Defining Service Codes (CPT, HCPCS) and Fees for Provided Services

(1) Navigate to the Billing tab in the Main Menu. Click "System Billing Configuration", then “Provided Services & Programs” and select the billable service you want to configure.
- The warning label seen in the screenshot below is normal for services that have not been completely configured for billing yet.

(2) With the Service selected, click the "Jump to Coding" button in the bottom right corner. This page allows Service Codes to be created and configured.

The codes should have standard formatting. HCPCS codes should have spaces to separate modifiers.
Unit Billing - Select this for fee for service.
These codes should have an Effective Date (if applicable).
- Effective/Termination dates are good practice, but not required.
- no dates = infinity
The "Restrict By" section - Restrictions should only be defined when absolutely necessary. They can be filtered by Funding Type, POS Code, Job Code, and Minimum/Maximum Minutes.
- Funding Type
- POS (Place of Service) Code - Allows defining codes specific to a place of service.
- Enter Job Codes (MHP,QMHP,LPHA,etc) for the corresponding Procedure Code.
  - *Note: Multiple job codes can be entered for a procedure, separated by commas.
- Min/Max Minutes - Allows defining codes which are specific to service durations.
- *Note: A Code without ANY restrictions will be used if no better match is available. If a default is needed, there should be only one per Service.

(3) With a Service Code selected, click the "Jump to Fees" button in the bottom right corner. This page is where Fees for Service Codes are defined.

Click "New" to add a new Fee for this Service Code or select an existing one.
- Enter the Onsite and Offsite Fees
- These codes should have an Effective Date (if applicable).
  - Effective/Termination dates are good practice, but not required.
  - no dates = infinity
The Restrict By: section is used to filter the Fees by Funding Type if applicable.
- *Note: A Fee without ANY restrictions will be used if no better match is available. If a default is needed, there should be only one per Code.

Clearinghouse Configuration

Most clients use Clearinghouses to simplify EDI processing. Multiple Clearinghouses can be defined in the system, but Payers can only be processed though one. If you have billable items that cannot be processed electronically, you can define your own Clearinghouse(s) to facilitate manual billing processes.
(1) Navigate to the Billing tab in the Main Menu. Click "System Billing Configuration", then “Provided Services & Programs” and then the “Clearing Houses” tab.
(2) From here, you can select a previously configured Clearinghouse or configure a new Clearinghouse.
(3) Fill in any and all relevant information and click “Save” to update the Clearinghouse.
(4) When selecting an existing Clearinghouse, all Payers that are assigned to the selected Clearinghouse will be displayed on the bottom of the page.

A Payer record is required for anything that will be billed electronically. If you have billings that cannot be processed electronically, you can define your own Payers, and assign them to clients, to facilitate data extracts for manual processes.
(1) Navigate to the Billing tab in the Main Menu. Click "System Billing Configuration", then “Provided Services & Programs” and then the “Payers” tab.
(2) From here, you can select a previously configured Payer or configure a new Payer by clicking the “New” button in the top left corner.
(3) Fill in any and all available and necessary information in the provided fields. A "Payer ID" is required for EDI processing. It is a standardized value and can be found at your chosen Clearinghouse portal or other online sources. If a Payer requires a specific Revenue code on your EDI submissions enter it here, if not, leave this field blank.
(4) Click “Save” to add the new Payer or update an existing Payer.
(5) When viewing a previously configured Payer, the clients with active funding assigned to the selected Payer are listed on the bottom of the screen.

A Funding record is central to all billing processes and should always be defined - even if the billing will be handled manually.
(1) Navigate to the Billing tab in the Main Menu. Click “Client Information” and then the “Funding” tab.
(2) One funding record must be configured as "Primary". At the time of writing this document, EDI extracts do not support Coordinated billing. Any funding source below Primary must be billed manually.
(3) After selecting the appropriate client in the top drop down list, you will see the client’s existing funding records, if any exist. The active funding record will be denoted by a “**” in the far left side of the table under “”. This is set by checking the “Active Funding” box below the table.
(4) Fill in the appropriate information for the “Funding Type”. Select the correct “Guarantor / Subscriber”. If "Parent/Guardian" is selected as Subscriber, the proper person must be selected in the corresponding drop-down. If the Subscriber does not appear in the drop-down, you must add them on the "Parent / Guardian" form (The tab immediately below Funding).

(5) Scrolling further down the page you will see the “Coverage / Policy Information” portion. Select the appropriate Payer that you configured prior and any additional information that may be needed in this part of the form.