This article describes how to set up a chart item for waterfall billing if the first payer only partially pays or denies.
General ChartItem Setup
- Ensure both payers are active with current dates for the client, and with the priorities indicating the order that you want them to bill.
- Before approving a chart item for the client make sure both payers are listed at the bottom of the chart item.
- The first payer will bill normally, and if it denies or is partially paid then you can use Next Payer to bill the next payer.
- Whatever
the Due Amount is on the first claim item is the amount that will be
billed the second payer, so before you Next Payer you should add a
writeoff or adjustment if you want to change the amount billed the
second payer.
- If everything is working the claim item should show up immediately as a Posted claim item.
Troubleshooting
Q: What do I do if a chart item was approved before a second payer was listed at the bottom of the chart item?
A: To
fix this you have to go to each chart item, do Update Payer, and verify
that the second payer shows up. Once both payers are listed on the
chart item, then Next Payer should work on the claim item. If everything
is working correctly then both payers should show up on the client's
chart items without you having to always Update Payer.
Q: OKHCA is always denying. What may fix this problem?
A: Current understanding is that OKHCA is a
payer of "last resort", which means if the client is eligible for
another payer you have to bill the other payer first and then OKHCA. If
you bill OKHCA first it will always deny. To fix this, set the chart item to try to bill the other payer first, and OKHCA second.