Setting up Payers

1. From the navigation menu click the  icon.
   
2. There are 2 ways you can add a new payer. After clicking the  icon you can select Add New or you can select the payer list and click the icon at the bottom right of your screen.
   
3. After entering the Payer's name select the Payer Type (Insurance/Regional Center/School/Other) and add the payer's basic information. 
4. Once completed you will land on the Payer's profile.
   
5. Select Services from the top.
   
6. Select the Add icon on the bottom right corner to add a new service.  These services are taken from the Settings > Services that you set up previously.  If you do not see a service that you need, you must go back to the Settings section to add it in.
   
7. Use the chart below to help you complete this section.
   
8. Click Save. Repeat steps 5-8 until you have added all your services for this payer.
1. 
   

   
   

   Field Name	Description
   Charge Rate	The rate that you have set as a provider as a charge per unit.  This does not have to be the same as the contract rate; many organizations charge a higher rate than their contract states.  Make sure the rate matches the unit.
   Contract Rate	The rate for the service provided in your fee schedule from the payer.
   Unit Size	Unit of measure (15 Min/30 Min/Appointment/Day/Flat)
   Rounding	How would you like to round for fractional units?  AMA/Up/Down/Nearest/Not Allowed  AMA (American Medical Association) - Round up if unit is > 50%, otherwise round down (this rule is also known as the 8 minute rule).
   Required Credential	The minimum credential requirement before services can be provided.  Credentials are pulled from Staff Qualifications.   Only select the minimum.  For example, if a BCaBA or a BCBA can perform a service, select BCaBA.
   DX Code	Select your diagnosis code from the drop down list. Autism is F84.0.  This can be overridden for specific clients.
   Billing Code	Select your billing code from the drop down list.
   Add Modifier	Select your modifier from the drop down list.

2. Default Modifier

   The Default modifier should be selected if you want to pull the modifier every time.  For different educational modifiers (e.g., HO, HN, HM), select "highest credential" to pull the modifier based on the qualifications in the staff profile.

Setting up Staff

1. From the navigation menu click the  icon.
   
2. There are 2 ways you can add a staff. Either select Add new from the navigation menu or from the staff list click the button at the bottom right of the screen.
   
3. Fill in the staff's basic information and click Save.
   

Profile

Personal Info

Custom Fields

Clinical Teams

1. 1. Select Staff> Manage Clinical Team 
   

2. 
   

Supervisor

1. Select on the top right of the card.
   
2. Check to make sure the Status is Active.
   
3. Select the Staff Name from the drop down.
   
4. A From date is required to indicate when this person began supervising the staff.
   
5. Click Save.
   

Qualifications

1. Click the  button on the bottom right had corner.
   
2. Select the qualification from the drop down list.  New qualifications can be added under Settings > Qualifications
3. Fill in the general qualification information.
   
4. Click Save.
   

Pay Rates

Adding a Hourly Pay Rate

1. Click the icon on the bottom right hand corner.
   
2. Click the  icon on the top right of the window.
   
3. Select an Earning Code from the drop down list.
   
4. The From Date is required, and the To Date is not required. A To Date should only be used if you are planning to change your employee's pay on a planned date (e.g., they receive a rate increase after 90 days of employment).  If you do not have a new rate starting for them, leave the To Date blank. 
5. Enter the hourly Rate.  
   
6. Repeat this process for different rates (e.g., PTO, Non-billable, Admin, Sick).
7. Click Save.
   

Adding Salary Pay Rate

1. Click the drop down on the top left hand corner, and select Salary Exempt. 
2. Click the Add icon in the bottom right hand corner.
   
3. Repeat steps 3-5 from above and enter the Monthly Salary Rate.  Make sure to check off all rates the staff member is qualified for (e.g., Admin time, PTO).
   
4.  Click Save.

Adding Provider Identifiers (NPI/Tricare/Medicaid/Referring Provider)

Adding Provider Identifiers

1. From the left navigation menu click the Billing icon and select Provider Identifier.
   
2. On this screen you will notice General, Tricare ID, Medicaid ID, BHPN, and Referring Provider tabs along the top.
   
3. Select which tab you would like to add an ID for.
   
4. Clear the filters.
   
5. Use the search at the top to locate the staff then add their identifier on the right. 
   

Setting up Clients

1. From the navigation menu click the  icon.
   
2. From here there are 2 ways to add a new Client. The first way is to select Add New from the navigation menu. The 2nd is to click Client List and hit the  button on the bottom right of your screen.
   
3. The Add Client window will appear. Complete this section with your client's general information.
   
4. Click Save.
   

Personal Info

Custom Fields

Contacts

1. For new clients you will notice an Add Contact in the middle of the card and for clients who already have contacts, you can click the  on the top right of the card.
   
2. Complete the Contacts general information
   
• Responsible Party - Generally this is the person who is responsible for the bill (only 1 contact can be marked as the Responsible Party at a time).
  
• Client Portal - Allow this contact to access Client Portal to view their schedule and more.  See Client Portal

An email address is required In order to allow contacts to access client portal.

Client Assignments

1. For new clients you can click the Manage Client Assignments link in the middle of the card. For existing clients who already have staff/teams assigned you can click on the button on the top right of the card.
   
2. Enter the staff/team's name in the Add Staff / Team and select from the drop down.
   
3. Depending on whether you add an individual staff or team, will determine where it will be placed within the Assigned Staff or Assigned teams section. 
   
4. Click Save.
   

Authorizations

1. Click the Add button on the bottom right.
   
2. Use the drop down and select the Payer.
   
3. Fill out the client's insurance information.  Make sure to check the name on the card and note whether the  insurance is in the name of the client or their parent.
   
   **Note: Normally this can be found on the client's medical card.
   
                                           
   
   
   
4. Click Save.
   

The Effective Date should be the effective date of the insurance, not the authorization.  If there is no effective date on the card, put Jan 1 of the year.  Most insurance doesn't expire; the expiration date can be left blank unless you know the authorization is expiring.

1. Find the Payer's card and select Add Authorization the  icon on the top right of the card.
   
2. Enter the client's authorization information here.
   
1. In this section you can enter the authorization as it appears on your contract or you can customize the hours that can be provided during a certain period. The limit section allows you to customize the authorization to fit your organization.  If the hours roll over for the entire authorization (e.g., they aren't "use it or lose it"), it is recommended to enter the authorization as units per authorization
   
1. Examples: (Allowed Limits / Select Type / Per)
   
• 40 Hours per Week
  
• 20 appointments per month
  
• 30 dollars per day
2. When you enter the first service, use this opportunity to set default rendering provider, place of service and service facilities when you can (e.g., the BCBA who is always the rendering provider).  These along with the authorization dates will copy down to each service that you add.  This will save you time when entering schedules.
3. If services are pulling from the same bucket of units (e,g., Direct Service- RBT and Direct Service- BCBA), you can put them on the same line.  If they are pulling from different buckets (e.g., 100 units of Parent Training and 300 units of Supervision), make sure to use the button in the top right corner of the authorization to add additional services.  Note:  You should only be entering each authorization number one time, not once for each service.
3. Click Save.
   

Adding a new Post

1.  Click the  on the bottom right hand corner.

Delete, edit or hide a Post

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