The Claim SIM Options tab on the Encounter Rate Billing Library Maintenance window contains options that provide the capability to show non-Encounter Rate SIMs on claims or affect automatic adjustments.
Open an Encounter Rate Billing library.
The Encounter Rate Billing Library Maintenance window opens.
Select the Claim SIM Options tab.
In the Claim Service Range Options section, select open menu button and select New.
The Alt Payer Number SIM Range window opens.
Enter the SIM number or the beginning SIM number for a range of SIMs that you want to apply to a claim SIM option.
For a range of SIM numbers, enter the ending SIM number. The ending SIM is required, but can be the same as the beginning SIM, functionally choosing that as a single SIM.
Select OK.
The claim SIM options are available for selection.
Select the applicable option based on the following descriptions:
Exclude from Encounter Rate Insertion: Select this option to make the service exempt from the Encounter Rate. This option functions the same way as the Enc rate exempt option on the General tab in the SIM library. If the Exclude from Encounter Rate Insertion option is selected, it overrides the option in the SIM library. If this option is not selected, the SIM library option is used by default.
Exclude from Sum of Charges: Select this option to exclude the dollar value of the SIM from all Sum of all charges calculations or other calculations on the Claims tab of the Encounter Rate Billing library that add up to only covered charges.
Exclude from COB Adjustments: Select this option to exclude the dollar value of the SIM from all adjustment calculations on the Secondary Encounter Rate and Tertiary Encounter Rate tabs in the Encounter Rate Billing library.
Include on Claim with $0: Select this option to force the SIM data (CPT and/or revenue code) to display on the claim with a $0 value, regardless of which option is selected on the Claims tab of the Encounter Rate Billing library. If the Force patient responsibility option is selected on the General tab in the SIM library, it overrides this option. Monetary calculations are not affected by this selection. When this option is selected, the Include on Claim with original value and the Exclude from Claim options are unavailable.
Include on Claim with original value: Select this option to force the SIM data (CPT and/or revenue code) to display on the claim regardless of which option is selected on the Claims tab of the Encounter Rate Billing library. If the Force patient responsibility option is selected on the General tab in the SIM library, it overrides this option. Monetary calculations are not affected by this selection. When this option is selected, the Include on Claim with $0 and the Exclude from Claim options are unavailable.
Exclude from Claim: Select this option to prevent the SIM data (CPT and/or revenue code) from displaying on the claim, regardless of which option is selected on the Claims tab of the Encounter Rate Billing library. The monetary calculations are not affected by this selection. When this option is selected, the Include on Claim with $0 and the Include on Claim with original value options are unavailable.
