Insurance > Provider Level Adjustments

Key Info  
Purpose:

Configure provider level adjustments which are used to map each standardized HIPAA X12N predefined provider adjustment code to an axiUm adjustment code and allow remittance processing to auto-add non-patient type adjustments.
Related Module(s):

Insurance
Accessed From:

Maintenance > Insurance > Provider Level Adjustments
Window(s):

Provider Level Adjustments

Provider Adjustment Codes

Dependencies: Adjustment Codes

Provider Level Adjustments Window

Provider level adjustments map each standardized HIPAA X12N predefined provider adjustment code to an axiUm adjustment code and allow remittance processing to auto-add non-patient type adjustments.

Example: 50 - Late Charge can be mapped to an axiUm debit adjustment code.

The Provider Level Adjustments window allows you to review and manage these mappings.

Field Description
Code

A text field that indicates the provider level adjustment.

The ellipsis is used to display the Provider Adjustment Codes window and select a provider level adjustment.
Description

A text field that indicates populates the description of the provider level adjustment.

Tip: This field is auto-populated from the selected Code.
Inactive

A check box that, when selected, indicates this code is inactive and not in use.
Type

A drop-down list that indicates the type of provider level adjustment:

  • Debit
  • Credit
  • Either
Debit

Note: This field is enabled if Type is set to Debit or Either.

A text field that indicates the adjustment code to use for debit type provider level adjustments.

The ellipsis is used to display the Adjustment Codes window and select a adjustment code.

Note: The adjustment codes in the Adjustment Codes window are filtered to display debit to payment adjustment codes.

Credit

Note: This field is enabled if Type is set to Credit or Either.

A text field that indicates the adjustment code to use for credit type provider level adjustments.

The ellipsis is used to display the Adjustment Codes window and select an adjustment code.

Note: The adjustment codes in the Adjustment Codes window are filtered to display credit to payment adjustment codes.

Task Procedure
Add Provider Level Adjustments
  1. Click the Clear Data () icon.
  2. Complete the fields as necessary and click the Add a new Record () icon.
Edit Provider Level Adjustments
  1. Select a listed entry.
  2. Make any necessary changes and click the Modify Record () icon.
Delete Provider Level Adjustments
  1. Select a listed entry and click the Delete Record () icon.
  2. When prompted, click Yes to confirm the deletion.
Preview/Print Report
  1. (Optional) To preview the Provider Level Adjustments report, click the Preview Report () icon.
  2. To print the Provider Level Adjustments report, click the Print Report () icon.

    3. Note: The Provider Level Adjustments report uses the plreason.rpt file.

Provider Adjustment Codes Window

(Maintenance > Insurance > Provider Level Adjustments)

Provider adjustment codes are standardized HIPAA X12N codes that allow remittance processing to auto-add non-patient type adjustments.

Note: Several types of predefined HIPAA (X12N) standardized codes are required for the EDI Remittance module. These are loaded by axiUm Support at the time of installation. You are responsible for any changes required after installation.

The Provider Adjustment Codes window allows you to review and manage these adjustment codes. It displays when you open the Provider Level Adjustments window and click the Code ellipsis.

Field Description
Code

A text field that indicates the code that identifies the provider adjustment code.
Description

A text field that describes the provider adjustment code.
Task Procedure
Add Provider Adjustment Codes
  1. Click the Clear Data () icon.
  2. Complete the fields as necessary and click the Add a new Record () icon.
Edit Provider Adjustment Codes
  1. Select a listed entry.
  2. Make any necessary changes and click the Modify Record () icon.
Delete Provider Adjustment Codes
  1. Select a listed entry and click the Delete Record () icon.

  2. When prompted, click Yes to confirm the deletion.