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Additional Information on Claims Error Corrections

Depending on where a charge is at in its lifecycle, and what needs to be corrected, error corrections can be made in various areas of the system. The further along in the lifecycle a charge is the more complex it is to fix the error.

Provided below is a list of common scenarios and how to correct them in SmartCare.

Is the service signed by clinician, and completed? No

  • Because no charges were created the clinician can correct the service and billing does not have to be involved.

Is the service signed? Yes

  • Service Override Detail (Golden Key) – only use if change to Service Detail does not affect billing
  • Progress Note Document Edit (if allowed) – only edit note if it is content related, and does not affect what was recorded, and subsequently billing.

Is this Service Completed? Yes.  A completed note has generated a charge based on the service details, therefore changes to the details would not recalculate for billing.

Is the service billed? No

  • Because no claims were created the clinician can correct the service following “error” process and billing does not have to be involved. “Error” process involves setting service status as Error (retract service), or to create a new service using Copy Service icon and move document function.

Did the client pay? Yes

  • Move the payment off the service to be applied to another service or to be refunded to client.

The service was billed

  • Need to send a void claim
  • If service was marked as error before the void claim, the claim will be marked as voided. The work process to run claims will need to include periodic checks for “error” services marked for void claiming.

Did we get paid by insurance?

  • Wait for payer to do takeback, or recoupment in future payment file after void claim submission

 

* SmartCare will not stop staff from attempting to edit a service that is already completed, billed, etc.  Counties can restrict access to Service Detail thru Role Definition, which will permit clinical staff to continue doing session notes but will prevent them from accessing the Service Detail screen.  

Edit Options:

  • Signed Session Note but not yet in Completed status:
    • Thru Service Note: clicking Edit will make billing strip editable as well as the note.
    • Thru Service Detail: Use golden key to edit. Does not allow note edit.
  • Completed Note:
    • Thru Service Note: edit feature will allow for note edit but many of the billing strip fields on the Service tab are grayed out including Program, Procedure, Location, Start Date, time fields and Specific Location.
    • Thru Service Detail: Same as signed note. Use golden key to edit.  Does not allow note edit.  Need to be aware of Service billing status and potential implications.

Service Detail “Copy Service” and Move Documents feature:

  • Copy Service toolbar icon will create a copy of the original service with date set to today’s date and a status of Scheduled. Staff may need to modify the date/time on the copied service.  This ONLY copies forward the service details info (i.e. no progress note).  Use the Move Documents button to copy forward the note. 
  • The original service remains as is.
  • Click the Move Documents button on the copied service to copy forward a note. This button is only visible from the Service Detail screen.  Note: the status of the service that the note is being copied from (i.e. the original service) will automatically be set to “Error”.

Service Detail “Error” feature:

  • This should be used to error out a service that should not have been recorded. Otherwise, use the Copy Service/Move Documents process, which will error out the original service when finished. 
  • Simply change the service Status to Error.
  • Golden Key can be used to modify fields but the status of Error cannot be changed.
  • Service will no longer appear on Services/Notes list page.