Clinitrak Funding Source Setup Webinar November 1, 2011 Overview of Funding Source Set-Up Training Understanding the Payor Profile Screen Creating/Editing Payor Profiles Assigning Funding Sources to Individual Clients Tools for Diagnosing Problems with Funding Sources Questions and Answers 1
Payor Profile Screen The Payor Profile Screen is located in the Agency Settings Module 2
Payor Profile Screen The Payor Profile Screen is restricted for access to Database Administrators 3
Payor Profile Screen The Payor Profile Screen is one of many set-up screens in Agency Settings 4
Payor Profile Screen The Payor Profile Screen is highly customizable and controls Funding Source Set-Up. By default you see Funding Sources (Payors) selected for display. The Payor Profile Screen is pre-loaded with basic DMH Payor data and IS Plans Some Funding Source Records can be deleted Visible Delete in a Funding Source Record: funding source not yet used by the Agency. Deleting records from Payor Profile screen not recommended Can suppress display of records by removing Start Date or inserting an End Date 5
Quick Review of Pre-Loaded Plans Payor Profile Screen Use the List All Payors function to check the pre-loaded Funding Source records before creating new ones 6
Quick Review of Pre-Loaded Plans You can see a full list of Payors that are already in the system for your agency by placing a check in the List all Payors checkbox 7
Quick Review of Pre-Loaded Plans Clinitrak includes a list of all Plans from the list of IS Plans that was published in 2009 An updated list of DMH IS Plans is available from DMH: http://lacdmh.lacounty.gov/hipaa/edi_technical_specifications.htm The List of IS Plans is located on the EDI Technical Specifications page of the DMH Website 8
Quick Review of Pre-Loaded Plans List of DMH IS Plans This is a three page document: Page 1 9
Quick Review of Pre-Loaded Plans List of DMH IS Plans Page 2 10
Quick Review of Pre-Loaded Plans List of DMH IS Plans Page 3 11
Adding New Funding Sources to the System by Creating/Modifying Payor Profiles Checklist for Funding Source Set-Up The following steps are required: Select a Cost Center from the Dropdown Options Select an existing Plan ID or create a new one Assign (or select) a Funding Source Name Assign (or select) a Funding Source Display Label Complete Funding Source Attributes Expense Tracking designates this as a Funding Source that should show-up in the Client Expense Tracking screen COS Funding designates this payor as authorizing (and paying for) COS (Community Outreach Services) Medi-Cal Billable designates services associated with this payor as reimbursable by Medi-Cal Medicare Billable designates services associated with this payor as reimbursable by Medicare Other Billable designates services that are neither Medi-Cal or Medicare 12
Adding New Funding Sources to the System by Creating/Modifying Payor Profiles Use the Display checkbox to select a funding source for default display (optional) Show in Billing Log (optional)- This tells the system to display billable records associated with this payor in the Billing Log(s) EPSDT must be used if the service is to be billable to EPSDT Healthy Families must be checked if the service is to be billable to Healthy Families Show Address (optional) is only applicable to services billable to Medicare Late Code (optional) allows the agency to insert a specific Late Code for the selected funding source to over-ride Clinitrak s built-in business rules for the submission of EDI claims Start and End Dates Control display of Payors in the Funding Source drop-down for individual clients System compares current (today s) date with dates in Payor Profile table 13
Assigning a Funding Source to an Individual Client Client Funding Source Screen: is located in Client Data: Create/Update Files The Funding Source Dropdown is populated from the Payor Profile Table: once a Funding Source is selected, the system will display its Start Date and whether it is associated with EPSDT, Healthy Families, Medicaid and Medicare 14
Assigning a Funding Source to an Individual Client The Eligibility Start Date refers to the Client: first day of month client became eligible for coverage by this funding source. Entering an Eligibility End Date: the selected Funding Source is no longer valid for this client The Episode Dropdown allows the user to attach a funding source to a particular Clinitrak episode By linking a funding source to a particular Episode (with emphasis on a Service Type) the selection of an Episode in a Progress Note can tell the system how the service should be billed Billing Medi/Medi Clients A Medi-Medi client: one who is eligible for both Medicare and Medi-Cal; they are generally older clients Medi-Medi clients need two funding sources: one for Medicare and one for Medi-Cal If the client is assigned to a funding source that is billable to Medicare, the system will automatically check whether the CPT code needs to be submitted to the Medicare Intermediary Assigning Other Billing Characteristics for Individual Clients Screen allows user to enter an EPSDT Aid Code The user can also indicate whether the client meets a variety of other conditions: Emergency Aid, Pregnancy, a combination of both, and, if applicable, the type of Wraparound Funding SED should be used for Healthy Families 15
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How the Integrated Services Report can Identify Funding Source Use Reports Menu Screen Integrated Services Report Screen 17
How the Integrated Services Report can Identify Funding Source Use Access to the Integrated Services Report (ISR) Screen is assigned by Database Administrators to individual users in their Access Privileges screen By default the ISR automatically displays data for the current fiscal year. Integrated Services Report Filters The default displays all notes Although the system automatically shows claim status data for agencies using EDI, not all notes are attached to claims The system recognizes the funding source for claims that are pending, submitted, approved, denied, or void If a record is in Billing Ready, Validation Pending, or Clinitrak Pending, technically DMH hasn t acknowledged a claim The Claim Funding Source field does not reflect claims that have been submitted through the Manual Billing option Claims submitted through the Manual Billing option are categorized as Validation Pending and the system does not recognize a Claim Funding Source since it does not recognize an EDI claim as having been created 18
How the Integrated Services Report can Identify Funding Source Use WARNING: The Claim Funding Source field will display No Funding Source if no claim was created. If the Current Funding Source is present but the Claim Funding Source field says no funding source then it is either an EDI claim that is in Validation Pending or Billing Ready, or that the Agency is not using EDI. Pinpointing Notes/Claims with Problems The Group By filter: allows the user to identify which funding sources are in use, and/or it can be used to reveal which clients have notes associated with a selected funding source Use dedicated filter to identify Notes without Billing Rates: Integrated Services Report Filters 19
How the Integrated Services Report can Identify Funding Source Use Pinpointing Notes/Claims with Problems Use dedicated filter to identify Records where Current Funding Source differs from Claim Funding Source Integrated Services Report Filters 20
Diagnosing and Fixing Problems with Funding Sources Using the Administrative Tool to Identify Problems The Administrative Tool: Is accessible only to Database Administrators Is located in the Agency Settings Module Automatically displays combinations of Cost Centers/Service Types/Rate Categories and Reporting Units that do not have Billing Rates Using the Billing Rates Screen to Correct Problems Billing Rates Screen 21
Diagnosing and Fixing Problems with Funding Sources The Billing Rates Screen: Shows All Current (and Past) Rates Allows users to Manipulate Filters to Isolate Problem Records Includes filters for Reporting Unit, Cost Center and Rate Categories Facilitates creation of modified records by using Save as New A Billing Rate Record is comprised of five components: Cost Center e.g. LAC-DMH or LAC-DCFS Service Type e.g. MH OPT or PEI or MAT or TBS or Wraparound Service Sub-Type e.g. MHS, Case Management Brokerage or Med Support Rate Category e.g. MHS, or TCM, or MEDS, or Crisis Reporting Unit e.g. 9999-A Customizing Components Caveat: Each of these components can be customized to the needs of the individual agency, but it is important to remember that if things are too customized, it will compromise the ability of the program to extract meaningful composite reports. Agencies are encouraged to retain the hierarchical arrangement of components. Example: If an agency combines components by creating a LAC-DMH MAT Cost Center, then it will no longer be able to filter on LAC-DMH and get all the data that will be billable to DMH. 22
Diagnosing and Fixing Problems with Funding Sources Missing Billing Rates Once it is determined that a billing Rate is missing, the user needs to use the Rate Category dropdown to confirm that the appropriate combination of the first four components exists If the appropriate combination is not included in the Rate Category dropdown, then the user must work backwards through the previous screens to determine what is missing The Billing Rate records in question are most likely missing so we have to create new ones to make the problems go away Because the Administrative Tool and Integrated Services Report are offline, the changes/corrections will not be reflected until the following day. Note: The above information can be found in Clinitrak in the Help Module under FAQs 23