CalMHSA 705 – Priority Greater Than 1 Medi-Cal Claims Details Report

Report Description

Report is designed to generate a detailed list of Medi-Cal charges that were billed in the past and that have a Coordination of Benefits (COB) priority level higher than 1.

Report Name

Menu Path

Client Based

Report RDL Name

CalMHSA 705 – Priority Greater Than 1 Medi-Cal Claims Details Report

 CalMHSA 705 – Priority Greater Than 1 Medi-Cal Claims Details Report (My Office)

N

RDLCalMHSA_705_MediCalPriorityGreater1Detail

Parameters

Data Type

Hidden

Comments

StartDate

Date

N

A Date filter that allows users to specify the beginning of the data range of which the report will be using to pull Services data whose date of service is within.

EndDate

Date

N

A Date filter that allows users to specify the end of the data range of which the report will be using to pull Services data whose date of service is within

Show Header/Footer

Single Select Dropdown

N

A toggle select that allow users to specify whether the report’s header and footer will be displayed or not.

DataSets

Form(s)

CDAG enforced

Comments

DateSet1

Charges/Claims (My Office), Service Note (Client)

N

The main dataset for the report. It pulls data from the Services table with joins to the following tables:

·       Charges

·       GlobalCodes

·       Programs

·       ProcedureRates

·       ProcedureCodes

·       Location

·       OpenCharges

·       ERClaimLineItemCharges

·       ERClaimLineItems

·       ERBatches

·       ERFiles

·       ERBatchPayments

·       Payers

·       ARLedger

The dataset pulls data to the following criteria:

·       Regarding records from Services, Charges, ERClaimLineItemCharges, ERClaimLineItems, and ERBatches table. The query will only pull non-softdeleted records.

·       Only pull the Services data where the associated ERBatchPayments record’s payer is Medi-Cal payer

·       Only pull Service data where the associated ERClaimLineItems record’s CliamStatusCode is 4 (I.E. Denied)

·       Only pull Service data where the associated Charges record’s Priority is greater than 1

·       Only pull Service data where the associated ARLedger record’s Amount is greater than 0 (I.E. where there is an outstanding balance)

·       Only pull Service data where the DateOfService is within the date range is setup by the StartDate and EndDate parameters

·       Only pull the first/initial Service data base on the associated ChargeId, ClaimLineItemId, and ERClaimLineItemId (in mentioned order)

GetCountyLogo

N/A

N/A

County logo image for display on page header

 

Default User Roles

County Affiliate SysAdmin

Billing Supervisor

Billing

CalMHSA SysAdmin