As we continue working towards providing agencies with multipayor support for Enterprise Edition, HEALTHCAREfirst has implemented several modifications throughout the software. In its entirety, multipayor support will involve a wide range of modifications. To ease the transition towards full multipayor support for agencies, this functionality has been grouped into multiple release updates.
To serve as an introduction to the multipayor feature, all new multipayor functionality is detailed on this page and has been grouped according to the area of the software that has been modified (e.g. P Page, Schedule Review, User Security, Authorizations, etc.).
The first multipayor release (in the 17.2.3 release) includes components primarily designed to provide the following functions:
● Payor selection fields in areas involved in the scheduling and billing process (to ensure a one-to-one relationship between charges and payors).
This field has been added to the following screens:
o Patients | Orders | Order Generation Calendar
o Patients | Orders | Scheduled Visit
o Patients | Orders | Scheduled Visit (Complete page)
o Patients | Documents | P Page
o Accounts | Productivity
o Tools | Schedule Review
● Each Payor field includes mouse hover text that displays the name of the associated plan, as seen in the sample image.
● Allow users to change the payor during any part of clinical or billing process.
● Allow users to assign a large number of visits to specific payors upon scheduling.
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To support these specifications, additional enhancements are required for this initial release. This tertiary functionality includes modifications to Charge Verification, Insurance, and User Security, and Level of Care. Please review all of the details on this page (or in the 17.2.3 release guide) to learn about all changes related to multipayor support. |
The second multipayor release (in the 17.6.1 release) consists of functionality that enables the software to utilize payor coverage dates for certain Payor drop-down fields that were implemented with the first multipayor release. Additionally, this release contains several other updates for patient insurance. Previously, the Payor drop-down fields would simply utilize the insurance listed on the patient chart. With the release of 17.6.1, the software only allows users to associate an insurance record with a visit if it coincides with the payor coverage dates that are entered in Patients | Intake / Referral | Insurance.
As part of the multipayor update, functionality has been implemented within Master Files | Payors / Plans so users cannot delete a payor or plan if it is associated with a patient chart. Additionally, users are not able to edit the Name field (in the Payors screen) or the Name field (in the Plans screen) if the payor or plan is associated with a patient chart.
As seen in the sample images, various text has been added to supplement this functionality, which will display when the mouse cursor hovers over the “Delete” button (when disabled) as well as the Payor ID and Name fields (when disabled).
A new Payor drop-down field has been added to Patients | Orders to provide users with the ability to associate visits with a payor while in the Order Generation Calendar screen. This functionality is not exclusive to orders that are already generated. Users are able to assign a payor for both generated and ungenerated visits.
The new Payor field in the Order Generation Calendar screen uses the following specifications:
● This field is available prior to generating visits (as other filter options).
● This field is not required.
● Payors attached to the patient chart will be available for selection. This excludes payor plans that have the Schedule from Auth box checked in Master Files | Payors / Plans | Plans.
● By default, the software will populate this field with the primary payor saved in the patient chart. Once the user saves data on this screen, the Payor field will be blank and function as the other drop-down fields.
● If desired, users can use this field to assign a Payor to a large number of visits by selecting it on an order (using the grid view or standard calendar view).
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If a Payor is selected (while in calendar view), it will affect all visits in the order. To specify individual visits, users must select Grid View (using the Calendar View field) and then check the box(es) next to the visit(s) you want to update with the data entered in the fields above. |
Additionally, revised functionality was implemented within the Order Generation Calendar screen so users will only need to click Generate one time in order to generate all corresponding visits. As soon as the user clicks this button, all applicable visits will display on the calendar as generated. Previously, users had to generate visits by using a two-step process.
Functionality has been implemented within Patients | Orders in order to make the new Payor drop-down field available for each Scheduled Visit. This provides users with another way to associate a payor with an individual visit.
As seen in the sample image, the Payor field is also available in the “Complete” screen. Users can access this area by clicking the 
button at the top of the Scheduled Visit screen. In this screen, users are able to enter actual visit times and designate visits as “complete”.
The Payor fields in Scheduled Visit utilize the following specifications:
● By default, this field will display the payor that was selected when the visit was generated.
● The Payor field is not required for a scheduled visit.
● The Payor field can be edited on a visit after it has been released or approved (but has not been batched) by using one of the following processes:
o If using the charge verification release process, return to the P Page.
o If using the scheduling release process, proceed to the Complete screen for the Scheduled Visit and then unreleased the visit to enable editing.
o If the visit has been batched, remove it from the batch and then use the appropriate method listed above to edit the manually entered visit.
● The Payor field can also be edited in Charge Entry (for Homecare) or Productivity (for Hospice), up until the charge is added to a batch.
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In the Complete screen, a status of “Released” will display once a charge released before it is batched/posted (as seen in sample image). When a charge is batched, the following message displays on the right side of the screen (under the Directions field): “Scheduling items cannot be un-released when in a billing batch". |
As part of the multipayor enhancements, functionality was implemented within Patients | Intake / Referral | Schedule so that users are able to determine the payor and plan associated with a visit while viewing a patient’s schedule. As mentioned in the previous section, this field is not required. If a payor has been associated with a visit, it will display when the mouse cursor is hovered over the visit in the calendar.
Modifications were made within Patients | Documents to provide users with the ability to enter a payor in the P Page of a document. A new Payor drop-down field has been added to the bottom of the Visit section in the P Page.
The Payor field in the P Page uses the following specifications:
● By default, this will display the payor that was selected when the visit was generated (if applicable).
● This field will remain editable after it is verified.
● This field is not required.
● Users will not be able to select a visit assigned to another document (or already released) in the Order/Auth field. Users cannot save the P Page until they select an applicable visit.
A Payor drop-down field is available in Accounts | Productivity to provide hospice agencies with the ability to select a payor when logging visits on the Productivity screen. Though this is available within firstHOMECARE, this modification is targeted for agencies using firstHOSPICE because they log visits in Productivity (while Home Health agencies use Charge Entry).
The Payor field in Productivity uses the following specifications:
● Displays the payor that was selected in the corresponding P Page or scheduled visit.
● Editable for each individual charge in the Productivity screen.
● Required for charges that are manually entered.
● If there is no Patient selected, this field will not be required. If a record is saved without a patient associated, the Payor field will become disabled and can no longer be edited. If a Patient is saved on the record, this field will then become editable. This functionality is intended for agencies that log office hours or miscellaneous charges for employees.
● If a charge is included in a batch, or has already been billed, the payor will not be editable.
Modifications were made to add a new Payor filtering option in Tools | Schedule Review. This field allows users to filter search results for schedule items according to a specific payor. By default, this filtering option is set to “All Payors”.
A Payor field is also available in the Schedule Update screen, which is accessed by clicking the 
button at the top of the Schedule Review screen. This screen allows users to edit the schedule for a specific employee, patient, discipline, service, office, or status.
Users cannot set a visit with a Status of “Released” if there is no Payor assigned. If a user attempts to approve a charge that does not have a payor assigned, an error message will display in red and the corresponding entry will be highlighted in pink (as seen in sample image). Existing functionality allows users to change the payor for a schedule item. To do this, click Edit Insurance (for the corresponding line item), select the desired payor from the drop-down menu options, and then click Update Insurance.
In addition to this, a new report is available in the Schedule Update screen that will automatically display when the user clicks Save. This report lists any visits that cannot be released because a payor is not assigned. Users are able to print the report for convenience, so the problems can be resolved.
Revised functionality has been implemented in Tools | Charge Verification so the software requires each charge to have a payor assigned before it can be approved. If a user attempts to approve a charge that does not have a payor assigned, an error message will display in red and the corresponding entry will be highlighted in pink (as seen in sample image). In the scenario that a user attempts to approve a mixture of charges (some with a payor and some without), the charges with a payor assigned will be approved while the ones without will remain in Charge Verification.
Though this functionality is available for both lines of business, please note that the Charge Verification screen in firstHOSPICE does not contain an Insurance column or an Edit Insurance option in the display grid.
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This functionality is only applicable if the charge verification release process is being used, as previous functionality would allow users to approve a charge in Charge Verification without a payor assigned. This would cause the charge to be sent to Productivity (Hospice) or Charge Entry (Homecare) without a payor assigned to it. |
A new Insurance (visit) field has been added to Administration | User Security. This security option controls user permissions for the new Payor fields that used to assign insurance information for visits. Refer to the “Scheduled Visit” and “P Page” sections for additional information.
Agencies will use the Insurance (visit) section to designate user permissions for the new Payor drop-down fields that are now available in the following screens:
● Patients | Documents | P Page
● Patients | Orders | Scheduled Visit
● The “Complete” screen in Scheduled Visit
This new user security option contains all of the same permission checkboxes (i.e. Allow, View, Print, Edit, Remove ), though the Print and Remove checkboxes have no effect. A user account must have the boxes next to Allow, View, and Edit checked in order to interact with the Payor fields. User permissions that were established for the previous Insurance security option have been used to set user permissions for the new Insurance (visit) section.
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The existing Insurance option in User Security has been renamed as “Insurance (patient)”, for clarification. This only changes the name and does not change the functionality; this option is still only used to control the Insurance screen in the patient chart. |
Revised functionality has been implemented in Patients | Intake / Referral | Insurance to require users to enter a Begin date in the Payor coverage dates section — the End date remains optional. With the next multipayor release, these effective dates will be used to determine which payor displays in patient visits. For consistency, the following disclaimer (previously displayed in the Payor coverage dates section) has been removed: "Leave dates blank for continuous coverage during admission encounter ".
Additionally, this functionality no longer allows users to delete a payor (if there are any visits associated). With the release of 17.2.3, users can only delete a payor from the patient chart if it is not associated with any visits (regardless if it has been billed or not). If a payor is associated with any visits, the following text will display when the user hovers the mouse cursor over the 
button: “Payor cannot be deleted if already associated to visit(s). Remove Payor from visits in order to delete Payor. “
With the release of 17.2.3, users are required to enter effective Begin dates (for all new patients created) and update the effective Begin dates (for existing patient insurance records), as necessary. We encourage all agencies to advise their staff to review existing patient insurance records created prior to the 17.2.3 release and update the effective Begin dates.
The next phase of multipayor functionality will be released within 30-45 days and will use the effective dates to determine which payor displays in the Payor drop-down fields. If there are no effective dates present, then the Payor fields will be blank (upon the next multipayor release).
All agencies must update the payor coverage dates as soon as possible.
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If a payor has any visits associated with it, users can still use Schedule Review to remove the payor. However, if charge(s) for the associated visit(s) have already been billed, users must back out the charge(s) and then remove the payor from the corresponding charge(s). After completing this process, users can then delete the payor from the patient chart. |
Functionality has been implemented within Patients | Intake / Referral | Insurance so that the software will automatically assign a payor to visits that are setup to be scheduled by authorizations. When the Schedule from Auth box is checked for a plan (in Master Files | Payors / Plans | Plans), all corresponding visits must be generated from the Authorizations screen.
The software then assigns the payor and plan (as displayed in the Payor/Plan field) to the corresponding visits that are generated. As detailed previously in this guide, the payor and plan will display in the Scheduled Visit screen as well as in the patient Schedule.
Functionality has been implemented within Reports | Patients | Payor Source so the Patient Payor Source report display payor coverage dates for each patient record included in the report. This assists agencies in the process of ensuring that effective dates are entered for all active patient insurance records.
The Patient Payor Source report has been updated to include the following specifications:
● Coverage Dates column:
o Displays the Begin and End payor coverage dates entered for the corresponding payor in Patients | Intake / Referral | Insurance.
o Added between the existing Payor Source and Primary Diag columns.
o Data displays the begin and end dates as a date range (e.g. “1/1/2017-3/1/2017”).
o If there are no payor coverage dates present, this column will be blank.
o If there is only a Begin date entered and the End date field is blank, the date range will display appropriately (e.g. “1/1/2017- “).
● Include only patients with blank payor coverage dates checkbox filtering option:
o If checked, the report will display data for patients that do not have a Begin or End payor coverage date entered in Patients | Intake / Referral | Insurance.
o The report data will still consider other filtering options when this option is selected.
o This box is not checked by default.
