Auto Entry of Clinic # / Doctor # for Billings
Date of Tech Note: 15 July 1999
Enhancement: 15 July 1999
Bug Fix: N/A
Description
When sending in billings to OHIP or to the HSO department, a code is send along with each billing. These codes indicate the clinic or physician and the agreement with the ministry as to payment. Additionally it identifies the billing capability.
MediFile attempts to make the entry of this code as simple as possible. It does this by recognizing the physician and patient and entering the code for you. You can always over ride this code if necessary.
There are essentially 3 different places that MediFile checks to place the code.
Detail
Other Billing
The code is determined after you search for a patient. It is done at this time because of the possibility that the patient is a rostered patient as per an HSO agreement.
Once the patient is found MediFile looks to see if the Patient Type field in the patient record equals ‘Rostered’.
vPatType:=[Patients]Patient_Type
If (vPatType="Rostered")
vFuncCenter:=GetSpecificPref (19;"0660")
Else
If ([Accounts]FacilityNo#"")
vFuncCenter:=[Accounts]FacilityNo
Else
vFuncCenter:=GetSpecificPref (24;"0660")
End if
End if
If the patientis a rostered patient MediFile uses the HSO code as contained in the Preference file.
If the patient is not rostered as would be the case for all patients in a non-HSO clinic, MedIFile looks into the area account record to see if there is a specific code for the area account. If there is, it places that code into the Billing Type.
If the FacilityNo field is blank in the area account, MediFile will use the code contained in the Admin Prefs billing area for this.
Through the above all specific billing arrangements can be handled by MediFile.
If a specific doctor has more than one billing arrangement, all that is needed to do to accomplish this is to create extra area accounts with the specific ‘FacilityNo’ for that billing arrangement.
Bill Daysheet
This is handled seamlessly by MediFile when using the Bill Daysheet as it is in Other Billings. The only difference in Bill Daysheet is that you cannot over ride what MediFile finds.
`--- The Clinic Number ---
If ([Patients]Patient_Type="Rostered")
[Billing]FunctionalCente:=GetSpecificPref (19;" ")
Else
`
`--- OHIP or HSO # ---
Case of
: (×aImpMod{$FeeLine}="Technical")
[Billing]FunctionalCente:=[Accounts]TechnicalFac
: (×aImpMod{$FeeLine}="Profession")
[Billing]FunctionalCente:=[Accounts]ProfessionalFac
Else
If ([Accounts]FacilityNo#"")
[Billing]FunctionalCente:=[Accounts]FacilityNo
Else
[Billing]FunctionalCente:=GetSpecificPref (24;" ")
End if
End case
End if
If the Patient is rostered then the Admin Preference for the HSO number is used.
If the patient is not rostered, then MediFile checks to see if the claim was a technical or professional claim. If it is then it uses the code as specified for that in the area account.
If it is not either of a technical or Professional billing, then MediFile looks to see if there is a code identified in the Accounts FacilityNo field. It will use it if it is not blank.
If that is blank then it uses the code in the Administration preferences for that code.
Administration Preferences
The two arrows point to the fields in the Administration prefs that need to be set up for this to work properly. If you are an HSO clinic the HSO area MUST be filled in. The OHIP # only needs to be filled in if you are not going to fill in the code for each Area Account. We recommend that you fill this in as a backup in case you forget to fill this in for each Area Account.
Area Account Setup
In the Area Account the place to set these up is in the Province Specific area of the record. If the area account submits as part of a group number then enter that group number. If the Area Account submits under their own billing number then enter INDV.
In all cases the Provider number must be entered.
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