Batch Payment/Adjustment Rules

Batch Payment / Adjustment Rules

(Topic Last Updated On: 04/26/2018)

Accounting > Third Party Billing (Advanced) > Batch Payment / Adjustment Rules

The Batch Payment / Adjustment Rules item on the Third Party Billing (Advanced) sub-menu, found on the Accounting menu, launches the Batch Payment / Adjustment Rules screen. This screen is used to create and manage Service Line and 835 Mode adjustment rules that are applied when making batch payments to claims. These rule configurations are applied to service lines and dictate how underpayments are handled. Rules configured from this screen are applied at the time of a 835 file import or when payments are being applied to service lines on the Batch Payment screen. A basic understanding of Methasoft's advanced third-party billing features is helpful when using this screen. Click Here to view Methasoft Accounting and Billing videos.

Field Descriptions

Applies To

This field contains a dropdown menu of Payment Mode options '835 Modes' or 'Service Line Mode'. 835 Modes refers to the available Payment Modes, '835 File' and '835 Existing' modes. Available Payment Modes are governed by Accounting Preferences. *See the Batch Payments topic of more information.

Payer

This field contains a dropdown menu of Payer/Rate Groups. Payers are configured using the Payer/Rate Groups menu item on the Accounting menu.

Billable Service

This field contains a dropdown menu of all Billable Services configured using the Billable Services screen found on the Accounting menu.

Rule Type

The field contains a dropdown menu of available Rule types that are specific to the selected Payment Mode option in the 'Applies To' field.

Group Code

This field contains a dropdown menu of common 835 Group Codes. This field is only available when using the '835 Modes' Payment Mode option in the 'Applies To' field and the 'Group Code' or 'Group and Reason Code' Rule Type is selected.

Reason Code

This field contains an extensive list of common 835 Reason Codes. This field is only available when using the '835 Modes' Payment Mode option in the 'Applies To' field and the 'Reason Code' or 'Group and Reason Code' Rule Type is selected.

Trans or Adj/Disc

This field contains a dropdown menu with the options 'Adjustment/Discount' or 'Transfer'.

Adj/Disc/Trans Type

This field contains a dropdown menu of adjustment, discount, and transfer types.

Grid Columns

Applies To

This column displays the selected Payment Mode option from the 'Applies To' menu.

Payer

This column displays selected Payer/Rate Group.

Billable Service

This column displays the selected Billable Service. If no service is specified, the Adjustment Rule will apply to 'All Services'.

Rule Type

This column displays the selected 'Rule Type'.

Group Code

This column displays the selected 'Group Code'. If the Payment Mode and Rule Type combination does not require a Group Code, this column will display 'N/A'.

Reason Code

This column displays the selected 'Reason Code'. If the Payment Mode and Rule Type combination does not require a Reason Code, this column will display 'N/A'.

Adj./Disc. or Trans.

This column displays the selected 'Trans or Adj/Disc'.

Adj./Disc./Trans. Description

This column displays the selected 'Trans or Adj/Disc/Trans Type'.

Command Buttons

New

Clicking this button allows for the creation of new Batch Payment / Adjustment Rules.

Edit

After selecting a Batch Payment / Adjustment Rule from the grid, clicking this button allows the general properties to be changed.

Delete

After selecting a Batch Payment / Adjustment Rule from the grid, clicking this button permanently deletes the record.

Save

This button applies changes made when creating a new or editing an existing Batch Payment / Adjustment Rule.

Cancel

This button will disregard any changes made when creating a new or editing an existing Batch Payment / Adjustment Rule.

Clicking this button closes the Batch Payment / Adjustment Rules screen.

Procedures

How to Add a Batch Payment / Adjustment Rule
1.) Click on New. 2.) Select the Payment Mode type that the Adjustment rule is going to be applied to using the 'Applies To' dropdown menu. 3.) (Optional) Select the Payer/Rate Group from the 'Payer' dropdown menu. If no Payer selection is made, then the Adjustment rule will be applied to all claims for the selected Payment Mode. 4.) (Optional) Select the Billable Service from the 'Billable Service' dropdown menu. To apply the Adjustment rule to all Billable Services associated with the selected Payer/Rate group, leave this dropdown 'empty' or 'open' by selecting the blank option at the top of the dropdown list. 5.) Select a Rule Type from the dropdown menu. Rule Types are specific to the selected Payment Mode in the 'Applies To' field. Available Rule Types are: Apply Remaining To - This Rule Type allows the remaining unpaid balance of the claim to be applied as an Adjustment/Discount or Transferred to a balance type. Group and Reason Code - This Rule Type is specific to 835 Payment Mode selections. This Rule Type requires a Group and Reason Code selection to be made from their corresponding dropdown menus. When the 835 file is imported, and the chosen Group and Reason code combination is returned in the service line, the Adjustment rule will be applied. Click this link for more information on EDI 835 Group and Reason codes. Group Code - This Rule Type is specific to 835 Payment Mode selections. This Rule Type requires a Group Code selection to be made from the Group Code dropdown menu. When the 835 file is imported, and the chosen Group code is returned in the service line, the Adjustment rule will be applied. Reason Code - This Rule Type is specific to 835 Payment Mode selections. This Rule Type requires a Reason Code selection to be made from the Reason Code dropdown menu. When the 835 file is imported, and the chosen Reason code is returned in the service line, the Adjustment rule will be applied. If Expected = Paid, Apply Remaining To - This Rule Type allows for the remaining unpaid balance of the claim to be applied as an Adjustment/Discount or Transferred to a balance type, if associated Billable Services' pre-configured 'Expected Amount to be Paid by Payer' is met. This amount is configured using the More... button on the Billable Services screen. See the Billable Services topic of more information. 6.) Select 'Adjustment/Discount' or 'Transfer' from the 'Trans or Adj/Disc' dropdown menu. 7.) Select a corresponding 'Adj/Disc/Trans Type' from the dropdown menu. 8.) Click on Save.

How to Edit a Batch Payment / Adjustment Rule
1.) Select the Batch Payment / Adjustment Rule to be edited from the grid. 2.) Click on Edit. 3.) Make changes as needed to the general properties fields. 4.) Click on Save.

How to Delete a Batch Payment / Adjustment Rule
1.) Select the Batch Payment / Adjustment Rule to be deleted from the grid. 2.) Click on Delete. A 'Delete this Record?' application message will appear, confirming you are sure you want to delete the selected Adjustment rule. 3.) Click on Yes to delete the rule or No to cancel.