Billing Review Problems and Resolutions

• Missing Patient Name

• Missing Patient Address

• Missing Patient City

• Missing Patient State

• Missing Patient Zip Code

• Missing Patient Date of Birth

• Missing Patient Gender

• Missing Patient SNN

• Medicaid Number must be 8 characters

• Miss Patient MR Number (appears as Patient ID)

1. Search and select the applicable Patient Profile (Patient > Patient Search).

2. In the Patient Profile, click on the Profile page (link) from the left navigation index.

3. Click on the Edit button.

4. Enter values for the missing Patient information in the corresponding field(s).

5. Click Save.

• Alt Patient Number should not be blank

• Alt Patient ID must be 11 characters

• Missing Contract Start Date

1. Search and select the applicable Patient Profile (Patient > Patient Search).

2. In the Patient Profile, click on the Contract page (link) from the left navigation index.

3. Click on the Edit link in either the Alt Patient ID or Service Start Date column.

4. Enter a value for the Alt Patient ID and or the contract Start Date.

• Missing Primary Diagnosis

1. Search and select the applicable Patient Profile (Patient > Patient Search).

2. In the Patient Profile, click on the MD Orders page (link) from the left navigation index.

3. Click on the Add button to enter a new MD Order or click on the MD Order ID (link to edit an existing one.

4. In Section 11 (Primary DX) click on the Add button to enter the Patient's Diagnosis.

• Missing Authorization Number

1. Search and select the applicable Patient Profile (Patient > Patient Search).

2. In the Patient Profile, click on the Authorization/Orders page (link) from the left navigation index.

3. Click on the Add button to enter a new Authorization or click on the Edit link to update an existing one.

• Visit Start/End Time cannot be blank

• Missing Service Code

• Visit cannot have TEMP Authorization

• Missing Caregiver Name

• Scheduled hours exceed Authorization

• Schedule Duration does not match Authorized Hours

• Billing by Export Code Greater than 24 Hours

• Maximum hours should not exceed the limit specified

1. Navigate to Visit > Visit Search.

2. Use the search filters to locate the visit with missing and/or incorrect information.

3. Click on the edit icon ( ) to open the visit window.

4. Navigate to the appropriate tab to fix and/or enter the required information.

5. Click Save.

• Missing Export Code

• Missing Revenue Code

• Missing Taxonomy Code

1. Navigate to Admin > Reference Table Management.

2. Select Contract Service Code from the Reference Table dropdown field.

3. Locate and select the applicable Service Code.

4. Enter the respective value in the Export, Revenue, and/or Taxonomy Code fields.

5. Click Save.

• Invalid CNR Import Reference Number

1. Search and select the applicable Patient Profile (Patient > Patient Search).

2. In the Patient Profile, click on the Calendar page (link) from the left navigation index.

3. On the calendar date cell, click on the V link to access the visit.

4. In the Schedule tab enter the correct CRN Import Reference Number.

5. Click Save.

• Missing Caregiver NPI Number

   

• Missing Caregiver Professional License Number (PLN)

1. Search and select the applicable Caregiver Profile (Caregiver > Caregiver Search).

2. In the Caregiver Profile, click on the Profile page (link) from the left navigation index.

3. Enter the Caregiver NPI Number and/or the Caregiver PLN Number.

4. Click Save.

• Missing CNR Employee Number

1. Search and select the applicable Caregiver Profile (Caregiver > Caregiver Search).

2. In the Caregiver Profile, click on the Others page (link) from the left navigation index.

3. Enter the Caregiver CNR Emploee Number.

4. Click Save.

• Missing Physician NPI Number

1. Seach and select the applicalbe Physician (Admin > Physician > Physician Setup).

2. Enter the Physician's NPI Number.

3. Click Save.

• Pending Billing of Additional Shifts on Same Day

1. Navigate to Action > Confirm Visits.

2. Use the search filters to locate additional visits on the date in question.

3. Confirm any applicable visits and click on the Save link for each one.

• Visits on Same Day/Service Code must be Billed on same Invoice

Option 1 (Merge Invoice)

1. Navigate to Billing > Invoice Search > By Visit.

2. Use the search filters to locate the visit(s) in question.

3. Review the visit(s) to verify that they were billed on the same day and have the same Service Code.

4. Once confirmed, select the applicable vist(s) checkbox(es) and click on the Merge Invoices button.

Option 2 (Delete Invoice)

1. Navigate to Billing > Invoice Search > By Invoice.

2. Use the search filters to locate the Invoice in question.

3. In the Invoice, review visits to verify they were billed on the same day and have the same Service Code.

4. To remove visits from the Invoice, click on the delete icon.

5. Click on the Patient Name (link) to route to the Patient Calendar. On the Calendar, select the visit to access the visit window.

6. On the visit window edit the Service Code.

7. Click Save.

Note: Additional steps may be required if visists are exported or paid.

• Visit should NOT be placed on Manual Hold

1. Navigate to Billing > Invoice Search > By Visit.

2. Use the search filters to locate the Invoice in question.

3. Click on the Y link in the E-Billing Manual Hold column.

4. Select Single Claim from the options.

5. Click OK.

• Does NOT meet POC Compliance Requirements

1. Review the Contract Required Compliance rules.

2. Click on the edit icon ( ) to open the visit window and select the Visit Info tab.

3. Manually enter the Dutes to satisfy the Required Compliance rule.

4. Click Save.

• Review Contract Start Date and Alt Patient Number

• Missing Contract Start Date

• Discharge Date Elapsed

1. Navigate to Patient > Contract.

2. Review the Alt Patient ID. Click on the Edit link and enter the Alt Patient ID in the text window. (Contact the Payer if the field is unavailable to edit.)

3. Click on the Update link.

4. Review the Service Start Date. Click on the date (link) to edit on the pop-out window.

5. Click Save.

• Dx Code May Fail Specificity Guidelines (if configured to validate for Flag 10 ICD Codes)

1. Navigate to Patient > Authorizations/Orders.

2. Click on the Edit link to open the Patient Authorization window.

3. Click on the Add button in the Billing Diagnosis Code(s) section.

4. On the Authorization Default DX Code, click on the ? (to the right of the ICD field) to search for the diagnosis.

5. Click on the most specific ICD code that applies to the Patient (without a Flag code).

6. Click Save to apply the ICD Code to the authorization.