How to Run the Report
Eligibility verification are requests sent to NC Tracks to verify a patient’s eligibility for one month. Every patient’s eligibility is either approved or denied on a calendar month basis. It is pertinent that eligibility is verified monthly, as beneficiaries lose benefits or change insurance. This ALL affects billing.
Patients that will be excluded from the report are: patients without a sex entered on the referral, patients with a discharge date before the From date on the report, status of cancelled or Referred, not admitted - unless the checkbox "Include Referred but Not Admitted" is checked.
We recommend using the following reports before creating the eligibility. The reports will help verify that all required patient information is complete. From Barnestorm Office click on Reports > Audit, use reports 07.01 and 07.02.
To Create Medicaid Eligibility Verifications file:
This step creates the electronic file to send to NC Tracks. You are also able to print the report of patients that will be sent for review.
To Send the Eligibility Transmission - file type 270:
This step transmits the electronic file to NC Tracks.
To Receive Medicaid’s Response:
This step will receive a response file back to confirm that they have received the file without any issues.
To Receive Medicaid's Verification Report
This step will receive the verification report from Medicaid so that you can print it from Barnestorm.
To Print the Eligibility Verification - file type 271:
How to Read the Report
Will print all three options; Problems Only, Carolina Access Only.
** Inactive means that patient does not have Medicaid for the selected month of the report.
** Pvt Ins will let you know if the patient also has a private insurance policy. Nothing else needs done unless the patient is being billed for skilled services, which may require a denial from the insurance first.
Carolina Access Only:
OK if the eligibility status is OK
MQ Medicare Premium Only = Medicaid will not pay claims, they only pay the Medicare Part B insurance premium.
DE Deductible = This patient must meet a monthly deductible before Medicaid begins paying claims.
EM ER Only = Medicaid pays for Emergency Room only.
HC Health Choice = This patient is enrolled in Health Choice - children under 21 - and must be billed to the Health Choice provider.
Will give the date of the month for eligibility.
Including the Carolina Access Provider number.
Will show the name of the Carolina Access Provider.
****MISSING**** means that no CA# was assigned for that month.
****MISSING**** Updated to means that the CA# was missing in referral but the description that came back in the EDI file is an exact match for one of the descriptions in the cross-reference file, Billing > Other > Carolina Access to NPI CrossReference, so the referral screen was updated with the matching CA#.
If the top and bottom line have slightly different names for Carolina Access Provider = The top line is what came back in the EDI file; the second line is what the CA# cross-reference has, Billing > Other > Carolina Access to NPI CrossReference.
Medicare Missing D9 - NC Only:
This report checks to see if the patient has Medicare. If so, it will check to see if the patient has the condition code D9 setup in the Referral > Payer > Extra Billing Info screen.
If the patient has Medicare but is not homebound, then you have to bill Medicaid and use the D9 condition code on the claim to indicate that Medicare is not the primary payer for that service.
If you admit a homebound patient but only confirmed the Medicaid, and didn’t know about Medicare, then you will need to switch the payers, from Referral > Payer, to be Medicare standard.
EDS does not use the same patient information database to verify eligibility that they use to pay claims. That's why claims for a patient can be paid, and the eligibility returns a response of Patient Unknown. If the spelling of the first name is different, if the date of birth doesn't match what's in the eligibility system, these can cause a Patient Unknown response.
Medicaid eligibility only uses the above processes.
NOTE: The Check Eligibility tab option in the Referral screen is only for Zirmed (Medicare).
Dates of Service in Future:
You’ll need to recreate the verification. The original eligibility that was created had a thru date past the current date. Use the default dates on the screen when creating verification for the current month. Example, if creating it on the third of the month it should look like: From 08/01/2009 – Thru 08/03/2009.
From Barnestorm Office click on Employee Activity > Visit Entry
Use this screen to enter a chargeable/non chargeable visit. This is screen is used when the visit is not added using the clinical Point-of-Care software.
The information entered on this screen is what triggers the charge amount, units, HCPCS codes for the billing claim.
The top portion of this screen allows you to enter visits and the bottom portion allows you to look up past visit entries. You can customize the Data Entry Settings to how you would like to enter the information.
To enter a keyed visit:
*Note: The [Enter] key acts as the [Tab] key to help speed up data entry
This screen is used to enter multiple visits that have the same visit information. To access this screen, (Barnestorm Office) click on Employee Activity > Medicaid Weekly Visits. Here is a brief description of each section:
HOW IS TIME ENTERED (Top, left of screen)
There are several options under this section:
Total Hours; Total Units; Time In/Out– Military; AM/PM – Based on the option you choose, you will be able to enter time in total hours, total units, or key in the time using military or am/pm.
Round Time to nearest 0.05 hr (3 min): The time will be rounded to the next 0.05 hour. For ex: 10:55 will be rounded to 11:00.
Round Time to nearest ¼ hour: The time will be rounded to the next ¼ hour. For Ex: 11:53, will be rounded to 12:00.
Alert when total hours is 8 or more: This will alert you when total hours (for one day) totals 8 or more hours. The number of hours will be highlighted in pink.
1st Day of Week (0-Sun, 6-Sat): Type 0 (zero) if you want the first day of the week to display as Sunday; Type 1 for Monday; 2 for Tuesday; 3 for Wednesday; 4 for Thursday; 5 for Saturday and 6 for Sunday.
For the Week Beginning: Choose the week you want to key in your visits.
Get Job Code From Employee: If you choose this option, the system will automatically enter the job code that is listed under that employee’s code.
Use 001 for the Job Code: If you choose this option, the system will automatically use this job code (001) for your entries.
Copy Payer Code to Job Code: If you choose this option, the system will automatically use the payer code (you are using) also as the Job Code.
IHA/C and IHA/A Codes: For this field, you can type in your job code for IHAC-Child, and IHA/C Adult.
Recent Visits (Bottom, left section of screen)
From/Thru date– Key in the date range you want to review visits entered. Then click the Refresh button. You can also use the -1 Week and +1 Week buttons to get to the right week.
Show Last: Choose the number of visits you want displayed on the screen.
Employee: If you wish to pull up visits for a particular employee, type in the employee code, then hit Refresh Button. Otherwise leave blank to search all.
Program: If you wish to pull up visits for a particular program, type in the program code, then hit Refresh Button. Otherwise leave blank to search all.
Payer: If you wish to pull up visits for a particular payer, type in the payer code, then hit Refresh Button. Otherwise leave blank to search all.
Job Code: If you wish to pull up visits with a particular job code, type in the job code, then hit Refresh Button. Otherwise leave blank to search all.
Visit Status: If you wish to pull up visits with a particular status, type in the status code, then hit Refresh Button.
Memo Code: The Visit Memo Code can be used to justify why a visit was skipped or not completed as planned. Each agency can setup their own Visit Memo Codes and a description (ie. Holiday). Click Here for instructions on creating Visit Memo Codes.
Adding New Visit (Top, middle of screen)
Search patients for the employee# option: When you check this option, the screen will only show patients that are assigned to that employee (in the Referral/Employee screen). Leave the box unchecked to search all patients.
Entering your data:
Allow Multiple Entries Per Week: If you have multiple entries for the week, click this checkbox. Otherwise, you will get this popup if you enter charges for a week that already has existing charges:
Allow Times To Cross Over Midnight: If you have times that cross over midnight, click this checkbox.
Don’t blank out the chart# after Save: If you click this option, the chart number will stay at the top to make additional entries.
Split Visits That Cross Over Midnight Into 2 Separate Visits: If you click this option, the system will separate the visits into 2 separate visits.For example: Time in was Saturday 5 pm and Time Out is 7 am. There will be two visits displayed (after you save your entry):
Click the Save button.
*If you choose to enter visits, on Medicaid Weekly Visits screen, those visits will not show up as "KeyedBy" on the visit/assessment screen.
From Barnestorm Office click on Employee Activity > Medicaid Monthly Visits. This screen will allow you to key in up to an entire month of entries at the same time - using the same billing information for each entry.
How to Enter Charges in Barnestorm
Entering Charges and Mileage Using Units or Hours
You can enter the mileage and hours/units onto the month by using one of the Copy buttons, or you can manually enter them in the grid displayed at bottom of screen.
Using the Copy buttons:
(Copy to Every Day) or (Copy to M-F Only)
Based on the option you choose, the system will filter in that information directly to the Grid, as well as generate the total hours (or units) and total miles.
**Be patient, it takes a few seconds for the copy to generate, please wait.
Manually Type or Change the Hours (or Units) and Mileage, as needed
To Make Changes or Delete an Entry:
NC MCO Payers: If you have only one PCSNPI, then all the MCO claims can be created at the same time by selecting payers 840,860,870,880,890 (and if you have children billed as 99509:HA, then add payers 841,861,871,881,891). If you have different NPI numbers for each program, then create separate files for each NPI.
This step is very important for non-PPS payers - it will generate charges to show up in accounts receivable. This is the step that shows the 'Amount Billed' in the AR history. This process is usually ran right after claims have been prepared for a select time frame OR to update the Amount Billed in the case of charges being modified (added/deleted/changed).
Go to Accounts Receivable > Post Charges to A/R item at the top of the screen.
Post Charges to Accounts Receivable
Important Note: If the billing cycle you just finished includes two months, be sure to repeat the instructions for both months.
· First, select the month you want to create charges for:
Month to be Transferred -Select the month and year you need to transfer charges over to the AR, this will be the month you just prepared claims for or the month you need to update in case of changes to charges.
Charges Cutoff Day - You have the option to transfer partial month of charges. This is optional for those agencies who bill every 2 weeks, instead of monthly. Enter the charges Cut-off date. Setting this to a day, prior to the end of the month, allows you to transfer charges for a partial month. If you do not have a cut-off, leave the date as is. The default is the last day of that month to be transferred.
· Optional: Next, we have a few different optional fields you can use, as needed:
Transfer Just One Chart # - Check this box, if you are only transferring the A/R information for one patient. A box will appear to enter that chart number. If the transfer is not specific to a single patient, do not checkthis box to select ALL patients.
Program(s) /Payer(s) -You have the option to enter a specific program and/or payer. If you want to select ALL program and payers then leave these fields blank.
· Next, select which report option you want to print:
You may click the Print Detail to print patient detail or the Print Summary Only to print a summary by program/payer.
Optional: If you are reposting a month because changes were made to charges, then check this box to recalculate the Amount Billed already in the AR.
Remove Previously Posted amounts for .... If this button is selected, the system will remove any previously posted amounts for that month. You will receive a popup confirming that you want to delete those previously posted amounts. Select Yes or No to proceed. NOTE: This popup will only appear after you choose your option on the last step.
· Final Step: The last step is posting the charges in AR. We have step 1 and step 2. You can either run these steps separately or together all at once.
Create and View Charges or Create and Transfer Charges
OPTION A: Selecting the Create and View Charges button. First you will click the Create and View the Charges button. A report of charges to be created will generate. Next you will need to click the Transfer Created Charges button to A/R to transfer those charges. A duplicate report will appear from the Create and View Charges step. We recommend using step 1 and 2 separate if you would like to review the charges before posting them.
OPTION B: Selecting the Create and Transfer Charges button will do it all in one click of the button.
Printing the Report:
Click the printer icon in the upper left to print. Click the X in the upper right to close the print preview screen or hit Close to return to screen.
Report 05.17 - Compare A/R to Charges
This report is used for non-PPS payers. It will compare the visit and supply amounts to the amount in accounts receivable. If there is any difference between the two it will show up on this report. Note: If there are no conflicts, you will receive this message, "All A/R Amount Billed entries agree with the charges." For more information on this report, click this link Report 05.17 Compare A/r to Charges.
You will use Accounts Receivable > Post Payments >Post Electronic Payments to post any ERA files.
You will first need to download the ERA files to the appropriate folder.
Post Elec Remit Files (835/ERN):
The checkbox next to this button only gets used when a change has been made in the software to handle something new and you would need to re-post the RA.
Use these steps when you have entered a payment/adjustment incorrectly or need to delete an entry altogether.
NOTE: Payments can be posted under the Post Payments tab, but you will need to use the Inquiry tab to make any corrections/deletions.
The AR Inquiry screen allows you to view the history of a patients account. From the Main Menu in Barnestorm Office click on Accounts Receivable (or Billing) > Inquiry > AR Inquiry.
This screen will show you everything you need related to billing. From the Main Menu in Barnestorm Office click on Billing (or Accounts Receivable) > Inquiry > Patient Billing Inquiry. When you select a patient, by name or chart, the patient's demographics appear at the top. This includes the payers, admit date and status (active or discharged).
When you click on the 485s tab a list of episodes will appear. This is handy for patients who have multiple episodes. When you click on an episode the From and Thru dates (from the top/right of screen) will change to that episode. Only the dates for that 485 episode will appear when you click on the Visits and Supplies tab.
The OASIS tab will show you all the OASIS Reason for Assessment, HIPPS code, Lock Date and Status.
This will give you a list of all OASIS entered (on and after 1/1/2008). This gives you a quick look at the details of the PPS episode. The from and thru dates are the episode dates. The first HIPPA code shown is what appeared on the RAP, or the Amount Billed in A/R. The MO826 is the answer on the OASIS for that episode. The TherVx is the actual number of visits done. Tot Vx is the total number of visits completed. The second HIPPX code is the code after the episode was calculated for Therapy, Supplies, LUPA, etc… The $Amount column is the value that goes with the HIPPA codes column. $Expected shows the amount that Barnestorm has calculated should be paid after allowing for Therapy, Supplies, LUPA adjustments. $Diff shows the difference between $Amount and $Expected.The $Paid column only shows an amount when the episode is paid in full. It reflects what was actually paid. The $SupChrg column shows the charge amount for supplies.
The A/R tab will give you the history of the patient’s billing/accounts receivable transactions. Use the 485 tab to select the episode of A/R you want to view or use the From and Thru dates at the top/right corner to select specific dates.
Visits will show you all the visits for the selected patient. When you need to troubleshoot billing issues this is a great place to start. You can see the payer, time in, and time out. . Use the 485 tab to select the episode of visits you want to view or use the From and Thru dates at the top/right corner to select specific dates.
Supplies will show you all the supplies entered for the selected patient. You can see the quantity and charge amount. Use the 485 tab to select the episode of supplies you want to view or use the From and Thru dates at the top/right corner to select specific dates.
*Note: There are options in the top/right part of the screen to only select specific information.
UPDATE: 3/25/2021 Added new grid to screens in wide screen; added Date Billed on the Amount Billed > Comments line; added a note when charges disagree with amount billed. When only RAP Billed then the date billed does not show up in comments because it is the actual Amount Billed date. If billed multiple times in a month then all billed dates show up in comments. Actual billed date will not show up if the claim has not been created yet.
1. Select the Patient by entering the chart number or patient’s last name
2. Choose the correct date range for the time period you wish to view; OR
3. You can choose “Only Show Unpaid,” “Show All,” or “Show Newest First.”
4. Then click View
NOTE: If result is "No A/R Found," make sure the appropriate member of staff has performed the Post Amount Billed for the month/patient.
This report is used for non-PPS payers. It will compare the visit and supply amounts to the amount in accounts receivable. If there is any difference between the two it will show up on this report. (Note: If there are no conflicts, you will receive this message, "All A/R Amount Billed entries agree with the charges.").
Examples of reasons why there would be a difference: amounts were not posted to the A/R (Amount Billed will not show up in the A/R and the report might show a negative), charges were entered after the billing was done, amount billed was deleted from the a/r, visits were changed from non-charge to charge.
Reports > Accounts Receivable > 05.17 Compare A/R To Charges
How to Run the Report
Year/Month From and Thru = Pulls charges entered for the months selected.
Program(s) = Filter report by entering program number(s). Or leave blank to select all.
How to Read the Report
Year / Mo = Year and month of charges.
Visit+Supply$ = The actual amount that has been entered into the Barnestorm system.
A/R $Billed = The amount that was transferred to AR using Accounts Receivable > Post Charges to A/R. PPS payers will automatically appear once the RAP is created.
A/R Balance = The difference between Visit+Supply$and A/R $Amount.
This report sorts the information by program and has a grand total at the end.
NOTE: As of February 2015, this report is intended for use with NC Medicaid payers only.
How to Run the Report
From Barnestorm Office click on Reports> Employees > 02.35 NC Medicaid Billed/Paid Summary. This report will show a summary of what’s been billed/paid, including hours for CAP, PCS, PDN and Other. This report also displays adjusted amounts, as well as any unpaid balances. If you would like a detail of each date of service, choose the Print Date By Date Details option (more details below). This report will show a variety of information, based on the filtering option(s) you choose below:
How to Read the Report
NOTE: The columns seen on your report will be based on the “Print By”option you choose above. The following may or may not appear, based on your “Print By” selection. The totals/calculations, that appear on your report, will be based on the From/Thru period entered above.
Medicaid claims may be replaced directly from Barnestorm. Each Medicaid claim sent for each patient has a unique identifying number, called an ICN. An ICN is a 15-digit number that uniquely identifies one payment of one claim (NC Medicaid).
You need to create a replacement claim when the original claim that was transmitted was incorrect due to missing information or incorrect information (examples: the claim did not include a visit that was added to the system after the claim was sent, or the number of hours billed was incorrect).
Here are the steps to locate/manually enter the ICN/DCN/Claim Number required for all Replacement Claims:
Verify ICN Information
If the ICN you need to replace is not there, you can enter it manually using these steps:
The 837 file has information regarding the UB04 claim:
on the line starting CLM* , after the :: there is a number--
1 = original claim
7 = replacement claim (If there is no “7” then you have not created a replacement claim.)
8= void claim
line after the CLM* has the ICN number
On the claim, itself, the TOB will show 0327 (top right corner of claim).
The 837 file has information regarding the CMS1500 claim:
1 = original claim
7 = replacement claim (If there is no “7” then you have not created a replacement claim.)
8= void claim
REF*F8*1234567890 (represents the ICN#)
Medicare claims are cancelled directly in DDE.
Medicaid claims, however, may be voided directly from Barnestorm. Each Medicaid claim sent for each patient has a unique identifying number, called an ICN.
You need to void a claim when the original claim that was transmitted was incorrect due to incorrect information. If the claim will be replaced, please follow the instructions for Replacement Claims. If the claim will NOT be replaced, you will void the claim.
Here are the steps to void a Medicaid (or nonPPS payer) claim:
If the dates you need to replace are NOT listed, you will need to manually enter the ICN information.
Your ICN entry will now appear in the list.
The 837 file has information regarding the claim:
On the line starting CLM* , after the :: there is a number--
1 =original claim
7 =replacement claim
8= void claim (If the number 8 does not show, you did not create a void claim.)
line after the CLM* has the ICN number.
*Note: If multiple payments were made for the month, make sure you use the correct ICN when creating a replacement or void. When multiple payments are made only the most recent ICN will show up in the ICN Edit screen.
To send back a payment on supplies / visits (when multiple services paid on one claim):
To send back a payment on a supply / visit (when it is the only service paid on one claim):
If a partial payment was made on a visit / supply then complete the steps on creating a Replacement Claim.
If a visit / supply did not receive any payment: (case management and aide)
By doing this process you change the date on the visit/supply date keyed and when you resend the claim only those changes will appear on the claim.
If a full payment needs sent back due to changing all visits / supplies to a different payer:
To Get a Total$ of Your Write-offs, Here Are a Few Report Options:
05.07 Pay/Adj Code Totals by Quarter - This report does not include the option to filter by pay/adj code.
05.08 Selected Detail - This report does include the option to filter by pay/adj code. If you are just printing details of write-offs, enter your agency code(s) for write-off in the pay/adj code field.
05.11 Totals By Program/Pay/Adj Code - This report includes the option to filter by pay/adj code. If you are just printing details of write-offs, enter your agency code(s) for write-off in the pay/adj field.
To Locate Your Payment/Adjustment Codes, Go To:
Barnestorm Office > Accounts Receivable > Pay/Adj Codes
The codes will be listed on bottom, right of the screen. Select the program number to view the pay/adj codes your agency has set up. Use the Print buttons to view the reports.
If you need to set up a new pay/adj code, click here for the article link.