Add or Edit a Procedure

1. The Customary Amount is provided by the insurance company as the usual charge for this procedure.
2. The Contractual Amount is the amount which you are contracted to with your insurances. Only fill this out if utilizing a contractual option, which will need to be checked on the 2nd General Tab of Clinic Options.
3. The Contractual Write Off is the difference between the Customary Amount and the Contractual Amount that you expect to write off, to ensure your AR report is more in line.
4. The General Ledger # field is left blank.
5. The Revenue Code is used for Medicaid/Managed Care Billing.
6. The Units of Svc (service) field needs to be populated with a 1 not a 0 or left blank.
   • This is only if you are not utilizing units of service.
7. In the Principal Procedure field, insert a principal procedure code if you are billing inpatient.
8. The NDC field is only used for injections.
9. The Medicaid Rate Code is used for insurances with Medicaid flag checked. Any procedures with the same APG Rate Code will be grouped together and sent as one claim.
10. The Procedure Type is a legacy billing selection and does not apply.
11. The BHRS Procedure Type is for Behavioral Health Rehabilitation Services, specific to Pennsylvania clients.
12. For Unit Type, if the measured unit is anything other than the US standard, select the proper unit of weighted measurement for the procedure.
13. The Medicaid Rate Code - SED is used for insurances with the Medicaid flag checked. Any procedures with the same APG Rate Code will be grouped together and sent as one claim.
14. The Monthly Budgeted Units field is used for special billing.
15. The Proc Class is a legacy billing selection and does not apply.
16. Enter all Modifiers associated with the procedure.
17. The MAT/OTP Code field can be used to allow more flexibility when grouping procedures on the charges. The MAT/OTP code will override the Medicaid Rate Code field if there is a value in it. 
18. Leave the Functional Type blank. This is customer specific.
19. The APG Weight field orders claims with the highest weight being the first claim when bundled through APG billing, given by payer.
20. For Place of Service, only use this if you need a specific place of service for a specific procedure code.
21. The MDOC Procedure Type is only applicable for CCWM.
22. The B2H Waiver Type applies to Bridges to Health program type flags.
    • Choose SED if the B2H waiver type is Severely Emotionally Disturbed.
    • Choose DD if the B2H waiver type is Developmentally Disabled.
    • Choose MEDF if B2H waiver type is Medically Fragile.
23. The PROS options apply to Personalized Recovery Oriented Services.
    • Select CRS if the procedure is to be marked as Community Rehabilitation and Support.
    • Select ORS if the procedure is to be marked as Ongoing Rehabilitation and Support.
    • Select IR if the procedure is to be marked as Intensive Rehabilitation.
    • Select CTMD if the procedure is to be marked as Clinical Treatment.
    • Select CTMR if the procedure is to be marked as Clinical Treatment.
24. Select Methadone only if you provide Methadone dispensing.
    • For First Dose Methadone Override, if a methadone dose is selected here, the fee would not be included with the claim.
25. In the CFTSS Billing, Linked Offsite Procedure field, start typing a procedure code or name and select the procedure from the list generated.
    
    
     
26. For this list of checkboxes, see the descriptions below:
    • Check the box for Inactive to make the procedure inactive. Procedures cannot be deleted, only made inactivated.
    • Check the box for Not Insurance Billable if the procedure can only be billed to a Responsible Party (non-billable procedures).
    • Check the box for Auth Alert to alert the clinician that an auth will be needed before the procedure is performed.
    • Check the box for Require Referring if the procedure requires a referring provider to be identified.
    • Check the box for SED if the procedure can be used for Severely Emotionally Disturbed.
    • Check the box for Exclude from Day Cap to exclude this procedure from Day Cap set in Program/Billing Defaults, meaning you can bill this procedure even if the day cap has been reached.
    • Check the box for Use Unit Cap to cap the number of units a Procedure can have.
      • For Max Units, enter the number of units at which the Procedure can be capped.
      • For Minutes Per Unit, enter the number of minutes each unit represents.
      • For Payroll Units, use when clinicians are paid per services rendered each day.
    • Check the box for Use Unit Range to enter a range of units a Procedure can have.
    • Check the box for Medical for a medical-specific procedure.
    • Check the box for Use with Complex Care to make a Complex Care note billable.
      • If a Complex Care note (set at the Visit Type level) is completed, it will verify if the procedure with this flag turned on has been completed within five business days.
      • Programs flagged as Mental Health will only look 5 days prior whereas all other programs look both prior and after the Complex Care date of service.
    • Check the box for Bill using After Hour Add-On (99051) when services using this procedure are eligible for the add-on if provided within the after-hours times specified in the Program/Billing Defaults set up.
      • In addition to setting it up at the procedure level, it must also be set up at the Insurance level to automatically bill the add-on procedure.
      • Procedure code 99051, Bill Using After Hour Add-On will also need to be created.
    • Check the box for Crisis Service to have eCR look to the Crisis After Hours table in Program/Billing Defaults when determining the After Hours Add-On.
    • Check the box for Staff Modifier Eligible to automatically include the Staff Modifier on the charge if the Staff Modifier is set up on the User screen for User signing Progress Note.
    • Check the box for Do Not Use Auth to sets default for the procedure if an auth is not required.
    • Check the box for Do Not Send Admitting Diagnosis in 837 to not send the admitting diagnosis on the 837.
    • Check the box for CCBHC Qualified if this procedure will be bundled with other CCBHC procedures performed on the same day.
    • Check the box for Send Service Time in NTE in 837 to send the actual start and end times of the visit on the 837.
    • Check the box for Lab to indicate that this procedure is a lab and eCR will send the CLIA number on the 837.

1. The DCF fields; DCF Cost Center, DCF Setting and DCF Mod 4, are for Florida customers only. They are associated with their DCF contract.
2. The DARTS fields are specific to Indiana. Please talk to your Project Manager if your agency is in Indiana.
3. Video Counseling is specific to DARTS. Please talk to your Project Manager for details.
4. DCF FASAM fields are specific to Florida. Please talk to your Project Manager for details.

In the Variations tab, you can enter any variation you require from the Procedure Info tab. When billing, by default, the system will use all the information on the Procedure Info tab EXCEPT if the billed-to payer is indicated on the Variation tab.

Essentially, a Variation is considered an exception. For example, you need to bill using all the information as shown on the Procedure Info tab except when you need to bill using the information on the Variation tab.

A Responsible Party variation can also be created, which would supersede any sliding scale fee on Patient Details. This is not a mandatory field.

The Billing Format Variations tab allows you to override the billing format on the specified insurances, if this Procedure is on the first line of the claim.

This is used if the billing format is different from the default billing format for the procedure.

• In the Insurance drop-down menu, select the specific payer.
• In the Billing Format drop-down menu, adjust the billing format.
• In the Drop to Paper Format drop-down menu, adjust the drop to paper format.

Talk to your Project Manager to determine if this tab is applicable to your agency.

The CVX tab is used only if a client has a CVX Program set up to track immunization registry.

• In the Code field, enter the CVX code.
• In the Name field, enter the name associated with the CVX code.

The Procedure Restriction tab prevents the restricted procedure from being completed on the same day as the parent procedure.

• The procedure you are creating is considered the parent procedure.
• The procedure selected from the drop-down list has already been created and is the restricted procedure.

Prevents modifiers from being sent when billing particular insurances.

• Enter the Insurance name and the Excluded Modifier.
  • As you start to type the name of the insurance, options will appear in a list below.
  • Only one modifier can be entered per line.  For additional modifiers for the same insurance, enter it on the next line.

1. In the Search field and enter the Procedure Code you would like to edit.
2. Click on the Procedure name in the list provided.
3. Click the Proc Modifiers button.
4. Check the box in the Inactive column to inactivate any Procedure Modifiers that are not applicable.
5. Click on any Procedure Modifier and update as appropriate.
   
   
    
6. To add a new Modifier, scroll all the way to the bottom and enter the new Modifier.