Before you can bill, client data must be entered into AWARDS.  This data is necessary to identify clients for whom invoices will be generated, as well as to populate required fields in the claim file or claim form.  Specific client data required to generate invoices for services provided include:

  Client identifying information - Includes name, date of birth, gender, and address.  This information is collected in required fields during the admission process in AWARDS.  It can be updated at any time using the Profile module Face Sheet feature. 

  Entitlement records - When a new payer is configured during the BillingBuilder setup process, AWARDS automatically adds the new payer to the selection list available in the Entitlements module Certified Entitlements feature as an "Insurance/Subsidized Payments" entitlement.  When generating invoices for that payer, only clients with an entitlement record for that payer will get an invoice generated (assuming all other eligibility requirements are met).  

  TIP: When creating an insurance entitlement record for a client, there is a selection list that allows you to choose whether the insurance company is a "Primary," "Secondary" or "Tertiary" payer.  If an insurance company is designated as a "Secondary" payer for a client then AWARDS will generate invoices for the insurance company if:

There are no billing types set for the "Primary" insurance for a single program,

Or the "Secondary" insurance has procedure codes that do not exist for the "Primary" insurance.  Invoices will only be created for the procedures with differing procedure codes than the "Primary" insurance.

"Primary" designations will not affect billing if no "Secondary" selection is made.  The "Tertiary" designation will have no affect on billing.  

  Diagnosis information - A diagnosis is required in order to bill for services provided to a client.  This information can be entered for a client via his or her Face Sheet, or using the Diagnoses feature of the Medical module.  

  TIP: When working with diagnosis information, keep in mind that:

A primary disability is not required in order to bill for services provided to the client.

In most cases, only the Axis I or Axis II information is needed to bill for services provided to the client. 

If there is more that one Axis I entered for a client, only the FIRST line of Axis I diagnosis is taken for the claim file.  The other diagnoses are not read.

When generating invoices, AWARDS uses the diagnosis code, not the diagnosis description.  If a diagnosis description is entered without a corresponding code, an invoice will NOT be generated for that client. 

When generating claim files, AWARDS will translate the DSM-IV codes entered to an ICD-9 code for the claim file.

  https://demodb.footholdtechnology.com/help/?11431