Access the Consolidated Services Claim Maintenance window for the applicable library.
Note: To access a library, refer to the procedure Accessing a Consolidated Services Claim Library.
Select the Claim Header Rules tab.
In the Select Responsible Attending Provider by Specialty area, select Open Folder .
The Attending Specialty Hierarchy window opens.
On the Attending Specialty Hierarchy window, do one of the following:
To add a specialty to the Included list, select the specialty in the Available list, and then select Include .
The specialty moves from the Available list to the Included list.
To remove a specialty from the Included list, select the specialty in the Included list, and then select Exclude .
The specialty moves from the Included list to the Available list.
Note: The list can be sorted numerically by selecting on Specialties column header or alphabetically by selecting the Description column header.
Select OK.
The Consolidated Services Claim Maintenance window displays with the selected specialties in hierarchical order.
The default check box Responsible Attending from Encounter with greatest dollar value when two provides of the same specialty are found across same-day encounters is automatically selected.
When this check box is enabled the following applies:
This option is unavailable until at least one specialty is selected on the Attending Specialty Hierarchy window.
When two or more CSC candidate encounters have the same provider specialty, the provider from the CSC candidate claim with the greatest total dollar value populates the claim header.
When two encounters with the same specialty and the same dollar amount (double-tie) occur on a CSC candidate claim, the encounter with the lowest encounter number populates the claim header.
When this check box is disabled, the following applies:
When two or more CSC candidate encounters have the same provider specialty the responsible attending provider must be manually selected from the Primary Responsible Attending field under the Consolidated Services Claim sub-tab on the Claims tab of the Encounter Maintenance window.
Enable the check box Ignore COB order for consideration. Use other payers from Encounter with Responsible Attending on consolidated claims to do the following:
When this check box is enabled, claims will be consolidated when encounters/claims have different payers.
When this check box is disabled, claims/encounters with different payers will not be consolidated.
Note: When the check box is disabled the following claims will not be consolidated.
Claim A has a primary payer of Medicare and a secondary payer of Medicaid.
Claim B has a primary payer of Medicare and a secondary payer of Medicaid Dental.
