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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: Medicare is primary and MACSIS is secondary. MACSIS is the only valid payer for SIM code 165. If this option is checked, the balance on the 165 will move to the MACSIS bucket when the charge is entered. Medicare is primary and AARP is secondary. MACSIS is the only valid payer for SIM code 165. If this option is checked, the balance on the 165 will move to the patient bucket when the charge is entered.
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. Note: This option is applicable only when you enter charges on the Charge Entry window. The adjustment code will not be applied when you post a payment on the Payment Entry window.
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. Note: This option applies only if the Automatically move the balance to a valid payer, else patient option was not selected in the Balance Control section above.
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.

Setting Up Non-Coordinated SIM Rules