How to Set-Up an ECM

Step One (Optional): Create/Designate a Program as an ECM Program

  1. Click the Search icon.
  2. Type Programs in the search bar. 
  3. Click to select Programs (Administration).
  1. Click the New icon or select an existing program.
  1. On the General tab, complete the following fields:
    1.  Name
    2. Display As
    3. Type
    4. National Provider ID
    5. Service Area
    6. Tax ID
  1. On the Rules tab, navigate to the Plans section.
  2. Click the Add Plans button to add plans that cannot be charged.
    1. It is recommended that you add Managed Care plans to this section to ensure ECM charges do not fall into those plans.
  3. Click Save.

Step 2: Create/Designate a Plan as an ECM Plan for each ECM Program

  1. Click the Search icon.
  2. Type Plan in the search bar. 
  3. Click to select Plans (Administration).
  1. Click the New icon or select an existing plan.

NOTE: You will need to create a new Plan for each ECM program.

  1. On the General tab, complete the following fields:
    1. Enter a Name 
    2. Click in the Display As field to populate
    3. Click the drop-down and select a Payer
    4. Enter the Type
    5. Click the Calendar icon to select a date to Begin ICD1O Billing
    6. Enter the COB Priority 
    7. Click the button to Add Service Areas
    8. Enter the Claims Address
    9. Click the drop-down to select the Standard Electronic Claim Format
    10. Click the drop-down to select the Standard Paper Format
    11. Click the drop-down to select the Claim Filing Indicator Code 
    12. Enter the Electronic Claims Payer ID
    13. Enter the National Provider ID

Step 3: Add a New ECM Payer Type

  1. After you have created your Plan above, on the General tab, click the drop-down arrow in the Payer field and select <Add Modify/Payer>
  1. Enter the Payer Name
  2. Click the drop-down arrow and select the Payer Type.
  3. Click the drop-down arrow and select the Payer Code.
  4. Click Insert. 
  5. Click Save. 

Step 4: Create the Procedure Codes

NOTE:

Rates cannot be triggered Plan and can also vary by Plan, so recommendation is to create Procedure Codes for each ECM Plan. Example criteria for these Codes could be:

  • Procedure Code for Clinical Staff
  • Procedure Code for Clinical Staff (Outreach)
  • Procedure Code for non-Clinical Staff
  • Procedure Code for non-Clinical Staff (Outreach)
Instructions:
  1. Click the Search icon.
  2. Type Procedure in the search bar. 
  3. Click to select Procedure/Rates (Administration).
  1. Click the New icon. 
  1. Enter a Name
  2. Enter Display As
  3. Click the drop-down arrow and select the Entered As
  4. In the Rules section, select the Associated Note
  1. Click the Rates/Billing Codes tab and complete the following:
    1. Charge
    2. From
    3. To
    4. Standard Billing Code
  2. Click Insert
 
NOTE: Multiple entries can be added to this tab based on specific criteria – such as inserting a row with a specific modifier for Telehealth Services. These specific criteria are determined by selecting options in the screenshot above (like Place of Service, Location)

 

  1. Click the Programs/Credential tab and associate the appropriate programs and Licenses/Degrees. 
  2. Click Save.