National Billing Provider Setup

National Billing Provider Setup

Setting Up Billing Module

Create Funding Source A Funding Source is a person or entity paying the Claims or Invoices for one or more individuals. Funding sources are used when creating Service Authorizations for an individual. Electronic payers such as: Florida Medicaid, KMAP, emedny Manual payers may be: Boards of Education, DVR, County Funding, Grants or individuals Enter all the information regarding the Funding Source as appropriate Select the appropriate Payer

Funding Source List Providers can create multiple funding sources with both EDI Electronic Claim submission and for manual invoicing.

If Manual Billing is selected as the option for the payer field, the billing system can produce a manual Invoice for these Funding Sources and will produce billing data reports, based on same information as Electronic Claiming.

Create Billing Provider Therap s Billing module allows for setting up of the Billing Provider with detailed information which includes Provider NPI Number, Medicaid Provider number, Provider Commercial Code, Taxonomy Code, Provider address, contact details etc. Select Entity from the drop down menu as appropriate

Billing Providers for the set-up will be created for each State Medicaid Provider numbers and or each National Provider Identification (NPI) number assigned to the provider agency. We have found that the use of NPI, State Medicaid numbers varies from state to state. In Florida the NPI number is required for all Billing Providers except HCBS Waiver Providers, which continue to use just the State Medicaid Provider number for the agency and copy that number in the Provider Commercial Number box. In Delaware on the NPI number or Provider Commercial Number is used, along with the related Taxonomy number. In Colorado only the NPI number is used. In Kansas, the NPI and the provider s State Medicaid Number are used.

Users will need to enter their Provider's commercial number; in general it should contain the legacy ID, if required by your state.

Claims will be rejected if P.O.Box number is entered in the address fields. Claims will be rejected if 9 digit zip field is not entered.

Service Description Code Description Codes will be state specific as agreed with CMS for the State HCBS Waiver, these Services may or may not have associated Procedure Modifiers. Most states require the use of a Primary Diagnosis, such as defaults 7999, or 318, and the Diagnostic Pointer 1, the State of Alaska requires an actual diagnosis code for each person for their presenting condition.

Sample of per diem Day Unit Rate set-up

Day Hab Service with 15 min Unit Rate Calculation

Create Attendance Type Day Habilitation Sample for 15 min Unit Calculations with Time in and Time Out required Click on the checkboxes to make the options billable

Sample is for Residential Services -Daily Unit Calculation Attendance Type used for Transportation Tracking, with each individual having a separate Unit Rate Cost.

Attendance Type for calculation of Billable Monthly Unit for Residential Services. Sample is Florida s 25 day requirement. Date for the Residential Service for a Monthly Unit can be date range of services, First Date of services or last date of services.

Custom Invoice The Billing system will create a HCFA-CMS 1500 Invoice, setting up details for a customized invoice, users are also be able to enter printing instructions for CMS- 1500 Print Calibration.

Creating Service Authorization

Service Authorization for Residential Services, with Daily Unit Rate Method. Attendance Type selected, not Time In or Time Out. The Attendance Type selected for Monthly Unit Calculation would need to have the bundling formula detailed in the Attendance Type set-up. Method of Data Collection: Attendance Select appropriate Attendance Type

Once the Service is saved it is shown under the Service section of the Service Authorization form. Click here to add another service if required

Day Habilitation Service, with 15 min Unit Calculation, Attendance used with Time In and Time Out required

Service Authorization for Daily Rate, with Time In and Time Out to determine a full billable day.

Service Authorization with Billing Data Input used for services such as: Dental, Durable Medical Equipment, Transportation per Mile, Vision Exams.

Enter total dollar value or number of Units in Billing Data entry, and date or date range used.

Service Authorization for ISP Billing Method, with a Link to ISP Program, using Time In and Time Out to create either 15 min Unit or a single monthly Unit for Services Click here to link to ISP Program

Clicking on the Add link opens a Select ISP Program pop-up Click here to add the Program On clicking the Save button, the ISP Program is added to the Service.

When creating ISP Program, the following should be marked to link to ISP Billing Section: Select Non-Grid for Input Method Select Yes Mark the ISP Program Billable

Generate Billing Data from ISP Select appropriate Date Range Select appropriate Service Click here to view Individual List Individual List

Attendance Tracking to Create Billing Data Select Attendance Option and Time In/Out time for the Individuals Click here to record attendance data Already submitted data Already approved data Click here to select the data for approval

Success messages will be shown for the respective Billing data. Data submitted for billing Attendance Report and Statistics Report can be acquired from the Attendance module.

Creating 837P, ASC X-12 Professional Claims Select the appropriate date range, click on the Next button to view the list of Individual.

Generated Claims, not yet sent to Medicaid, currently in Billable Status

Search the claims that are to be sent Sending Claims The search result will be displayed based on your search parameters.

Claims sent to Medicaid, some claims had errors which need to be corrected, system does a number of validations as shown.