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myEvolv NX*: Where are Those Checkboxes Series

Plan/Contract Rates

– Dani Evans

 

Remembering where all the important checkboxes are when setting up finance in myEvolv can be overwhelming!

In our 4th post of our “Where are Those Checkboxes Series”, we look at setting up Plan/Contract Rates. Keep in mind that these settings are specific to the Plan, Program, AND Service.

 

Breadcrumbs: Finance Setup > Payer/Contract/Rates Setup > Payer/Contract/Rates Setup > Contracts Setup

• The highlighted settings are commonly used, however, be sure to review all settings and testing in your development environment to identify other setups that could benefit your agency. 
• Don’t forget to hover over the setting options. Netsmart did a great job of adding directions/descriptions to assist you with making decisions on your finance setup. It seems so basic but super easy to ignore.

 

1st: Search and Select Payer

2nd: Click Actions > Edit this Plan/Contract next to the contract you wish to review/update

 

3rd: Click over to the Plan/Contract Rates Tab and use the three dropdowns as you wish to filter results.

4th: Select Program and rate, then Actions>Open (These are specific to the plan, program and service)

 

• All Program Modifiers (N/A)

• • • When an enrollment modifier is selected, it will limit a rate to bill only for services that are entered for a client that is assigned a certain program modifier (assigned on Enrollment page)

• Managing Offices

• • • This setting can limit a rate to bill only for services entered for a client under a specific office/facility location. (Selected on the service. Facility Providing Service). 

• Authorization Required

• • • This is a billing authorization.  If this box is checked that means the client has to have a billing authorization on file or the services will not bill for that payer.

• Supervisor Approval or e-Signing Required

• • • This will create a claim but mark it Held if the service has not been e-signed or submitted/routed/approved.

• Service Authorization Required

• • • This is an authorization for a single service.  This setting allows you to put restrictions on the number of units allowed to bill per service during a time period or billing authorization effective period.

• Copay Applies

• • • This button only works (in reality) if the client also has a self-pay plan with a copay amount setup. 
    • However, using this does allow you to collect copayments in Front desk which, if setup and completed correctly, can automatically apply the payment to the claim (HUGE time-saver for the billing staff).

• Hold Claim if no Valid Treatment Plan

• • • This setting allows a claim to be created for a service but marks it Held unless there is an active treatment plan on file (not expired) for the SAME program as the one providing service OR there is a subform on the event that allows the event to link to another active treatment plan on file. 

• Hold Claims if Other Services on Same Day

• • This setting is helpful if you have two services that are supposed to consolidate and not bill out individually if they are completed on the same day.

 

Questions? Contact us via email: [email protected]

 

*KHIT Consulting is not an affiliate of or associated in any way with Netsmart Technologies. Implement customizations at your own risk and test workflows and processes in development before implementing in production.  Netsmart does not support system customizations that are not outlined in their own documentation and resources. KHIT Consulting is not responsible for any negative outcomes as the result of your implementation of custom processes.