Service Codes

Create a Service Code

Step

Action

1

Navigate to Admin > Reference Table Management .

 

Admin - Reference Table Management

Admin: Reference Table Management

2

Select Contract Service Code from the Reference Table field and click Search to continue.

 

Reference Table: Contract Service Code

Reference Table: Contract Service Code

3

On the Search Results page, click on the Add button.

 

Contract Service Code: Add Button

Contract Service Code: Add Button

4

On the Contract Service Code window, select all required fields to include a Contract , Discipline, Service Code, Rate Type, and Visit Type.

 

Adding a Service Code Window

Adding a Service Code Window

5

Click Save to finalize.

 

Additional Service Code Fields

Additional Service Code fields (as illustrated in the image below) on the Contract Service Code window are used to address specific billing and scheduling scenarios (described in the table underneath the image).

 

Contract Service Code: Additional Fields

Contract Service Code: Additional Fields

 

Field

Description

Mutual

Select this checkbox if the Service Code is used for Mutual Visits. Overlapping visits scheduled with a Mutual Service Code may be scheduled with the same Caregiver without triggering a validation error.

Allow Patient Shift Overlap

Select this checkbox if the Service Code is used for visits that overlap. This allows two separate Caregivers to be scheduled for a single Patient at the same time without triggering a validation error.

Bypass Prebilling Validations

Select this checkbox to allow visits scheduled with the associated Service Code to bypass Prebilling validations, with the following exceptions:

 

  • Incomplete Confirmation

  • With TEMP Caregiver

  • OT/TT Not Approved

  • Restricted Caregiver

Bypass Billing Review Validations

Select this checkbox to allow visits scheduled with the associated Service Code to bypass all Billing Review validations.

Auto-Schedule Service Type ID

This field allows Agencies using the Service-Specific EVV Confirmation model to enter a 4-digit identifier for the Service Code. When a Caregiver enters this 4-digit identifier at Clock Out, the system applies the Service Code to the visit.
Location Code Code based on the location (region) of the servicing Agency/Office for billing purposes.
Weekend/Holiday Codes Select this checkbox to activate the second Weekend Holiday Code fields. Codes entered in these fields only apply to respective weekdays (with weekday code) and weekends (weekend code).
Apply the Holiday Code to Weekday Selecting this checkbox applies Weekend/Holiday Codes on either weekends OR holidays according to the chosen Holiday Template. Authorizations selected as “Weekend/Holiday” in the authorizations section pulls from visits that occur on a weekend OR a weekday if the holiday happens to fall on a weekday (M-F).
Mileage Code Select this checkbox to apply a mileage event on the Patient Calendar.
Default Mileage Code Select this checkbox to display entry on the Patient and Caregiver Calendars allowing the default code to be billable and payable. Only two “Default Mileage Codes” can be enabled per Contract; apply to Other (Skilled) and Other (Non-Skilled) disciplines.
Custom Hourly Rounding

Select to apply custom hourly rounding logic to the Service Code, as follows:

 

  • 0-52 minutes: EVV visit confirmation times between 0 to 52 minutes amount to 0 units; thereafter, billing units are calculated in increments of 59 minutes.

  • 0-14 minutes: EVV visit confirmation times between 0 to 14 minutes amount to 0 units; 15 to 60 minutes are rounded up to the hour. Thereafter, 30 minutes or more are rounded up to the hour; less than 30 minutes are rounded down to the hour. Billing units are calculated accordingly.

 

Note: Once selected, all visits with this Service Code applied override Contract-Level Rounding Rules.

Description

Enter content to include in the Notes section of a claim file to help support/reference the claim.

Note: If left blank, then the visit Confirmation Times are displayed on the claim.
Code Configuration
Export / Revenue / Taxonomy / HCPCS / Location Code These codes are used in the actual Invoice file for Billing. The Export and Weekend/Holiday Code fields are created and managed in the Export Code Reference Table. Refer to the Export Code Reference Table section below.

 

Export Code Reference Table

All Export Codes (including Weekday and Weekend Codes) are created and stored in the Export Code Reference Table. To access the table, navigate to Admin > Reference Table Management and select Export Code (under the Fiscal category) from the Reference Table field. Click the Search button to generate the table (as seen in the image below).

 

Export Code Reference Table

Export Code Reference Table

 

Creating an Export Code

To add a new value, click the Add button above the search grid (as seen in the image above). The Add Export Code window opens. Enter the Export Code in the required field (denoted with a red asterisk). The Status field is Active by default. Click Save.

 

Add Export Code

Add Export Code

Note: Export Codes cannot be duplicated or deleted. To deactivate an Export Code, set the Status to Inactive.

 

Editing an Export Code

To edit an existing Export Code, click on the applicable Export Code Name (link) from the Export Code Reference Table. The Edit Export Code window opens. Edit the Export Code in the required field (denoted with a red asterisk). Select Inactive to deactivate the code; otherwise, leave as Active. Click Save.

 

Edit Export Code

Edit Export Code

The Edit window contains a History link to view the past activity for the Export Code.

 

Note: When adding a modifier to an existing Export Code, a “:” (colon) must be added after the existing code. For example, Export Code T1019 with a modifier of 95 is entered as T1019:95 in the Export Code text field.

 

Adding a Modifier to the Export Code

Adding a Modifier to the Export Code

 

Contract Service Code

On the Contract Service Code window (Contract Setup > Search Contract >Service Code (link)), the Export Code fields (Weekday and Weekend/Holiday Codes) are dropdown fields to select from (as highlighted in the following image).

 

Contract Service Window: Export Code

Contract Service Window: Export Code

 

Inactive Export Codes

If an existing Active Export Code is made Inactive, then the code displays with an (Inactive) on the dropdown, as seen in the following image. Inactive Export Codes are unavailable selections in the Contract Service Code window.

 

Inactive Export Codes

Inactive Export Codes

 

Adding a Service Code to a Contract

Step

Action

1

Navigate to Admin > Contract Setup >Search Contract to locate the applicable contract.

2

Select the applicable contract from the search results.

 

Select Contract

Select Contract

3

Select the Billing Rates tab and click on the New Rate button.

 

Billing Rates Tab: New Rate

Billing Rates Tab: New Rate

4

On the Contract Rate window, complete the required fields (denoted by red asterisk) to include:

Discipline, Service Code, From/To Date, Rate, and Billing Units Per Hour.

 

Contract Setup: Billing Rates Tab

Contract Setup: Billing Rates Tab

5

Click Save.