Add Claim Consolidation Rules to a CSC Library
To enable claims consolidation, you must select the form types that you want to consolidate. Then you can choose to consolidate only encounter rate claims and/or claims with the same encounter rate SIM. These rules will apply to all of the payers in the Valid Payers list.
- Access the Consolidated Services Claim Maintenance window for the applicable library.
Note: To access a CSC library, refer to the Accessing a Consolidated Services Claim Library procedure.
- After opening the Consolidated Services Claim Maintenance window, select a valid payer for the claim, then Claim Consolidation Rules.
- From the Claims Consolidation Rules tab, select a Claim Consolidation Rules row (CCR row) and open by doing one of the following:
- Right-click the library and select Open.
- Select the open menu button and select Open.
The CSC Timespan Rules window opens for the library you selected. - Complete the timespan rules.
Note: When creating a new library, the Claim Consolidation Rules row (CCR row) is not required. However, a CCR row must be created before any claims consolidation occurs. You can create a new CCR row and complete the timespan rules by right-clicking the library and selecting New or by selecting open menu button and selecting New.
- Select Length of Timespan (the default timespan from the CSC maintenance window is Consolidate Same Day Claims). Available Length of Timespan options are:
- Daily - all encounters for the same day for the same patient may be rolled into a daily claim.
- Weekly - all encounters for the same week for the same patient may be rolled into the weekly claim.
Note: A weekly timespan only covers 7 days and is based on when your week starts. For example, a weekly claim can be Sunday through Saturday or Monday through Sunday.
- Monthly - first day of month till last day of month - all encounters for this time period for the same patient can be rolled into the monthly claim.
- Case - all encounters for the same patient for a case may be rolled into a case claim. Claims for a particular case are grouped together based on the same patient, and are separated for any other claims not associated with the specific case.
Note: Dates in Encounter Rate Service Line Dates of Services change based on the timespan you select (Weekly, Monthly, etc.) and when you select Yes to Rollup Encounter Rate Service Line. For example, selecting to consolidate weekly claims and selecting Yes to rollup encounter rate service line, will allow you to select the day of the week that starts the grouping of your encounters that will consolidate for the week.
- On the Claim Consolidation Rules tab, use the following table as a reference when you add or modify claim consolidation rules.
Note: Claims with non-matching Encounter Rate SIMs can be set to Pending during the CSC process.
- Select the consolidation rules for the selected time span.
- To hide the timespan rules, enable the Hide Timespan Rules check box.
- Select OK.