up treatment programs, see Set Up Treatment Programs.

7 In the Programs field, search for the program you want added to the current episode type, and use the drop-down list to select the appropriate program. Click Add to add the program to the program list. Repeat as needed for adding multiple programs to associate them with this episode of care.

8 Click Submit in the status bar. A program validation page appears to ensure all programs being added are not already associated with another episode type.

Note: If there are validation issues with the programs you are adding because they are already associated with another episode type, you must first end date the programs in their current episode types before adding them to a new episode type (see Change Dates for Programs Associated with Episode of Care Types for more information).

9 Select the programs with which there are no validation issues, and click Submit in the status bar to add the selected programs to the episode type.

The episode type record is saved to the system and listed on the Episode Type list page.

Update Episode of Care Types Names This task includes instructions for updating episode type names after they have been created.

To update an episode type name: 1 Access the Episode Type administration page (see Episode of Care Types). 2 Click the Select button that corresponds with the episode type you want to update.

The Episode Type data entry page appears. All fields can be edited. 3 Make any necessary changes to the episode type name associated with the episode

type. 4 Click Submit in the status bar.

The episode type record is saved on the system.

Update Programs Associated With Episode of Care Types This task includes instructions for updating the program information of all programs associated with a selected episode type and deleting any unused programs from the episode of care type.

To update programs associate with episode types: 1 Access the Episode Type administration page (see Episode of Care Types). 2 Click the Program button that corresponds with the episode type you want to update.

The Episode Program list page appears, displaying all active and inactive programs associated with the selected episode type.


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Note: The Delete button only appears if no client has been admitted to the selected program within the episode type. Once a client is admitted to the selected program, it can no longer be deleted.

This page is used to complete the following tasks: Change Dates for Programs Associated with Episode of Care Types Add Programs to Existing Episodes of Care Types

Change Dates for Programs Associated with Episode of Care Types This task includes instructions for changing the dates around programs that are already associated with an episode type. For example, if you decide the detox program should be moved from the Inpatient episode type to the Substance Abuse episode type, you would end date the detox program in the Inpatient episode type and add the detox program to the Substance Abuse episode with a begin date that is after the end date of the detox program you set in the Inpatient episode type.

To change dates for programs associated with episode types: 1 Access the Episode Programs list page (see Update Programs Associated With Episode

of Care Types). 2 Click the Select button that corresponds with the program you want to change the

dates around. The Program date entry page appears.

3 Make any necessary changes to the program dates that affect the time frame at which the program should be associated with the selected episode type.

4 Click Submit in the status bar. The program date changes are saved to the system.

Add Programs to Existing Episodes of Care Types This task includes instructions for adding programs to existing episode types that have been set up in your system.

after the end date of the detox program you set in the Inpatient episode type.

To add programs to existing episode types:


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1 Access the Episode Programs list page (see Update Programs Associated With Episode of Care Types).

2 Click the Add Programs button in the status bar. The Episode Type data entry page appears.

Note: This screen will appear almost just as it did when setting up the episode type initially; however, the organization and episode type name cannot be changed from this page.

Important: If the program you are adding to an existing episode type was already part of another episode type, the begin date you set here for the new episode with which the program should be associated must be after the end date you set for the program in the old episode type it was associated with.

3 The Begin Date field is used to set the begin date automatically for all programs being added to the selected episode type.

Note: Entering a date in this field sets the begin date only for the new programs being added to the existing episode type.

4 If the programs you are adding to the existing episode type have a definitive end date, enter the last day on which clients can be admitted to these programs being associated with the selected episode type in your system in the End Date field.

Important: Each program you have set up in your system can only be added to one Episode Type for each organization because the Episode Type is driven off of the admission program. For more information on setting up treatment programs, see Set Up Treatment Programs.

5 In the Programs field, search for the program you want added to the current episode type, and use the drop-down list to select the appropriate program. Click Add to add the program to the program list. Repeat as needed for adding multiple programs.

6 Click Submit in the status bar. A program validation page appears to ensure all programs being added are not already associated with another episode type.

Note: If there are validation issues with the programs you are adding because they are already associated with another episode type, you must first end date the programs in their current episode types before adding them to a new episode type (see Change Dates for Programs Associated with Episode of Care Types for more information).


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7 Select the programs with which there are no validation issues, and click Submit in the status bar to add the selected programs to the episode type.

The episode type record is saved to the system and listed on the Episode Type list page.

Delete Episode of Care Types This task includes instructions for deleting episode types and removing them from the system.

Important: The Delete button only appears if no client has been admitted to a program within the episode type. Once a client is admitted to one or more of these programs, the episode type can no longer be deleted.

To delete an episode type: 1 Access the Episode Type administration page (see Episode of Care Types). 2 Click the Delete button that corresponds with the episode type you want to delete.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected episode type. 4 Click Submit in the status bar.

The selected episode type is deleted from the system.

Medications The Medications option is used to maintain a list of medications that can be prescribed to clients. The medications that are set up in this section are used to populate all of the Medication drop-down list fields that appear in the Clinical Record module. A clinician can only prescribe the medications that are set up in this section.

To access the medications list: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Medications.

The Medication List page appears. The top half of the Medication List page contains all of the active medications that are set up in the system. A medication is classified as active if the current system date falls within the medication’s begin date and end date. The bottom half of the page lists all of the inactive medications. Medications with an end date that meets or exceeds the current system date are classified as inactive.

This page is used to perform the following tasks: • Add Medications • Associate Medications with Organizations • Update Medications


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Add Medications This task includes instructions for entering medications into the system. Once a medication is added, it is available at the organization you are currently logged into only. If you want to make a medication available to child organizations, see Associate Medications with Organizations.

Note: Once a medication is added to the system, you can use the Select button on the Medication List page to update it (see page 143).

To add medications: 1 Access the Medication List page (see Medications). 2 Click the Add a Medication button.

The Medication Information page appears. All required fields are highlighted.

3 In the Begin Date field, enter the date the medication becomes active in the system. This is the first date the medication can be prescribed to clients. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

4 If the medication is to be active for a defined date range only, enter the end date in the End Date field. This is the last date the medication can be prescribed to a client through the system. If the medication is to remain active indefinitely, leave this field blank.

5 In the Name field, enter the name of the medication. 6 In the Code field, enter the code which is used to identify the medication. 7 In the Medication Description field, enter a description or comments about the

medication. Your entry can be up to 500 characters. 8 In the Controlled Substance field, indicate if the medication is a controlled substance.

If a medication is classified as a controlled substances, then a client cannot possess it without a prescription from a doctor.

9 In the Allergic Reaction field, indicate if a client can have an allergic reaction to the medication. If you select Yes, the medication is listed on an allergy form.

10Click Submit in the status bar. The medication record is saved and listed on the Medication List page.

Associate Medications with Organizations


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When a new medication record is added (see Add Medications), it is only available at the organization of the staff member who added it. This task includes instructions for making medications available to child organizations.

To associate medications with organizations: 1 Access the Medication List page (see Medications). 2 Locate the medication you want to associate with organizations and click the

Organization button. The Organization List page appears for the selected medication. This list includes the organization you are currently logged into and all its child organizations.

3 To associate the selected medication with an organization, select the checkbox next to each organization that it should be associated with

Note: To associate the selected medication with all organizations, select the checkbox in the table header at the top of the checkbox column. To exclude the selected medication from all organizations, deselect the checkbox in the table header at the top of the checkbox column.

4 Click Submit in the status bar. The medication organization matrix record is saved.

Update Medications Once a medication is added to the system, you must use the instructions in this task to update it.

To update medications: 1 Access the Medication List page (see Medications).

2 Click the Select button of the medication you want to update. The Medication Information page appears. You can edit any of the fields on this page. All required fields are highlighted. See Add Medications for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated record is saved and listed on the Medication List page.


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Medication Reconciliation The object of Medication Reconciliation is for the Eligible Provider who receives a patient from another setting of care or provider of care or believes an encounter is relevant to perform medication reconciliation.

The Medication Reconciliation feature is turned off by default. Administrators must enable it in order to use it. Enabling the Medication Reconciliation feature will display a Reconciliation button on the Medications module and in any service document that contains the Medications module, which will display the Medication Reconciliation entry page when selected.

Note: Emdeon Clinician must be enabled for the Medication Reconciliation to be enabled. If Emdeon Clinician is not enabled, enabling Medication Reconciliation will have no effect.

Set Up Medication Reconciliation The Medication Reconciliation feature can be configured at any organization level. Child organizations will inherit parent configurations unless the child configuration is explicitly set.

Qualifacts recommends setting it at the parent level only unless a business case necessitates exceptions. Contact Qualifacts for assistance.

Medication Consent The Medication Consent process allows staff to obtain a client’s consent to medication. Client consent creates a record which can be reviewed. Only organizations that choose to use Medication Consent will have the data and process displayed.

The Medication Consent feature is n-tier compliant. Child organizations can override their parent organization’s selection by configuring the Medication Consent feature at their level.

Organizations can customize the Medication Consent service document to meet their needs. Each organization using Medication Consent must have an electronic signature pad to capture the client’s signature.

The Medication Consent feature is enabled by configuration. It is disabled by default and must be enabled to be visible. The configuration enables the Medication Consent process; the Consent Button and Medication Consent report buttons will be displayed on the Medication screen. Contact Qualifacts for assistance.

Signatures can be captured in a service document or separately. Documents must be instanced to include the Medication Consent module.

Note: Expiring consents will trigger an alert that displays the name of the expiring consent document. The alert provides a link to the expiring client consent form.

Create a Medication Consent Service Document A Medication Consent service document must be created to capture consents and signatures. The service document code must be MEDCON and the service document must be able to be created in the ECR. Refer to Add Service Documents.


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The service document can be configured to capture the client signature on the same page as the information being consented to or capture the signature separately.

Instance a Medication Consent Service Document The Medication Consent service document must include the Medication Consent module to enable the Medication Consent procedure. Refer to Add Instances to Service Documents.

Configure Medication Consent Service Document The Medication Consent service document configuration enables customization of the service document. Four configurable text areas are available to provide information and instruction, capture staff notes, and capture client inputs. A fifth read only field can be used to customize the consent question, while customizable fields are available for Yes and No statements. All text fields can be hidden or displayed.

The service document can be configured to capture the client signature on the same page as the information being consented to or capture the signature separately.

1 Navigate to Administration → Service Documents → service document → Instances → Configuration.

2 Complete the form; all entries are required if displayed: • Consent date is editable? Defaults to Set to Today, which enters

today’s date in the form as a read-only field. Change to Allow consent Date to be Set if a date should be manually entered

• Text area is: Select as desired for text areas 1-4. Selection controls how the service document displays the next field.

• Read Only displays a text area, labeled Verbiage for Text Area, that will be displayed in the document as read-only text and can be used for information and instruction. Text Field displays a label field, labeled Label for Text Area, that will be displayed in the document as a label for a text-entry field to capture client responses or staff notes. Do not Display hides the text field in configuration and in the service document

• Verbiage (or Label) for Text Area: Controlled by previous selection

• Display Text Area 5: Controls whether a fifth text area is displayed to enter a consent question

• Verbiage for Text Area 5: Controlled by previous selection

• Display Consent Answers: Controls whether the Yes and No answer text fields are displayed

• Answer 1 additional text: Text for Yes answer, controlled by previous selection

• Answer 2 additional text: Text for No answer, controlled by previous selection

• Include Guardian Name: Includes Guardian’s name on consent form if selected

• Include Relationship to Client: Includes Guardian’s relationship to client on consent form if selected

• Signatures appear on Service Document: Displays signatures if Yes is selected


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3 Click Submit.

Supervisor Groups • The Supervisory Group Admin module is used to set up and maintain Admin, Clinical, Group Approval Staff, and Incident To supervisor groups. • The Admin supervisor groups can be assigned to individual staff members in the Employee

module (see page 50 the Employee User Guide). • In addition to assigning the Clinical supervisor groups to individual staff members in the

Employee module (see page 50 the Employee User Guide), these groups are also used to filter the Next Staff to Sign drop-down list on the Signatures page of service documents (see page 190 the Clinical Record Guide).

• The Group Approval Staff consists of the staff members who will either approve or reject client referrals to groups. When referring a client to a group through the Group Referrals module in the ECR (see page 59 the Clinical Record Guide), the Group Approval Staff field contains only the staff members who are assigned to this supervisor group. The Group Approval Staff member also receives a Group Referral alert when the new group referral record is submitted (see page 13).


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• If you indicated that a staff member bills through a supervisor on the Employment Entry page (see page 51 the Employee User Guide) or if the Show Bill To Staff configuration is enabled (contact Qualifacts for assistance), the Incident To supervisor groups are used to filter the Bill To Staff drop-down list, which appears when marking the status of a scheduled activity (see page 35 the Scheduling Guide).

To access supervisor groups: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Supervisory Group Admin.

The Supervisory Group Search page appears. This page is used to access supervisor groups by entering search criteria. Note: You can enter as much search criteria as desired. The more criteria you enter, the more narrow the

search results will be. If you want to view all of the supervisor groups in the system, click Submit without entering any search criteria.

3 If you want to access the supervisor groups that were created on or after a certain date, enter the desired date in the Begin Date field.

4 If you want to access the supervisor groups that were created on or before a certain date, enter the desired date in the End Date field.

5 If you want to access a supervisor group by group type, use the drop-down list in the Group Type field to select an option. If you do not select a group type in this field, the search will consider all group types.

6 If you want to access a supervisor group by organization, use the drop-down list in the Organization field to select an option. This drop-down list includes only the organization you are currently logged into and all child organizations. If you do not select an organization in this field, the search will consider all organizations.

7 If you want to access a supervisor group by name, use the drop-down list in the Supervisory Group field to select an option. This drop-down list only includes the supervisor groups associated with the selected organization and all of its child organizations. If you do not select a group name in this field, the search will consider all of the supervisor group names that have been set up.

8 Click Submit in the status bar. The Supervisory Group list page appears, which contains all active and inactive supervisor groups that match your search criteria.


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This page is used to perform the following tasks: • Add New Supervisor Groups • Update Supervisor Groups • Update the Members in a Supervisor Group

Add New Supervisor Groups This task includes instructions for creating one of the following types of supervisor groups: Admin, Clinical, or Incident To. After creating the supervisor group record, you can select the staff members you want to assign to the group.

To add new supervisor groups: 1 Access the Supervisory Group list page (see Supervisor Groups). 2 Click Add New Group in the status bar.

The Supervisory Group Form page appears. All required fields are highlighted.

3 In the Begin Date field, enter the date the supervisor group becomes active in the system. This is the first date an Admin and Clinical supervisor group can be assigned to a staff member in the Employee module, the first date the Next Staff to Sign field on the Signature page of service documents is populated with the Clinical supervisor groups, and the first date the Bill To Staff field is populated with the Incident To supervisor groups.

4 If you want to define an end date for the supervisor group, enter the desired date in the End Date field. The end date is the last date an Admin and Clinical supervisor group can be assigned to a staff member in the Employee module, the last date the Next Staff to Sign field on the Signature page of service documents is populated with the Clinical supervisor groups, and the last date the Bill To Staff field is populated with the Incident To supervisor groups.

5 Use the drop-down list in the Group Type field to select the type of supervisor group you are creating. The options are Admin, Clinical, Group Approval Staff, and Incident To.

6 In the Name field, enter the name of the supervisor group. This is the name that will be used to identify the supervisor group throughout the application. This entry can be up to 50 characters.

7 The Organization field is used to select the organization of the supervisor group. This drop-down list includes only the organization you are currently logged into and all child organizations.

8 Click Submit in the status bar. The supervisor group record is saved and the Batch Group Member Entry page appears. You can add as many staff members as desired to the supervisor group.


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9 In the Begin Date column, enter the first date the staff member will become an active member of the supervisor group. The begin date you enter in this field cannot be earlier than the begin date of the supervisor group record.

10If you want to define the date the staff member will no longer be a part of the supervisor group, enter the desired date in the End Date column. The end date you enter in this field cannot be later than the end date of the supervisor group record.

11The Staff column is used to select the staff member you want to add to the selected supervisor group. In the text field, enter the full or partial name of the staff member and press the Tab key to filter the drop-down list. You can then use the drop-down list to select the desired staff member.

12The Day of the Week column is used to identify the days of the week the staff member will be a part of the supervisor group. You can select as many check boxes as desired.

13Click Submit in the status bar. The staff member assignment is saved and listed on the Group Members list page. To add additional staff members to the supervisor group, click Add Members in the status bar and repeat Steps 9 through 13.

Update Supervisor Groups This task is used to modify supervisor group records. See Update the Members in a Supervisor Group for instructions about updating the staff members assigned to the group.

To update supervisor groups: 1 Access the Supervisory Group list page (see Supervisor Groups). 2 Click the Select button that corresponds with the record you want to update.

The Supervisory Group Form appears. You can edit any of the fields on this page. See Add New Supervisor Groups for field descriptions.


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3 After making the desired edits, click Submit in the status bar. The supervisor group record is saved and listed on the Supervisory Group list page.

Update the Members in a Supervisor Group This task is used to modify the staff members who are currently a part of a supervisor group. See Update Supervisor Groups for instructions about updating the supervisor group record.

To update the members in a supervisor group: 1 Access the Supervisory Group list page (see Supervisor Groups). 2 Click the Members button that corresponds with the record you want to update.

The Group Membership list page appears for the selected supervisor group.

3 To update the date range and days of the week schedule for a current staff member, click the Select button.

The Days of the Week page appears for the selected staff member.

4 If you want to change the date the staff member becomes active in the supervisor group, enter the desired date in the Begin Date field. The begin date you enter in this field cannot be earlier than the begin date of the supervisor group record.

5 If you want to change the date the staff member will no longer be a part of the supervisor group, enter the desired date in the End Date column. The end date you enter in this field cannot be later than the end date of the supervisor group record.

6 The Day of the Week field identifies the days of the week the staff member will be a part of the supervisor group. If desired, you can select different days of the week by selecting the appropriate check boxes. You can select as many check boxes as desired.

7 To add new staff members to the supervisor group, click Add Members in the status bar.


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The Batch Group Member Entry page appears. See Add New Supervisor Groups for instructions for adding new staff members.

8 Click Submit in the status bar. The staff member assignments are updated.

Service Documents Service documents are made up of clinical modules, and, in some cases, clinical orders. CareLogic includes a large assortment of standard clinical modules (see page 165 the Clinical Record Guide). In addition to the standard clinical modules, you can use the Configurable Forms module to build the clinical modules that are specific to your organization (see Build Clinical Module Forms). A service document can consist of any number of clinical modules and clinical orders.

The process of setting up service documents involves several steps. Refer to the following outline as a guide.

Step 1Create Service Documents (described in this topic).

Step 2Create Links for Service Documents in the Menu Management System (see Add Menu Items).

Step 3Set Up Service Document Crosswalks, if you want to associate the service documents with activities (see Service Document Crosswalks).

Step 4Complete Clinical Modules Within Service Documents (see page 97 the Clinical Record Guide).

Step 5As an optional step, complete the Clinical Orders (see page 165 the Clinical Record Guide).

Important: Although clinical orders can be linked to a service document, it is important to understand that they are not a part of the service document. The orders that are created through service documents must be signed separately from the service document.

Step 6Maintain Service Documents (see page 181 the Clinical Record Guide).


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To access service documents: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Service Documents.

The Service Documents page appears.

The process of creating a service document involves completing the following tasks: • Add Service Documents • Add Instances to Service Documents • Add an Instance to Service Document Groups • Configure Service Documents • Add Signature Filters to Service Documents • Associate Service Documents with Organizations

Add Service Documents This task is used to create service document records. After the service document record is created, you must add an instance to the service document (see Add Instances to Service Documents) before it can be used. Service Documents can be created outside of the ECR and do not have to be related to a client.

To add service documents: 1 Access the Service Documents page (see Service Documents). 2 Click the Add Service Document button in the status bar.

The Service Document Data Entry page appears. As indicated by the field highlights, Code, Description, and Document Type fields are required.


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3 In the Code field, enter a code for the service document. This entry can be up to 10 characters.

4 In the Description field, enter the name of the service document. Once this service document is created, it will be listed in the Clinical Record under this name. The name of the service document can be up to 95 characters.

1. 5 Use the Document Type field to determine access methods for the document. Type selections are Staff, Client and Organization. Staff documents contain information about individual staff members. Client documents contain information about individual clients. Organization documents contain information not related to individual clients or staff members.

6 Indicate if the service document can be created in the client’s ECR or not. Note: This field only appears if your organization has this configuration turned on. See an administrator

or QSI Support for more information on this configuration. If you select No in this field, the Add a Service Document button will not be available in the Service Document List screen. Service documents not directly related to a client will be available outside of the ECR. Users will be able to search for service documents by Client, Organization, Staff and Service Date Range. Staff and organization service documents can be accessed in non-ECR menus through menu links added in Menu Management. Client types will only be available in ECR menus; Staff types will only be available in Employee menus; Organization types will be available in all other menus.

7 Indicate if this is a Service Document Group or not. Note: If you select Yes in this field, when you click Submit, you will be taken to the Service Document

Group Instance Entry page (see Add an Instance to Service Document Groups).

8 Click Submit in the status bar. The service document record is saved and listed on the Service Documents page.

Add Instances to Service Documents After the service document record is created (see Add Service Documents), you must create an instance for it. An instance defines the begin date, specifies the clinical modules, and identifies the signature requirements for the service document.

To add instances to service documents: 1 Access the Service Documents page (see Service Documents).

2 Click the Instance button that corresponds with the service document to which you want to add an instance.

3 The Instances page appears for the selected service document.


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4 Click the Add Instance button in the status bar. The Service Document Instance Entry page appears.

5 In the Begin Date field, enter the first date the service document will be available for

use in the system. This entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

6 The Enable Signature Fields checkbox is selected by default. Deselecting it removes the Signature Information section from the page and limits your ability to set signature requirements on your service document.

General section: 7 If your system is configured to use Service Document Trending, select the Enable

Progress Trending Chart checkbox to display the Progress Trending Chart Questionnaire section. 8 By default, the Orders module is not enabled for service documents, which means you

cannot create an order through a service document. If you want the ability to create orders through a service document, select Yes in the Enable Orders Option field. Once this option is enabled, the Orders module appears in the service document (see page 185 the Clinical Record Guide).


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9 By default, the Session Information section at the top of the service document will not display the payer name, procedure code, and units. If you want to display this information in the service document, select Yes in the Show Primary Professional Claim Payer Procedure and Units in Session Information field. Once this option is enabled, the Session Information section of the service document displays the Payer, Procedure, and Units.

Note: The payer, procedure, and units information will only be added to primary Professional claims. For all other types of claims, secondary Professional and Institutional, the Session Information section of the service document will not display the payer, procedure, and units.

10By default, a scheduled service cannot be created from a service document. However, if your organization wants the ability to create scheduled services from service documents, select Yes in the Schedule a Service as Part of This Document field. Once this option is enabled, the Schedule form appears in the service document (see page 187 the Clinical Record Guide).

11If you selected Yes in the previous field, indicate where you want the Schedule form to appear in the service document. The options are at the top or bottom of the service document.

12Program Selection in a service document allows the service document to be associated with a program when it is completed separately from activity documentation. This is important if the service document should be included in state reporting, and may be useful in other situations.

Note: The Edit Session Information link in a service document will only be displayed if the program selection is required and the service document is not attached to an activity. The program selection validation is done in the signature module. Refer to Add Instances to Service Documents.

Signature Information section: 13In the Number of Staff Signatures field, enter the maximum number of staff

signatures that are allowed on the service document. If the service document does not require staff signatures, enter 0.

14In the Minimum Number of Required Staff Signatures field, enter the minimum number of staff signatures that are required for the service document. For example, if a staff member and a supervisor are required to electronically sign a service document, enter 2.

15In the Next Staff to Sign field, indicate if the Next Staff to Sign field should only allow users to select one staff member at a time or if they can select multiple staff members to sign until the minimum number of staff members has been selected (based on the number you entered in the Minimum Number of Required Staff Signatures field).

16In the Number of External Signatures field, enter the number of external signatures required for the service document. External signatures can include client and guarantor signatures. If the service document is set up for external signatures, the External Signature fields appear in the service document (see page 190 the Clinical Record Guide) as an optional field.

17In the Can only the Staff Who Creates the Document Sign It? field, indicate whether the service document can be signed only by the staff member who created it.

18By default, the service document automatically includes the standard signature module. If you want to use a custom signature module instead of the standard signature module, select Yes in the Use Custom Signature Module field and then use the drop-down lists below to select the desired custom signature module.

Note: All custom signature modules must be developed by Qualifacts Systems.

19In the Enable Complete/Incomplete option field, indicate whether the service document can be marked as Complete or Incomplete prior to the staff member signing the document.


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Note: This field only appears if your system is configured to use the Sign service Document as incomplete functionality.

20In the Require Delete Unsigned Documents Privilege field, indicate whether the service document can be deleted without privileges if it is unsigned. Selecting No allows deletion without privileges; selecting Yes will only allow those with the appropriate permissions to delete an unsigned service document.

21By default, once a multi-page service document is signed, it is locked and cannot be modified by anyone, including the supervisor of the staff member who signed. If you want to give supervisors the ability to accept or reject signed service documents, select Yes in the Enable Accept/Reject Option field. Once this option is enabled, an accept/reject Signatures module is added to the service document (see 191 and 192 the Clinical Record Guide).

22The Require Incident/Bill to Signature field is used to indicate if this service document requires incident/bill to staff members to approve and sign service documents completed by the original service provider.

Note: This field only appears if your system is configured to use the Incident/Bill To functionality.

23If you selected the Enable Progress Trending Chart checkbox, you have the option to add 3 questions and a rating scale to your service document in the Progress Trending Chart Questionnaire section. Complete the following fields to set up your questionnaire.

• Enter up to 3 questions that you want the client to rate on a likert scale (for example, 1-10). Each question may be up to 200 characters.

• Enter the lowest number in your likert scale in the Answer Low Range field.

• Enter the highest number in your likert scale in the Answer High Range field.

Note: The Service Document Trending questions and rating scale appear on the signatures page of your service document.

Note: The remainder of the page is used to select the clinical modules that you want to appear in the service document. All of the standard clinical modules are documented in page 129 the Clinical Record Guide. While you can include as many clinical modules in the service document as desired, you can only add up to 10 clinical modules at a time. For example, suppose you want to include 15 clinical modules in a service document. The first step is to select the first 10 clinical modules and then Submit the form. When you open the service document instance in edit mode, the form will include 10 additional drop-down lists that can be used to add up to 10 more clinical modules. The final step for you in this scenario is to select the five remaining clinical modules, which would create a total of 15 clinical modules for the service document.

24The Page Order column lists the order in which the clinical modules appear in the service document. The Modules column contains a drop-down list of all the standard clinical modules that are available in the system and all of the custom clinical modules you created through the Configurable Forms module (see Build Clinical Module Forms). For each page order number, use the drop-down list in the Modules column to select the desired clinical module. These two columns give you the ability to define which clinical modules you want to include in the service document and the order in which you want them to appear.

If you want to use the copy service document feature (see page 300 the Clinical Record Guide) on the service document, you must select the ‘Copy Service Document’ option in the Modules column. This feature allows you to copy information from a previous, unsigned service document of the same type. The copy service document feature only works if no service document pages have been submitted.


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Note: The document selection area will be replaced with an error message if a page in the open document has been submitted before selecting the Copy Service Document page.

Note: By default, the Remove column is empty. Once you Submit the record and then Select it for edit mode, a button with an X appears in this column. This button is used to delete individual clinical modules from the service document, if necessary.

25Click Submit in the status bar. The service document instance is saved and the clinical modules become part of the service document. Once the begin date arrives, the service document will be available for use. Important: After creating the service document, you must add the menu link through the Menu

Management System (see Add Menu Items). Once the menu link for the service document is added, the service document appears in the ECR.

Configure Service Documents Some modules can be customized when they are included in a service document. This section describes accessing the service document configurations. As each module’s configuration is different, configuration details are described in the setup for each module with this capability.

Note: Only certain modules can be configured. Modules that cannot be configured will not display a Configure button or be included in the configuration side menu.

Access a service document configuration: 1 Go to Administration → Service Documents. 2 Click the Instances button for the desired service document.

The instances for the selected service document will be displayed. Note: The service document must be instanced before the Configure option will be displayed. Refer to

Add Instances to Service Documents.

3 Click the Configure button on the desired instance. Each module that is configurable will be displayed in the side menu


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Note: The Configure button will only be displayed if at least one module included in the instance can be configured.

4 Select a module in the side menu. 5 Complete the configuration form according to organization needs and module

documentation.

Add an Instance to Service Document Groups After the service document group record is created (see Add Service Documents), you must create an instance for it. An instance defines the begin date and specifies the clinical modules.

To add instances to service document groups: 1 Access the Service Documents page (see Service Documents).

2 Click the Instance button that corresponds with the service document group to which you want to add an instance.

The Instances page appears for the selected service document. 3 Click the Add Instance button in the status bar.

The Service Document Group Instance Entry page appears.


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Note: This page can also be accessed when you add a service document and indicate it is a service document group (see Add Service Documents).

4 In the Begin Date field, enter the first date the service document will be available for use in the system. This entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 In the Number of Staff Signatures field, enter the maximum number of staff signatures that are allowed on the service document group. If the service document does not require staff signatures, enter 0.

6 In the Minimum Number of Required Staff Signatures field, enter the minimum number of staff signatures that are required for the service document. For example, if a staff member and a supervisor are required to electronically sign a service document, enter 2.

Note: The remainder of the page is used to select the service documents that you want to appear in the service document group. While you can include as many service documents in the service document group as desired, you can only add up to 11 service documents at a time. For example, suppose you want to include 15 service documents in a service document group. The first step is to select the first 10 service documents and then Submit the form. When you open the service document group instance in edit mode, the form will include 11 additional drop-down lists that can be used to add up to 11 more service documents. The final step for you in this scenario is to select the five remaining service documents, which would create a total of 15 service documents for the service document group. For each service document you select, you must enter the minimum number of documents that must be completed before the final staff gets an alert that the service document group needs to be signed off on. You can also set a maximum number of documents that can be added to the group.

Note: By default, the Remove column is empty. Once you Submit the record and then Select it for edit mode, a button with an X appears in this column. This button is used to delete individual clinical modules from the service document, if necessary.

7 Click Submit in the status bar. The service document group instance is saved and the clinical modules become part of the service document. Once the begin date arrives, the service document will be available for use.

Add Signature Filters to Service Documents After the service document instance record is created (see Add Instances to Service Documents), you can create a signature filter for it. A signature filter allows you set up credential-based signature requirements for the select instance of service document. These credential-based signature filters are tied to payer types or payer plans and must be set up to meet the requirements of the selected payer.

To add signature filters to service documents: 1 Access the Service Documents page (see Service Documents).


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2 Click the Signature Filter button that corresponds with the service document to which you want to add a signature filter.

The Service Document Signature Filters list page appears for the selected service document, displaying all active and inactive signature filters for the selected service document.

3 Click the Add Filter button in the status bar. The Service Document Signature Filter Entry page appears.

4 In the Filter Name field, name the signature filter you want to create. 5 In the Begin Date field, enter the date at which the signature filter becomes active in

the system. This entry must be the following format: mm/dd/yyyy.


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6 If you want to enter an end date for the signature filter record, enter the desired date in the End Date field. This is the last date that the signature filter will be used to validate signatures on the selected service document.

Important: Signature filters are associated with payer types or payer plans, and one of these fields must be entered to complete the form.

7 The Active Payer(s) Payer Type(s) field is used to select the payer type for client’s payer(s). In the text field, enter the full or partial name of the payer type and press the Tab key to filter the drop-down list. You can then use the drop-down list to select the desired payer type. After selecting the appropriate payer type, click Add.

8 The Active Payer Plan(s) field is used to associate the signature filter with the desired payer plan(s). The first drop-down list can be used to select a payer, which then filters the second drop-down list to display only the payer plans set up in your system for the selected payer. Select the desired payer plan, and click Add.

The selected payer plan appears in the list, which means it will be used for the created signature filter. 9 In the Payer Type or Plan must be primary? field, indicate if the payer or payer plan

(depending on which field you entered) must be the primary payer/payer plan for the signature filter to apply in the service document.

10The Filter Second Signature field to include only staff with at least one of these Credentials field is used to set the credential-based requirements for the second signature on the service document. In the text field, enter the full or partial name of the desired credential and press the Tab key to filter the drop-down list. You can then use the drop-down list to select the desired credential requirement. After selecting the appropriate credential, click Add.

11The Filter Third Signature field to include only staff with at least one of these Credentials field is used to set the credential-based requirements for the second signature on the service document. In the text field, enter the full or partial name of the desired credential and press the Tab key to filter the drop-down list. You can then use the drop-down list to select the desired credential requirement. After selecting the appropriate credential, click Add.

12The Filter Fourth Signature field to include only staff with at least one of these Credentials field is used to set the credential-based requirements for the second signature on the service document. In the text field, enter the full or partial name of the desired credential and press the Tab key to filter the drop-down list. You can then use the drop-down list to select the desired credential requirement. After selecting the appropriate credential, click Add.

13Click Submit in the status bar. The signature filter is saved to the system and listed on the Service Document Signature Filters list page.

Associate Service Documents with Organizations When a new service document is created (see Add Service Documents), they are only available at the organization of the staff member who added them. This task includes instructions for making service documents available to child organizations.

To associate service documents with organizations: 1 Access the Service Documents page (see Service Documents). 2 Locate the service document you want to associate with organizations and click the

Organization button. The Organization List page appears for the selected service document. This list includes the organization you are currently logged into and all its child organizations.


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Note: When the button appears in the Included column, the service document is associated with the organization. When the button appears in the Excluded column, the service document is not associated with the organization.

3 To associate the selected service document with an organization, click the Excluded button.

The page is refreshed and the button is moved to the Included column, which means the service document is available to the selected organization. You can associate the service document with as many organizations as desired. Note: To associate the selected service documents with all organizations, click the Include All button in

the status bar. To exclude the selected service document from all organizations, click the Exclude All button.

4 Click Submit in the status bar. The service document organization matrix record is saved.

Configurable Forms By default, CareLogic includes a wide variety of clinical modules (see page 121 the Clinical Record Guide) that can be used to capture and report on a client’s diagnosis and treatment progression. Each of these clinical modules can be used to build service documents (see Add Service Documents). If your organization needs additional clinical modules, you can use the Configurable Forms module to create them.

The Configurable Forms module gives your organization the ability to create clinical modules that can be incorporated into service documents. As you build service documents, you can include both the standard clinical modules as well as the clinical modules created through the Configurable Forms module. The flexibility offered by the Configurable Forms module ensures that you can build the service documents that meet the specific needs of your organization.

This chapter includes the following topics: Build Clinical Module Forms Previewing Clinical Module Forms Editing Clinical Module Forms Copying Clinical Module Forms Deleting Clinical Module Forms

Build Clinical Module Forms


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This section includes instructions for creating clinical module forms. Once a clinical module form is created and deployed (as described in this section), it appears in the Modules drop-down list on the service document Instance Entry page (see Add Instances to Service Documents). At this point, the clinical module form can be used to build service documents (see Service Documents).

To build clinical module forms: 1. Navigate to Administration > Show Menu > Configurable Forms.

The Configurable Forms list page appears. This page lists all of the clinical module forms that have been created. Once a clinical module form has been deployed, it cannot be updated or deleted.

2. Click New Form. The Form Entry **New** screen appears.

1. In the Form Name field, enter the name of the new form. 2. From the Template drop-down, select the desired template. 3. In the Is This A Template? section, mark the Yes or No radio button.

4. Important: Service documents that include randomized configurable forms will always display the form link in the service document wizard. However, if the client was not randomly selected for the configurable form to be completed, a message appears notifying the staff that the client was not selected to view this form. Please submit and move on to the next page in the service document wizard.

6. Configurable Forms can be set to enforce completion of required fields. The Enforce Validation on Signature field controls whether required fields in the form must be completed in any service document containing it. Selecting No will allow the form to be bypassed, which will allow the service document to be submitted without any entries in the configurable form module. Selecting Yes will not allow the service document to be signed unless required fields in the configurable form module are completed.


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Note: The Configurable Form must have validation enabled during form creation. Any deployed Configurable Form which does not have validation enforced must be rebuilt and redeployed to enable validation enforcement.

7. By default, all configurable forms that are included in service documents appear in that service document for every client. In the Randomly show this form? field, indicate if you only want this configurable to appear randomly in service documents.

8. If you indicated you want this configurable form to appear randomly in service documents, enter the percentage of service documents you want to include it in the Sample Pool % field.

Note: CareLogic will dynamically display the configurable form in service documents based on the percentage you enter.

9. Click Submit in the status bar.

The data is saved, the Configurable Forms wizard is refreshed, and the Form Design screen appears. This screen is used to define the fields that will appear on the clinical module form. All required fields are highlighted.

5. By default, the Number of Fields field displays the number of fields that are defined in the template you selected. If desired, you can modify the number of fields that appear on the clinical module form you are creating by selecting a different value in the drop-down list. The maximum number of fields allowed on a clinical module form is 100.

6. Note: If you change the number of fields on this page, you must click Submit in the status bar to refresh the page. Once you do this, the corresponding number of fields appear on this page. For example, if you select 15 in the Number of Fields field and click Submit, this page displays Fields 1 through 15.

2. The Field Copy Feature section is used to copy the attributes of an existing field in another clinical module form to the clinical module form you are creating. If you do not want to copy a field into the clinical module form you are creating, ignore this step. If you want to copy a field into the form you are creating, you must complete the following steps.

• The Copy From Form.Field field is used to select the field in an existing form that you want to copy. In the text entry field, enter the full or partial name of the field you want to copy and press Tab. The drop-down list is filtered based on your search criteria.

Note: The format of the options in the drop-down list is ‘form.field’. For example, if you want to copy the field ‘Client Name’ in the clinical form ‘Adult Progress Note’, you would select ‘Adult Progress Note.Client_Name’.

• From the Copy To Field drop-down,select the field number in the current form that you want to copy the existing field to.

3. Click Submit in the status bar to refresh the page. The field you copied appears in the field position you defined.


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4. For each Field Number section listed on this page, enter the following information. • In the Field Label field, enter the field label as you want it to appear on

the clinical module form. The field label can be up to 100 characters.

• In the Field Type field, use the drop-down list to select the type of field you want to create. The following field types are available.

• Activity Counter. Select this option to include a read-only field which displays the total number of sessions the client attended between the date of intake and the service document date. When you select this field type, you must select the desired activity classifications on the Field Code page. Once the service document is deployed, all of the activities associated with the selected activity classifications will be displayed in the Activity Counter field.

• Address. Select this option to add the Address fields to the clinical module form. When you deploy the form, the following address fields will be included: Country, Street 1, Street 2, Apt/Suite, City, State/Province, Postal Code, Zip, and County.

• Check Box. Select this option to create a field with check box options. If you select this field type, you must define the options that appear for each check box in the Enter Answers field on the Field Code page.

• Date. Select this option to create a Date field. When the clinical module form is deployed, a Calendar icon appears beside the Date field.

Note: By default, all of the Date fields that appear on clinical modules that were created through the Configurable Forms module are blank.

• Date Time. Select this option to create a Date and Time field. When the clinical module form is deployed, a Calendar icon appears beside the Date field, and radio buttons for AM and PM appear beside the Time field.

• Descriptor Check Box. Select this option to create a check box field that contains values based on a List Modifier record. If you select this field type, you must select a List Modifier record in the Type field on the Field Code page. When the clinical module form is deployed, each check box will contain a List Modifier descriptor value.

• Descriptor Drop-Down. Select this option to create a drop-down list field that contains values based on a List Modifier record. If you select this field type, you must select a List Modifier record in the Type field on the Field Code page. When the clinical module form is deployed, the drop-down list will include all of the descriptor values that are set up in the List Modifier record you selected.

• Drop-Down. Select this option to create a drop-down list. If you select this field type, you must define the options that appear in the drop-down list in the Enter Answers field on the Field Code page.


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• Form Break. Select this option to insert a section break in the clinical module form. If you select a form break, you must enter the name of the form break in the Break Label field on the Field Code page.

• Gender. Select this option to add a Gender field to the form. When this form is deployed, the Gender field contains the following two radio buttons: Male and Female.

• Phone. Select this option to add a phone number field to the form. When this form is deployed, the Phone Number field allows users to enter an area code, a telephone number, and up to a 5-digit extension.

• Program Drop-Down. Select this option to add a Program drop-down list field to the form. This drop-down list will include all of the programs that have been set up for the current organization and all of its child organizations.

• Radio Button. Select this option to create a field with radio button options. If you select this field type, you must define the values that appear for each radio button in the Enter Answers field on the Field Code page.

• Ready-Only Text. Select this option to enter read-only text on the form. This entry can be up to 4,000 characters.

• Referral Source Drop-Down. Select this option to add a Referral Source drop-down list field to the form. This drop-down list will include all of the referral sources that have been set up for the current organization and all of its child organizations.

• SSN. Select this option to add a Social Security Number field to the form. Once this form is deployed, the system automatically validates the format of the SSN field each time the form is submitted by users.

• Staff Drop-Down. Select this option to add a Staff drop-down list field to the form.

• Text Area. Select this option to create a text area field, which is used for large blocks of text. When the clinical module form is deployed, the text area will appear with a scroll bar. The maximum length for text areas is 1,000 characters.

• Text Field. Select this option to create a text entry field. When the clinical module form is deployed, the text field will appear as a single line. The maximum length for text fields is 30 characters.

• Time. Select this option to add a Time field to the form. Once this form is deployed, the Time field contains radio buttons for AM and PM.

• Yes or No. Select this option to create a Yes/No field with radio buttons.

5. In the Required Field field, indicate if the field is required. If the field is required, users must either enter or select a value in order to submit the form. If the field is not required, the form can be submitted without entering or selecting a value in the field.


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6. In the Field Position field, enter the position number in which the field will appear on the clinical module form you are creating. By default, the fields are listed in the order in which they were set up in the template you selected in Step 6. If desired, you can change the field position numbers to meet the needs of your organization. When entering field position numbers, you can also use decimals.

Tip: The use of decimals is helpful when you want to add a field after you have already set up and defined the field positions on the form. For example, suppose you set up a form that contains 15 fields, and then you realize you need to add a 16th field and you want it to appear in the second field position. In this scenario, you can add the new field and assign the field position as 1.5. By using a decimal in this scenario, you will not have to manually change the field positions of the remaining 14 fields.

7. Click Submit. The data is saved, the Configurable Forms wizard is refreshed, and the Field Code page appears. This page is used to define the attributes for each field that will appear on the clinical module form. All required fields are highlighted.

Note: If you selected Text Area or Text Field in the Form Design screen, click here. 1. By default, the Select Field field is set to ‘Navigate Code in Sequence,’ which

means you can set up the field attributes according to the field position numbers you defined in Step 10.d. When this field is set to ‘Navigate Code in Sequence’, the field that was designated as position 1 is displayed by default. After you complete this form and click Submit, the field designated as position 2 appears. This process continues until you set up each field. If desired, you can use the drop-down list in the Select Field to select a specific field. This allows you to set up the field attributes in the order you choose.

Note: The remaining fields on this page are determined by the type of field that is currently selected in the Select Field drop-down list. Depending on the type of field that is currently selected, the following fields may appear.

• The Field Name is a system-generated label that mirrors the name of the Field Label. This field should not be modified.

• The Field Label that was entered in Step 10.a. appears in this field. If desired, you can edit the field label here.

• Break Label. When setting up form breaks, the Field Label changes to Break Label. Enter the text that you want to appear in the Form Break on the clinical module form. The break label can be up to 100 characters.


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• Field Description. This field is used to enter notes or instructions about the field. The text you enter in this field appears on the clinical module form. This entry can be up to 450 characters. See the ‘Check Box Field’ on the form preview (page 245) for an example field description.The Required field contains the value that you selected in Step 10.c. If desired, you can modify this field here.

• The Activity Classification field is used in conjunction with the Activity Counter field type (see Step 10.b). This field lists all of the activity classification options that are available on the Activity Entry page (see Adding Activity Codes). You must specify which activity classifications should be used by the activity counter by selecting the desired check boxes. The activity classifications you select will determine which activities will be counted. Once the service document is deployed, it will contain an Activity Counter field displaying the number of sessions the client has attended between the date of intake and the document date.

• Enable Copy Forward. This field allows you to designate which fields will be copied forward when the service document is set up to allow the copy forward feature (see page 300 the Clinical Record Guide). By default, this field is set to No. Select Yes for each field you want to copy forward.

• Enter Answers. This section is used to populate the options that appear in non-descriptor drop-down lists, check boxes, and radio buttons. Use the following process to enter answers.

Note: Special characters such as $%^*! can be entered in the Answers field.

• In the text entry field, type the answer as you want it to appear on the clinical module form and press Tab.

The answer appears in the drop-down list. • Click the Add button.

The answer appears in the list, which means it will be an answer for the selected field.

• Type. This field appears for descriptor check boxes and drop-downs. You must use the drop-down list to select the descriptor values you want to use for the check box options or drop-down lists. All of the descriptor values in this field are set up in the List Modifier (see Setting Up the List Modifier).

2. Click Submit in the status bar. The data is saved, the Configurable Forms wizard is refreshed, and the Business Rules screen appears.

7. Click Add a Business Rule. The Conditions and Actions screen appears.


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8. Select Conditions. 1. From the Field drop-down, select the desired field. 2. From the Comparison drop-down, select the desired comparison (Exactly Matches, Does Not Match,

Like, Is Null, or Is Not Null. 3. In the Value field, enter the desired value.

9. Select Actions. 1. From the Action drop-down, select the desired action (Do Not Allow, Hide, or Require). 2. From the Field drop-down, select the desired field. 3. From the Value drop-down, select the desired value.

10. Click Submit. The business rule you just created is listed in the Business Rules screen.

The data is saved, the Configurable Forms wizard is refreshed, and the Deploy Form page appears. Important: Before deploying a clinical module form, it is recommended that you preview it to verify it

was created as intended (see Previewing Clinical Module Forms).

Note: The name of the clinical module form is displayed in the Form Name field. This field cannot be modified because it is in view-only mode. If you want to modify the name of the clinical module form, you must do so on the Form Entry page (see Step 4).


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17If you want to preview the form before deploying it (see Previewing Clinical Module Forms), click No in the Deploy This Form field. If the clinical module form is ready to be deployed, select Yes. Once this form is deployed, it cannot be updated or deleted.

Important: The clinical module form must be deployed before it can be incorporated into service documents.

18Click Submit in the status bar. The clinical module form is saved and listed on the Configurable Forms list page.

• If the form was not deployed, the Select and Delete buttons appear.

• If the form was deployed, the Select and Delete button are not available because you cannot update or delete a form after it has been deployed. Once the form is deployed, the name of the clinical module form appears in the drop-down list on the service document Instance Entry page (see Add Instances to Service Documents). At this point, you can use the clinical module to build service documents (see Setting Up Service Documents).

Previewing Clinical Module Forms Before deploying a clinical module form to be used in a service document, it is recommended that you preview it to verify it was created as intended. When previewing clinical module forms, the system allows you to test the form with existing client data.

To preview clinical module forms: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Configurable Forms.

The Configurable Forms list page appears.

3 Locate the clinical module form you want to preview and click the Select button. The Configurable Forms wizard opens, displaying the Form Entry page.

4 In the Configurable Forms Wizard, click the Deploy Form link. The Deploy Form page appears.


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5 Click Preview Form in the status bar. The page is refreshed and the clinical module form is displayed exactly as it will appear when used in a service document. If the form displays correctly, it is ready to be deployed. The following example is based on the All Fields template; it shows all of the 16 different field types. Notice that the Check Box Field contains a field description and the Address and SSN fields are required.

Editing Clinical Module Forms Once a clinical module form has been deployed for use in a service document (see Setting Up Service Documents), it cannot be updated. You can only edit the clinical module forms that have not been deployed.

To edit clinical module forms: 1 Click Administration in the navigation bar.



3 Locate the clinical module form you want to update and click the Select button.


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The Configurable Forms wizard opens. You can edit any of the fields in this wizard. See Build Clinical Module Forms for field descriptions. Warning: If you modify the number of fields that appear on a clinical module form (through the Form

Design link), the fields are automatically added or removed from the bottom of the page. The system does not remove the fields according to their field position number. For example, suppose a form contains 11 fields, and their field positions appear in the following order: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 1.5. In this scenario, if you update the number of fields on the form to only include 10 fields, the field labeled with position 1.5 would be removed instead of the field labeled with position 10. This is because the field labeled with position 1.5 was the last field added to the form.

4 After making the desired edits, click Submit in the status bar. The clinical module form is saved and listed on the Configurable Forms list page. At this point, you should preview the form (see Previewing Clinical Module Forms) and review the edits.

Copying Clinical Module Forms Once a clinical module form is created, it can be copied to create a new form. When you use the Copy feature, the original form remains unchanged and a new form is created. After the new form is created, you can modify it to meet your needs. A form can be copied at any point, regardless if it has been deployed or not.

To copy clinical module forms: 1 Click Administration in the navigation bar.



3 Locate the clinical module form you want to copy and click the Copy button. The Configurable Forms list page is refreshed to display the newly-created clinical module form. By default, the system names the new form the same as the copied form, followed by the word ‘Copy’. For example, if you copy the ‘Adult Progress Note’ clinical module form, the system names the new form ‘Adult Progress Note *Copy*’. Once the new form is created, you can modify any of the fields in the wizard to meet your specific needs. See Build Clinical Module Forms for field descriptions.

Deleting Clinical Module Forms Once a clinical module form has been deployed for use in a service document (see Setting Up Service Documents), it cannot be deleted. You can only delete the clinical module forms that have not been deployed.

To delete clinical module forms: 1 Click Administration in the navigation bar.


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3 Locate the clinical module form you want to delete and click the Delete button. A delete confirmation page appears.


The selected clinical module form is deleted and cannot be used in service documents.

Service Document Crosswalks A service document crosswalk defines what service documents are required for a scheduled activity. Each time an activity is marked as Kept in the Schedule module, the system checks to see if a service document is required. If a service document is required, the activity cannot be billed until the service document is completed and signed.

To access service document crosswalks: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Service Doc Crosswalk.

The Service Document Crosswalk page appears. This page lists all of the service document crosswalks that are set up in the system. At the bottom of the page, all of the inactive service document crosswalks are listed. Service document crosswalks with an end date that meets or exceeds the current system date are classified as inactive. Note: If multiple crosswalk records contain the same dates for program, activity, and credential, the

Schedule module lists all of the service documents when the activity is marked as Kept. At this point, staff members must select the particular service document that is most appropriate for the activity.

This page is used to perform the following tasks: • Add Service Document Crosswalks • Update Service Document Crosswalks


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• Delete Service Document Crosswalks

Add Service Document Crosswalks This task is used to add service document crosswalk records.

Important: A service document crosswalk record must be created for all of the activities that are set up in the Activities module (see Setting Up Activity Codes). Even if an activity does not require a service document, a service document crosswalk record must be created to map the activity to the service document, ‘None - No Service Documentation’.

Note: Once a service document crosswalk is added to the system, you can use the Select button on the Service Document Crosswalk page to update it (see page 175).

To add service document crosswalks: 1 Access the Service Document Crosswalk page (see Service Document Crosswalks). 2 Click the Add a Service Document button.

The Service Document Crosswalk Entry page appears. All required fields are highlighted.

3 In the Begin Date field, enter the date the service document crosswalk becomes active. This is the first date the service document will be required for the scheduled activity selected in Step 6. This entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

4 If the service document crosswalk is to be active for a defined date range only, enter the end date in the End Date field. This is the last date the service document crosswalk can be used in the system. If the service document crosswalk is to remain active indefinitely, leave this field blank.

5 From the Organization drop-down, select the desired organization to assign to the service document crosswalk mapping.

Note: All current service document crosswalk mappings will automatically be assigned to the highest-level organization. All child organizations will inherit these mappings. The administrator will be able to modify the pre-existing crosswalks by entering the Service Document Crosswalk module, selecting a mapping, and then selecting a different organization via the drop-down .

When setting up a new service document crosswalk, the user must assign an organization to the mapping.


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6 The Program field is used to restrict this service document crosswalk record to a specific treatment program.

• If the activity selected in Step 6 is scheduled with this program, then this service document crosswalk record is used.

• If the activity selected in Step 6 is scheduled with another program, then another service document crosswalk record is used.

7 The Activity field contains a list of all the activity codes set up in the Activities module(see page 49). In order to schedule an activity as a service, you must create a service document crosswalk record for it. Use the drop-down list to select the activity upon which this crosswalk record is based.

• If this scheduled activity meets all of the requirements in this crosswalk record (date range, program, licensure, and age range), then this crosswalk record is used.

• If this scheduled activity fails to meet even one of the requirements in this crosswalk record (date range, program, licensure, and age range), then another service document crosswalk record is used.

8 The Licensure field is used to restrict this service document crosswalk record to a specific staff licensure.

• If the scheduled activity (Step 6) is delivered by a staff member with this licensure, then this service document crosswalk record is used.

• If the scheduled activity (Step 6) is delivered by a staff member with another licensure, then another service document crosswalk record is used.

9 In the Service Document field, use the drop-down list to select the service document you want to use for this service document crosswalk record. You must select an entry in this field. If the scheduled activity (Step 6) does not require a service document, then select ‘None - No Documentation Required’ in this field. This field only includes the service documents that were setup for the current organization and all child organizations.

10 The Age Range field is used to restrict this crosswalk record to clients in a specific age range.

• If the scheduled activity (Step 6) is delivered to a client within this age range, then this service document crosswalk record is used.

• If the scheduled activity (Step 6) is delivered to a client outside of this age range, then another service document crosswalk record is used.

Important: The following two fields (Collective or Staff Documentation and Copy Collective to Individual) are used for collective documentation. See Business Scenarios for Collective Documentation for a description of the collective documentation business scenarios supported by CareLogic.

11 In the Collective or Staff Documentation field, indicate if the selected service document will be used to provide collective documentation for a group activity. Collective documentation applies to all clients within the group. For example, you could use collective documentation to describe the same intervention for all members within the group.

12 If this crosswalk record will be used for collective documentation (as indicated in the previous field), use the Copy Collective to Individual field to indicate if the collective service document should be copied down to the individual members in the group. If No is selected in the previous field, then No should always be selected in this field.


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13 In the Determine Service Documents field, indicate if you want the system to determine the correct service document for scheduled activities with a service document error. If you select Yes in this field, the system determines the correct service document, based on date range, when you encounter a service document error for a scheduled activity.

14 Click Submit in the status bar. The new service document crosswalk is saved and listed on the Service Document Crosswalk page.

Business Scenarios for Collective Documentation When creating service document crosswalk records for group activities, CareLogic supports the following four business scenarios for collective documentation.

1 For a group activity, create one document that applies to all clients in the group. This is a collective document. The content of the document applies to all members of the group, and any addenda apply to all members of the group. For this setup, select Yes in the Collective or Staff Documentation field and No in the Copy Collective to Individual field.

2 For a group activity, create individual documents for each client in the group. The documents will be created, completed, and signed for each client in the group. For this setup, select No in the Collective or Staff Documentation field and No in the Copy Collective to Individual field.

3 For a group activity, create one document that applies to all clients in the group and another document for each client. This scenario allows collective documentation for the group as well as client-specific documentation. For the collective document, follow the setup in Scenario 1. For the individual document, follow the setup in Scenario 2.

4 For a group activity, create a document that applies to all clients in the group. When the collective document is signed, copy the document to the individual clients. At the individual client level, complete any client-specific content in the same type of document. For this setup, select Yes in the Collective or Staff Documentation field and Yes in the Copy Collective to Individual field. For this scenario, the following workflow is required to complete the service document.

• Once the group activity is marked as Kept, a No-Add button appears in the SvcDoc column of the Schedule.

• A staff member must complete the collective portion of the service document and then sign it. The collective portion of the document applies to all of the clients within the group.

• At this point, a Yes-Signed button appears in the SvcDoc column of the Schedule for the group activity, and a Yes button appears in the SvcDoc column of the Schedule for each group member. This indicates that the collective service document has been successfully copied to each individual client within the group.

• The appropriate staff member must complete and sign the individual portion of each service document. The individual portion of the document, which is specific to each client, could include such information as the goals addressed.

• At this point, a Yes-Signed button appears in the SvcDoc column of the Schedule for each group member. This indicates that the collective service document is complete and ready to be processed by the nightly run of the Claim Engine.

The following table provides further explanation for the business scenarios described above.


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Business Need Collective/Staff Documentation

Field

Copy Collective to

Individual field

# of Crosswalk

Records

Steps to Complete Service Documentation

1 service document with content that applies only to the specific client.

No No 1 1. Schedule and keep the group activity. 2. Complete and sign the individual documentation. 3. Repeat Step 2 for each client. NOTE: Any information that is common across all clients must be re-entered for each client.

1 service document with content that applies to all clients in the group.

Yes No 1 1. Schedule and keep the group activity. 2. Complete and sign the collective documentation. NOTE: Client-specific information is not supported in this scenario.

1 service document with content that applies to all clients in the group.

1 service document with content that applies only to a specific client.

Yes No 2 1. Schedule and keep the group activity. 2. Complete and sign the collective documentation. 3. Complete and sign the individual documentation. 4. Repeat Step 3 for each client. NOTE: Any information that is common across all clients must be re-entered for each client.


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1 service document with content that applies to all clients in the group. 1 service document with content that applies only to a specific client, based on the content of the collective document.

Yes Yes 1 1. Schedule and keep the group activity. 2. Complete and sign the individual documentation. CareLogic copies the collective content to the individual client. 3. Add client-specific information to the individual documentation. 4. Sign the individual documentation. 5. Repeat Steps 3 and 4 for each client. NOTE: With the Copy Collective to Individual field set to Yes, any information from the collective document does not need to be re-entered.

Update Service Document Crosswalks After service document crosswalk records are added to the system, you must use this task to edit them.

To update service document crosswalks: 1 Access the Service Document Crosswalk page (see Service Document Crosswalks).

2 Click the Select button of the service document crosswalk record you want to update. The Service Document Crosswalk Entry page appears. You can edit any of the fields on this page. All required fields are highlighted. See Add Service Document Crosswalks for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated service document crosswalk record is saved and listed on the Service Document Crosswalk page.


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Delete Service Document Crosswalks This task includes instructions for deleting service document crosswalk records.

To delete service document crosswalks: 1 Access the Service Document Crosswalk page (see Service Document Crosswalks).

2 Click the Delete button of the service document crosswalk record you want to delete. The Delete Service Document Matrix Entry page appears.

3 Select Yes to confirm you want to delete the selected service document crosswalk record.

4 Click Submit in the status bar. The selected service document crosswalk record is deleted from the system.

Unsign Service Documents Once a service document is electronically signed by a staff member, it is locked in the system and cannot be modified. The Service Document Unsign module gives system administrators the ability to unsign service documents so they can be modified. This module is available to system administrators only.

Important: The process of unsigning a service document is a potential HIPAA violation. In order to monitor this process, CareLogic records all unsigning activity in the audit table.

To unsign service documents: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Service Document Unsign.

The Signed Document Search page appears. This page is used to access the service document you want to unsign.


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3 If you want to access a service document related to a particular client, use the Client field to select a client. The first field is used to access a client by entering search criteria, such as the client’s full or partial name, client ID number, social security number, or birth date. After entering the search criteria, press the Tab key or click off the field. The drop-down list in the second field is filtered based on your search criteria. Use the drop-down list to select a client.

Note: See the page 23 Introduction to CareLogic Guide for information about the search formats allowed.

4 If you want to access a service document that was created within a particular date range, enter the desired dates in the Document Date Range field. All date entries must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 If you want to access a service document that contains a particular clinical module, use the drop-down list in the Document Type field to select the desired module.

6 If you want to access a service document that was signed by a particular staff member, use the drop-down list in the Staff Name field to select the desired staff.

7 Click Submit in the status bar. The Signed Document List page appears, which lists all of the signed service documents that match your search criteria. For each service document, this page lists the client’s name, the service document name, the staff member who created the service document, the service date of the document, whether the whether the service document has been signed, and whether the activity related to the service document has been billed.

8 Click the Select button of the service document you want to unsign. The Unsign Document Form appears for the selected service document. The Document Information section lists general information about the service document, such as the client name, the staff member who created the service document, the service document name, the date of the related activity, the activity code related to the service document, and whether the activity is billed. The Signature History section provides a history of the document’s signature history. Each time the service document is either signed or unsigned, a new record is created in this section.


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Important: The process of unsigning a service document is a potential HIPAA violation. In order to monitor this process, CareLogic records all unsigning activity in the audit table.

9 In the Unsign This Document field, select Yes to indicate you want to unsigned the selected service document.

10In the Reason field, enter a description of the modifications that need to be made to the service document. This entry can be up to 1,000 characters. An entry in this field is required.

11In the Electronic Signature field, enter your electronic signature to unsign the service document. If you selected Yes in Step 8, an entry in this field is required.

12Click Submit in the status bar. An unsign confirmation page appears.

13Select Yes to confirm you want to unsign the selected service document. 14Click Submit in the status bar.

The following actions occur: • The selected service document is unsigned, which means it can be modified. • An alert is sent to all of the staff members who previously signed the service document,

indicating that it has been unsigned. This is an informational alert that appears in the My Alert module (see the page 12 Clinical Record Guide).

• A record of the unsign activity is written to the audit table. This unsign record will appear in the Signature History section of the service document, as shown below.


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Order Statuses The Order Status Admin module is used to set up and maintain all of the order statuses that will be used during the order workflow life cycle. After the order statuses are set up, you can incorporate them into the workflow life cycle of each order type (see Configuring Order Status Workflows).

To set up order statuses: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Order Status Admin.

The Order Status Records list page appears, which lists all of the active and inactive order statuses that are set up in the system. An order status is active if the current system date falls within the records date range. An order status is inactive if the current system date meets or exceeds the records end date.

3 Click Add an Order Status in the status bar. The Admin Order Status New Status Form appears. All required fields are highlighted.

4 In the Name field, enter the name of the status you want to add. This entry can be up to 50 characters.


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5 In the Begin Date field, enter the first date the status will be active in the system. This is the first date the status can be set up as part of an order type’s workflow life cycle (see Configuring Order Status Workflows).

6 If the status will be used for a particular date range only, you can enter an end date in the End Date field. If the status will be used indefinitely, leave this field blank.

7 Click Submit in the status bar. The status record is saved and listed on the Order Status Records list page. You should repeat this task until you have created an order status record for every phase of your order workflow life cycle. See Configuring Order Status Workflows for instructions about configuring an order workflow life cycle for each order type.

Clinical Orders The Orders Administration module is used to set up and configure clinical orders. For all of the clinical orders, you can define the order types, configure the order statuses, set up alerts, define the conditions for blockers and triggers, and set up privilege levels. For the billable orders, you can also configure the system to generate claims and set up order/procedure code mappings. The Orders Administration module enables you to configure the following types of orders:

• Medication • Lab (billable) • Automated Lab (electronic) • Radiology (billable) • Durable Medical Equipment (DME) (billable) • EKG (billable) • Admit • Consultation • Seclusion or Restraint • Transfer • Generic • Discharge • Dietary • Precaution • Activity Level • Rating Scale • Transportation

Note: Once the orders are configured, you can enter them into the system through the ECR module (see page 171 the Clinical Record Guide).

To access clinical orders: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Order Modules.

The Order Modules list page appears, which lists all of the order types that are available in the system.


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This page is used to perform the following tasks: • Configuring Orders to Generate Claims • Configuring Clinical Orders • Setting Up Order/Procedure Mappings • Defining Order Privilege Levels

Configuring Billable Orders Although there are a wide variety of orders in the system, only the following order types are billable: Lab, Radiology, Durable Medical Equipment (DME), and EKG. This section includes an outline of the steps required to configure the billable order types to generate claims. Once the billable order types are properly configured, the Claim Engine will process them in the same manner as scheduled services. After the order activities are converted to claims, they can be batched and sent out for billing.

Process to configure billable orders: Step 1Set Up Procedure Codes/Standard Fees (see Setting Up Procedure Codes).

Step 2Set Up Payer Plan Fee Matrices (see Setting Up a Payer Plan’s Fee Matrix).

Step 3Create Order Activity Codes (see Setting Up Activity Codes).

Step 4Create the Order Statuses That will be Used by All Order Types (see Setting Up Order Statuses).

Step 5Mark Each Order Type to Generate Claims (see Configuring Orders to Generate Claims).

Step 6Associate Each Order Type to an Activity (see Configuring Clinical Orders).

Step 7Define the Types Configuration for Each Order Type (see Configuring Order Types).

Step 8Define Additional Radiology Configurations (see Configuring Additional Options for Radiology Orders).

Step 9Define the Order Status Workflow for Each Order Type (see Configuring Order Status Workflows).


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Step 10Configure Alerts, Triggers, and Blockers Throughout the Order Status Workflow (Optional) (see Setting Up Order Status Alerts and Defining the Conditions for Order Status Blockers and Triggers).

Step 11Define an Order/Procedure Mapping Record for Each Order Type (see Setting Up Order/Procedure Mappings).

Step 12Define Order Privilege Levels for Each Order Type (see Defining Order Privilege Levels).

Step 13Enter the Orders into the System (see page 194 the Clinical Record Guide).

Step 14Set the Order to Its Finish State Status (see page 271 the Clinical Record Guide).

Configuring Orders to Generate Claims Although there are a wide variety of orders in the system, only the following order types are billable: Lab, Radiology, Durable Medical Equipment (DME), and EKG. This task can be used by system administrators to start and stop the claiming process for billable order types. Each time the claiming process is started or stopped, an administrator must issue their electronic signature. Once the billable order types are properly configured, the Claim Engine will process them in the same manner as scheduled services. In order for the system to generate claims, an order/procedure mapping must also be set up (see Setting Up Order/Procedure Mappings).

Note: If an order type is not billable, the Claim button does not appear on the Order Modules list page.

To configure orders to generate claims: 1 Access the Order Modules list page (see Setting Up Clinical Orders). 2 Click the Claim button that corresponds with the order type you want to configure to

create claims. The Claim History page appears. The top section of the page provides a claim history for the selected order type. Each time you complete and submit this page a new record is added to the Claim History section. In the following example, the selected order type is configured to generate claims.

3 Select Yes in the Create Claim field to indicate you want the system to generate claims for the selected order type.

4 Enter an e-signature in the Electronic Signature field. 5 Click Submit in the status bar.

The claim history record is saved and the Order Modules list page appears. The Create Claim column is updated to indicate if the order type will create claims.

Configuring Clinical Orders


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Before you can enter orders into the system through the ECR module (see page 172 the Clinical Record Guide), you must use this section to configure the order types. For each of the clinical orders, you can define the order types, configure the order statuses, set up alerts, and define the conditions for blockers and triggers.

Note: The following task includes instructions for adding configuration date range records. The process is the same regardless of the order type selected. After the configuration date range record is created, you can configure the types and statuses for each order type.

To add configuration date range records: 1 Access the Order Modules list page (see Setting Up Clinical Orders). 2 Click the Configuration button.

The Configuration History list page appears for the selected order type. 3 Click Add Configuration in the status bar.

The Configuration Date Range page appears for the selected order type. This page is used to define the active date range for the configuration record. There can be only one active configuration record for a given date range. A Begin Date is required on this page.

4 In the Begin Date field, enter the first date the configuration record becomes active in the system. The is the first date you can enter the selected order type into the system through the ECR module.

5 If this configuration record is to be active for a given date range only, enter the end date in the End Date field. If the configuration record is to remain active indefinitely, leave this field blank.

Note: If you are setting up a configuration record for a billable order, the Activity field appears on this page. You must select an option in this field in order to associate the order with an activity.

6 In the Activity field, use the drop-down list to associate the order with an activity. This drop-down list is filtered to include only the activities that have been set up for orders (see Setting Up Order/Procedure Mappings). Once the order is associated with an activity, the Claim Engine will be able to process it just like a scheduled service and generate a claim.

7 If you are configuring the Automated Lab Order, use the Lab Results Document field to select the service document that is set up to store the electronic lab results received.

8 Click Submit in the status bar. The configuration record is created and the Configuration Wizard appears in the left pane, with the Types option displayed by default.


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The Configuration Wizard is used to perform the following tasks: • Configuring Order Types • Associating Service Documents with Order Types • Configuring Order Status Workflows • Setting Up Order Status Alerts • Defining the Conditions for Order Status Blockers and Triggers • Configuring Additional Options for Radiology Orders • Configuring Additional Options for Consultation Orders • Configuring Additional Options for Precaution Orders • Configuring Additional Options for Transfer Orders • Configuring Additional Options for Activity Level Orders

Configuring Order Types Before you can enter orders into the system through the ECR module (see page 172), you must use this task to set up the Types configuration for each order type. Each order contains a unique set of user-defined Types configurations. The options that are set up in the Types configuration are used to populate the Order Type drop-down lists in the ECR module.

Note: In the following example, order types are set up for Lab orders. The process of entering order types is the same, regardless of the order type.

To configure order types: 1 Access the Configuration Wizard (see Setting Up Clinical Orders). 2 Click Types in the left pane.

The Lab Order Types list page appears for the selected order type.

3 Click Add Type in the status bar. The Lab Type Entry page appears for the selected order type.

4 In the Name field, enter the name of the lab order type you want to create. This entry can be up to 100 characters. The name you enter in this field is used to populate the Lab Test drop-down list on the Lab Order Form (see the Clinical Record Guide).

5 Click Submit in the status bar. The lab order type record is saved and listed on the Lab Types list page for the selected order.


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Note: You can enter as many order types as desired. To enter additional order types, repeat Steps 3 through 5.

Associating Service Documents with Order Types This task is used to associate a service document with an order type. If desired, you can use a service document as a blocker or trigger at any phase of the order status workflow life cycle (see Defining the Conditions for Order Status Blockers and Triggers). Once a service document is associated with an order, the document can be accessed directly through the order (see page 272 the Clinical Record Guide).

Note: In the following example, a service document is associated with a lab test. The process of associating a service document with an order type is the same regardless of the order type.

To associate service documents with order types: 1 Set up the Types configuration for a lab order the order type you want to associate

with a service document (see page 187) (see Configuring Order Types). 2 In the Configuration Wizard, click Types in the left pane.

The Lab Order Types list page appears for the selected order type.

3 Click the Documents button for the lab test order type you want to associate a service document with.

The Lab Order Types Document Setup page appears. This page allows you to associate up to 10 service documents with the selected order type.

4 To select a service document, enter the full or partial name of the service document in the first field and press the Tab key.

The drop-down list is filtered to include the service documents that match your search criteria. 5 Use the drop-down list to select the desired service document. 6 Click Submit in the status bar.

The service document is associated with the selected order type.


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Note: To associate additional service documents with an order type, repeat Steps 3 through 6.

Configuring Order Status Workflows For each type of order, you can use this task to define an order status workflow. Each workflow configuration requires a start and final state. Once the start state is defined for an order type, all orders of that type are automatically assigned that status when the order is created. The finish state status is used to indicate that billable orders are ready to generate claims.

For each workflow configuration, system administrators can also create state transitions, which allow a given status to change to a next status. A single status may have multiple next status records. By setting up the workflow statuses, you can define how orders move through their life cycle. Once the order status workflow is established, you can create alerts (see Setting Up Order Status Alerts) and define the conditions for blockers and triggers (see Defining the Conditions for Order Status Blockers and Triggers), as desired.

Important: Automated Lab Orders must use the following statuses: Final Reported, Partial Reported, and Transmitted.

To configure order status workflows: 1 Access the Configuration Wizard (see Configuring Clinical Orders). 2 Click Status in the left pane.

The Order Status page appears for the selected order type. The top section of the page is used to define a start and finish status for the order. The bottom section is used to establish an order status workflow.

3 With the exception of lab and medication orders, the Start State field is used to define the beginning state for all other order types. Use the drop-down list to select the start status that will be assigned to the order. Once the order is created, the system automatically assigns this status to it.

4 With the exception of lab and medication orders, the Finish State field is used to define the ending state for all other order types. Use the drop-down list to select the ending status that will be assigned to the order.

5 Click Submit in the status bar. The start and finish status values are saved for the selected order. With the exception of lab and medication orders, you must follow the remaining steps in this task to define the intermediate workflow statuses.

6 Click Add Status in the status bar. The Order Status Entry page appears. This page is used to define each progression in the order status workflow.


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7 By default, the Current Status field is populated with the status you selected as the start state (Step 3). Since you are creating the first workflow record, do not change this status.

8 In the Next Status field, use the drop-down list to select the next status the order can be changed to. When you select a status in this field, you are creating a rule that tells the system the status selected in the previous step can be changed to this status only.

Note: If desired, you can create multiple workflow status records with the same current status state and different next status states. For example, suppose you want to allow an order with the status of Created to be changed to either Waiting or Pending Consent. In order to do this, you would create two workflow status records: both of which would contain the current status of Created, and one with a next status of Waiting and the other with a next status of Pending Consent.

9 Click Submit in the status bar. The order status record is saved and listed on the Order Status List page. Note: The Select and Delete buttons will not be available for lab and medication orders because their

workflow transition records are predefined.

10Click Add Status in the status bar. The Order Status Entry page appears.

11In the Current Status field, use the drop-down list to select the beginning status for the next workflow record.

12In the Next Status field, use the drop-down list to select the next status the order can be changed to. When you select a status in this field, you are creating a rule that tells the system the status selected in the previous step can be changed to this status only.

13Click Submit in the status bar. The order status record is saved and listed on the Order Status List page. You can repeat this process to create as many workflow records are desired.


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Setting Up Order Status Alerts For each order status workflow record (see Configuring Order Status Workflows), you have the ability to set up alerts that will be sent to the Recorded By staff, Covered By staff, or Ordered By staff. The alert will be sent when the order status changes from one state to another, as defined in the order status workflow record.

Tip: Even though the order status workflow records are predefined for lab and medication orders, it is recommended that you set up an alert for each status transition.

To set up order status alerts: 1 Access the Configuration Wizard (see Configuring Clinical Orders). 2 Click Status in the left pane.

The Order Status page appears for the selected order type. In the Order Status List grid, the Number of Alerts column indicates the number of alerts that are currently set up for each of the order status workflow records.

3 Locate the order status workflow record you want to set up an alert for and click the Alerts button.

The Order Status Alert List page appears. 4 Click Add Alert in the status bar.

The Order Status Alert Form appears.


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5 In the Alert Narrative field, enter the text of the alert you want to send. This entry can be up to 30 characters.

6 The Send Alert To field is used to select the staff member the alert is sent to. The options are Recorded By staff, Covered By staff, and Ordered By staff. Once this alert is sent, it appears as an informational alert on the selected staff members Alerts page.

7 Click Submit in the status bar. The alert record is saved and listed on the Order Status Alert List page. If desired you can enter additional alerts for the selected order status workflow record.

8 After entering all the desired alerts, click Return in the status bar. The Order Status List page appears and the Number of Alerts column reflects the number of alert records set up for the selected workflow record.

Defining the Conditions for Order Status Blockers and Triggers This task is used to set up blocker and trigger conditions throughout the order status workflow life cycle. For each order status workflow record (see Configuring Order Status Workflows), you can set up as many blocker and trigger conditions as desired.

Blockers are conditions that prevent a state transition from occurring. When a blocker is created, the order status cannot be changed until the defined condition is met. For example, you could set up a blocker condition at a particular phase in the order workflow life cycle that requires a service document to be completed before the order status can be changed.

Triggers are actions that cause an automatic state transition. When a trigger is created, the order status is automatically changed when the defined condition is met. For example, you could set up a trigger condition at a particular phase in the order workflow life cycle that tells the system to change the order status once the Ordered By staff signs the order.

Tip: Even though the order status workflow records are predefined for lab and medication orders, you can set up blockers and triggers for them, as desired.

To define the conditions for order status blockers and triggers: 1 Access the Configuration Wizard (see Configuring Clinical Orders). 2 Click Status in the left pane.

The Order Status page appears for the selected order type. In the Order Status List grid, the Number of Triggers and Number of Blockers columns indicate the number of triggers and blockers that are currently set up for each of the order status workflow records.


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3 Locate the order status workflow record you want to set up blockers and triggers for, and click the Blockers/Triggers button.

The Order Status Blocker/Trigger List page appears. 4 Click Add Blocker/Trigger in the status bar.

The Order Status Blocker/Trigger Form appears.

5 In the Blocker/Trigger field, indicate whether you are creating a blocker or trigger record.

6 The Trigger Type field is used to select the condition that will be required to satisfy the blocker or trigger. The following conditions are available:

Staff Signature. Select this option if you want to set up a staff signature as a condition to block or trigger the selected status workflow record. When you select this option, the Signed Blocker/Trigger field appears, which is used to select the staff member that must sign the order in order to satisfy this blocker/trigger condition. The options are Recorded By staff, Covered By staff, and Ordered By staff.

Document. Select this option if you want to set up a service document as a condition to block or trigger the selected status workflow record. When you select this option, the Service Document Blocker/Trigger field appears. Use the drop-down list to select the service document that must be completed and signed in order to satisfy this blocker/trigger condition. This drop-down list is filtered to include only the service documents that have been associated with the selected order type (see Associating Service Documents with Order Types).

7 Click Submit in the status bar. The blocker or trigger record is saved and listed on the Order Status Blocker/Trigger List page. If desired you can enter additional blocker or trigger records for the selected order status workflow record.

8 After entering all the desired blockers or triggers, click Return in the status bar. The Order Status List page appears and the Number of Triggers and Number of Blockers columns reflect the number of records set up for the selected workflow record.


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Configuring Additional Options for Radiology Orders In addition to the Types configuration (see Configuring Order Types), Radiology orders require additional configuration set up for Sub-Types and Positions. The configuration options that are set up in this task are available in the drop-down lists in the Radiology order entry page (see page 182 the Clinical Record Guide).

To configure additional options for radiology orders: 1 Click Administration in the navigation bar.


The Order Modules list page appears. 3 Click the Configuration button for the Radiology Order.

The Radiology Order Configuration History page appears.

4 Click the Configure button. The Radiology Order Types page appears, with the Configuration Wizard in the left pane.

5 Click Radiology Sub Type in the left pane. The Radiology Order Values page appears.


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6 In each of the text entry Value fields, you can enter a Radiology sub-type. Each value can be up to 100 characters. The values entered on this page are used to populate the Subtype drop-down list on the Radiology Order Form (see page 182 the Clinical Record Guide).

7 Click Submit in the status bar. The sub-types values are saved and the Radiology Order Values page is refreshed.

8 Click Radiology Position in the left pane. The Radiology Order Values page appears.

9 In each of the text entry Value fields, you can enter a Radiology position. Each value can be up to 100 characters. The values entered on this page are used to populate the Position drop-down list on the Radiology Order Form (see page 182 the Clinical Record Guide).

10Click Submit in the status bar. The position values are saved and the Radiology Order Values page is refreshed.

Configuring Additional Options for Consultation Orders In addition to the Types configuration (see Configuring Order Types), Consultation orders require additional configuration set up for Urgency. The configuration options that are set up in this task are available in the drop-down lists in the Consultation order entry page (see page 192 the Clinical Record Guide).

To configure additional options for consultation orders: 1 Click Administration in the navigation bar.


The Order Modules list page appears. 3 Click the Configuration button for the Consultation Order.

The Consultation Order Configuration History page appears.

4 Click the Configure button. The Consultation Order Types page appears, with the Configuration Wizard in the left pane.


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5 Click Urgency in the left pane. The Consultation Order Values page appears.

6 In each of the text entry Value fields, you can enter an urgency value that will be used to characterize consultation orders. Each value can be up to 100 characters. The values entered on this page are used to populate the Urgency drop-down list on the Consultation Order Form (see page 192 the Clinical Record Guide).

7 Click Submit in the status bar. The urgency values are saved and the Consultation Order Values page is refreshed.

Configuring Additional Options for Precaution Orders In addition to the Types configuration (see Configuring Order Types), Precaution orders require additional configuration set up for Justifications. The configuration options that are set up in this task are available in the drop-down lists in the Precaution order entry page (see page 214 the Clinical Record Guide).

To configure additional options for precaution orders: 1 Click Administration in the navigation bar.


The Order Modules list page appears. 3 Click the Configuration button for the Precaution Order.

The Precaution Order Configuration History page appears.

4 Click the Configure button. The Precaution Order Types page appears, with the Configuration Wizard in the left pane.

5 Click Justifications in the left pane. The Precaution Order Values page appears.


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6 In each of the text entry Value fields, enter a justification value that will be used to characterize precaution orders. Each value can be up to 100 characters. The values entered on this page are used to populate the Justification for Use of Precautions drop-down list on the Precaution Order Form (see page 214 the Clinical Record Guide).

7 Click Submit in the status bar. The justification values are saved and the Precaution Order Values page is refreshed.

Configuring Additional Options for Transfer Orders In addition to the Types configuration (see Configuring Order Types), Transfer orders require additional configuration set up for External Locations and Modes of Transport. The configuration options that are set up in this task are available in the drop-down lists in the Transfer order entry page (see page 195 the Clinical Record Guide).

To configure additional options for transfer orders: 1 Click Administration in the navigation bar.


The Order Modules list page appears. 3 Click the Configuration button for the Transfer Order.

The Transfer Order Configuration History page appears.

4 Click the Configure button. The Transfer Order Types page appears, with the Configuration Wizard in the left pane.

5 Click Transfer to External in the left pane. The Transfer Order Values page appears.


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6 In each of the text entry Value fields, enter an External Location value that can be used when creating transfer orders. Each value can be up to 100 characters. The values entered on this page are used to populate the Transfer to External drop-down list on the Transfer Order Form (see page 195 the Clinical Record Guide).

7 Click Submit in the status bar. The external location values are saved and the Transfer Order Values page is refreshed.

8 Click Mode of Transport in the left pane. The Transfer Order Values page appears.

9 In each of the text entry Value fields, enter a Mode of Transport value that can be used for transfer orders. Each value can be up to 100 characters. The values entered on this page are used to populate the Mode of Transport drop-down list on the Transfer Order Form (see page 195 the Clinical Record Guide).

10Click Submit in the status bar. The transport mode values are saved and the Transfer Order Values page is refreshed.

Configuring Additional Options for Activity Level Orders In addition to the Types configuration (see Configuring Order Types), Activity Level orders require additional configuration set up for Mobility Level. The configuration options that are set up in this task are available in the drop-down lists in the Activity Level order entry page (see page 206 the Clinical Record Guide).

To configure additional options for activity level orders:


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1 Click Administration in the navigation bar. The Administration menu system is loaded.

2 Click the Show Menu arrow in the shortcut bar and select Order Modules. The Order Modules list page appears.

3 Click the Configuration button for the Activity Order. The Activity Order Configuration History page appears.

4 Click the Configure button. The Activity Order Types page appears, with the Configuration Wizard in the left pane.

5 Click Mobility Level in the left pane. The Activity Order Values page appears.

6 In each of the text entry Value fields, enter a mobility level that will be used when creating activity orders. Each value can be up to 100 characters. The values entered on this page are used to populate the Mobility Level drop-down list on the Activity Level Order Form (see page 206 the Clinical Record Guide).

7 Click Submit in the status bar. The mobility level values are saved and the Activity Order Values page is refreshed.

Setting Up Order/Procedure Mappings For each billable order, you must set up a procedure code mapping. Order/procedure mappings contain user-defined criteria that the Claim Engine uses to establish a charge for the order. In order to be adjudicated by payers, every claim you send out must have a procedure code on it. When setting up your order/procedure mappings, you should remember that multiple mappings can exist for the same order type.

This section includes instructions for setting up procedure mappings for the following billable order types: • Setting Up Procedure Mappings for Lab Orders • Setting Up Procedure Mappings for Radiology Orders


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• Setting Up Procedure Mappings for DME Orders • Setting Up Procedure Mappings for EKG Orders • Setting Up Procedure Mappings for Transportation Orders

Setting Up Procedure Mappings for Lab Orders In order to bill for lab orders, you must use the instructions in this task to set up a lab order/procedure mapping.

To set up procedure mappings for Lab orders: 1 Access the Order Modules list page (see Setting Up Clinical Orders). 2 Click the Billing Config button for the Lab order type.

The Lab Order Billing Configuration list page appears. 3 Click Add Configuration in the status bar.

The Lab Order Billing Configuration Form appears.

4 In the Begin Date field, enter the date the order/procedure mapping becomes active in the system. This is the first date the Claim Engine will use the mapping record to establish a charge for lab orders. By default, this field is populated with the current system date. If desired, you can enter a different date.

5 If you want the order/procedure mapping to be active for a particular date range only, enter the end date for the mapping in the End Date field. This is the last date the Claim Engine will use the mapping record.

6 The Organization field is used to select the organization the lab order procedure mapping will apply to. This drop-down list includes only the organization you are currently logged into and all child organizations.


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7 In the Is This a Non-Billable Mapping field, indicate if the order/procedure mapping will create a billable service. If you select Yes, the orders matching this mapping record will not be billed. If you select No, you must also select a procedure code (Step 8) so the orders matching this mapping record can be billed.

8 By default, this order/procedure mapping will consider to all of the lab tests that are set up in the system. If you want the mapping to apply to a specific lab test only, use the drop-down list in the Lab Test field to select the desired lab test.

9 In the Procedure Code field, use the drop-down list to select the procedure code you want to link to lab orders. The Claim Engine will use the standard fee associated with this procedure code to generate claims for lab orders.

10By default, the Claim Engine considers all lab orders, regardless of the staff credentials associated with them, when applying this mapping record. If you want to narrow the credential criteria associated with this mapping record, use the drop-down list in the Billing Category field to select the desired credential. Once you select a credential in this field, the Claim Engine will consider only the lab orders associated with the selected credential when applying this mapping record.

11By default, the Claim Engine considers all lab orders, regardless of the treatment program associated with them, when applying this mapping record. If you want to narrow the program criteria associated with this mapping record, use the drop-down list in the Program field to select the desired program. Once you select a program in this field, the Claim Engine will consider only the lab orders associated with the selected program when applying this mapping record.

12By default, the Claim Engine considers all program classifications when applying this mapping record. If you want to narrow the program classification criteria associated with this mapping record, use the drop-down list in the Program Classification field to select the desired option. Once you select an option in this field, the Claim Engine will consider only the lab orders associated with the selected program classification when applying this mapping record.

13By default, the Claim Engine considers all lab orders, regardless of the payer plan associated with them, when applying this mapping record. If you want to narrow the payer plan criteria associated with this mapping record, use the drop-down list in the Payer Name field to select the desired payer plan. Once you select a payer plan in this field, the Claim Engine will consider only the lab orders associated with the selected payer plan when applying this mapping record.

14By default, the Claim Engine considers all lab orders, regardless of the payer type associated with them, when applying this mapping record. If you want to narrow the payer type criteria associated with this mapping record, use the drop-down list in the Payer Type field to select the desired payer type. Once you select a payer type in this field, the Claim Engine will consider only the lab orders associated with the selected payer type when applying this mapping record.

15The Modifier fields allow you to select up to four modifiers that the Claim Engine will attach to the procedure code when using this mapping record. The drop-down lists in this field are populated by the Modifiers module (see Setting Up Modifiers).

Important: If you select multiple modifiers in this field, it is important to remember that only one of the modifiers can affect the fee calculation. If you select more than one modifier that affects the fee calculation, the Claim Engine will generate an error and move the service into Failed Claims.

16Click Submit in the status bar. The lab order/procedure mapping is saved and listed on the Lab Order Billing Configuration list page.

Setting Up Procedure Mappings for Radiology Orders In order to bill for radiology orders, you must use the instructions in this task to set up a radiology order/procedure mapping.


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To set up procedure mappings for Radiology orders: 1 Access the Order Modules list page (see Setting Up Clinical Orders). 2 Click the Billing Config button for the Radiology order type.

The Radiology Order Billing Configuration list page appears. 3 Click Add Configuration in the status bar.

The Radiology Order Billing Configuration Form appears.

4 In the Begin Date field, enter the date the order/procedure mapping becomes active in the system. This is the first date the Claim Engine will use the mapping record to establish a charge for radiology orders. By default, this field is populated with the current system date. If desired, you can enter a different date.


6 The Organization field is used to select the organization the radiology order procedure mapping will apply to. This drop-down list includes only the organization you are currently logged into and all child organizations.


8 By default, this order/procedure mapping will consider all of the radiology types that are set up in the system, regardless of their type, subtype, or position. If you want to narrow the radiology criteria associated with this mapping record, you can use the drop-down lists in the Order Type, Subtype, and Position fields to select the desired options. The more criteria you enter in these fields, the more narrow the mapping record will be.


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9 In the Procedure Code field, use the drop-down list to select the procedure code you want to link to radiology orders. The Claim Engine will use the standard fee associated with this procedure code to generate claims for radiology orders.

10By default, the Claim Engine considers all radiology orders, regardless of the staff credentials associated with them, when applying this mapping record. If you want to narrow the credential criteria associated with this mapping record, use the drop-down list in the Billing Category field to select the desired credential. Once you select a credential in this field, the Claim Engine will consider only the radiology orders associated with the selected credential when applying this mapping record.

11By default, the Claim Engine considers all radiology orders, regardless of the treatment program associated with them, when applying this mapping record. If you want to narrow the program criteria associated with this mapping record, use the drop-down list in the Program field to select the desired program. Once you select a program in this field, the Claim Engine will consider only the radiology orders associated with the selected program when applying this mapping record.

12By default, the Claim Engine considers all program classifications when applying this mapping record. If you want to narrow the program classification criteria associated with this mapping record, use the drop-down list in the Program Classification field to select the desired option. Once you select an option in this field, the Claim Engine will consider only the radiology orders associated with the selected program classification when applying this mapping record.

13By default, the Claim Engine considers all radiology orders, regardless of the payer plan associated with them, when applying this mapping record. If you want to narrow the payer plan criteria associated with this mapping record, use the drop-down list in the Payer Name field to select the desired payer plan. Once you select a payer plan in this field, the Claim Engine will consider only the radiology orders associated with the selected payer plan when applying this mapping record.

14By default, the Claim Engine considers all radiology orders, regardless of the payer type associated with them, when applying this mapping record. If you want to narrow the payer type criteria associated with this mapping record, use the drop-down list in the Payer Type field to select the desired payer type. Once you select a payer type in this field, the Claim Engine will consider only the radiology orders associated with the selected payer type when applying this mapping record.



16Click Submit in the status bar. The radiology order/procedure mapping is saved and listed on the Radiology Order Billing Configuration list page.

Setting Up Procedure Mappings for DME Orders In order to bill for DME (durable medical equipment) orders, you must use the instructions in this task to set up a DME order/procedure mapping.

To set up procedure mappings for DME orders: 1 Access the Order Modules list page (see Setting Up Clinical Orders). 2 Click the Billing Config button for the DME order type.

The DME Order Billing Configuration list page appears.


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3 Click Add Configuration in the status bar. The DME Order Billing Configuration Form appears.

4 In the Begin Date field, enter the date the order/procedure mapping becomes active in the system. This is the first date the Claim Engine will use the mapping record to establish a charge for DME orders. By default, this field is populated with the current system date. If desired, you can enter a different date.


6 The Organization field is used to select the organization the DME order procedure mapping will apply to. This drop-down list includes only the organization you are currently logged into and all child organizations.


8 By default, this order/procedure mapping will consider all of the DME types that are set up in the system. If you want to narrow the DME criteria associated with this mapping record, you can use the drop-down list in the DME Type field to select a specific option. The more criteria you enter in these fields, the more narrow the mapping record will be.

9 In the Procedure Code field, use the drop-down list to select the procedure code you want to link to DME orders. The Claim Engine will use the standard fee associated with this procedure code to generate claims for DME orders.


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10By default, the Claim Engine considers all DME orders, regardless of the staff credentials associated with them, when applying this mapping record. If you want to narrow the credential criteria associated with this mapping record, use the drop-down list in the Billing Category field to select the desired credential. Once you select a credential in this field, the Claim Engine will consider only the DME orders associated with the selected credential when applying this mapping record.

11By default, the Claim Engine considers all DME orders, regardless of the treatment program associated with them, when applying this mapping record. If you want to narrow the program criteria associated with this mapping record, use the drop-down list in the Program field to select the desired program. Once you select a program in this field, the Claim Engine will consider only the DME orders associated with the selected program when applying this mapping record.

12By default, the Claim Engine considers all program classifications when applying this mapping record. If you want to narrow the program classification criteria associated with this mapping record, use the drop-down list in the Program Classification field to select the desired option. Once you select an option in this field, the Claim Engine will consider only the DME orders associated with the selected program classification when applying this mapping record.

13By default, the Claim Engine considers all DME orders, regardless of the payer plan associated with them, when applying this mapping record. If you want to narrow the payer plan criteria associated with this mapping record, use the drop-down list in the Payer Name field to select the desired payer plan. Once you select a payer plan in this field, the Claim Engine will consider only the DME orders associated with the selected payer plan when applying this mapping record.

14By default, the Claim Engine considers all DME orders, regardless of the payer type associated with them, when applying this mapping record. If you want to narrow the payer type criteria associated with this mapping record, use the drop-down list in the Payer Type field to select the desired payer type. Once you select a payer type in this field, the Claim Engine will consider only the DME orders associated with the selected payer type when applying this mapping record.



16Click Submit in the status bar. The DME order/procedure mapping is saved and listed on the DME Order Billing Configuration list page.

Setting Up Procedure Mappings for EKG Orders In order to bill for EKG orders, you must use the instructions in this task to set up a EKG order/procedure mapping.

To set up procedure mappings for EKG orders: 1 Access the Order Modules list page (see Setting Up Clinical Orders). 2 Click the Billing Config button for the EKG order type.

The EKG Order Billing Configuration list page appears. 3 Click Add Configuration in the status bar.

The EKG Order Billing Configuration Form appears.


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4 In the Begin Date field, enter the date the order/procedure mapping becomes active in the system. This is the first date the Claim Engine will use the mapping record to establish a charge for EKG orders. By default, this field is populated with the current system date. If desired, you can enter a different date.


6 The Organization field is used to select the organization the EKG order procedure mapping will apply to. This drop-down list includes only the organization you are currently logged into and all child organizations.


8 By default, this order/procedure mapping will consider to all of the EKG types that are set up in the system. If you want the mapping to apply to a specific EKG type only, use the drop-down list in the EKG Type field to select the desired option.

9 In the Procedure Code field, use the drop-down list to select the procedure code you want to link to EKG orders. The Claim Engine will use the standard fee associated with this procedure code to generate claims for EKG orders.

10By default, the Claim Engine considers all EKG orders, regardless of the staff credentials associated with them, when applying this mapping record. If you want to narrow the credential criteria associated with this mapping record, use the drop-down list in the Billing Category field to select the desired credential. Once you select a credential in this field, the Claim Engine will consider only the EKG orders associated with the selected credential when applying this mapping record.


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11By default, the Claim Engine considers all EKG orders, regardless of the treatment program associated with them, when applying this mapping record. If you want to narrow the program criteria associated with this mapping record, use the drop-down list in the Program field to select the desired program. Once you select a program in this field, the Claim Engine will consider only the EKG orders associated with the selected program when applying this mapping record.

12By default, the Claim Engine considers all program classifications when applying this mapping record. If you want to narrow the program classification criteria associated with this mapping record, use the drop-down list in the Program Classification field to select the desired option. Once you select an option in this field, the Claim Engine will consider only the EKG orders associated with the selected program classification when applying this mapping record.

13By default, the Claim Engine considers all EKG orders, regardless of the payer plan associated with them, when applying this mapping record. If you want to narrow the payer plan criteria associated with this mapping record, use the drop-down list in the Payer Name field to select the desired payer plan. Once you select a payer plan in this field, the Claim Engine will consider only the EKG orders associated with the selected payer plan when applying this mapping record.

14By default, the Claim Engine considers all EKG orders, regardless of the payer type associated with them, when applying this mapping record. If you want to narrow the payer type criteria associated with this mapping record, use the drop-down list in the Payer Type field to select the desired payer type. Once you select a payer type in this field, the Claim Engine will consider only the EKG orders associated with the selected payer type when applying this mapping record.



16Click Submit in the status bar. The EKG order/procedure mapping is saved and listed on the EKG Order Billing Configuration list page.

Setting Up Procedure Mappings for Transportation Orders In order to bill for Transportation orders, you must use the instructions in this task to set up a transportation order/procedure mapping.

To set up procedure mappings for Transportation orders: 1 Access the Order Modules list page (see Setting Up Clinical Orders). 2 Click the Billing Config button for the Transportation order type.

The Transportation Order Billing Configuration list page appears. 3 Click Add Configuration in the status bar.

The Transportation Order Billing Configuration Form appears.


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4 In the Begin Date field, enter the date the order/procedure mapping becomes active in the system. This is the first date the Claim Engine will use the mapping record to establish a charge for Transportation orders. By default, this field is populated with the current system date. If desired, you can enter a different date.


6 The Organization field is used to select the organization the Transportation order procedure mapping will apply to. This drop-down list includes only the organization you are currently logged into and all child organizations.


8 By default, this order/procedure mapping will consider to all of the Transportation types that are set up in the system. If you want the mapping to apply to a specific Transportation type only, use the drop-down list in the Order Type field to select the desired option.

9 If you want the order/procedure mapping to be active for a particular actual mileage range only, enter the actual mileage range for the mapping in the Actual Mileage Range field.

10If you want the order/procedure mapping to be active for a particular estimated mileage range only, enter the estimated mileage range for the mapping in the Estimated Mileage Range field.

11In the Procedure Code field, use the drop-down list to select the procedure code you want to link to Transportation orders. The Claim Engine will use the standard fee associated with this procedure code to generate claims for Transportation orders.


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12By default, the Claim Engine considers all Transportation orders, regardless of the staff credentials associated with them, when applying this mapping record. If you want to narrow the credential criteria associated with this mapping record, use the drop-down list in the Billing Category field to select the desired credential. Once you select a credential in this field, the Claim Engine will consider only the Transportation orders associated with the selected credential when applying this mapping record.

13By default, the Claim Engine considers all Transportation orders, regardless of the treatment program associated with them, when applying this mapping record. If you want to narrow the program criteria associated with this mapping record, use the drop-down list in the Program field to select the desired program. Once you select a program in this field, the Claim Engine will consider only the Transportation orders associated with the selected program when applying this mapping record.

14By default, the Claim Engine considers all program classifications when applying this mapping record. If you want to narrow the program classification criteria associated with this mapping record, use the drop-down list in the Program Classification field to select the desired option. Once you select an option in this field, the Claim Engine will consider only the Transportation orders associated with the selected program classification when applying this mapping record.

15By default, the Claim Engine considers all Transportation orders, regardless of the payer plan associated with them, when applying this mapping record. If you want to narrow the payer plan criteria associated with this mapping record, use the drop-down list in the Payer Plan field to select the desired payer plan. Once you select a payer plan in this field, the Claim Engine will consider only the Transportation orders associated with the selected payer plan when applying this mapping record.

16By default, the Claim Engine considers all Transportation orders, regardless of the payer type associated with them, when applying this mapping record. If you want to narrow the payer type criteria associated with this mapping record, use the drop-down list in the Payer Type field to select the desired payer type. Once you select a payer type in this field, the Claim Engine will consider only the Transportation orders associated with the selected payer type when applying this mapping record.



18Click Submit in the status bar. The Transportation order/procedure mapping is saved and listed on the Transportation Order Billing Configuration list page.

Defining Order Privilege Levels For each order type, you must define a privilege level for each staff credential. Order privileging is based on the staff member’s primary credential. The privilege levels determine what functionality each credential has in relation to the selected order type. By default, all staff members with an existing ECR privilege level are assigned the lowest Orders privilege level, which means they have read-only access.

To define order privilege levels: 1 Access the Order Modules list page (see Setting Up Clinical Orders).


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2 Click the Privileges button that corresponds with the order type you want to define privilege levels for.

The Order Privileges page appears for the selected order type.

3 For each credential, select the radio button of the privilege level you want to assign. The following privilege levels are available:

Order & Sign. This privilege level enables staff members to issue orders and then sign them once they are complete. Typically, this privilege level is reserved for Medical Doctors and Nurse Practitioners.

Record & Sign. This privilege level enables staff members to enter orders into the system and then sign them once they are complete. Typically, this privilege level is reserved for staff members with nursing credentials.

Read Only. This privilege level enables staff members to access orders in read-only mode. Typically, this privilege level is assigned to staff members who have a secondary relationship with the client.

4 After defining all the desired privilege levels, click Submit in the status bar. The privilege level record is saved for the selected order type. You must define the privilege levels for each order type that is set up in the system.

Standing Order Protocols If your organization uses a defined set of orders for multiple clients, you can use the Standing Orders Protocol (SOP) module to group the individual orders together. For example, if your organization’s admission process requires a lab order, a consultation order, and an admit order, you can create an Admission SOP that consists of these three order types. When building SOPs, you can include as many individual orders as desired. Once the SOP is created, it is ready for use in the ECR>Orders module (see page 196 the Clinical Record Guide).

There are two steps involved in setting up SOPs: Creating the SOP record (see Creating Standing Order Protocols). This is the parent-level record that

defines the name of the SOP. Once an instance is added to the record, you can select the SOP name in the ECR>Orders module to complete it.

Adding an Instance to the SOP record (see Adding Instances to Standing Orders Protocol). This is the child-level record that defines the begin date and the individual orders that comprise the SOP. Every SOP record must have at least one instance associated with it.

Note: If a SOP contains a billable order (see Configuring Billable Orders), then the individual order will generate a claim once the SOP is completed. It is important to understand that billable orders apply to individual orders only. SOPs, as a whole, do not generate claims.

To access the Standing Orders Protocol module: 1 Click Administration in the navigation bar.



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2 Click the Show Menu arrow in the shortcut bar and select Standing Orders Protocol. The Standing Orders Protocol list page appears.

This page is used to perform the following tasks: • Creating Standing Order Protocols • Adding Instances to Standing Orders Protocol • Defining Standing Orders Protocol Privilege Levels • Deleting Standing Orders Protocol

Creating Standing Order Protocols This task is used to create a standing order protocol (SOP). After the SOP record is created, you must add an instance to it (see Adding Instances to Standing Orders Protocol) before it can be used.

To create standing order protocols: 1 Access the Standing Orders Protocol list page (see Setting Up Standing Order

Protocols). 2 Click Add Standing Orders Protocol in the status bar.

The Standing Orders Protocol Entry page appears. Both fields are required.

3 In the Name field, enter a name for the standing orders protocol. This is the name by which the SOP will be listed in the ECR>Orders module (see page 196 the Clinical Record Guide). This entry can be up to 100 characters.

Tip: The name you enter in this field should be unique and should not replicate the name of an existing standard order type (as listed in the Orders module on Setting Up Clinical Orders). For example, if you are creating a SOP for an admit order, you could name it ‘Admit Protocol’ or some other unique name. In this example, you should not name the SOP ‘Admit Order’ because there is already a standard order type with the same name, which means there would be two duplicate entries for Admit Order in the ECR>Orders module.

4 In the Description field, enter a description for the type of SOP record you are creating. This entry can be up to 1,000 characters.

5 Click Submit in the status bar. The SOP record is saved and listed on the Standing Orders Protocol list page.

Adding Instances to Standing Orders Protocol


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After the SOP record is created (see Creating Standing Order Protocols), you must create an instance for it. The instance defines which orders are associated with the SOP. By default, the “Sign & Complete SOP” link is added to the end of each SOP you create. The “Sign & Complete SOP” link is available when completing SOPs for clients (see page 266 the Clinical Record Guide).

To add instances to standing orders protocol: 1 Access the Standing Orders Protocol list page (see Setting Up Standing Order

Protocols). 2 Locate the SOP record for which you want to add an instance and click the

Instance button. The Instance page appears for the selected SOP.

3 Click Add Instance in the status bar. The Standing Order Protocol Instance Entry page appears for the selected SOP.

4 In the Begin Date field, enter the first date the SOP will be available for use in the system. This entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

Note: The Page Order column lists the order in which the individual orders will appear in the SOP. While you can add as many individual orders as desired, you can only add up to 10 orders at a time. For example, suppose you want to include 15 orders in a SOP. The first step is to select the first 10 orders and then Submit the form. When you open the SOP record instance in edit mode, the form will include 10 additional drop-down lists that can be used to add up to 10 more orders. The final step for you in this scenario is to select the five remaining orders, which would create a total of 15 orders for the SOP.

5 The Order Type column contains a drop-down list of all the order types that are available in the system. You must select at least one order type in order for the instance record to be submitted. You can select more than one of the same order types within the same instance. For example, if the SOP called for two different lab tests (CBC and Urinalysis), you would select Lab Order twice. You can then use the Order Name column to identify the specific type of lab tests that are to be performed.

6 If necessary, you can use the Order Name column to identify a specific type of order. For example, if you selected a lab order in the Order Type column, you could enter either CBC or Urinalysis in this column to identify the specific lab test that must be performed. The order name entered in this field appears as a link in the SOP in the ECR>Orders module.

7 The Required column is used to identify which orders within the SOP are required. Each order type that is marked required must be completed before the SOP can be signed. If a required order is not completed, then the SOP cannot be signed.


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Note: By default, the Remove column is empty. Once you Submit the record and then Select it for edit mode, a button with an X appears in this column. This button is used to delete individual orders from the SOP, if necessary.

8 Click Submit in the status bar. The SOP instance is saved and listed on the Instance list page. Once the begin date arrives, the SOP will be available for use in the ECR>Orders module.

The SOP Instance list page contains the following buttons: • Select. If the SOP instance has not been used to create a SOP for a client in the ECR, you can

use this button to maintain the SOP instance. Once you click this button, you can add additional order types to the SOP instance, change any of the existing order types for the SOP instance, or delete an order type for the SOP instance. If the SOP instance has been used to create a SOP for a client in the ECR, you cannot add, update, and delete the order types associated with it.

• Discontinue. If you no longer want to use an instance, you must end date it by clicking this button. Once the end date of a discontinued instance arrives, the SOP instance is no longer available in the ECR>Orders module.

Defining Standing Orders Protocol Privilege Levels For each SOP record, you must define a privilege level for each staff credential. The privilege level determines what functionality each staff member has, based on their credential. By default, all staff members with an existing ECR privilege level are assigned the lower Orders privilege level, which means they have read-only access.

Important: The SOP privilege level you define in this section overrides the privilege levels assigned to the individual orders that comprise the SOP. This means you can give staff members the ability to complete the entire SOP, even though they have not been granted the ability to complete each individual order outside of the SOP. This type of privileging prevents situations where staff members with certain credentials will only have the ability to complete parts of the SOP.

To define standing orders protocol privilege levels: 1 Access the Standing Orders Protocol list page (see Standing Order Protocols). 2 Locate the SOP record for which you want to define a privilege level and click the

Privileges button. The Order Privileges page appears for the selected SOP.


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3 For each credential, select the radio button of the privilege level you want to assign. The following privilege levels are available:

• Order & Sign. This privilege level enables staff members to issue SOPs and then sign them once they are complete. Typically, this privilege level is reserved for Medical Doctors and Nurse Practitioners.

• Record & Sign. This privilege level enables staff members to enter SOPs into the system and then sign them once they are complete. Typically, this privilege level is reserved for staff members with nursing credentials.

• Read Only. This privilege level enables staff members to access SOPs in read-only mode. Typically, this privilege level is assigned to staff members who have a secondary relationship with the client.

4 After defining all the desired privilege levels, click Submit in the status bar. The privilege level record is saved for the selected SOP.

Deleting Standing Orders Protocol This task is used to delete unused standing order protocol records. Once a SOP has been created for a client, the Delete button is replaced with the text “In Use.”

To delete standing orders protocol: 1 Access the Standing Orders Protocol list page (see Standing Order Protocols).

2 Locate the SOP record you want to delete and click the Delete button. The Standing Orders Protocol Delete page appears for the selected SOP.


The selected SOP record is removed from the system.

Client Groups All of the group services that your organization provides must be set up on the Group List page. Each group must have a leader defined as well as a roster of all the clients who participate in the group. Once all of the necessary information has been entered for the group, you can schedule group activities (see page 21 the Scheduling Guide).

To access client groups: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Groups.

The Group List page appears. This page lists all of the groups that are currently set up in the system.


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Note: At the bottom of the page, all of the inactive groups are listed. Groups with an end date that meets or exceeds the current system date are classified as inactive.

This page is used to perform the following tasks: • Adding New Groups • Updating Groups • Defining Group Rosters • Copying Group Rosters • Deleting Groups

Adding New Groups This task includes instructions for entering new group records into the system.

Note: Once a group is added to the system, you can use the Select button on the Group List page to update it (see page 225).

To create new groups: 1 Access the Group List page (see Setting Up Client Groups). 2 Click the Add New Group button.

The Group Information page appears. All required fields are highlighted.


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3 Enter a name for the group in the Group Title field. Your entry can be up to 60 characters.

4 In the Begin Date field, enter the date the group becomes active. When a group is classified as active, you can schedule services based on it. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 If this group is to be active for a defined date range only, enter the end date in the End Date field. This is the last date you can schedule services based on this group. If the group is to remain active indefinitely, leave this field blank.

6 The Organization field is used to select the organization that will provide this group service. This drop-down list includes only the organization you are currently logged into and all child organizations. Once an organization is selected in this field, the system automatically filters the Activity Code, Group Leader, and Group Assistant fields.

7 If this group service will always be associated with the same activity code, use the drop-down list in the Activity Code field to select the desired activity. If this group will be associated with multiple activity codes, do not select an option in this field.

8 If you want to assign a leader for the group, use the drop-down list in the Group Leader field to select the desired staff member. Other than the system administrator, the group leader is the only person who can modify the group roster.

9 If you want to specify an assistant to the group leader, use the drop-down list to select an option in the Group Assistant field.


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10In the Length of Session field, enter the number of minutes the group session will last. Your entry cannot exceed four digits.

11In the Fee for Service Bonus Configuration field, use the drop-down list to select the bonus configuration associated with the selected group (see Setting Up Group Bonus Configurations).

12In the Country field, use the drop-down list to select the country in which the group service will be provided.

Important: If you select the USA, or one of its territories, this page allows you to enter a domestic address (Steps 12 through 16). If the group service will be provided outside the USA, you must enter an international address. Once you select a country other than the USA, the page is refreshed to display all of the address fields (Steps 12 through 16) as text entry fields. This means that when you enter an international address, you must manually enter the city, state/province, postal code, and county.

13In the Street fields, enter the physical address of where the group service will be provided.

14If the street address contains an apartment or suite number, enter it in the Apt/Suite field.

15For addresses located within the USA, or one of its territories, use one of the following methods to enter the city, state/province, and postal code (zip code).

• To use the Postal Code Lookup feature, select the Do City/State lookup using Postal Code check box, enter the postal code (and postal code extension, if known), and press Tab. The system performs a postal code lookup and automatically populates the City and State fields. The city that is preceded by an asterisk is the postal service’s preferred city for the postal code entered.

• To manually enter the city, state, and postal code, uncheck the Do City/State lookup using Postal Code check box, enter the city, use the drop-down list to select the state, and enter the postal code (and postal code extension, if known).

16Before you can select the county in which the group service will be provided, you must select a state (by either method described in the previous step). The County field is automatically filtered to include only the counties that are located within the selected state. Use the drop-down list to select the appropriate county.

17In the Phone Number field, enter the 10-digit telephone number for the group service. If the group service has an international phone number, select the International Number check box (to modify the Phone Number field), and then enter the country code and international number. This entry can be up to 40 characters.

18In the Topic field, enter a description of the topic that will be discussed during the session. Your entry can be up to 500 characters.

19Click Submit in the status bar. The group record is saved and listed on the Group List page. At this point, you must create a group roster (see Defining Group Rosters).

Updating Groups Once a group is added to the system, you must use this task to update it.

To update groups: 1 Access the Group List page (see Setting Up Client Groups).


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2 Click the Select button that corresponds with the group you want to update. The Group Information page appears. You can edit any of the fields on this page. All required fields are highlighted. See Adding New Groups for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated group is listed on the Group List page.

Defining Group Rosters After creating new groups (see Adding New Groups), you can use this task to select the clients who will be part of the group.

To define group rosters 1 Access the Group List page (see Setting Up Client Groups).

2 Click the Roster button that corresponds with the group to which you want to add members.

The Roster page appears for the selected group. This page lists all of the active and former members of the group.

3 Click the Add New Member button. The Client Assignment page appears. All required fields are highlighted.

4 In the Client field, select the name of the client you want to assign to the group. You can use either of the following methods to select a client.


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• The first field is used to access a client by entering search criteria. You can search for a client by entering the client’s full or partial name, client ID number, social security number, or birth date. After entering the search criteria, press the Tab key or click off of the field. The drop-down list in the second field is filtered based on your search criteria. Use the drop-down list to select a client.

Note: See the Introduction to CareLogic for more information about searching for clients.

• If you do not want to filter the drop-down list by entering search criteria, you can simply select a client from the drop-down list.

5 In the Begin Date field, enter the date the client becomes an active member of the group. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

6 In the End Date field, enter the date the client becomes an inactive member of the group. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

7 In the Program field, use the drop-down list to select the program you want to associate with the client.

8 Click Submit in the status bar. The client is added to the group roster. Note: The remaining steps describe the process of adding members to the group by copying members

from another group.

9 On the Group List page (Step 1), click the Roster button. The Roster page appears for the selected group.

Copying Group Rosters There may be instances where you want to create a new group that may include many or all of the clients from another group. For situations such as this, use the following task to copy the members from one group roster to another group roster.

Important: You must complete the following task by selecting the group roster for the group you want to copy the group members to, not the group you want to copy the members from.

To copy group rosters: 1 Access the Roster list page for the group (see Defining Group Rosters). 2 Click the Copy Members button.

The Copy Members page appears. 3 Click the drop-down list to select the group from which you want to copy members. 4 Click Submit in the status bar.

The members of the selected group are added to the new group roster.

Deleting Groups You cannot delete groups that have been scheduled or contain clients on the roster.

To delete groups: 1 Access the Group List page (see Setting Up Client Groups).


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2 Click the Delete button that corresponds with the group you want to delete. The Delete Group page appears.

3 Select Yes to confirm you want to delete the selected group. 4 Click Submit in the status bar.

The selected group is deleted from the system.

Beds The Bed Administration module is used to manage the occupancy and availability of the beds in your treatment facility. In addition to adding beds, this module allows you to set up the programs for which the beds are used.

Note: Clients are assigned to beds through the Point of Entry wizard (see page 41 the Point of Entry Guide).

To access the beds for a particular location: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Bed Administration.

The Active Beds page appears, which provides a view of all the beds by organization. By default, this page lists all of the active beds that are set up for the organization you are currently logged into. If child organizations have been set up for your current organization, you can use the drop-down list in the Select Organization field to access the beds for a child organization. The Status column indicates whether the bed is empty or occupied by a client. If your system is configured to use bed statuses, you may also see beds listed as Absent when clients are still active in the bed but have absentee dates entered for their inpatient or residential program because they have a day pass or some other reason for being out of the facility.

This page is used to perform the following tasks: • Adding Beds


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• Setting Up Programs for Beds • Updating Beds • Deleting Beds

Adding Beds This task includes instructions for adding beds to the selected location.

Note: Once a bed is added to the system, you can use the Select button on the Active Beds page to update it (see page 114).

To add beds: 1 Access the Active Beds page (see Setting Up Beds). 2 Click the Add a Bed button.

The Bed Administration page appears. All required fields are highlighted.

Note: The Organization field lists the selected organization. This is the organization at which you are adding a bed.

3 In the Beginning Date field, enter the first date the bed becomes available to clients. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

4 In the End Date field, enter the last date the bed is available to clients. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 In the Room Number field, enter the room number in which the bed will be located. Your entry can be up to 10 numbers.

6 In the Bed Number field, enter a number for the bed you are adding. Your entry can be up to 10 characters.

Note: The Room Number and the Bed Number are combined to form a unique ID for the bed.

7 In the Gender field, select the intended sex of the client who will occupy the bed. If the bed is designed for either a male or female, select Either.

8 If you want to define a specific age range for the clients who can occupy the bed, enter the range in the Age Range field.


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Note: If you enter a beginning age only, the bed will be available to all clients who are the age you specify and up. For example, if you enter ‘18’ in the first field, the bed will be available to all clients who are 18 and up. If you enter an ending age only, the bed will be available to all clients who are the age you specify and under. For example, if you enter ‘18’ in the second field, the bed will be available to all clients who are 18 and under.

9 Click Submit in the status bar. The bed record is saved and listed on the Active Beds page for the selected organization.

Setting Up Programs for Beds Once a bed is added to the system, you can associate it with certain programs. By doing so, you are indicating that certain beds are reserved for clients who are enrolled in certain treatment programs.

To set up programs for beds: 1 Access the Active Beds page (see Setting Up Beds).

2 Click the Programs button. The Programs page appears for the selected bed and location. The Program and Begin Date fields are required.

3 In the Program column, use the drop-down list to select the program you want to assign to the selected bed.

4 In the Begin Date column, enter the date the bed becomes available to clients who are in the selected treatment program. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

5 In the End Date column, enter the last date the bed is available to clients who are in the selected treatment program. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

6 Click Submit in the status bar.


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The selected program, and the corresponding date range, is assigned to the selected bed. Note: To assign additional programs to the selected bed, repeat Steps 3 through 6. If you want to remove

a program that is currently assigned to the selected bed, click the Delete button.

Updating Beds Once a bed is added to the system, you must use this task to update it.

To update beds: 1 Access the Active Beds page (see Setting Up Beds).

2 Click the Select button of the bed you want to update. The Bed Administration page appears. You can edit any of the fields on this page. All required fields are highlighted. See Adding Beds for field descriptions.

3 After making the desired edits, click Submit in the status bar. The updated bed is saved and listed on the Active Beds page for the selected organization.

Deleting Beds This task includes instructions for deleting beds from the selected organization.

Note: You cannot delete a bed that has been reserved for a client or has a client assigned to it.

To delete beds: 1 Access the Active Beds page (see Beds).


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2 Click the Delete button of the bed you want to delete. The Confirm Delete page appears.

3 Select Yes to confirm you want to delete the bed and click Submit in the status bar. The selected bed is deleted from the system.

Treatment Plan Grids The Treatment Plan Grid module is used to set up all the problem types that your organization addresses. For each problem type, this module also allows you to set up treatment goals and objectives.

To set up problem types: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Treatment Plan Grid.

The Problem Types page appears. This page lists all of the problem types that have been set up in the system.

3 Click Add Problem in the status bar. The Problem Entry page appears. All required fields are highlighted.


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4 In the Begin Date field, enter the first date the problem type record becomes active in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

5 In the End Date field, enter the date the problem type record becomes inactive in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

6 In the Type field, enter the name of the problem type. This entry can be up to 60 characters.

7 In the Problem field, enter a description for the problem type. This entry can be up to 250 characters.

8 Click Submit in the status bar. The problem type record is saved and listed on the Problems list page.

This page is used to perform the following tasks: • Associating Treatment Plan Grids with Organizations • Adding Diagnosis Codes • Adding Sub Problems • Setting Up Treatment Goals • Setting Up Treatment Objectives • Setting Up Treatment Interventions

Associating Treatment Plan Grids with Organizations When a new treatment plan grid is created (see Setting Up Treatment Plan Grids), it is only available at the organization of the staff member who added it. This task includes instructions for making treatment plan grids available to child organizations.

To associate treatment plan grids with organizations: 1 Access the Problem Types list page (see Setting Up Treatment Plan Grids). 2 Locate the treatment plan grid you want to associate with organizations and click the

corresponding Select button. The Active Problems for the treatment plan grid page appears, which is divided into two sections. The top half of the page displays the active problems for the treatment plan grid, and the bottom half displays the inactive problems

. 3 Locate the problem to associate with an organization and click the corresponding

Organization button.


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The Organization List page appears for the selected treatment plan grid. This list includes the organization you are currently logged into and all its child organizations. Note: When the button appears in the Included column, the treatment plan grid is associated with the

organization. When the button appears in the Excluded column, the treatment plan grid is not associated with the organization.

4 To associate the selected treatment plan grid with an organization, click the Excluded button.

The page is refreshed and the button is moved to the Included column, which means the treatment plan grid is available to the selected organization. You can associate the treatment plan grid with as many organizations as desired. Note: To associate the selected problem with all organizations, click the Include All button in the status

bar. To exclude the selected problem from all organizations, click the Exclude All button.

5 Click Submit in the status bar. The treatment plan grid organization matrix record is saved.

Adding Diagnosis Codes After setting up a problem type, you must use this task to set up diagnosis codes for the treatment plan grid.

To set up diagnosis codes: 1 Access the Problem Types list page (see Setting Up Treatment Plan Grids). 2 Locate the treatment plan grid you want to assign a diagnosis code to and click the

corresponding Diagnosis button. The Diagnosis list page for the treatment plan grid page appears, which is divided into two sections. The top half of the page displays the active diagnoses for the treatment plan grid, and the bottom half displays the inactive diagnoses.

3 Click Add Diagnosis Link in the status bar. The Diagnosis Entry page appears.


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4 In the Category field, use the drop-down list to select the diagnosis category. 5 If applicable (based on the category you selected), use the drop-down list in the

Heading field to select a heading that further narrows the appropriate DSM codes for you. 6 If applicable (based on the heading you selected), use the drop-down list in the Sub-

Heading field to select a subheading that further narrows the appropriate DSM codes for you. 7 If you selected a category and/or heading and subheading, your options in the DSM

Diagnosis Code field drop-down will be narrowed down for your selection. If you did not make selections in those fields, you can search for the diagnosis code and then use the drop-down to make your DSM Diagnosis Code selection.

8 In the Begin Date field, enter the date the diagnosis code is to become active in the system. Your entry must be in the following format: mm/dd/yyyy.

9 In the End Date field, enter the date the diagnosis should be become inactive in the system. Your entry must be in the following format: mm/dd/yyyy.

10Click Submit in the status bar. The diagnosis is saved and listed on the Diagnosis list page.

Adding Sub Problems After setting up a problem type, you must use this task to add sub problems.

To add sub problems: 1 Access the Problems list page (see Setting Up Treatment Plan Grids). 2 Locate the treatment plan grid you want to add sub problems for, and click the

corresponding Sub Problems button. The Problems list page appears for the selected problem type.

3 Click Add Sub Problem in the status bar. The Sub Problem Entry page appears for the selected problem type.


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4 In the Begin Date field, enter the first date the sub problem becomes active in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

5 In the End Date field, enter the date the sub problem becomes inactive in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

6 In the Sub Problem field, enter the sub problem for the selected problem type. This entry can be up to 4,000 characters.

7 Click Submit in the status bar. The sub problem is saved and listed on the Sub Problems page.

Setting Up Treatment Goals After setting up a problem type, you must use this task to set up treatment goals.

To set up treatment goals: 1 Access the Problems list page (see Setting Up Treatment Plan Grids). 2 Locate the treatment plan grid you want to set up treatment goals for and click the

corresponding Goals button. The Goals list page appears for the selected problem type.

3 Click Add Goal in the status bar. The Goal Entry page appears. All required fields are highlighted.

4 In the Begin Date field, enter the first date the goal becomes active in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

5 In the End Date field, enter the date the goal becomes inactive in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

6 In the Goal field, enter the goal for the selected problem type. This entry can be up to 250 characters.

7 Click Submit in the status bar. The goal is saved and listed on the Goals page.


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Setting Up Treatment Objectives After setting up treatment goals, you must use this task to set up treatment objectives.

To set up treatment objectives: 1 Access the Problems list page (see Setting Up Treatment Plan Grids). 2 Locate the treatment plan grid you want to set up treatment objectives for and click

the corresponding Objectives button. The Objectives list page appears for the selected goal.

3 Click Add Objective in the status bar.

4 In the Begin Date field, enter the first date the objective record becomes active in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

5 In the End Date field, enter the date the objective record becomes inactive in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

6 In the Objective field, enter a description of the objective for the selected goal. This entry can be up to 250 characters.

7 Click Submit in the status bar. The objective record is saved and listed on the Objectives list page.

Setting Up Treatment Interventions After setting up treatment objectives, you must use this task to set up treatment interventions.

To set up interventions: 1 Access the Objectives list page (see Setting Up Treatment Objectives). 2 Locate the objective you want to add an intervention record for, and click the

Interventions button. The Interventions page appears for the selected objective.

3 Click Add Intervention in the status bar.


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4 In the Begin Date field, enter the first date the intervention record becomes active in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

5 In the End Date field, enter the date the intervention record becomes inactive in the system. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

6 In the Intervention field, enter a description of the intervention for the selected objective. This entry can be up to 4,000 characters.

7 Click Submit in the status bar. The intervention record is saved and listed on the Interventions list page.

Diagnosis Categories When clients are dually diagnosed, they may receive services on the same day that address each of the diagnoses. In such cases, your organization must ensure the correct diagnosis information, both axis and priority, is included on the claim. CareLogic offers the following approaches for assigning the correct diagnosis to a service:

• Manual Process. Using this approach, the staff member who provides the services must manually select the correct diagnosis via a service document containing the Attach Existing Diagnosis module (see the Clinical Record Guide).

• Automatic Process. Using this approach, your system administrator must set up the Diagnosis Category module. Once this module is set up, the system will automatically select the correct diagnosis by using the diagnosis category associated with the treatment program. In order to use the Diagnosis Category feature, you must use the following outline to set it up:

• Set Up the Diagnosis Category Module • Assign Diagnosis Categories to Programs

Set Up the Diagnosis Category Module This module is used to define diagnosis categories for treatment programs. A treatment program must be selected each time a service is scheduled. Once the service is delivered and the claim is batched, the system uses the diagnosis category associated with the program to determine which diagnosis to assign.

To set up the Diagnosis Category module: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Diagnosis Category.


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The Diagnosis Categories list page appears. The active records appear in the top list and the inactive record appear in the bottom list. A diagnosis category record is active as long as the current system date falls within its date range. A record becomes inactive when the current system date meets or exceeds its date range.

3 Click Add Diagnosis Category in the status bar. The Diagnosis Category Entry page appears. All required fields are highlighted.

4 In the Begin Date field, enter the first date this record will become active in the system. This is the first date this record will be available in the Diagnosis Category drop-down list in the Program module (see Assign Diagnosis Categories to Programs).

5 If this record is to be available for a defined date range only, enter the end date in the End Date field. This is the last date this record will be available in the Diagnosis Category drop-down list in the Program module (see Assign Diagnosis Categories to Programs).

6 In the Description field, enter a name for this diagnosis category record. This is the name by which this record will be listed in the Diagnosis Category drop-down list in the Program module (see Assign Diagnosis Categories to Programs). This entry can be up to 100 characters.

7 In the Type of Diagnosis Category field, indicate if the diagnosis category you have entered is a substance abuse or mental health diagnosis category.

Note: This field only appears for agencies in Connecticut whose systems are configured for DDaP reporting.

8 Click Submit in the status bar. The record is saved and listed on the Diagnosis Categories list page.


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9 Locate the record you just added and click the DSM Codes button. The Diagnosis Category DSM Codes page appears.

10Click Add Diagnosis Category DSM Code in the status bar. The Diagnosis Category DSM Codes Entry page appears. A starting and ending diagnosis code is required for each record.

11In the Starting Diagnosis Code field, use the search-and-select field to locate the beginning diagnosis code.

12In the Ending Diagnosis Code field, use the search-and-select field to locate the ending diagnosis code.

13Click Submit in the status bar. The diagnosis code range record is saved and listed on the Diagnosis Category DSM Codes list page.

Note: To enter additional records for the selected diagnosis category, repeat Steps 9 through 13. Once you have entered all the desired records, click Return to Diagnosis Category List in the status bar.

Assign Diagnosis Categories to Programs When using the Diagnosis Categories feature (see page 59), you must assign a diagnosis category to your treatment programs.

To assign diagnosis categories to programs: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Programs.


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The Program Administration list page appears. 3 Click Add a Program in the status bar.

The Program Administration page changes to add mode. All required fields are highlighted.

4 In the Program Code field, enter a code to represent the program. Your entry can be up to six characters.

5 In the Program Name field, enter a description of the program. 6 In the Begin Date field, enter the date the program becomes active in the system. Your

entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

7 In the End Date field, enter the date the program becomes inactive in the system. Your entry must be in the following format: mm/dd/yyyy. You can either manually enter a date or click the Calendar icon to select a date from the popup window.

8 In the HCPF Program Code field, enter the Health Care Financing and Policy code for the program. This field is used in Colorado state reporting.


9 In the EBP Service Category field, use the drop-down list to select the Evidence Based Practice service category for the state-defined program. This field is used in Colorado state reporting.


10In the DPAS Program ID, enter your DHMAS Provider Access System Program ID number.


11If you want to classify the program, use the drop-down list in the Program Classification field to select an option.


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12In the Per Diem field, indicate if this is a per diem treatment program. If you select Yes, you must set up the per diem activities you want to associate with the program (see Set Up Activities for Per Diem Programs).

13The CRS Site Facility Code field is used only for agencies located in Philadelphia and is used as a program-level code to identify the program in which the client is being served.


14In the Requires Diagnosis field, indicate if the treatment program requires a diagnosis to file claims.

15In the Capacity field, enter the client capacity for this program. Note: This field may or may not appear in your system based on how your system is configured. For

questions about this configuration, please contact QSI Support. Once the client admission capacity has been reached for the program, each subsequent attempt to admit a new client to the program will result in a scheduling validation issue alerting the person scheduling the service that the program capacity has been reached.

16In the Budgeted field, enter the number of budgeted enrollments for this program. Note: This field may not display on your system. It is a configurable field that is activated based on


17Click Submit in the status bar. The new program is saved and listed on the Program Administration page.

Call Logs A Call Log enables your organization to provide phone services to clients who may not be enrolled in a treatment program at the time of the initial contact. The Call Log Administration module is used to define the number of days after the initial call your staff should contact the client and the number of days for routine follow-up after the initial call.

To set up a call log: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Call Log Administration.

The Call Log Administration list page appears.

3 Click Add Call Log Administration in the status bar. Note: When an entry has an end date entered and you click the Copy button that corresponds with the

call log, a new entry appears with the Begin Date populated with the date following the End Date of the copied call log, and it also copies the number of days for follow-up calls after the initial call.


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The Call Log Administration entry page appears. All required fields are highlighted.

4 In the Name field, enter a name for the call log record. This name will be an option when configuring the service document instance.

5 In the Begin Date field, enter the first date this call log record will be available in the system. This is the first date this call log record can be selected when configuring a service document instance.

6 In the End Date field, enter the last date this call log record can be used in the system. This is the last date this call log record can be selected when configuring a service document instance.

7 In the # of Days to Follow Up After Initial Call field, enter the number of days your staff should wait before making the second contact with the client.

8 In the # of Days for Routine Follow Up After Initial Call field, enter the number of days your staff should wait to contact the client for routine follow-up calls.

9 Click Submit in the status bar. The call log administration record is saved and listed on the Call Log Administration list page. At this point, the call log administration record can be used to configure a service document instance.

DRG Codes Administration DRG (diagnostic related groupings) codes are diagnosis codes that are used by inpatient and residential treatment facilities. By default, the DRG module contains a list of all the nationally standardized codes. As a system administrator, you have the ability to activate and inactivate DRG codes. All of the active DRG codes can be used by clinicians to diagnosis clients. The inactive DRG codes will not be available to diagnosis clients.

Note: Clients are diagnosed with DRG codes through the Client DRG clinical module (see page 107 the Clinical Record Guide).

To update DRG codes: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select DRG Codes.

The DRG Codes list page appears. By default, all of the DRG codes are inactive in the system, which means they cannot be used to diagnosis clients. If desired, you can use this task to activate the DRG codes that your treatment facility will use.


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3 To activate a DRG code, click the check box in the Show By Default column. A check mark appears in the Show By Default column for the selected DRG code, which means the selected code is now active.

4 To make a DRG code inactive, click the check box in the Show By Default column again.

The check mark is removed from the Show By Default column for the selected code, which means the code is inactive. Note: By repeating Steps 3 and 4, you can activate and inactivate the DRG codes as desired.

5 Click Submit in the status bar. The active and inactive settings are saved for the DRG codes. At this point, your clinicians can use the active DRG codes to diagnosis inpatient and residential clients.

3rd Party Sources The 3rd Party Source module allows you to set up and store information for any 3rd party organizations or persons that may have relationships with clients that need to be tracked in CareLogic. For example, your agency may track client relationships with probation officers, referring physicians, and others.

To access 3rd Party Sources lists: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select 3rd Party Source.

The 3rd Party Source Search page appears, which allows you to filter by any 3rd party source types set up in your system.

Important: If you want to view all 3rd party sources set up in your system, you must leave both fields blank, and just click Submit in the status bar.


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3 If you want to search for a specific 3rd party source by name, enter the name of the source in the Name field.

4 If you want to filter your results based on 3rd party sources set up in your system, use the drop-down menu to select the source type you want to view in the 3rd Party Source Type field.

Note: The values in this field are driven by the values set up by your administrative setup. The List Modifier used to add and remove values in this field is 3rd Party Source Type.

5 Click Submit in the status bar. The 3rd Party Source list page appears.

This page is used to complete the following tasks: • Add 3rd Party Sources • Associate 3rd Party Sources with Organizations • Update 3rd Party Sources • Delete 3rd Party Sources

Add 3rd Party Sources This task is used to add 3rd party sources.

To add 3rd Party Sources: 1 Access the 3rd Party Sources list page (see 3rd Party Sources). 2 Click Add 3rd Party Source in the status bar.

The 3rd Party Source Entry page appears.


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3 In the Begin Date field, enter the date at which the 3rd party source is to become active in the system.

4 If the 3rd party source is only to be active for a set time, enter the last date at which it should be active in the End Date field.

5 Indicate if the 3rd party source you are entering is a Person or an Organization. Note: Depending on your selection, you must either enter an Organization name or a person’s First and

Last Name.

6 If you selected Organization in the field above, you must enter the name of the organization in the Organization field.

7 If you selected Person in the field above, you must enter the first name of the 3rd party source in the First Name field.

8 In the Middle Name field, you have the option to record the middle name of the 3rd party source you are entering.

9 In the Last Name field, you must enter the last name of the 3rd party source you are entering.

10In the Source Type field, use the drop-down list to select the 3rd party source type for the source you are entering.


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Note: The values in this field are driven by the values set up by your administrative setup. The List Modifier used to add and remove values in this field is 3rd Party Source Type.

11Enter the 3rd party source’s national provider ID number in the NPI field, where applicable.

12Enter the 3rd party source’s taxonomy code to indicate their provider specialty code for claims in the Taxonomy Code field, where applicable.

13Enter the 3rd party source’s federal tax ID in the Federal ID field. 14Enter the 3rd party source’s social security number in the Social Security

Number field, where applicable. 15In the Country field, use the drop-down list to select the country in which the 3rd

party source is located. Important: If you select the USA, or one of its territories, this page allows you to enter a domestic

address (Steps 16 through 19). If the payer plan is located outside the USA, you must enter an international address. Once you select a country other than the USA, the page is refreshed to display all of the address fields (Steps 16 through 19) as text entry fields. This means that when you enter an international address, you must manually enter the city, state/province, postal code, and county.

16In the Street fields, enter the physical address of the 3rd party source. 17If the 3rd party source’s address contains an apartment or suite number, enter it in

the Apt/Suite field. 18For addresses located within the USA, or one of its territories, use one of the

following methods to enter the payer plan’s city, state/province, and postal code (zip code). • To use the Postal Code Lookup feature, select the Do City/State lookup

using Postal Code check box, enter the 3rd party source’s postal code (and postal code extension, if known), and press Tab. The system performs a postal code lookup and automatically populates the City, State, and County fields. The city that is preceded by an asterisk is the postal service’s preferred city for the postal code entered.

• To manually enter the city, state, and postal code, uncheck the Do City/State lookup using Postal Code check box, enter the city, use the drop-down list to select the state, and enter the postal code (and postal code extension, if known).

19Before you can select the county in which the 3rd party source is located, you must select a state (by either method described in the previous step). The County field is automatically filtered to include only the counties that are located within the selected state. Use the drop-down list to select the appropriate county.

20In the Phone Number field, enter the3rd party source’s 10-digit telephone number. If the 3rd party source has an international phone number, select the International Number check box (to modify the Phone Number field), and then enter the country code and international number. This entry can be up to 40 characters.

21In the Fax Number field, enter the 3rd party source’s 10-digit fax number. If the 3rd party source has an international fax number, select the International Number check box (to modify the Fax Number field), and then enter the country code and international number. This entry can be up to 40 characters.

22Click Submit in the status bar. The 3rd party source information is saved in the system.


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Associate 3rd Party Sources with Organizations This task is used to associate 3rd party sources with the organizations they will be used at.

To associate 3rd party sources with organizations: 1 Access the 3rd Party Sources list page (see 3rd Party Sources). 2 Click the Organizations button that corresponds with the 3rd party source you want to

associate with organizations. The Organization List page appears.

3 By default, the 3rd party source is only associate with the organization at which it was created. To associate it with multiple organizations, you can select the individual organizations you want it associated with. To associate the source with all organizations, select the checkbox at the very top of the Organization List to select all.

4 Click Submit in the status bar. The 3rd party source is associated with the selected organizations.

Update 3rd Party Sources Once a 3rd party source is created, you must use this task to update it.

To update a 3rd party source: 1 Access the 3rd Party Sources list page (see 3rd Party Sources). 2 Click the Select button that corresponds with the source you want to update.

The 3rd Party Source Entry page appears for the selected source record. You can edit any of the fields on this page. Refer to Add 3rd Party Sources for field descriptions.

3 After making the desired edits, click Submit in the status bar. The selected rule is updated saved to the system.

Delete 3rd Party Sources This task includes instructions for deleting a 3rd party source.

Note: If the source has an active relationship to one or more clients, it cannot be deleted.

To delete a 3rd party source: 1 Access the 3rd Party Sources list page (see 3rd Party Sources). 2 Click the Delete button that corresponds with the source you want to delete.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected source. 4 Click Submit in the status bar.

The selected source is deleted and is no longer listed on the 3rd Party Sources list page.

Referring Physician Configurations The Referring Physician Configuration allows your agency to define basic rules to indicate when a client or service requires a Referring Physician, based on criteria like payer plan, procedure, and age range.

To access referring physician configurations:


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2 Click the Show Menu arrow in the shortcut bar and select Referring Physician Configuration.

The Referring Physician Configurations list page appears, which displays all referring physician configurations set up for your organization.

This page is used to complete the following tasks: • Add Referring Physician Configurations • Update Referring Physicians Configurations • Delete Referring Physicians Configurations

Add Referring Physician Configurations This task is used to create referring physician configurations that drive when a referring physician is required for a client or service.

To add a referring physician configuration: 1 Access the Referring Physician Configurations list page (see Referring Physician

Configurations). 2 Click Add Configuration in the status bar.

The Referring Physician Configuration Entry page appears.


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3 In the Name field, enter a name for the referring physician configuration being created. Generally, the name should indicate what the configuration refers to. For example, if you are creating a configuration that requires all clients who have Cigna as their primary payer to require a referring physician, you might name your configuration ‘Cigna - All Require Referring Physician’.

4 In the Begin Date field, enter the date at which the referring physician configuration is to become enforced in the system.

5 If the referring physician configuration is only to be enforced for a set time, enter the last date at which it should be enforced in the End Date field.

Important: A Referring Physician Configuration must use at least one of the criteria below: age range, payer plan, or procedure.

6 If you want to require all clients within a certain age range to require a referring physician, enter a begin and end range in the Age Range field.

7 The Payer Plan field allows you to include or exclude one or more payer plans from requiring a referring physician.

• Indicate if you are including or excluding the selected payer plans from requiring a referring physician.

• Filter the payer plan drop-down by selecting a Payer in the first drop-down list.

• Use the drop-down list to select the payer plan that you are including or excluding from the referring physician requirement, and click Add.

Note: For example, if you only want clients with Cigna to require a referring physician, you would select Include and select the Cigna payer plan and click Add.

8 The Procedure field allows you to include or exclude one or more procedures from requiring a referring physician.

• Indicate if you are including or excluding the selected procedures from requiring a referring physician.

• Filter the procedure drop-down by entering the full or partial name or procedure code for the desired procedure, and hit the Tab key.

• Use the drop-down list to select the procedure that you are including or excluding from the referring physician requirement, and click Add.

Note: For example, if you want all clients who receive Individual Therapy 20-44 minutes to require a referring physician, you would select Include and select the Individual Therapy procedure code and click Add.

9 Click Submit in the status bar. The configuration is saved and listed on the Referring Physician Configurations list page.

Update Referring Physicians Configurations Once a referring physician configuration is created, you must use this task to update it.

To update a referring physician configuration: 1 Access the Referring Physician Configurations list page (see Referring Physician

Configurations). 2 Click the Select button that corresponds with the configuration you want to update.

The Referring Physician Configuration Entry page appears for the selected configuration record. You can edit any of the fields on this page. Refer to Add Referring Physician Configurations for field descriptions.


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3 After making the desired edits, click Submit in the status bar. The selected configuration is updated and listed on the Referring Physician Configurations list page.

Delete Referring Physicians Configurations This task includes instructions for deleting a referring physician configuration.

To delete a referring physician configuration: 1 Access the Referring Physician Configurations list page (see Referring Physician

Configurations). 2 Click the Delete button that corresponds with the configuration you want to delete.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected configuration. 4 Click Submit in the status bar.

The selected referring physician configuration is deleted and is no longer listed on the Referring Physician Configuration list page.

Business Rules The CareLogic Business Rules module allows you to set business rules around Scheduling, Clinical Decision, and Treatment Plan activation for billing purposes at your facility.

For some clinical documents, the documentation must be updated periodically. When the document is “expired,” only certain services can be delivered. The Scheduling Rules module allows you to define documentation “expiration” and what activities can be scheduled until the documentation is updated.

If someone tries to schedule an unapproved activity before the documentation has been updated, they will receive a Scheduling Validation Issue on the schedule confirmation page.

Treatment Plan Rules relate to the following criteria:

• Activating Credentials • Duration for Initial Treatment Plan and Reviews • Claim Engine Enforcement, including Grace Period, for Active Treatment Plan • Staff and Supervisor Alerts for Treatment Plans approaching an End Date

To add Business Rules: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Business Rules.

The Business Rules wizard page appears, which displays all scheduling and treatment plan rules set up for your organization.


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This page is used to complete the following tasks: • Add Scheduling Rules • Add Clinical Decision Rules • Add Employee Document Rules • Add Treatment Plan Rules

Add Scheduling Rules This task includes instructions for adding scheduling rules around “expired” documentation that needs to be updated before more services can be scheduled.

1 Access the Business Rules wizard (see Business Rules). 2 Click the Scheduling Rules link in the wizard.

The Scheduling Rules list page appears. 3 Click Add Scheduling Rule in the status bar.

The Scheduling Rule Entry page appears.


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4 In the Begin Date field, enter the date at which the scheduling rule is to start being enforced for the Scheduling module.

5 If the scheduling rule is only to be enforced for a set time, enter the last date at which it should be enforced in the End Date field.

6 The Organization field is used to select the organization you want to associate with this scheduling rule. This drop-down list includes only the organization you are currently logged into and all child organizations.

7 In the Name field, enter the name of the scheduling rule so that it can be easily identified when updates are needed at a later date.

8 The Service Document field is used to the select the service document associated with this scheduling rule.

9 In the Number of Days field, enter the number of days after the selected documented is fully signed that the rule begins to be enforced.

Note: For example if you selected an Integrated Service Plan service document in the field above, and it must be reviewed and updated every 30 days for continuation of services, you would enter 30 in this field.

10In the Programs field, indicate how the scheduling rule will be applied to the selected programs. You have the option to apply the scheduling rule to the selected programs or to apply the rule to all programs, except the ones selected. Search for the programs you want to apply the rule to or exclude from the rule, and use the drop-down list to select the desired programs. Click Add to add the selected program to the list.


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11In the Activities field, indicate how the scheduling rule will be applied to the selected activities. You have the option to apply the scheduling rule to the selected activities or to apply the rule to all activities, except the ones selected. Search for the activities you want to apply the rule to or exclude from the rule, and use the drop-down list to select the desired activities. Click Add to add the selected activities to the list.

12The Confirmation/Error field is used to indicate if you will allow the scheduler to override the scheduling validation issue displayed on the scheduling confirmation page or not.

13The Message field allows you to enter the text that will appear on the schedule confirmation page when a scheduler tries to schedule an activity that falls outside of the rule you are defining. Your entry can be up to 4,000 characters.

14Click Submit in the status bar. The scheduling rule is saved to the system and listed on the Scheduling Rules list page.

Add Clinical Decision Rules This task includes instructions for adding clinical decision rules around criteria from Demographics, Labs, Medications, Treatment Diagnosis, and Vitals information to generate alerts with actions that need to be completed.

1 Access the Business Rules wizard (see Business Rules). 2 Click the Clinical Decision Rules link in the wizard.

The Clinical Decision Rules list page appears. 3 Click Add Clinical Decision Rule in the status bar.

The Clinical Decision Rule Entry page appears.

4 In the Begin Date field, enter the date at which the clinical decision rule is to start being enforced.


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5 If the clinical decision rule is only to be enforced for a set time, enter the last date at which it should be enforced in the End Date field.

6 The Organization field is used to select the organization you want to associate with this clinical decision rule. This drop-down list includes only the organization you are currently logged into and all child organizations.

7 In the Name field, enter the name of the clinical decision rule so that it can be easily identified when updates are needed at a later date.

8 In the Alert Message field, enter the message that you want to appear for staff members as an alert for the clinical decision rule you are entering. The message should clearly indicate what the message is about and why it is being used.

Important: At least one action must be entered, but up to four actions can be entered at one time, as needed.

9 In the Action 1 field, enter the text for what action the staff member should take to follow up on the issue identified by the alert.

10Repeat Step 9as needed if multiple actions should be taken. 11In the Defer Alert field, indicate if CareLogic should defer the alert or not. 12If you selected Yes in the Defer Alert field, enter the what action should be taken for

the deferral in the Deferral Action field. 13In the Conditions field, indicate if the conditions you are setting must all be met, or if

only one or more of them should be met. 14In the Clinical Decision Rule table, use the following steps to set your criteria for the

desired clinical decision rules: Note: Medication and Lab Test rules can use a wild card search instead of creating a separate rule for

each variant. Enter a partial value and place a percent sign at the end of the partial value. Any variation of the medication or lab test that begins with the partial value will trigger the rule alert. the wild card feature applies to medication names and lab result tests.

a In the Group column, use the drop-down list to select clinical information covered by this clinical decision rule.

b In the Criteria column, use the drop-down list to select which criteria you wish to compare as part of the clinical decision rule.

c In the Comparison column, use the drop-down list to select the method by which you wish to compare client information. For example, you may want to compare information about clients within a certain age range, so you could create a clinical decision rule only looking at clients with ages greater than or less than a certain age.

d In the Value column, enter the parameter that should be used with the comparison option you selected.

e Click Save to save the clinical decision rule information entered. The Clinical Decision Rule information you entered is saved, and new row appears to allow you to record more rules as part of the same clinical decision rule record.


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Add Employee Document Rules Documentation review business rules can be created and applied to staff by individual or role. Reviews can also be set based on service document. Review periods can be adjusted to suit business needs.

This task includes instructions for adding employee document rules for reviewing service documents.

1 Access the Business Rules wizard (see Setting Up Business Rules). 2 Click the Employee Document Rules link in the wizard.

The Employee Document Rules list page appears. 3 Click Add Employee Document Rule in the status bar.

The Employee Document Rules Entry page appears. 4 Complete the form:

a Begin Date: Date the rule becomes available to apply (required) b End Date: Date the rule will no longer be applied (optional) c Organization: Organization the rule will apply to; NTier compliant (required) d Name: Rule name (required) e Service Document: Select a service document the rule will apply to (required) f Number of days in Employee profile: Time period the rule will be in effect once applied (required) g To add another service document to the rule, click the Add button on the left end of the row and

repeat steps e-f (optional) h Repeat step g until all desired documents are added to the rule (optional)

5 Click Submit.

Add Treatment Plan Rules This task includes instructions for adding treatment plan rules around activating treatment plans for billing purposes.

1 Access the Business Rules wizard (see Business Rules). 2 Click the Treatment Plan Rules link in the wizard.

The Treatment Plan Rules list page appears. 3 Click Add Treatment Plan Rule in the status bar.


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The Treatment Plan Rule Entry page appears.

4 In the Begin Date field, enter the date at which the treatment plan rule is to start being enforced.

5 If the treatment plan rule is only to be enforced for a set time, enter the last date at which it should be enforced in the End Date field.

6 In the Priority field, enter the priority level for this treatment plan rule. This determines which rule is enforced if there are conflicts.

7 The Organization field is used to select the organization you want to associate with this treatment plan rule. This drop-down list includes only the organization you are currently logged into and all child organizations.

8 In the Name field, enter the name of the treatment plan rule so that it can be easily identified when updates are needed at a later date.


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9 The Service Document field is used to the select the service document associated with this treatment plan rule.

10In the Programs field, indicate how the treatment plan rule will be applied to the selected programs. You have the option to apply the treatment plan rule to the selected programs or to apply the rule to all programs, except the ones selected. Search for the programs you want to apply the rule to or exclude from the rule, and use the drop-down list to select the desired programs. Click Add to add the selected program to the list.

11In the Activating Credentials field, indicate which credentials should set a begin date for the treatment plan. For example, if a psychiatrist must sign the treatment plan before it is active, the Begin Date of the treatment plan is set to the first date on which the MD signed the document.

12In the Default Duration for Initial field, enter the default number of days the treatment plan is valid for.

13In the Default Duration for Review field, enter the default number of days after which the treatment plan should be reviewed.

14In the Enforce Active Tx Plan field, indicate if you want the Claim Engine to fail any services that have not been activated by an activating credential or not.

15In the Grace Period field, enter the number of days that a client’s services can be billed before the treatment plan must be activated.

16In the Days to Alert Primary Staff field, enter the number of days prior to the treatment plan expiration date that the client’s primary staff relationship should receive an alert.

Note: Alerts are episode-compliant. 17In the Days to Alert Supervisor field, enter the number of days prior to the treatment

plan expiration date that the supervisor of the client’s primary staff relationship should receive an alert.

Note: Alerts are episode-compliant. 18Click Submit in the status bar.

The treatment plan rule is saved to the system and listed on the Scheduling Rules list page.

Patient Portal The Patient Portal provides patients with timely electronic access to their health information. Clients and authorized individuals can view CareLogic records through the portal, if granted access. Access to a patient’s portal is controlled on a case by case basis by those with access to CareLogic and the client’s ECR. Portal access for any record is managed through the client’s ECR. Refer to Patient Portal.

Access to individual documents in the patient portal can be controlled. Restrictions can be set added and removed as needed.

The Patient Portal feature requires setup in two areas:

• Menu items are added to the Patient Access wizard (refer to Configuring the Menu Management System) to determine what item types will be available in the portal.

• The Portal Restriction Reason descriptor list is built and populated (refer to Setting Up the List Modifier) to record reasons an item was not available in the portal.

Items displayed in the side menu are determined by configuration of the Patient Access wizard and organization the patient is admitted to. Items chosen should include allergies, immunizations, lab results, medications, treatment diagnosis, and treatment plan at a minimum.


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The portal face sheet will display based on the organization the client is admitted to. See Face Sheet Administration to set up the patient portal face sheet.

A guide to using the portal is included in the ECR section.

Clinical Quality Measures The object of Clinical Quality Measures is to report ambulatory clinical quality measures to CMS. There are three core measures, three alternate core measures, and 38 additional measures. CareLogic provides nine measures to choose from. The measures are:

Core • NQF 0421, PQRI 128 – Adult Weight Screening and Follow-Up • NQF 0013 – Hypertension: Blood Pressure Management • NQF 0028 – Preventive Care and Screening Measure Pair: a. Tobacco Use Assessment, b.

Tobacco Cessation Intervention Alternate Core

• NQF 0041, PQRI 110 – Preventive Care and Screening: Influenza Immunization for Patients 50 Years and Older

• NQF 0024 - Weight Assessment and Counseling for Children and Adolescents • NQF 0038 – Childhood Immunization Status

Additional Measures • NQF 0004 – Initiation and Engagement of Alcohol and Other Drug Dependence Treatment:

a. Initiation, b. Engagement

• NQF 0105, PQRI 9 – Major Depressive Disorder (MDD): Antidepressant Medication During Acute Phase for Patients with MDD

• NQF 0027, PQRI 115 – Preventive Care and Screening: Advising Smokers to Quit Inputs are gathered through service document modules (see Add Service Documents) and reported via XML document. This document can be generated whenever the report is needed. These reports can be generated for any time period desired and made available for transmission to CMS.

A menu link for Clinical Quality Measures Report (admin_qm$.search_form) must be added to access reports. Refer to Configuring the Menu Management System.

Report Clinical Quality Measures The CQM reports headers now have information that makes it easy to identify the data that needs to be entered into the state or CMS website for attestation.

Each report now has the following information in the header:

• NQF # and PQRI # (if applicable)

• NQF Description

• Denominators

• Numerators


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• Exclusions (if applicable)

• Population Criteria Details link (which will display the details of the report when linked)

Examples

NQF 0421/PRQI 128

NQF 0013

NFQ 0028


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Create a Clinical Quality Measures Report 1 Navigate to Administration → Clinical Quality Measures Report → Add a Report 2 Fill out form

• Organization: select from drop-down (required) • Include Child Organizations? choose Yes or No (required)

• Begin Date: select the end date to pull data for the report (required)

• End Date: select the end date to pull data for the report (required)

• Clinical Quality Measure: select measure to report on from the drop-down (required)

3 Click Submit. The Clinical Quality Measures report page will be displayed and contain the completed report


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View a Clinical Quality Measures Report 1 Navigate to Administration → Clinical Quality Measures Report

2 Find the desired report and click Select 3 To see a measurement detail click on the Detail button in the desired measurement

4 To return to the report from details click Return to List 5 To return to all reports from a report click Return to Criteria


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System Administration This chapter includes instructions for setting up system administration. This chapter includes the following topics:

• Menu Management System • Setting Up the List Modifier • Setting Up Privilege Groups • Dashboard Administration • Face Sheet Administration • Accessing a Service Process Quality Management File • Setting Up Group Bonus Configurations • Setting Up Group Bonus Configurations • Setting Up Fee For Service Mapping • Setting Up Unit Cost Management • Mapping DRG Codes • Creating HL-7 Batches • Using the Clinical Audit Log • Setting Up Source of Payment Instances • Using Session Management • Using Session Management • Setting Up a Co-Pay Matrix • Setting Up Per Diem Schedules • Setting Up iCalendar Feeds • Setting Up Holidays

Menu Management System The menu management system is used to configure the CareLogic navigation bar and the options that are available when you click the Show Menu arrow in the shortcut bar. A different menu management system can be set up for each organization, if desired. The menu management system consists of the following five levels: Top Menu Systems. This level is used to configure the top-level menu systems that appear in the

navigation bar. Menu Systems. This level is used to configure all of the menu systems in the system. Button Systems. This level is used to configure the buttons on the right side of the navigation bar. Wizards. This level is used to configure the five wizards that appear in the system: Point of Entry, Staff,

Payer Plan, Payer Collections, and Guarantor Collections. Tabbed Forms. This level is used to configure the two tabbed forms that appear in the system:

Payment Entry and Claim Maintenance.

For each organization and menu level, you can edit the menu item names, set up privilege levels for the menu items, change the order in which the menu items appear, change the status of the menu items, and delete the menu items.


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Prior to configuring the menu management system, you should be aware of the following information. You must define privileges for each menu item. By default, there are no privileges assigned to the

menu items. Administrators are considered super users, which means they can see all menu items. In order to

confirm menu option items, administrators must set up a lower-level user account and log in to the system using this account.

There is more than one way to access certain areas of the system. The administrator must consider this fact when setting up privileges in order to maintain the integrity of the system.

For each menu level, the menu management system is used to perform the following tasks: Adding Menu Systems Select Menu Items Encrypt a Menu Link Setting Up Menu Items by Organization Defining Privilege Levels for Menu Items Changing the Order of Menu Items Deleting Menu Items Deleting Menu Items

Adding Menu Systems This task includes instructions for adding menu systems in the menu management system.

Important: If you select an Episode Type for the menu system, a default menu to filter by episode will be created for the episode type, which includes the following links: Demographics, Program History, Staff Relationships, Group Assignments, Bed History, Service History, Scheduled/Cancelled Visits, Service Document Reporting, Client Episodes, Treatment Diagnosis, and Orders. You can modify these default links based on organizational need. Any Clinical Modules you add for an episode menu system will filter the service document lists to only include the ones associated with the selected episode of care.

Setup for Top-Level Menu systems differs from all other levels. Both tasks are detailed in this section.

Add a Top-Level Menu System To add top-level menu systems:

1 Navigate to Administration → Menu Management 2 Click Select on Top Menu System. The Top Menu System Menus will be displayed 3 Click Add an Entry 4 Complete the form:

Menu Item Name: Enter a menu name (required) Linked Menu System: Select the desired menu system (required) Target: Leave blank Pass Encrypted Parameters in URL? No


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5 Click Submit Note: Privileges will not be available to set until the menu item is created.

Add a Lower-Level Menu System To add lower-level menu systems:


2 Click the Show Menu arrow in the shortcut bar and select Menu Management. The Menu Management System appears.

3 Click the Add a System button in the status bar. The Menu System Administration page appears. All required fields are highlighted.

4 In the Menu System Name field, enter the name for the menu system you are adding. Note: If you are adding a menu system for an episode type, Qualifacts recommends naming the menu

system the same name as the episode type to limit any miscommunication about which episode the menu system is associated with.

5 In the Episode Type field, use the drop-down list to select the appropriate episode of care type. For more information on episode of care types, see page 202. The options is this field include all episode types set up in the system that have not had a menu system created for them.

Note: If you select an Episode Type from the drop-down list, you must select Menu System in the Menu System Type field below.

6 In the Menu System Entry Point, enter the entry point for the menu system. 7 In the Title Function field, enter the primary function of the menu system. 8 In the Menu System Type field, indicate which system type the menu should be

categorized under.


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Note: For episode menu systems, you must select Menu System in this field.

Select Menu Items This task includes instructions for selecting menu items in the menu management system.

To select menu items: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Menu Management.

The Menu Management System appears, which consists of five levels: Top Menu Systems, Menu Systems, Button Systems, Wizards, and Tabbed Forms. Each item within the menu management system contains a Select button which is used to drill-down into the item.

3 Click the Select button of the menu system you want to access. The selected item is opened and the corresponding page appears. In the following example, the Select button for the Schedule menu system was selected and the Schedule System Menus page appears. This page lists the menu groups that are available in the Schedule menu system. Note: You can continue to click the Select button until you reach the desired level.


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Add Menu Items To add menu items:

1 Navigate to Administration → Menu Management 2 Select menu and submenu until the desired menu link destination is open 3 Click Add an Entry 4 Complete form:

Menu Item Name: enter the menu item name (required) Service Document: select No (required) Procedure/Link: leave blank Description: enter as desired (optional) Target: leave blank Pass Encrypted Parameters in URL: select No (required).

Note: This setting is only used for external links. Refer to Encrypt a Menu Link for details.

5 Click Submit

Encrypt a Menu Link Some practices may have an external website they wish to link to through CareLogic. To maintain HIPAA security CareLogic will require an encrypted link to enable menu links to non-CareLogic sites. External links will open in a new window, keeping CareLogic active.

To encrypt menu items: 1 Follow Add Menu Items procedures. 2 In the Pass Encrypted Parameters in URL field, select Yes. Three new fields will be

displayed (required). Key: enter the encryption key in AES-128 format (required) Address: enter the web address, from http through the ‘?’ symbol (required) Parameter: enter the web address of everything after the ‘?’ symbol (required).


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3 Click Submit

Editing Menu Items This task includes instructions for editing the menu item names in the menu management system.

To edit menu items: 1 Access the menu option you want to edit (see Select Menu Items).

In the following example, the Schedule System Menus page is selected.

2 Click the Edit button of the menu item you want to edit. The Edit Menu Entry page appears. The top half of the page allows you to edit the name of the menu item. Note: For instructions about using the bottom half of the page to add privilege levels to the menu item,

see Defining Privilege Levels for Menu Items.


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3 In the Menu Item Name field, enter a name for the menu item as you want it to appear in the menu system.

4 In the Service Document field, indicate if the menu item you are creating is for a service document.

If you select Yes, the Document field replaces the Procedure/Link field. Use the drop-down list to select the service document you want to associate with the menu item.

Note: Service documents can be added to the ECR and the Point of Entry Wizard.

If you select No, the menu item is automatically linked to the procedure listed in the Procedure/Link field.

Important: The Procedure/Link field lists the PL/SQL package name and function associated with the menu item. Do not modify this field without the assistance of Technical Support.

5 The Description field can be used to enter a tool-tip description for the menu item. Users will see the tool-tip description when they hover their cursor over the menu item. The description can be up to 1,000 characters.

6 The Target field is used to enter the frame you want to target for the menu item. If the target frame is ‘form’, you do not have to enter a value in this field. You should only enter a value if the frame is something other than ‘form’.

7 Click Submit in the status bar. The updated menu item name is saved and listed on the previous page.

Setting Up Menu Items by Organization The menu management system gives you the flexibility to set up menu systems, wizards, and tabbed forms by organization. This means each organization can have a unique menu system that is specific to its workflow.

Note: When setting up the menu management system by organization, you should be aware of the parent/child relationship. In this model, all configurations flow down the organization tree. This means that parent organizations can see the configurations of all child organizations, but the child organization cannot see the configurations of parent organizations.

To set up menu items by organization: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Menu Management.


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The Menu Management system appears. The following sections can be set up by organization: menu systems, wizards, and tabbed forms. The process for setting up the menu management system is the same whether you are setting up a menu system, wizard, or tabbed form.

3 Locate the menu system, wizard, or tabbed form you want to set up by organization and click the Organization button.

The Organization Matrix page appears for the selected item.

4 To associate the selected menu item with an organization, click the Excluded button. The page is refreshed and the button is moved to the Included column, which means the menu item is available to the selected organization. You can associate the menu item with as many organizations as desired. Note: To associate the selected menu item with all organizations, click the Include All button in the

status bar. To exclude the selected menu item from all organizations, click the Exclude All button.

5 Click Submit in the status bar. The menu item organization matrix record is saved.

Defining Privilege Levels for Menu Items This task includes instructions for defining the privilege level for a menu item. Once a privilege level is defined, all of the individual staff members who are assigned to the privilege level (see page 15 the Employee User Guide) are automatically granted access to the menu item.

To define privilege levels for menu items: 1 Access the menu item for which you want to define a privilege level (see Select Menu

Items). In the following example, the Schedule System Menus page is selected.

2 Click the Edit button of the menu item for which you want to define a privilege level. The Edit Menu Entry page appears. The bottom half of the page (Menu Privileges) is used to define privilege levels for the menu item. Note: For instructions about using the top half of the page to edit the name of menu items, see Encrypt a

Menu Link.

3 Click the Edit Menu Privileges button. The Add Privilege Level page appears. This page lists all of the privilege levels that have been set up in the system.


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4 In the Select column, check all of the privilege levels you want to grant access to this menu item.

5 Click Submit in the status bar. The privilege levels you selected are saved and listed on the Edit Menu Entry page.

Changing the Order of Menu Items The menu management system allows you to define the order in which the menu items are listed for each Top Menu System, Menu System, Button System, Wizard, and Tabbed Form.

To change the order of menu items: 1 Access the menu options you want to rearrange (see Select Menu Items).

In the following example, the Clinical Management System Menus page is selected.

2 Use the buttons in the Move Up and Move Down columns to arrange the order of the menu items to meet your preferences.


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When you click the button in the Move Up column, the corresponding menu item is instantly moved up one level in the list. You can move a menu item up as many levels as desired.

When you click the button in the Move Down column, the corresponding menu item is instantly moved down one level in the list. You can move a menu item down as many levels as desired.

Note: Repeat this task until you have defined the order of all menu items for each Top Menu System, Menu System, Button System, Wizard, and Tabbed Form throughout the system.

Deleting Menu Items This task includes instructions for deleting menu items for each Top Menu System, Menu Systems, Button Systems, Wizard, and Tabbed Form throughout the system.

To delete menu items: 1 Access the menu item whose status you want to change (see Select Menu Items).

In the following example, the Schedule System Menus page is selected.

2 Click the Delete button that corresponds with the menu item you want to delete. A confirmation prompt appears.

3 Click OK to delete the selected menu item. The deleted menu item is removed from the CareLogic system.

List Modifier The List Modifier is used to maintain all of the list modifier fields in the system. If you have administrative rights, you can add, up-date, and delete the options that appear in the drop-down lists of list modifier fields. List modifier fields appear throughout the system.

List modifier fields are recognizable to administrators only. If you have administrative rights, you will see a D at the end of list modifier fields. When you hover over the D, a descriptor is displayed. The descriptor is the name by which the field is identified in the List Modifier.

Important: When adding a new List Modifier, it must be named exactly the way it appears when you hover over the “D” in the system. For example, to use Document Library, you must set up a list modifier named “Document Type” to add the different types of documents your organization uploads to the Document Library. This list modifier must be exactly the same to work in the system. Naming the list modifier “document type” instead of “Document Type,” for example, would cause the system to not recognize the list modifier.

Users who do not have administrative rights will not see a bold D at the end of list modifier fields, which means they will not be able to distinguish list modifier fields from other drop-down fields in the system.

Note: The system contains several default list modifiers. Any list available in the Type dropdown can be edited.


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The List Modifier page is used to perform the following tasks: Select a List Modifier Type Add a New List Modifier Type Set a List Modifier Descriptor as the Default Editing a List Modifier Descriptor Deleting a List Modifier Descriptor

Select a List Modifier Type This task includes instructions for selecting list types in the List Modifier.

Note: For general information about the List Modifier, see page 22.

To select a list type: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select List Modifier.

The List Modifier page appears.

3 In the Type field, use the drop-down list to select the list type you want to access. The List Modifier page is refreshed and the selected list type appears.

This page contains the following columns. Begin Date. This column lists the first date the option will be available in the drop-down list. End Date. This column lists the last date the option will be available in the drop-down list. Set as Default. If you want to make an option the default selection in the drop-down list, select this

radio button. When you set an option as the default value, it is highlighted in green to provide a visual clue to the default selection. You can only set one option as the default value.

Name. This column lists the name of the option as it appears in the drop-down list.


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Mapped Value. This column lists any value that will be reported in place of the selected descriptor value.

Order. This column indicates the sort order of the options in the drop-down list. The sort order is defined when you add a new option (see page 26).

Priority. This column indicates the priority of the descriptor value.

Add a New List Modifier Type 1 Click Administration in the navigation bar 2 The Administration menu system is loaded. 3 Click the Show Menu arrow in the shortcut bar and select List Modifier 4 The List Modifier page appears. 5 Click Add New Type 6 Complete the form:

a Type: Enter the value displayed on a list modifier field (required) Important: When adding a new List Modifier, Type must be named exactly the way it appears when

hovering over the D beside a field. List Modifier types are case sensitive.

Note: Adding a new type combines adding the type and adding a list modifier descriptor. Only the first step is needed to build the type, but each type must have at least one descriptor available. The following steps apply to the descriptor being added. Refer to Add New List Modifier Descriptors to add more descriptors.

b Name: Enter the name of a descriptor to be selected from this list type (required) c Begin Date: Enter the first date the descriptor named above will be available (required) d End Date: Enter the last date the descriptor named above will be available (optional) e Sub Type: Enter a subtype (optional) f Mapped Value: Substitutes the mapped value for the selected value when reported. If a selected

value for the field needs to be reported as a different value, enter a mapped value (optional) g Priority: Sets reporting order. If a recorded value for the field needs to be reported in a certain order,

enter a priority level (optional) h List Order: Sets dropdown display order. Enter a list order. Default order is alphabetical; values in the

List Order field will override default values (optional) i Availability: Select whether availability is for the logged-in organization only or for all organizations

(optional) j HIPAA Mandated: Select Yes only if HIPAA mandated (optional)

7 Click Submit

Add New List Modifier Descriptors By default, all of the drop-down fields that are used throughout the system are populated with drop-down options. This task includes instructions for adding additional options to the drop-down list fields.

To add new list modifier options: 1 Select the list modifier type (see Select a List Modifier Type) to which you want to add

a new list modifier option.


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2 Click the Add New Descriptor button. The New Descriptor Entry page appears. All required fields are highlighted.

Note: The Add New Descriptor button name will change based on the list type selected. Do not confuse it with the Add New Type button, which will create a new type.

3 In the Name field, enter the name of the option you want to appear in the drop-down list. Your entry can be up to 60 characters.

4 In the Begin Date field, enter the first date the option becomes active in the system. This is the first date the option will be available in the drop-down list.

5 In the End Date field, enter the last date the option is active in the system. Once this date arrives, the option will no longer appear in the drop-down list.

6 In the Sub Type field, enter the subtype, if needed 7 In the Mapped Value field, enter the mapped value, if needed 8 In the Priority field, enter the priority, if needed 9 If you want to define the order in which the option is listed in the drop-down list, enter

a numeric value in the List Order field.


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10In the Availability field, indicate if the entry will be available for this organization only or for all organizations.

11In the HIPAA Mandated field, indicate if the new entry is mandated by HIPAA law. 12Click Submit in the status bar.

The new descriptor is saved and listed on the Language list modifier page.

Set a List Modifier Descriptor as the Default This task includes instructions for setting an option as the default selection. You can only set one descriptor as the default selection. Only one descriptor can be set as the default selection.

To set a list modifier descriptor as the default: 1 Select the list modifier type (see Select a List Modifier Type) that contains the

descriptor you want to set as the default. 2 In the Set as Default column, click the radio button that corresponds with the

descriptor you want to make the default selection. The selected descriptor is highlighted in green, which indicates it is the default selection.

Copy a List Modifier


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A descriptor list may contain several descriptors that are also used in a type being added. The copy feature allows existing descriptor lists to be copied into a type as it is created, saving entry time.

Note: The copy feature will not copy into an existing type. It will only copy as it creates a new type.

1 Click Administration in the navigation bar The Administration menu system is loaded.

2 Click the Show Menu arrow in the shortcut bar and select List Modifier The List Modifier page appears.

3 Click the Copy List button 4 Select the type to copy descriptors from 5 Enter the new Type name 6 Click Submit

A new type is created and descriptors populated from the type selected. Descriptors can be edited or removed as needed for the new type. Refer to Editing a List Modifier Descriptor and Deleting a List Modifier Descriptor for procedures.

Editing a List Modifier Descriptor In edit mode, you can modify the name of a list modifier descriptor, define the sort order for a list modifier descriptor, and specify if a list modifier descriptor is HIPAA mandated. This task includes instructions for editing a list modifier descriptor.

To edit a list modifier descriptor: 1 Select the list modifier type (see Select a List Modifier Type) that contains the

descriptor you want to edit. In the following example, the Language list modifier type is selected.

2 Click the Select button that corresponds with the list modifier descriptor you want to edit.

The New Descriptor Entry page appears. All required fields are highlighted. 3 Make desired changes. Refer to Add New List Modifier Descriptors. 4 Click Submit to save.

The selected list modifier descriptor is updated.


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Deleting a List Modifier Descriptor This task includes instructions for deleting list modifier descriptors.

To delete a list modifier descriptor: 1 Select the list modifier type (see Select a List Modifier Type) that contains the

descriptor you want to delete.

2 Click the Delete button that corresponds with the list modifier descriptor you want to delete.

A confirmation page appears. 3 Select Yes to confirm that you want to delete the selected descriptor. 4 Click Submit in the status bar.

The selected list modifier descriptor is deleted, which means it will not appear as a drop-down list descriptor for the selected list modifier type.

Setting Up Privilege Groups By default, the system includes several privilege groups that can be assigned to users. All of the privilege groups are assigned to users through the System module (see page 15 the Employee User Guide).

To set up privilege groups: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Privilege Groups.

The Privilege Level Groups page appears.


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3 Click the Add Privilege Group button. The Privilege Level Group Entry page appears. All required fields are highlighted.

4 In the Privilege Group Name field, enter the name of the privilege group you want to create. Your entry can be up to 30 characters.

5 Select the privilege levels you want to associate with the privilege group. See page 15 the Employee User Guide for a description of each privilege level.

6 Click Submit in the status bar. The new privilege group is created and listed on the Privilege Level Groups page. The new privilege group will be available in the drop-down list of the Privilege Group field on the Staff Checking Privilege Levels page (see page 15 the Employee User Guide).

Dashboard Administration The Dashboard Administration includes three areas: Dashboard, Face Sheet, and Patient Portal Face Sheet. Each area is discussed separately.


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Setting Up the Dashboard This section includes instructions for configuring the default settings for the Dashboard page.

The following modules are included on the Dashboard: Alerts, Claim Engine Information, Recent Payments, System Messages, and Upcoming Appointments. If you want other modules to appear on the Dashboard, contact the Qualifacts Professional Services department for assistance.

Note: Once the default Dashboard settings have been configured, they apply to all new users. All users, both new and existing, can use the User Preferences icon to override the default settings for their particular Dashboard page (see page 13 Introduction to CareLogic).

To set up the dashboard: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Dashboard Administration.

The Dashboard Modules page appears, which contains the following modules. Adjustments by Type. This module provides a pie chart view of all adjustments for the current

month and breaks them down by the entered adjustment types. Alerts. This module lists all of the system-generated, informational alerts for the current user. These

alerts are generated when you need to review something, such as the employee record of a new staff member who reports to you. Once the alert is reviewed, you can remove it from the Dashboard.

Avg Signature Time (My Staff). This module provides a bar chart of the 5 staff members for whom you are set up as a clinical supervisor who have the highest average time to sign documents. Average time to sign document is calculated from the day the document was created until the first signature is completed. For documents requiring additional signatures, the time is calculated from the time of the first signature until the second signature is complete.

Cash Collections. This module provides a bar chart view of the total amount of collections for the last 12 months. The chart also breaks down the amounts into Applied, Unapplied, and Unposted.

Claim Engine Information. This module lists information about the last Claim Engine run, such as the number of activities processed, the number of activities that failed, the number of claims that failed, and the number of activities that were successfully processed and are awaiting approval.

Consumers Seen vs. Scheduled. This module provides a parallel line graph view of the total number of client appointments that have been scheduled vs. the appointments that have been statused as Kept.

Last Seen (Active Clients). This module provides a pie chart view of the total number of clients who have been seen at your organization for the following intervals: 0-30 days, 31-60 days, 61-90 days, and 90+ days.

My Avg Signature Time. This module provides a bar chart that shows the average number of days it takes you to sign documents. Average time to sign document is calculated from the day the document was created until the first signature is completed. For documents requiring additional signatures, the time is calculated from the time of the first signature until the second signature is complete.

No Shows by Activity. This modules provides a pie chart view of all scheduled appointments that have been statused as DNS in the past 90 days and breaks them down by activities into percentages.

Payer Mix. This module provides a pie chart of the total percentages of payer types for the current month. For example, the chart would display all Medicaid, Commercial, and Self-Pay payments collected during the current month.

Program Capacity. This module is used to provide a bar chart view of the program capacity for all programs where the configuration is turned on to limit the number of clients admitted to a specific program.


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Recent Payments/Last Deposits Entered. This module lists the last 10 payments entered by the current user. For each payment, this module lists the entry date, deposit ID, deposit amount, the amount of unposted payments, the amount of unapplied payments, the amount of applied payments, and refunded amounts. If desired, you can access the details about the payment by clicking the Select button. Once the payments are completely applied and approved, they are removed from the Dashboard.

Revenue by Month. This module provides a bar chart view of total billed amounts for the last 12 months.

Schedule Summary. This modules provides a pie chart view of the total number of scheduled appointments in CareLogic. The scheduled appointments are broken down into Kept, None, and Other. You can click the Other sliver of the pie chart to see the other values and a breakdown of the number of other status values.

Note: Errored and Reversed activities are not included.

System Messages. This module lists all of the system messages that were set up through Administration (see page 261 the System Administration Guide).

Upcoming Appointments. This module lists all of the appointments you have scheduled for today. For each appointment, this module lists the appointment time, the name of the client or group, and the activity associated with the service.

Note: If your organization is using the E-Pharmacy/E-Lab configuration, the Clinician module is displayed on the Dashboard, with the link, ‘Today’s Status’. By clicking this link, you can view statistics about medication orders, reports, and the medication order statuses.

3 Click Default Dashboard in the status bar. The Optional and Mandatory Modules page appears.


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4 If you want to remove an optional module so that it does not appear on the Dashboard page for new users, uncheck the option in the Display column.

5 To change the column in which the module appears, select the desired radio button in the Column field.

6 Click Submit in the status bar. The configurations are saved and will be applied to the Dashboard page for all new users.

Face Sheet Administration The face sheet provides a consolidated client information page. Information in the ECR can be displayed on the face sheet. Selecting a link in the face sheet displays the corresponding module. The face sheet can be customized to display only what various organizations and staff groups want to see.

The Face Sheet Administration feature allows administrators to configure the face sheet according to their organization’s needs. The feature is part of Dashboard Administration and contains modules and layouts which can be built and displayed on the face sheet.

The modules available are Contact Information, Demographics, Diagnosis, Financial Information, Guarantors, Message Board, Payer Authorizations, Scheduled Appointments, Service Documents, Treatment Plan Expirations, and Upcoming Appointments.

Face sheet modules are arranged through the face sheet layout. Modules can be ordered vertically and horizontally. Layouts are set by organization and are NTier compliant.

The default face sheet layout contains demographics and contact information and is privileged for all users. Additional modules may be added.

Privileging allows organizations to show or hide modules in the face sheet based on privilege levels. The default face sheet is initially available to all users. Setting privileges by user authorization levels and layouts by organization provides a broad range of customization options.

The Patient Portal face sheet is configured separately from other CareLogic face sheets. It will display in the patient portal based on the client’s Admit To organization. This face sheet can be configured to show only specified modules. Configuration of a Patient Portal face sheet uses the same procedures as the CareLogic face sheet.


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Accessing a face sheet may not display a face sheet but instead display a note requesting a system administrator be contacted to set up the layout. This will occur if the Default layout is deleted and the modules contained in the user’s organization layout are all privileged above the user’s privilege level.

There is no CareLogic setup required to have face sheet functionality. However, to take advantage of the features available, face sheet contents and appearance can be adjusted. Modules control content type. Layouts control appearance through module display positions by organization and can be arranged to best fit business needs.

Modules are not available by default. They must be built to be used in a face sheet. Building a module makes it available to be selected in a face sheet layout. The layout determines what will be displayed and can be customized for different organizations. Only one layout may be built per organization.

Add a Face Sheet Module 1 Navigate to Administration → Dashboard Administration → Face Sheet 2 Select Add Module

3 Fill out form a Module Type: select from dropdown. These are all Qualifacts-defined types (required) b Module Name: Preset by type selection, change if desired (required) c Category: select from dropdown (required) Note: descriptors will need to be set up for this dropdown to be populated. Refer to (descriptor link) for

details on setting up a descriptor list.

d Release Date: set the date this module will first be available for face sheet use (required) e Discontinue Date: set the date this module will no longer be available for face sheet use (optional)

4 Click Submit


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Note: If a service document or scheduling module is created, clicking Submit will display the Configuration page. Refer to Configure a Face Sheet Module for directions on completing the configuration.

Delete a Face Sheet Module 1 Navigate to Administration → Dashboard Administration → Face Sheet 2 Click the Delete button for the desired module. A confirmation window will appear 3 Confirm deletion

Note: Deleting a face sheet module will also remove it from any layouts which included it.

Edit a Face Sheet Module 1 Navigate to Administration → Dashboard Administration → Face Sheet

2 Click the desired module 3 Make desired changes using Add a Face Sheet Module procedures 4 Click Submit

Configure a Face Sheet Module Configuration is only enabled for Service Document and Scheduled Appointments modules. If the Configure button is not visible the module is not configurable.

Configure the Service Document module 1 Navigate to Administration → Dashboard Administration → Face Sheet


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2 Click the Configure button for the desired module 3 Fill out form

a Service Document: select All or Specific. If specific is selected, a search/add form will be displayed. Enter a search and add documents from the results

b Document Status: select any document statuses to be included in the face sheet (required) c Number of Rows: set the maximum rows for this module to display in the face sheet (required)

4 Click Submit

Configure the Scheduled Appointments module 1 Navigate to Administration → Dashboard Administration → Face Sheet


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2 Click the Configure button in the desired module 3 Fill out form

a Service Document: select All or Specific. If specific is selected, a search/add form will be displayed. Enter a search and add documents from the results

b Appointment Status: select any appointment statuses to be included in the face sheet. Selecting c All will clear other selections (required) d Number of Rows: set the maximum rows for this module to display in the face sheet (required)

4 Click Submit

Privilege a Face Sheet Module Privilege levels may be set to limit who can view certain parts of the Face Sheet. By default, Uses privileges is set to No, allowing all users to view the module. Privileges do not need to be set unless a restriction is desired.

1 Navigate to Administration → Dashboard Administration → Face Sheet


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2 Click the Privileges button in the desired module 3 Select whether to use privileges. If No is selected, no privileges will apply, privilege

levels will not be selectable, and all users will see that module displayed when viewing a face sheet

4 If the Uses privileges is selected Yes, select desired privilege levels


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5 Click Submit

Edit Privileges for a Face Sheet Module Follow Privilege a Face Sheet Module procedures.

Add a Face Sheet Layout 1 Navigate to Administration → Dashboard Administration → Face Sheet → Layout

2 Select Add Layout 3 Fill out form

a Layout Name: b Organization: select organization from dropdown. NTier rules will apply Note: Only one layout may be created for each organization. Attempting to create a second layout for an

organization will cause an error message to appear.

c Select modules in each column as desired. Leave Select Module in the Module Name field for those module orders that should remain blank


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4 Click Submit. All associated face sheets will be displayed with the new layout 5 If desired, click Preview to see a dummy face sheet displaying the layout.

6 When finished with the preview, click Return to Face Sheet Layouts

Delete a Face Sheet Layout 1 Navigate to Administration → Dashboard Administration → Face Sheet → Layout


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2 Click the Delete button for the desired layout. A confirmation window will appear 3 Confirm deletion

Note: If no Face Sheet layout is set up, a note will be displayed requesting a system administrator be contacted to set up the layout. No other information will be displayed.

Edit a Face Sheet Layout 1 Navigate to Administration → Dashboard Administration → Face Sheet → Layout

2 Click the desired layout 3 Make desired changes using Add a Face Sheet Layout procedures 4 Click Submit. All associated face sheets will be displayed with the changed layout

Patient Portal Face Sheet Patient Portal Face Sheet procedures do not differ from standard face sheet procedures. Refer to Face Sheet Administration.

Select a Face Sheet Module To help administrators determine what modules they would like to include in the face sheet, each module is described here.

Contact Information – pulls information from the ECR Contact Information. This module can include physical, mailing, and work addresses; phone number and type for up to four phones; and email address. Clicking on any row will take the user to Contact Information entry.


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Demographics – pulls information from ECR Demographics. This module can include Name (hover the pointer over the name to see the name change history), CareLogic ID, client status, default episode, gender, birthdate, age, SSN, and picture. Clicking on any row will take the user to Client Demographics.

Diagnosis – pulls information from ECR Treatment diagnosis. This module can include all DSM-4 Codes with a Priority setting of 1, 2, or 3 from Treatment Diagnosis; Axis IV information; GAF score; diagnosis effective date; and staff name who diagnosed the client. Clicking a row will navigate to the entry page for that code for Treatment Diagnosis record.

Financial Information – pulls information from various locations. This module can include self-pay balance from Front Desk; client’s legacy balance from Financial Information; and client’s active payers from Payer module. Clicking on any row will take the user to Financial Information.

Guarantors – pulls information from ECR Guarantors. Self guarantors will not display. This module can include name and relationship to client; SSN; physical, mailing, and work addresses for each guarantor; phone number and type for up to four phones; and email address. Clicking on the title will take the user to Guarantors. Each row of a guarantor’s information is a link that leads to their record.

Message Board – displays all current messages related to the client from the Message Board module. Messages will retain selected color text and most current posted will be on top. Clicking on a row will take the user to Message Board recorded entry.

Scheduled Appointments – pulls information from the client’s schedule. This module can include date and time of a scheduled activity; the activity name; staff scheduled for the activity; organization the activity is at; and status of the activity. The scheduled appointments shown will be based on the number of visible rows chosen in Face Sheet Administration and the number of scheduled appointments. Appointments will be shown in reverse chronological order, with the most future appointment on top. Clicking on a row will take the user to the scheduled appointment selected in the Schedule.

Service Documents – pulls information from the client’s service documents. This module can include date the service document was created; the creating staff’s name; document status; document signature date or status; and service document name. Clicking on a row will take the user to the selected service document module.

Upcoming Appointments – pulls information from the client’s schedule. This module can include date and time of a scheduled activity; staff scheduled for the activity; the activity name; and location of the activity. The appointments shown will be based on the number of visible rows chosen in Face Sheet Administration and the number of upcoming appointments. Appointments will be shown for future appointments only. Clicking on a row will take the user to the appointment selected in the Schedule.

Use the Face Sheet Once a face sheet layout has been set it will automatically display. CareLogic will display the face sheet whenever a client’s ECR is accessed or the face sheet menu link is selected. The patient portal will display the face sheet upon login completion.

Note: If no Face Sheet layout is set up, a note will be displayed requesting a system administrator be contacted to set up the layout. No other information will be displayed.

Accessing an item from the face sheet 1 Navigate to a client’s face sheet


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2 Select any link. To see links, hover the mouse pointer over an item in the face sheet and watch the mouse pointer change to a link indicator

Adding System Messages This module is used to create system messages that appear on each staff member’s Dashboard page. System messages provide a convenient way of communicating company information to staff members.

To add system messages: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select System Messages.

The System Messages page appears. This page lists all of the system messages that have been set up in the system.

3 Click New Message in the status bar. The System-Wide Message Form appears. All fields on this form are required.

4 In the Message Date Range field, enter the date range you want the message to be displayed on each staff member’s Dashboard page. By default, the current system date appears in both fields, which means the message will be displayed for the current day only. You can either manually enter a date in mm/dd/yyyy format or click the Calendar icon to select a date.

5 In the Message field, enter the text of the message you want to display on each staff member’s Dashboard page. This entry can be up to 250 characters.


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The system message is saved. It appears on each staff member’s Dashboard page during the defined date range.

Accessing a Service Process Quality Management File CareLogic offers you the ability to extract Service Process Quality Management files which can be used by a third-party company to analyze and mine data regarding clients, staff, and other important information.

To access the SPQM extract list: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select SPQM Analysis.

The SPQM Extract List page appears.

This page is use to complete the following tasks: Retrieving SPQM Files Adding an SPQM Extract File Deleting an SPQM Extract File

Retrieving SPQM Files This task is used to search and retrieve SPQM files that have already been run.

To retrieve SPQM files: 1 Access the SPQM Extract List page (Accessing a Service Process Quality Management

File). 2 In the Begin Date field, enter the beginning date for the date range of the SPQM files

you want to search for. Your entry must be in the following format: mm/dd/yyyy.


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3 In the End Date field, enter the ending date for the date range of the SPQM files you want to search for. Your entry must be in the following format: mm/dd/yyyy.

4 Click Submit in the status bar. The SPQM search results page appear below the date search fields.

5 To save an SPQM file, click the Select button next to the corresponding SPQM file you want to save.

A File Download dialog box appears. 6 Click Save to save the SPQM file to your local hard drive.

Adding an SPQM Extract File This task is used to create an SPQM Extract that can be used for analysis.

To add an SPQM Extract file: 1 Access the SPQM Extract List page (Accessing a Service Process Quality Management

File). 2 Click Add SPQM Extract in the status bar.

The SPQM Analysis page appears.

3 In the Begin Date field, enter the beginning date of the date range for the activity data you want to include in the SPQM file. This entry must be in the following format: mm/dd/yyyy.

4 In the End Date field, enter the ending date of the date range for the activity data you want to include in the SPQM file. This entry must be in the following format: mm/dd/yyyy.

5 In the Activity Type field, indicate what activity types you want to include in the SPQM file.

6 Click Submit in the status bar. The SPQM Extract List page appears, displaying the SPQM file you created as the most recent.

7 To save the SPQM file, click the Select button next to the corresponding SPQM file you want to save.

A File Download dialog box appears. 8 Click Save to save the SPQM file to your local hard drive.

Deleting an SPQM Extract File This task is used to delete an SPQM Extract that has already been run.

To delete an SPQM Extract file: 1 Access the SPQM Extract List page (Accessing a Service Process Quality Management

File).


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2 Locate the SPQM file you want to delete, and click the Delete button next to the corresponding SPQM file you want to delete.

A Delete Analysis Entry confirmation page appears. 3 Select Yes to confirm you want to delete the selected SPQM file. 4 Click Submit in the status bar.

The selected SPQM file is deleted from the system.

Setting Up Group Bonus Configurations Group bonus minutes are awarded based on the number of group attendees. This section describes how to allow bonus minutes to be configured and tied to groups based on the number of group attendees.

To access group bonus configurations: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Group Bonus Configuration.

The Fee For Service Group Bonus Configuration page appears. This page lists all of the Group Bonus Configurations that are set up in the system.

This page is used to complete the following tasks: Adding Group Bonus Configurations Updating Group Bonus Configurations Deleting Group Bonus Configurations

Adding Group Bonus Configurations This task is used to add group bonus configurations to the system. This task allows users to associate specific bonus minutes with a range of group attendees.

To add group bonus configurations: 1 Access the Fee For Service Group Bonus Configuration page (see Setting Up Group

Bonus Configurations). 2 Click Add Configuration in the status bar.

The Group Bonus Configuration Entry page appears.


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3 In the Begin Date field, enter the date the Group Bonus Configuration record will become active in the system.

4 If you want to define the date the record becomes inactive in the system, enter the desired date in the End Date field.

5 In the Configuration Name field, enter the name of the configuration record you are creating.

6 The Attendees to Bonus Minutes field is used to indicate the minimum and maximum minutes and the number of group bonus minutes.

a In the Group Attendee Range fields, enter the minimum and maximum number of attendees associated with the bonus range. For example, if the initial bonus range is 0 to 6 attendees, enter these numbers in the associated fields.

b In the Group Bonus Minutes field, enter the number of bonus minutes associate the group attendee range.

Updating Group Bonus Configurations This task includes instructions to update group bonus configurations in the system.

To edit group bonus configuration records: 1 Access the Fee For Service Group Bonus Configuration page (see Setting Up Group

Bonus Configurations). 2 Locate the group bonus configuration record you want to edit, and click the

corresponding Select button. The Group Bonus Configuration Entry page changes to edit mode. You can edit any of the fields on this page. All required fields are highlighted (see Adding Group Bonus Configurations for field descriptions).

3 After making the desired edits, click Submit in the status bar. The group bonus configuration record is updated and listed on the Fee For Service Group Bonus Configurations page.

Deleting Group Bonus Configurations While reviewing the group bonus configuration records, you may decide the configuration record was not created as you intended. In this scenario, you must use this task to delete the group bonus configuration record.

To delete group bonus configuration records:


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1 Access the Fee For Service Group Bonus Configuration page (see Setting Up Group Bonus Configurations).

2 Locate the group bonus configuration record you want to delete, and click the corresponding Delete button.

3 The Delete Group Bonus Configuration confirmation page appears. 4 Select Yes to confirm you want to delete the selected group bonus configuration

record. 5 Click Submit in the status bar.

The selected record is removed from the system and no longer displayed in the Fee For Service Group Bonus Configurations page.

Setting Up Fee For Service Mapping Activities that are payable using the pay method called Unit/Hours must specify a timesheet category that is mapped to a range of minutes and to a fee for service wage amount (found on the employee history record and the program wage record, see the Employee User Guide). The range of minutes and wage amounts are used by the fee for service logic to convert the actual minutes for the activity to payable minutes and to calculate the dollar value of the total payable minutes using the mapped wage amount type.

To access fee for service mappings: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Fee for Service Mapping.

The Timesheet Category to Fee for Service Mapping page appears. This page lists all of the fee for service mappings that are set up in the system.

This page is used to complete the following tasks: Adding Fee For Service Mappings Updating Fee For Service Mappings Deleting Fee For Service Mappings

Adding Fee For Service Mappings This task includes instructions for adding fee for service mappings to the system.


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To add fee for service mappings: 1 Access the Timesheet Category to Fee for Service Mappings page (see Setting Up Fee

For Service Mapping). 2 Click Add Mapping in the status bar.

The Timesheet Category to Fee for Service Mapping Entry page appears.

3 In the Begin Date field, enter the date at which the fee for service mapping becomes active in the system.

4 If the mapping is to be active for a defined range only, enter the end date in the End Date field. If the mapping is to remain active indefinitely, leave this field blank.

5 In the Timesheet Category field, use the drop-down list to select the timesheet category specific to this fee for service mapping.

6 In the Which Wage Amount does this Timesheet Category use? field, indicate the wage amount for the selected timesheet category.

7 In the Enter Range in Minutes field, enter the minimum and maximum number of minutes associated with this fee for service mapping. Your entries can be up to 4 digits.

8 In the For the above minute range, pay this many minutes field, enter the number of payable minutes for the enter minute range. Your entry can be up to 4 digits.

9 Click Submit in the status bar. The fee for service mapping is saved to the system and listed on the Timesheet Category to Fee for Service Mapping page.

Updating Fee For Service Mappings This task includes instructions to update fee for service mappings in the system.

To edit fee for service mappings: 1 Access the Timesheet Category to Fee For Service Mapping page (see Setting Up Fee

For Service Mapping). 2 Locate the fee for service mapping you want to edit, and click the corresponding

Select button. The Timesheet Category to Fee for Service Mapping Entry page changes to edit mode. You can edit any of the fields on this page. All required fields are highlighted (see page 398 for field descriptions).

3 After making the desired edits, click Submit in the status bar. The fee for service mapping is updated and listed on the Timesheet Category to Fee For Service Mapping Entry page.


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Deleting Fee For Service Mappings While reviewing the fee for service mappings, you may decide the mapping was not created as you intended. In this scenario, you must use this task to delete the fee for service mapping.

To delete fee for service mappings: 1 Access the Timesheet Category to Fee For Service Mapping page (see Setting Up Fee

For Service Mapping). 2 Locate the fee for service mapping you want to delete, and click the corresponding

Delete button. A delete confirmation page appears.

3 Select Yes to confirm you want to delete the selected timesheet category to fee for service mapping.

4 Click Submit in the status bar. The selected mapping is removed from the system and no longer displayed on the Timesheet Category to Fee For Service Mappings page.

Setting Up Unit Cost Management The Unit Cost Management module allows you to report unit costs per service instead of standard value fees for 837P and HCPF flat files. These recorded values can be used for Encounter files to report unit cost per procedure.

To access the unit cost management list: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Unit Cost Management.

The Unit Cost Management list page appears. This page lists all of the unit cost management records that are set up in the system.

This page is used to complete the following tasks: Adding Unit Cost Management Records Updating Unit Cost Management Records Deleting Unit Cost Management Records

Adding Unit Cost Management Records This task includes instructions for adding unit cost management records to the system.

To add unit cost management records:


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1 Access the Unit Cost Management list page (see Setting Up Unit Cost Management). 2 Click Add Record in the status bar.

The Unit Cost Table page appears.

3 In the Begin Date field, enter the date at which the unit cost management record becomes active in the system.

4 If the record is to be active for a defined range only, enter the end date in the End Date field. If the record is to remain active indefinitely, leave this field blank.

5 The Organization field is used to select the organization to which the procedure code unit cost management record applies. This drop-down list includes only the organization you are currently logged into and all child organizations.

6 In the Procedure field, use the drop-down list to select the procedure to which the unit cost management record applies.

7 In the Unit Cost field, enter the unit cost per procedure amount to be used in Encounter files.

8 In the Comments section, enter any information or comments related to the unit cost management record that you want saved in the system.

9 Click Submit in the status bar. The Unit Cost Management record is saved to the system and listed on the Unit Cost Management list page.

Updating Unit Cost Management Records This task includes instructions to update unit cost management records in the system.

To edit unit cost management records: 1 Access the Unit Cost Management list page (see Setting Up Unit Cost Management). 2 Locate the unit cost management record you want to edit, and click the corresponding

Select button. The Unit Cost Table entry page changes to edit mode. You can edit any of the fields on this page. All required fields are highlighted (see Adding Unit Cost Management Records for field descriptions).

3 After making the desired edits, click Submit in the status bar. The unit cost management record is updated and listed on the Unit Cost Management list page.

Deleting Unit Cost Management Records


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While reviewing the unit cost management records, you may decide the record was not created as you intended. In this scenario, you must use this task to delete the unit cost management record.

To delete unit cost management records: 1 Access the Unit Cost Management list page (see Setting Up Unit Cost Management). 2 Locate the unit cost management record you want to delete, and click the

corresponding Delete button. A delete confirmation page appears.

3 Select Yes to confirm you want to delete the selected unit cost management record. 4 Click Submit in the status bar.

The selected record is removed from the system and no longer displayed on the Unit Cost Management list page.

Mapping DRG Codes Diagnosis Related Group codes are used by payers to determine a patient classification that relates types of patients treated to the resources they consume. The DRG codes are related to a group of diagnoses. The DRG Mapping module is used to map a group of diagnoses to a DRG code, eliminating the need for you to manually enter these in the client ECR.

To map DRG codes: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select DRG Mapping.

The DRG Mapping page appears.

3 In the Diagnosis From field, enter the full or partial name or DSM code of the diagnosis code you are mapping, press Tab to filter the drop-down list, and then use the drop-down list to select the desired diagnosis.

4 In the Diagnosis To field, enter the full or partial name or DSM code of the diagnosis to which you are mapping the diagnosis from, press Tab to filter the drop-down list, and then use the drop-down list to select the desired diagnosis.

5 In the DRG Code field, enter the full or partial name or DRG code of the DRG code for diagnoses to which you are mapping the other diagnoses, press Tab to filter the drop-down list, and then use the drop-down list to select the desired DRG code.


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6 Click Submit in the status bar. The DRG Mapping record is saved to the system. Note: After you have mapped DRG codes in the system, you can delete them by accessing the DRG

Mapping page and clicking the Delete button that corresponds with the DRG mapping record you want to delete.

Creating HL-7 Batches HL-7 is an international standard for data exchange between computer systems, and CareLogic offers you the ability to export your data using an HL-7 batching process that can be set up to run on a nightly basis or can be run manually as needed.

Important: The HL-7 Batch option is used to batch immunization records to be submitted to immunization registries. The batch option is also used to batch syndromic surveillance for clinical information that is shared and used to drive decisions about health policy and health education.

To access the HL-7 Batch list: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select HL7 Batches.

Important: The HL-7 Batch list page does not display any batches by default. You must enter at least one or more search parameters from the HL7 Batch Search section at the top of the page and click Submit in the status bar to display your HL-7 batch files.

The HL7 Batches list page appears, with search parameters at the top of the page that can be used to filter your batches by entering your search parameters and clicking Submit in the status bar.

This page is used to complete the following tasks: Adding HL-7 Automated Job Configuration Manually Creating HL-7 Batches Accessing Records Included in HL-7 Batches Downloading HL-7 Batches Deleting HL-7 Batches

Adding HL-7 Automated Job Configuration


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The HL-7 Automated Job Configuration allows you create a daily HL-7 batch file that captures all new clients and all client changes since the previous batch run. By setting up an automated batch configuration, your agency does not have to manually create HL-7 batches on a daily basis.

To add HL-7 Automated Job Configurations: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select HL7 Automated Job

Configuration. The HL7 Automated Job Configurations list page appears, displaying all active and inactive HL-7 automated job configurations set up for your system.

3 Click Add HL7 Configuration in the status bar. The HL7 Job Configuration Entry page appears. All required fields are highlighted.

4 In the Begin Date field, enter the date at which you want this automated job configuration to take effect.

5 In the End Date field, enter the date at which you want this automated job configuration to stop.

6 In the HL7 File Type field, use the drop-down list to select the file type you wish to export the HL7 batch to.

7 In the Organization field, use the drop-down list to select the organization at which you want to batch records as part of this automated job configuration.


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8 Indicate if you want to include all child level organizations or just the parent level organization in this automated job in the Include all child organizations field.

9 Indicate if you want to send the HL-7 files created based on this automated job configuration to an secure file transfer site in the Send HL7 file to an SFT site field.

10If you selected Yes in the Send HL7 file to an SFT site field, you must enter the following fields to complete the form:

a SFT Path. Enter the secure file transfer site’s web address. b Username. Enter the username that is used to log into the SFT site. c Password. Enter the password associated with the username previously entered. d Confirm Password. Enter the password associated with the username previously entered again to

ensure that the password matches and can successfully log into the SFT site. e When to send email alerts. Indicate when email alerts should be sent about the HL-7 batch creation

and its publication to the SFT site. f Send email alerts to. Enter the email addresses of the people who should receive notices when there

are failures and/or successes for publishing the HL-7 batch files to the SFT site. Email addresses must be separated by semi-colons.

11Click Submit in the status bar. The HL-7 Automated Job Configuration is saved to the system and listed on the HL7 Automated Job Configurations list page and begins running on a nightly basis as of the Begin Date you entered in the job configuration setup.

Manually Creating HL-7 Batches As part of the HL-7 Automated Job Configuration (see Adding HL-7 Automated Job Configuration), a nightly HL-7 batch can be created for you each night. However, there may be times when you need to create an HL-7 batch in between nightly runs. This task is used to manually create an HL-7 batch.

To manually create HL-7 batches: 1 Access the HL-7 Batch list page (see Creating HL-7 Batches). 2 Click Create HL7 Batch in the status bar.

The Manual HL7 Batch Creation page appears.

3 In the Reporting Date Range field, enter the first and last dates for which the HL-7 batch should pull records into the batch file.

4 In the HL7 File Type field, use the drop-down list to select the file type you wish to export the HL7 batch to.

5 If you are batching syndromic surveillance records, you must indicate the Starting and Ending ICD9 Codes to be included in the batch.


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6 In the Organization field, use the drop-down list to select the organization at which you want to batch records.

7 Indicate if you want to include all child level organizations or just the parent level organization.

8 Click Submit in the status bar. The HL-7 batch is created and listed on the HL-7 Batch list page.

Accessing Records Included in HL-7 Batches Each HL-7 batch contains a set of updated client records that can be exported for further data mining or aggregation. This task is used to access the records included in your HL-7 batches.

To manually create HL-7 batches: 1 Access the HL-7 Batch list page (see Creating HL-7 Batches). 2 Locate the HL-7 batch you want to view records for, and click the corresponding Select

button. The HL7 Batch Detail page appears, listing all client records included in the HL7 batch file.

3 Locate the client’s record for whom you want to access, click the corresponding ECR button.

The client’s ECR appears, allowing you to review any information from the client’s record.

Downloading HL-7 Batches As either part of the nightly HL-7 batching process or a manual HL-7 batch creation, you must download the batch file in order to upload the information to another system, such as a third-party data mining and reporting tool. This task is used to download your HL-7 batches.

To download HL-7 batches: 1 Access the HL-7 Batch list page (see Creating HL-7 Batches).


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2 Locate the HL-7 batch you want to download, and click the corresponding Download HL7 button.

A browser pop-up prompts you to Open or Save the HL-7 batch file. You must save the file to your local drive and then upload it to your external software to pull in the most recent HL-7 batch information.

Deleting HL-7 Batches There may be times when you need to delete an HL-7 batch in order to combine the batch contents with another batch, for example. This task is used to delete your HL-7 batches, as needed.

To delete HL-7 batches: 1 Access the HL-7 Batch list page (see Creating HL-7 Batches). 2 Locate the HL-7 batch file you want to delete, and click the corresponding

Delete button. A delete confirmation page appears.

3 Select Yes to confirm you want to delete the selected HL-7 batch file. 4 Click Submit in the status bar.

The selected batch file is removed from the system and no longer displayed on the HL-7 Batch list page. Any records associated with that batch file are now eligible to be batched as part of the next HL-7 batching process.

Using the Clinical Audit Log The Audit Log module allows you to monitor the activities associated with electronic health information for all clients. The Audit Log records actions related to all client electronic health information. These actions are defined as Viewed, Created, Modified, Deleted, or Printed.

Note: Alerts can be set up to notify certain people when a staff member accesses a client’s record which they were unauthorized to view. Contact QSI Support for information on setting up these alerts.

Important: The Audit Log can only be used to search the last 90 days of activity for a client’s record. Attempting to enter a Begin Date older than the previous 90 days results in a pop-up message notifying you of the earliest date at which you can begin the search. Client record activity older than 90 days is archived.

To view the audit log: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Audit Log.

The Audit Log Search page appears, which allows you to define the parameters for the audit records you want to view.


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3 In the Begin Date/Time field, enter the date and time at which you want to begin viewing electronic health record audit trails.

4 In the End Date/Time field, enter the date and time at which you want to end viewing electronic health record audit trails.

5 In the Organization field, use the drop-down list to select the organization at which you want to view audit records.

6 By default, the audit log considers all of the clients who match the other criteria entered. If you want to limit the audit log to a single client, use the Client Name field to select the desired client. To select an individual client, enter the full or partial client name in the text entry field, press Tab, and then use the drop-down list to select the desired client.

7 By default, the audit log considers all staff who access electronic health record which match the other criteria entered. If you want to limit the audit log to a single staff member, use the Staff field to select the desired staff. To select an individual staff member, enter the full or partial staff name in the text entry field, press Tab, and then use the drop-down list to select the desired staff.

8 By default, the audit log considers all service documents that have been viewed, created, modified, printed, or deleted. If you want to limit the audit log to a single service document, use the Service Document field to select the desired document. To select an individual service document, enter the full or partial service document name in the text entry field, press Tab, and then use the drop-down list to select the desired document. All service documents that have been set up in your system are available.

9 In the Action field, indicate which actions to client records you want to review. 10Click Submit in the status bar.

The Audit Log search results page appears, displaying a list of all audit records which meet the criteria you entered. The audit log search results can be sorted in ascending or descending order by clicking the column header by which you want to sort your results.


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Important: The Audit Log list page displays the primary key (an internal tracking key), the date and time the audit record occurred, the client whose health information was accessed, the staff member who accessed the client’s record, the action the staff member took, the page on which the action occurred, and any comments associated with the action (which includes Black Box, Client Access Log, and Portal Restriction comments,). The Audit Log results page can be exported as a spreadsheet by clicking the Export to Excel button in the status bar.

Setting Up Source of Payment Instances The Source of Payment module allows providers in the state of Arkansas to map values to the data file used for state reporting to match up claim filing statuses with the appropriate codes.

Important: This module only appears for and is used by in-patient facilities in the state of Arkansas. Please contact QSI Support for more details about this configuration.

To access the Source of Payment list page: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Source of Payment.

The Claim Filing Status - Source of Payment Instances list page appears, displaying all active and inactive source of payment records. For each source of payment record, this page lists the effective date range and the organization to which the record applies.

This module is used to perform the following tasks. Adding Source of Payment Records Updating Source of Payment Records


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Adding Matrix to a Source of Payment Record Deleting Source of Payment Records

Adding Source of Payment Records This task is used to set up a source of payment record to be used for creating state reporting batch files.

To add source of payment records: 1 Access the Source of Payment list page (see Setting Up Source of Payment Instances).

2 Click Add Source of Payment in the status bar. The Source of Payment entry page appears. All required fields are highlighted.

3 In the Begin Date field, enter the first date this source of payment record will be active in the system. This is the first date the system will attempt to apply this source of payment record for state reporting.

4 If you know the last date this source of payment record should be active in the system, enter that date in the End Date field.

5 In the Organization field, use the drop-down list to select the organization to which this source of payment record applies.

6 Click Submit in the status bar. The Source of Payment record is saved to the system and listed on the Source of Payment list page.

Updating Source of Payment Records This task is used to modify the source of payment records already set up in your system.

To update source of payment records: 1 Access the Source of Payment list page (see Setting Up Source of Payment Instances).


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2 Locate the source of payment record you want to update and click the corresponding Select button.

The Source of Payment Entry page appears. All required fields are highlighted. 3 Update the values on this page as desired. See Adding Source of Payment Records for

field descriptions. 4 Click Submit in the status bar.

The updated record is saved and listed on the Source of Payment list page.

Adding Matrix to a Source of Payment Record Once the source of payment record is created (see page 137), you must define a matrix for it. This task enables your organization to define the source of payment for all claim filing indicators.

To add a matrix to a source of payment record: 1 Access the Source of Payment list page (see Setting Up Source of Payment Instances).

2 Locate the source of payment record you want to add a matrix to and click the corresponding Matrix button.

The Claim Filing Indicator - Source of Payment Matrix page appears.


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3 For each Claim Filing Indicator, use the drop-down list in the Source of Payment column to select the correct source of payment.

Note: Each Source of Payment option can only be used once.

4 Click Submit in the status bar. The source of payment matrix is saved to the system.

Deleting Source of Payment Records This task is used to delete a source of payment record.

To delete source of payment records: 1 Access the Source of Payment list page (see Setting Up Source of Payment Instances).

2 Locate the source of payment record you want to delete and click the corresponding Delete button.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected record.


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4 Click Submit in the status bar. The source of payment record is deleted and removed from the Source of Payment list page.

Using Session Management The Session Management feature is used to monitor and track staff sessions that are in use real-time and allows administrators to terminate sessions that are unnecessary or may have been accidentally left active.

Important: Session Management should be used while logged into your parent organization to ensure that you see all sessions. Only users with the Administrator privilege have the ability to terminate active sessions. The Terminate button is disabled for your own active session, meaning you cannot terminate your own session.

To view active/most recent sessions or terminate sessions: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Session Management.

The Active Sessions list page appears, displaying all active staff sessions, the organization they are logged into, the date/time stamp of the last time the system was accessed, the last time the staff accessed a session, and the date/time stamp of the staff’s last login.

3 Complete the following steps to search for active or the most recent session for an individual staff member:

a To view the active/most recent session for an individual staff member, enter the partial or full staff member’s name in the Staff field, and hit the Tab key to filter the Staff drop-down list. Using the drop-down list, select the desired staff member’s whose last session you wish to view.

b Click Submit in the status bar to filter the Sessions List to view only the selected staff member. 4 Complete the following steps to terminate an active session for an individual staff

member: a Click the corresponding Terminate button for the staff session you wish to end. b Click Yes on the Terminate Session Confirmation page to confirm you wish to terminate the session,

and click Submit in the status bar.

Setting Up a Co-Pay Matrix


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The Co-Pay Matrix feature allows you to define standard co-pay dollar amounts or coinsurance percentage amount based on individual procedure codes. Co-pay matrices can be associated with one or more payer plans and organizations.

To access the Co-Pay Matrix list page: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Co-Pay Matrix.

The Co-Pay Matrix list page appears, displaying all active and inactive co-pay matrix records. For each record, this page lists the name of the co-pay matrix, the begin and end date range of the record, and the organization to which the co-pay matrix record applies. Note: If the payer plan associated with the co-pay matrix has been added to a client record, the Delete

button is disabled, and the co-pay matrix record cannot be deleted unless the client payer is removed first.

This module is used to perform the following tasks. Adding Co-Pay Matrices Updating Co-Pay Matrices Associating Payer Plans with Co-Pay Matrices Deleting Co-Pay Matrices

Adding Co-Pay Matrices This task is used to set up a co-pay matrix to be used by a certain payer plan and organization.

To add co-pay matrices: 1 Access the Co-Pay Matrix list page (see Setting Up a Co-Pay Matrix).

2 Click Add Co-Pay Matrix in the status bar. The Co-Pay Matrix Entry page appears. All required fields are highlighted.


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3 In the Organization field, use the drop-down list to select which organization the co-pay matrix applies to.

4 In the Name field, enter the name of the co-pay matrix record. The co-pay matrix name should clearly indicate to which payer plan the record applies.

5 In the Begin Date field, enter the date on which the co-pay matrix record should take effect.

6 If a co-pay matrix is no longer active or if you know when it will expire, enter the last date on which the co-pay matrix record should apply in the End Date field.

Important: By default, all co-pay matrix amounts are dollar amounts. To indicate a coinsurance percentage for a certain procedure code or billing category, select the % checkbox.

7 Complete the following steps to define your co-pay matrix table: a All co-pay matrix records require a Default co-pay amount or coinsurance percentage. The main

Default amount is recorded in the first row of the table and is used for all procedure codes not recorded in the co-pay matrix.

b In the Procedure column, enter the full or partial procedure code number in the text field and press Tab to filter the drop-down list. Use the drop-down list to select the desired procedure code.

c Each Procedure selected in the previous step can have a Default amount that applies to any billing categories not individually defined in the co-pay matrix.

d For each billing category, enter the contracted rate that has been negotiated with the payer plan for which you are setting up the co-pay matrix. When staff members with this licensure provides services to clients related to this procedure/payer plan combination, the client will be billed the amount you enter.

e Repeat Steps B-E to enter additional records for other procedure codes. 8 Click Submit in the status bar.

The co-pay matrix is saved to the system and listed on the Co-Pay MAtrix list page.

Updating Co-Pay Matrices This task is used to modify the co-pay matrices already set up in your system.

To update co-pay matrices: 1 Access the Co-Pay Matrix list page (see Setting Up a Co-Pay Matrix).


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2 Locate the co-pay matrix you want to update and click the corresponding Select button.

The Co-Pay Matrix Entry page appears. All fields can be modified as needed. 3 Update the values on this page as desired. See Adding Co-Pay Matrices for field

descriptions. 4 Click Submit in the status bar.

The updated record is saved and listed on the Co-Pay Matrix list page.

Associating Payer Plans with Co-Pay Matrices This task is used to associate a co-pay matrix with one or more payer plans.

To associate payer plans with co-pay matrices: 1 Access the Co-Pay Matrix list page (see Setting Up a Co-Pay Matrix).

2 Locate the co-pay matrix record you want to associate with a payer plan and click the corresponding Payer Plans button.

The Payer Plan Entry page appears.

3 To filter your Payer Plan drop-down list, select a payer from the Payer drop-down first.

4 Use the drop-down list to select the payer plan with which you want to associate the co-pay matrix.

5 n the Begin Date field, enter the date on which the co-pay matrix record should take effect for the selected payer plan.


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6 If a co-pay matrix is no longer associated with a payer plan or if you know when it will expire, enter the last date on which the co-pay matrix record should apply to the payer plan in the End Date field.

7 Click the Save button to associate the selected payer plan to the co-pay matrix record. Your entry is disabled, and new row appears to allow you to associate the co-pay matrix record with additional payer plans. Important: If a previously entered payer plan needs to be deleted, click the Remove button to cancel

your entry for that row. The Remove button only appears for payer plans not currently tied to client records.

8 Repeat Steps 3-7 to associate the co-pay matrix to multiple payer plans. 9 Click Submit in the status bar.

The selected payer plan is associated with the co-pay matrix record.

Deleting Co-Pay Matrices This task is used to delete a co-pay matrix. Once a co-pay matrix record’s associated payer plan has been tied to a client record, the Delete button is disabled. The associated payer plan must be deleted from all client records before the Delete button can be accessed. For such instances, end date the co-pay matrix record and create a new co-pay matrix with the correct fees.

To delete co-pay matrices: 1 Access the Co-Pay Matrix list page (see Setting Up a Co-Pay Matrix).

2 Locate the co-pay matrix record you want to delete and click the corresponding Delete button.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected matrix. 4 Click Submit in the status bar.

The co-pay matrix record is deleted and removed from the Co-Pay Matrix list page.

Setting Up Per Diem Schedules When setting up basic per diem programs/activities in CareLogic (see Set Up Activities for Per Diem Programs), no distinction is made between weekdays, weekends, or holidays, for example. The Per Diem Schedule allows you to exclude specific days of the week or holidays for per diem billing to enhance the standard per diem charges that are generated by CareLogic.

For example, if your per diem charges are related to school-based services, you may only bill for Monday through Friday and wish to exclude Saturdays in Sundays. The Per Diem Schedule would allow you to set up per diems to only bill for weekdays and to exclude any weekends when creating per diem claims.


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To access the Per Diem Schedule list page: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select Per Diem Schedule.

The Per Diem Schedule list page appears, displaying all active and inactive co-pay matrix records. For each record, this page lists the name of the per diem schedule and the begin and end date range of the record.

This module is used to perform the following tasks. Adding Per Diem Schedules End Dating Per Diem Schedules and Removing Non-Billed Days Associating Payer Plans with Co-Pay Matrices Deleting Per Diem Schedules

Adding Per Diem Schedules This task is used to set up a per diem schedule to be used by a certain organization to exclude certain days from billing.

To add per diem schedules: 1 Access the Per Diem Schedules list page (see Setting Up Per Diem Schedules).

2 Click Add Per Diem Schedule in the status bar. The Per Diem Schedule page appears. All required fields are highlighted.


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3 In the Begin Date field, enter the date on which the per diem schedule record should take effect.

4 If a per diem schedule is no longer active or if you know when it will expire, enter the last date on which the per diem schedule should apply in the End Date field.

5 In the Per Diem Schedule Name field, enter the name of the per diem schedule. The per diem schedule name should clearly indicate to which organization or excluded days the record applies.

6 In the Organization field, use the drop-down list to select which organization the per diem schedule applies to.

7 In the Select Days to Include in Per Diem Billing field, indicate which days of the week the enter per diem schedule applies.

8 Click Submit in the status bar. The per diem schedule is saved and listed on the per diem schedule list page.

End Dating Per Diem Schedules and Removing Non-Billed Days This task is used to end date the per diem schedules already set up in your system.

To end date per diem schedules: 1 Access the Per Diem Schedules list page (see Setting Up Per Diem Schedules).

2 Locate the per diem schedule you want to end date and click the corresponding Select button.

The Per Diem Schedule page appears. Only end dates and non-billed days can be modified or removed.


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3 Update the values on this page as desired. See Adding Per Diem Schedules for field descriptions.

4 Click Submit in the status bar. The updated record is saved and listed on the Per Diem Schedules list page.

Adding Non-Billed Days to a Per Diem Schedule This task is used to add non-billed days to a per diem schedule. For example, if you provide services as part of a school based program, you may want to exclude holidays from the per diem schedule to ensure no claims are generated for days when the client is not there.

To add non-billed days to per diem schedules: 1 Access the Per Diem Schedules list page (see Setting Up Per Diem Schedules).

2 Click Add Non-Billed Day in the status bar. The Non-Billed Days page appears.

3 In the Begin Date field, enter the date on which the per diem schedule non-billed days record should take effect.

4 Enter the last date on which the per diem schedule non-billed days should apply in the End Date field. For example, if Thanksgiving is on November 25, 2010, you would enter 11/25/2010 as the Begin and End Dates to ensure no per diem claims were generated for the holiday.

5 In the Non-Billed Day(s) Name field, enter the name of the per diem schedule non-billed days. The per diem schedule non-billed days name should clearly indicate to which organization or excluded days/holidays the record applies.

6 In the Organization field, use the drop-down list to select which organization the per diem schedule non-billed days applies to.


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7 In the Select Schedules to apply Non-Billed Day to field, indicate to which per diem schedule the non-billed days applies.

Note: All active per diem schedules as of the Begin Date you entered are displayed.

8 Click Submit in the status bar. The per diem schedule is saved and listed on the per diem schedule list page.

Deleting Per Diem Schedules This task is used to delete a per diem schedule.

To delete per diem schedules: 1 Access the Per Diem Schedules list page (see Setting Up Per Diem Schedules).

2 Locate the per diem schedule you want to delete and click the corresponding Delete button.

A delete confirmation page appears. 3 Select Yes to confirm you want to delete the selected per diem schedule. 4 Click Submit in the status bar.

The per diem schedule is deleted and removed from the Per Diem Schedule list page.

Setting Up iCalendar Feeds CareLogic allows providers to export their CareLogic schedules to their Outlook, Google Calendar, or iCal calendar to view scheduled appointments when not logged into CareLogic.

Before users begin exporting their iCal feeds to Outlook, you must use the following steps to set up the format of exported appointments to secure client and staff information.

You must include at least one format string in the Subject and Location fields.

Important: The iCalendar feed is only a one-way transmission of schedule information. Your CareLogic schedule can be displayed in Outlook, but Outlook appointments do not flow back into CareLogic. The default iCalendar export includes the following information: Activity Name, Client First Name (Number of Group Members for group activities), Activity Status, and the Organization where the service is scheduled to be provided. Only change these settings if you want to remove or add additional information to the iCal feed.


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To set up iCalendar Feeds: 1 Click Administration in the navigation bar.

The Administration menu system is loaded. 2 Click the Show Menu arrow in the shortcut bar and select iCalendar.

The iCalendar page appears, displaying the default settings for your organization’s iCal feed.

3 To remove any information that is included in the iCal feed by default, highlight the text and hit Delete in the keyboard. This will remove that information from your staff member’s iCal feeds.

Note: For example, if you don’t want the client’s first name to appear in the iCal feed, highlight the text “<%= ScheduledActivity.Client.firstName %>” and delete it from the Subject field.

4 To add any information to the existing iCal feed for client, group, or staff activities, complete the following steps to copy and paste the information strings into the Subject or Location fields of your calendar. Each appointment type can be formatted differently.

The following information from the Notes field can be included about activity information, clients, or scheduled organizations by copying and pasting the string information into the Subject or Location fields:

If you do not remove the strings from the Notes field, the information will be included in the body of the calendar appointment.

Activity Name: <%= ScheduledActivity.Activity.name %> Activity Code: <%= ScheduledActivity.Activity.code %> Activity Count: <%= ScheduledActivity.count %> Activity Description: <%= ScheduledActivity.description %> Activity Status: <%= ScheduledActivity.status %>.


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Client Full Name: <%= ScheduledActivity.Client.fullName %> Client First Initial: <%= ScheduledActivity.Client.firstInitial %> Client Middle Initial: <%= ScheduledActivity.Client.middleInitial %> Client Last Initial: <%= ScheduledActivity.Client.lastInitial %> Client First Name: <%= ScheduledActivity.Client.firstName %> Client Middle Name: <%= ScheduledActivity.Client.middleName %> Client Last Name: <%= ScheduledActivity.Client.lastName %> Client Number: <%= ScheduledActivity.Client.clientNumber %> Client ID: Client ID: <%= ScheduledActivity.Client.clientId %> Client Primary Phone #: <%= ScheduledActivity.Client.primaryPhone %> Organization Name: <%= ScheduledActivity.Organization.name %> Organization Short Name: <%= ScheduledActivity.Organization.shortName %> Organization Code: <%= ScheduledActivity.Organization.code %>

Important: For example, the default iCal feed for client appointments would appear in the following format: Subject: “Individual Therapy with Lisa (Kept)” Location: “CareLogic University” If you did not want to include the client’s first name in the appointment export information, but rather, you preferred to include the client ID, you would highlight the string “<%= ScheduledActivity.Client.firstName %>” and delete it from the Subject field. You would then replace the deleted format string with the Client ID string “<%= ScheduledActivity.Client.clientId %>” Your new iCal feed format would now appear in the following manner: Subject: “Individual Therapy with 2569871 (Kept)” Location: “CareLogic University”

Setting Up Holidays 2. Navigate to Administration > System Admin > Holiday Administration.

The Holiday Administration screen appears.

3. Click Add Holiday.


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The Schedule a Holiday screen appears.

4. In the Begin Date field, enter the date the holiday begins.

5. In the End Date field, enter the date the holiday ends.

6. In the Holiday Name field, enter the name of the holiday.

7. Click Submit.

The Holiday Administration screen reappears, and the holiday you created is listed.

8. To assign the holiday to your organization, click Organization.

The holiday’s Organization List screen appears.

Note: The checkbox is marked for the organization that is currently logged in to CareLogic.

9. Mark the checkbox(es) that correspond to the organization(s) that will observe this holiday.

10. Click Submit.

The Holiday Administration screen reappears.

11. To apply this holiday to per diem schedules, click Per Diem.

Note: For clients that do not use per diems, the Per Diem button will not appear in the Holiday Administration screen.

The Apply [holiday] to Per Diem Schedules screen appears.


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12. If this holiday will be non-billable, mark the Non-Billable? checkbox.

13. Click Submit.

14. Repeat steps 2-12 to add more holidays.

Soft Warning

If you try to schedule an activity on one of the holidays, the following message will appear:

To proceed with scheduling the activity on this holiday, mark the Yes radio button in the Are you sure you want to schedule this activity? section.

CareLogic System Administration User Guide, Part 1 -...

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