Add or Modify an Institutional Billing Library
- Open File Maintenance.
- Select Libraries, and then Institutional Billing.
The Institutional Billing List window opens.
- Do one of the following:
- To add a new library, select open menu button and select New.
- To modify an existing library, select the row for the library in the list, select open menu button and select Open.
Institutional Billing Library Maintenance window opens. - In the Institutional Billing Library Name field, enter a descriptive name for the library. This field is required.
- In the Payer Rules for Institutional Billing section, existing payer configurations display as separate rows in descending date order. This section is required. Do one of the following:
- To add new payer rules, select open menu button and select New.
- To modify existing payer rules, select the row for the rule set in the list, select open menu button and select Open.
- To copy existing payer rules, select the row for the rule set in the list, select open menu button and select Copy.
The Institutional Billing Maintenance window opens. - In the Effective Date and Expiration Date fields, enter an effective date and an expiration date for the payer rules. These fields are required. Dates cannot overlap between payer rules for the same payer. If dates overlap, the following prompt appears when OK is selected: Effective/Expiration dates overlap with [Payer Rules Name].
Note: In order for the payer rules to apply to an encounter, the Billable Date on the Encounter Maintenance window must fall within the Effective/Expiration Dates defined here.
- In the Description field, enter a descriptive name for the payer rules. This field is required.
- For the Use as default billing rules for Institutional Claims check box, do one of the following:
- To define payer rules for specific payers only, do not select this check box. The Valid Payers section becomes enabled.
- To define default payer rules for all other payers that do not have specific rules defined, select this check box. The Valid Payers section becomes disabled.
- In the Valid Payers section, select Open Folder
.
The Payers window opens. - Select one or more payers to which the rules apply from the Available section on the left. and then move them to the Included section on the right.
Note: To list only payers included in a specific financial class, select the Financial Class.
- To save changes and close the window, select OK.
- Define rules for the selected payers as needed on the following tabs:
- Define TOB by Rev Code Tab
- Claim Rules by TOB
- Payer Exception Claim Rules
- To save changes and close the window, select OK.