Setting Up Non-Coordinated SIM Rules
The following table shows the non-coordinated SIM rules that you should setup for SIM configuration.
| Field | Description |
|---|---|
| Automatically move the balance to a valid payer, else patient | Select this option to move the non-coordinated SIM balance to the first valid payer bucket in Balance Control during charge posting. If a valid payer is not present on the encounter, the non-coordinated SIM balance is moved to the patient bucket in Balance Control. Some of the examples are:
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| Check mark any balances moved for billing | Select this option if non-coordinated SIM charges moved to a valid payer bucket in Balance Control should have a green check mark so those charges are billed to the valid payer when the next billing and claims process is run. |
| Automatically adjust Non-Coordinated SIM if valid payer is not present | If there is no valid payer on the encounter, and each non-coordinated SIM charge was moved to the patient bucket in Balance Control, and the patient should not be responsible to pay for those charges, select the patient adjustment transaction code to be used to auto-adjust the non-coordinated SIM charges to a balance of $0.00.
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| Suppress Non-Coordinated SIM from claims for invalid payers | You can use this option to prevent non-coordinated SIM codes from appearing on claims for payers other than valid payers.
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| Only send Non-Coordinated line if status of other lines is forwarded | You can use this option if claims for a valid payer should include only non-coordinated SIM charges when the other charges were already forwarded to the valid payer by the prior payer. For example, charge 1 bills to Medicare primary payer and charge 2 which is non-coordinated moves to Medicaid secondary payer during charge posting. When Medicare pays on charge 1, the claim is forwarded to Medicaid. When the Medicare payment is posted with a Forwarded status, non-coordinated charge 2 is flagged to bill to Medicaid but charge 1 is not. This prevents a duplicate Medicaid claim for charge 1. |
| Create as Primary Claim | You can use this option if claims for a valid payer should always be created as a primary claim, even though the valid payer may actually be a secondary or a tertiary payer on the encounter. For example, a non-valid payer is a primary payer and a valid payer is a secondary payer on an encounter. A charge for a non-coordinated SIM is entered on the encounter and the charge balance automatically moves from the Ins1 bucket to the Ins2 bucket during charge posting. When a claim is created for the secondary (valid) payer, it appears as if it is a primary claim with no references to the actual primary (non-valid) payer. |