Procella HelpdeskGeneral Information
The Financial Manager module is where Clients Invoicing and Provider Payment information is established. The critical information needed includes the registration of 3 entities.
The Financial Manager is accessed through the primary menu button in the top left of the screen.
Click on the Financial Manager icon.
On clicking into Financial Manager, you will be presented with the Client section of the financial manager. The sub menu will land in the Invoice Manager for the Client.
Invoice Manager
The Invoice Manager component is where the Client is created and managed. A Client record is required for Group setup.
BEST PRACTICE: You should always setup your Client for the intended group or groups prior to setting up those group records. The Client information is stamped on the claim at the time of claim processing.
An ADMINISTRATIVE client could be created if the group record is to be used internally or as a test group.
The process to create a client is consistent with other record creation. Click on the plus icon at the bottom right of the Invoice Manager-Client screen. A template will open to enter the information.
Client, General Information
A Client is simply an invoicing entity. A Client may be used for one or more Groups as appropriate. The primary limitation is that a client has a single setup for fees, contacts and invoices.
If you have a client that has different fees or contacts or invoice formats, a different Client will need to be established.
Each client has base information that is required.
Client Name: The Client Name is unique and cannot be duplicated.
Client Code: The Client Code is the code assigned to the Client.
Client Type: The Client Type is for your classification.
Eff Start date: The Start Date for the information in the record.
Eff End date: The End Date for the information in the record.
Accounting Code: This field is intended for mapping to an accounting system.
IMPORTANT: Make sure the start date in the CLIENT record is effective on or before the GROUP records it will be associated.
Fees
The Fees section is where different types of fees can be established. All fee types are required fields. A Zero is a valid entry.
Transaction Fees
Transaction Fees are specific to processed claims. The types of transactions identified are:
- Paid
- Reversed
- Denied
- Rejected
These are the same claim status types as reflected in the Customer Service screens. Numeric values, both positive and negative, are valid. For instance, a paid claim may have a fee of $1.25 but the reversal claim may have a fee of ($1.25). The Net Fee for one paid and one reversal would be $0.00.
Claims may also be different between types of claims. POS, DMR/Manual, BATCH can have different transaction fees assigned.
Per Member Fees
The Per Member Fees currently only capture the information but may be used in the future enhancement of the Financial Manager.
The fee types classified are Per Member Per Month (PMPM), Per Subscriber Per Month (PEPM), and Per Utilizer Per Month (PUPM).
Other Fees
This section of fees is informational and still requires population. The current fee types available in Other Fees are for Authorizations and its different types (Prior Authorization, Exclusions, Inclusions, and Overrides).
Contacts
The contact information allows the registering of specific client contacts. There is a requirement of one contact for the Contact Type of 06-Billing. This screen is consistent with the other system screens for contact information with the addition of Organization Name.
Invoice Setup
The invoice setup is where the periodic invoice information is set up.
Invoice Cycle: This reflects the invoicing cycle for the Client. The options supported are bi-monthly (twice/month) or monthly.
Summary Invoice: This allows the selection of the high-level invoice for the Client.
Invoice Detail: This allows the selection of the invoice detail report for the client.
Invoice Detail Format: This option sets the output format of the invoice. PDF, XLSX, or Text File.
Accounting File: This function, WHEN IMPLEMENTED, will output a file to be loaded into an accounting system.
Detail Data File: This option sets the detail data file for output.
Detail Format: This option sets the output format of the invoice. PDF, XLSX, or Text File.
Output Directory: TBD – To Be Developed in the future.
Once the Client Record is complete, save the DRAFT, review, and ACTIVATE as appropriate.
Client Invoice Job - Data Management
- Once the Client Record is activated, a client invoice job will automatically get created in the Data Management module.
- The job will be scheduled to run either monthly on bi-monthly based on the 'Invoice Cycle' option in the Invoice setup. The default time would be 00:00 and the time zone will be based on the default time zone
- For Example - when user selects monthly option in invoice cycle ,in data-management job gets created automatically as
- when user selects Bi-Monthly option in invoice cycle ,in data-management job gets created automatically and job gets triggered on every 1st and 16th day of the month.
Updating Client Invoice
- There could be a need to update the client invoice setup. The update could be fee updates, contact, or invoice setup updates.
- When you edit a Client Invoice record, a new version will be created. The different version of a client record should not overlap with effective dates.
- For eg., Lets say we have a record 'Client A Invoice' with effective date 01/01/2023 to 12/31/9999. If you want to edit the 'Client A Invoice' setup, then open the active version of the record. Use the 'Change Effective Date' option to update the effective end date (say 03/31/2023 because you want new fees to be applied starting 04/01/2023).
- After updating the effective end date of the current version, a new version can be created using the 'Edit Client' option
- When you create the new version, make the necessary changes. Importantly, the effective start date should be 04/01/2023 (per the example). Basically, the effective dates of versions should not overlap. If it overlaps, you would receive an error when saving the data.
Payment Manager
The Payment Manager module captures 2 sets of information, Payment Group and Remittance Group.
To access the Payment Manager, go into Financial Manager and then select in the sub menu, Payment Manager.
Within Payment Manager, navigating between the Payment Group and the Remittance group is as simple as clicking the link on the left-hand side.
Payment Group
The Payment Group captures the information and Payment collaterals (data file, remittance advice, etc) to generate for the Payment Group.
Click on the Payment Group link on the left side to access the Payment Group search screen. Search for the appropriate Payment Group or click on the plus icon at the bottom right of the screen to create a new one.
Payment Group General
The general information on a Payment Group includes the following:
Payment Group Name: This is your description of the payment group and must be unique.
Eff Start: This is the effective start date for the record.
Eff End: This is the effective end date for the record.
Payment Group ID: This is the defined Payment Group ID assigned to this Payment group. This value must be unique.
NPI: This would be the NPI, or National Provider ID, if available for the Payment Group.
Federal Tax ID: This is the Payment Group federal tax id.
IMPORTANT: Make sure the start date in the Payment Group record is effective on or before the Provider Network records it will be associated.
Contacts
The contact information allows the registering of specific payment group contacts. There is a requirement of one contact for the Contact Type of 08-Contracting. This screen is consistent with the other system screens for contact information with the addition of the Company Name.
Fees
The Fees section captures the fees charged to the Payment Group (or credits if the values are negative). There are three categories currently established, Administrative Fees, Network Fees, Transmission Fees.
Administrative Fees
These are the same claim status types as reflected in the Customer Service screens. Numeric values, both positive and negative, are valid.
Network Fees
These are the same claim status types as reflected in the Customer Service screens. Numeric values, both positive and negative, are valid.
Transmission Fees
These are the same claim status types as reflected in the Customer Service screens. Numeric values, both positive and negative, are valid.
Payment Cycle Setup
The Payment Cycle setup is where the cycle and ancillary reports and data files are established.
Financial Cycle Type: This is where the frequency is set. Bi-monthly and monthly are supported.
Remittance Advice Detail Type: 835 and standard.
Data File Summary Type: None and standard.
Remittance Advice Summary Type: None and standard.
Output Directory: For future use.
Once the payment group Record is complete, save the DRAFT, review, and ACTIVATE as appropriate.
Once the payment group Record is activated , based on financial cycle type dropdown options selected by user, job will automatically gets created in data-management type as Provider invoice with a default time = 00:00 and default Time-Zone
when user selects Bi-Monthly option in invoice cycle ,in data-management job gets created automatically and job gets triggered on every 1st and 16th day of the month .
Remittance Group
The Remittance Group is simply contact information for recipient of the remittance advice files.
Remittance, General
The general information captured includes the following:
Remittance Reconciliation Name: This is your description of the remittance group and must be unique.
Eff Start: This is the effective start date for the record.
Eff End: This is the effective end date for the record.
Remittance Reconciliation ID: This is the defined Remittance Reconciliation ID assigned to this Remittance group. This value must be unique.
NPI: This would be the NPI, or National Provider ID, if available for the Remittance Group.
Federal Tax ID: This is the Remittance Group federal tax id.
Contact Information
The contact information allows the registering of specific payment group contacts. This screen is consistent with the other system screens for contact information with the addition of Company Name.
Transition Impacts
For Procella clients who started prior to the implementation of the Financial Manager, historical Group and Provider Network records will require updates when these records are changed.
Group
In Benefit Manager, Group, a new field has been added. This field, CLIENT, is a drop down based on the Client records created in Invoice Manager.
Any existing record prior to the implementation of the Financial Manager module will have the new field but “Select” will be presented on the screen. This field must be populated with an active Client from the drop down or the record will be unable to be saved.
Provider Network
The Provider Network record has 2 new fields to address. The Payment Group ID and the Remittance Group ID are drop down that will present the entities to associate to the Provider Network.
Any existing record prior to the implementation of the Financial Manager module will have the new fields but “Select” will be presented on the screen. These fields must be populated with an active Payment Group ID and Remittance Group ID from the drop downs or the record will be unable to be saved.
