This article provides details on how the Contract Provider Charges Export pulls data from SmartCare into the report and can be used as a guide to troubleshoot why charges may not be appearing on the report.
Quick Troubleshooting Checklist
- Confirm the user generating the report has CDAG access.
- Confirm the user generating the report has access to the programs used in the report parameters.
- The services must be in a ‘Complete’ status.
- A Plan must be attached to the charge.
- The charge must have a billing code attached.
- The Charge Date of the Service must fall between the time span entered in the Report parameters.
- CalAIM Say Day Rule – if services fall into the Same Day Rule, then only the first service will show on the report if the services have been claimed.
- The clinician must have a valid billing license.
- The procedures must be attached to the degree associated with the clinician who performed the charges
This article will explain how to check each item listed in the Quick Troubleshooting Checklist.
The article is divided into 4 main areas for troubleshooting:
- How to run the report
- CDAG and Program Access
- Charges
- Procedure Codes
How to Run the Contract Provider Charges Export Report
- Click the Search icon.
- Type Contract Provider into the search bar.
- Click to select Contract Provider Charges Export (My Office).
The report will open in a new window. The following parameters are available to filter your report:
- Programs: This is a dropdown that allows you to pick which programs you want to be included in the report or you can select all.
- Charges Created Start: This is a start date selection field that allows you to select a date range for the report.
- Alternatively, you can leave the null checkbox to checked leave it blank.
- Charges Created End: This is an end date selection field that allows you to select a date range for the report.
- Alternatively, you can leave the null checkbox checked to leave it blank.
- Contract Provider Charge Export radio button: Select the True or False radio button to include or exclude.
- Click View Report.
CDAG and Program Access
To generate the report, the user must have access to the CDAG and Program for the related data to populate in the report. You can check the user’s access by using the following workflow:
Charges
For a charge to appear on the report, the following criteria must be met:
- The service associated with a charge must be set to a ‘Complete’ status.
- A Plan needs to be tied to the charge.
- The charge must have a billing code.
- The charge date must fall during the time span entered in the Report parameters. The Charge Date may not be the same as the Date of Service.
- Click the Search icon.
- Type Charges in the search bar.
- Click to select Charges/Claims (My Office).
- If necessary, click the Financial Assignment dropdown and select return charges.
- Click Apply Filter. The appropriate charges will be filtered in the grid below.
- In the list of returned charges, ensure the plan name is attached.
- Ensure the charge amount is displays.
- To check for the charge date, click the Charge ID hyperlink.
- In the Charge Details screen, click the Status History tab.
- The charge creation date will display.
The CalAIM Same Day Billing Rule can also impact if a charge shows on the report. The rule looks at services performed for a client and if the beneficiary’s CIN, Rendering Provider NPI, Procedure code/modifier, and date of service are the same then the claim will roll up to one charge.
If the Export runs before the procedure is claimed then each service will show on the report. If the report runs after the procedure has been claimed then only the first service will show up.
The Charges/Claims screen can be used to determine if a client’s services have been rolled up. Look for the Claim Line Item ID column. If the Claim Line Item ID’s are identical then the charges for that day were rolled up on the claim:
- Click the Client Search icon.
- Type the client’s name into the search bar.
- Hover over the client’s name.
- Click Services in the client pop-out menu.
A list of services will return for the client.
- Use the dropdowns to filter the returned services, if necessary.
- Click Apply Filter.
- Confirm the service has a status of Complete.
Procedure Codes
Both CalMHSA created and county created procedures can be included in the Contract Provider Charge Export.
When running the Contract Provider Charge Export the radio button, ‘Include County Created Procedures’ must be changed from False to True if county created procedures should be included in the Export:
- Click the True Radio button.
- Click the Search icon.
- Type Procedure/Rate into the search bar.
- Click to select Procedure/Rates (Administration).
- Enter the name of the procedure.
- Click Apply Filter.
- Click the Procedure hyperlink for one of the entries that appear in the list.
- In the Procedure Code Details screen, click the Program/Credentials tab.
- Navigate to Licenses/Degrees section and ensure that the appropriate license/degree is checked off. (if it is not, check it off and click save)
Next, confirm the Clinician has a valid billing license entered for the degree. Follow the steps below:
- Click the Search icon.
- Type User/Role into the search bar.
- Click to select User/Role Setup (Administration).
- Type the clinicians name in the search field.
- Click Apply Filter.
- Click the Clinician’s hyperlinked name.
- In the Staff Details screen, click the Licenses/Degrees tab.
- In the License History section,confirm a license was active for the report parameters entered and Billing shows Yes.
