What's New in Release 14.2.2 & 14.3.1

• 835 files with more than 500 line items

• Changes to patient statement counts

• Making a patient payment from the Claim page

• Report updates

• Workers' Compensation and Automobile available as secondary payers

• MCM users - Facility notes copied from parent to the child

• Payment posting balance warning disabled

• XS modifier now available

• Merge claim message for exact matching patients

835 files with more than 500 line items

To improve system efficiency, manual or automatic imported 835 files that contain more than 500 line items will be split into smaller files. The smaller files will show the name of the larger file appended with a number that represents the number of splits (ex: 123456_1, 123456_2, etc.). Users will be taken to the first split file automatically and will then see a banner message at the top of the page that contains hyperlinks to each split file. Multiple line items for the same claim will be grouped together and display in the same transaction. Users can work each file as a separate transaction.

Changes to patient statement counts

The patient statement count now resets when the coordination of benefits updates back to the patient. In instances where a patient is the current payer, one or more statements are sent before insurance is found. When insurance is found, the insurer becomes the current payer and the patient moves to secondary. Once insurance processes the claim, any remaining balance shifts back to the patient which makes the patient the current payer again.

In this scenario, ZOLL Billing will reset the patient’s statement count to zero when patient becomes the current payer again. If there was a suspension on the account, it will be removed. If a next statement date is missing, it will be set to the day after the reset. This ensures statements are properly sent when the patient responsibility updates.

Making a patient payment from the Claim page

A patient payment can now be made directly from the Claim page using the new "Add a patient payment" button on the Credits tab.

1. On the Claim page > Credits tab, click the Add a patient payment button.

   

2. The Patient Payment window will display.

   

   Enter the deposit date, transaction type (not required), transaction number, and transaction date.

3. Enter the patient payment amount per HCPCS.

4. Click the Post now button.

A patient payment posted on the Claim page will display on the Credits tab and can be reversed if needed.

Report updates

Two reports were updated in this release.

All Claim Details Report

The following additions were made to the All Claim Details report:

• A PRID column now displays at the end of the report after the tags column

• An Incident Number column now displays after the PRID column

• A Charge Category column now displays after the Incident Number column

  

Patient Addresses Report

• The Patient Addresses report now includes ZOLL provided payers (i.e. Medicare) as an option for the current payer selector.

  

Workers' Compensation and Automobile available as secondary payers

When Commercial is set as the primary payer on a claim, Workers' Compensation and Automobile can be selected as secondary payers. If the primary payer is changed to something other than Commercial, the Automobile and Workers' Compensation selections will not display in the Secondary column.

MCM users - Facility notes copied from parent to the child

For linked facilities, facility notes created, edited, or deleted on the parent company will propagate to the child companies. The date, user, description, and details for the note will display in the Audit Trail of the child company. Facility notes created or edited on the child company will not copy up to the parent company. In addition, if a user deletes a note on the child company that was copied down from the parent company, it does not reappear again but remains deleted.

Payment posting balance warning disabled

To ensure that the following payment posting warning message displays correctly, it will be disabled for a period of time after which is will be reintroduced in a future sprint.

XS modifier now available

The XS modifier was added to ZOLL Billing. The XS modifier is defined as a "Separate Structure, a service that is distinct because it was performed on a separate organ/structure."

 

Merge claim message for exact matching patients

During a NEMSIS import, a merge claim message will display when the patient matching logic equals to:

• A minimum match of 60 points from the Imported Claims page - TBD link

• A minimum match of 79 points if the claim is manually created

  

In addition, the "Incomplete - Verify patient account" label on the Dashboard changed to " Incomplete - Verify duplicates."

Background matching information

ZOLL Billing creates claims from NEMSIS and Dispatch imports. When Billing receives an import, we match existing patients using a weighted algorithm. The algorithm consists of a set of criteria, each assigned a number of points. The points are totaled to determine if the imported patient is an exact match or no match.

In the weighted algorithm, each of the following matching criteria is given a number of points:

• Social security number: 19

• Personal information:

  • Date of birth: 30

  • Sex: 0

  • First name: 9

  • Middle name: 2

  • Last name: 34

• Address:

  • Address line 1: 6

  • Address line 2: 2

  • City: 6

  • State: 5

  • Zip: 6

Exact match: The new patient record is considered an exact match of an existing record when the combined weights of the above criteria is 79 or greater.

After finding an exact matching patient, the system then looks for existing claims associated with that patient.

• NEMSIS import:

  • Claim found with the same DOS and run number: TBD will display on the Imported Claims page. When the user clicks TBD, a duplicate message will display.

  • Claim found with the same DOS but different run number: TBD will display on the Imported Claims page. When the user clicks TBD, a merge message will display.

  • Claim found with different DOS: A new claim will be created for the patient.

• Dispatch import:

  • Claim found with same DOS and run number: TBD will display on the Imported Claims page. When the user clicks TBD, a duplicate message will display.

  • Claim found with different DOS: If there is an exact patient match and no claims exist for the patient, then a claim will be created based on the import. There will not be a merge message for a dispatch import.

When user clicks TBD on the Imported Claims page, the message that displays depends on the matching criteria value.

Multiple claims for the patient found

Multiple matching patients