1. Configuring Epitomax®

Congratulations on being a part of the Epitomax team. Now it is time to get the system set up and running so you can enjoy all the benefits Eptiomax has to offer. This guide will walk you through step by step of all the data setup requirements that must be performed before going live with your new system.

It is important to understand that when setting up your system that data must be entered in a particular sequence. You may not understand the sequence initially but as you continue to enter the data you will see how the sequence makes the data entry easier.

Click here for a short video introduction to setting up Epitomax

2. Data Entry Sequence

The following is the suggested sequence for data entry

I. Locations

The locations are the places in which your services will take place. Click here for a brief video on setting up Locations

To enter the Locations perform the following steps:

From the Administration menu select Code Table Maintenance, then select the letter L from the list of letters in the code table Maintenance page.
Select the Location link.

You will then see the criteria screen that all code tables have within code table maintenance. From here just select Submit to return all rows in the table. Since there are so many fields in the Location code table, you will need to use the scroll bar on the right to scroll down to the Submit button.

The image above is before scrolling down, and the image below shows after scrolling down to see the Submit button. Click on the Submit button without entering any information in the criteria fields to see all Locations.

From here select Insert Row and a blank row will appear and you can now enter your data.

The following data should be entered:

Building Name – This is the name that you will use throughout the application, from associating it with programs, to entering service activity, so this name should be something that relates to your facility that Staff will understand (i.e – Inpatient D&A or Broad Street)
Building Address – This is the address that will be used on the claim forms and is the physical address.
Claim Facility Name – This is the name of the facility using in box 32 on CMS 1500 claims and as the Facility Name in 837 claims. If this is blank the Building Name will be used.
Claim Facility Address – This is the facility address. If this is blank, Building Address is used.
Building City – This is the City portion of the facility address.
Building State – This is the State portion of the facility address.
Building Postal Code – This is the 9 digit zip code for the facility address. Electronic claims require the zip plus 4.
Country – This is optional.
Uses Location Schedule – Check this box if services are scheduled at this location.
Area – Locations can be grouped into regions or areas. Areas can be added/maintained using the Area code table.
Phone Number – The primary phone number at this location.
Fax Number – The fax number at this location.
Hospital No – Added for a specific customer’s G/L interface.
Back Color – Background color to use when displaying this location on a schedule. Many color names will work and all HTML hex colors work.
Text Color – Text color to use when displaying this location on a schedule. Many color names will work and all HTML hex colors work.

You can keep clicking on the Insert Row button to add as many locations as you need. Make sure you click on the Update button or none of the changes will be saved and you could lose all the work that you just did. Code Table Maintenance is the only place in Epitomax where you won’t be warned if you leave without saving your changes.

II. G/L Accounts

G/L Accounts must be added early in the data entry process because Programs and activities relate to these G/L numbers that will in turn populate your General Ledger. If you don’t plan to integrate Epitomax with you General Ledger system, you can just use the default G/L Accounts already in Epitomax (skip to section III Programs). Epitomax can integrate with QuickBooks Pro and most General Ledger systems. Contact support (click on the Support link at the top right in Epitomax) if you’d like to have your chart of accounts loaded into Epitomax for you.

Notes:

· You must designate as least one G/L Account as a holding account. This account will be used to hold the unapplied cash until it is posted to the correct charges.

· You must also dedicate at least one (or more) cash transaction accounts. These accounts are used to place your receipt into different G/L buckets.

· If you are not integrating Epitomax with a General Ledger system, move on to section III Programs.

Click here for a brief video on G/L Accounts

To enter the G/L Accounts perform the following steps:

From the administration menu select Code Table Maintenance, Select the letter G from the list of letters in the code table Maintenance page.
Select the GL Account link

Click on the Submit button on the criteria screen and you will get a list of all the G/L accounts (on first install of Epitomax no G/L Accounts are installed)
From here select Insert Row and a blank row will appear and you can now enter your data. (Sample data has been entered for example purposes only)

Enter the following for each G/L account that will be posted to your G/L Program:

Company – This will be defined as your company
Account No – This should be the exact G/L account number that will be posted to G/L. Validation is done against this account no so it is critical that this matches you G/L
Description – This will be displayed on the Remittance Advice screens
Holding Account Indicator – At least one account must be marked as a holding account. This account will be used later in the initial setup. This account will tell Epitomax what G/L account to use to post the offsetting entry for the receipt. It will also be the offsetting entry when the cash is posted to the account. This account will usually balance to zero at the end of the month if all receipts have been applied.
Cash Transaction Indicator – This indicator tells Epitomax which accounts are used for posting of cash to the client accounts (the offsetting entry to this would be the holding account). At least one account must be designated as a cash transaction account or you will not be able to enter cash into the system.
Account Type – This is the account type that the G/L number relates to (i.e. Asset). This may or may not be used when posting transactions to your G/L.

You can keep clicking on the Insert Row button to add as many G/L Accounts as you need. Make sure you click on the Update button or none of the changes will be saved and you could lose all the work that you just did.

III. Programs

These are the programs that your facility runs. These programs are designated by type of care (also known as level of care) in the system. Programs can be thought of as cost centers on the financial side. They can also be thought of as a course of treatment on the clinical side. When a client is admitted in Epitomax, they are admitted to a Program.

To enter the programs perform the following steps:

From the administration menu select Program Maintenance,

Click on the Add button on the criteria screen to add a new program (if programs are already installed you can select one from the drop down list and select the Edit button)

Enter the following for new Program:

Program – This is the name that will be displayed throughout the system. If this name is too long it may not display entirely in some screens.
Type of Care – The type of care that relates to this program. Type of care must be selected. Type Of Care is sometimes referred to as Level Of Care.
Department - Used for G/L integrations. Leave blank for now.
G/L Revenue Account – Based on how your G/L system is set up this is the account that is used as the offset to the actual charge. The other half of the charge is usually derived, but does not have to be. If you are not integrating with a G/L system just select any G/L for this field.
G/L Receivables Account – Used for G/L integrations.
Program Code – This should be 4 characters or less and unique for each program. It is not visible to users.
Program Group - Determines what Problems, Goals, and Objectives lists are used for the Treatment Plan. You can specify a different Program Group for each Program or the same one for each Program. (You can build Problem Groups using Administration->Treatment Plan Data Maintenance.)
Cost Center – Used for G/L integrations. Leave blank for now.
Treatment Plan Update Frequency – Indicate how often (in days) the Treatment Plan must be updated for this Program.
Prevent Statement to Clients – This field will force the system to not send a client Self-Pay statement to any client in this program.
County Funded program – This indicates that this program is funded by the county. This field could be used for customizations to your system if needed.
Active indicator – Indicates if this is an active program that can be selected by users. Uncheck this checkbox when the program is no longer valid.
Attending Physician – This is the primary attending for the program. The system will use this attending, if entered, as the default on new admissions. The actual care giver role that Attending Physician refers to can be renamed to Clinical Supervisor or whatever role name is appropriate for your organization. (See the Care Giver Role section later in this guide.)
Support Staff – Currently not used.
Program Manager – Currently not used.
Restrict Access to the Clinical Tab to Staff with – If a role is entered here, only staff who have this role will have access to the clinical forms of clients in this program.
Number of Required Group Sessions – Used for court ordered services to track the number of sessions the client attended against the requirement for this program.
Number of Required Group Hours - Used for court ordered services to track the number of hours the client attended against the requirement for this program.
Form Packet to Add to All New Admissions – This field indicates the packet of forms that should be added to each new client admission to this program. (Form Packets are configured using Administration->Form Packet Maintenance.)
Dependent Provider Code – Custom for a specific customer.
Delinquent Provider Code – Custom for a specific customer.
Compliance Number – Custom for a specific customer.
Invoice Comment – If invoices are generated for charges in this program, the comment to include on the invoices.
Diagnosis Not Required – Check this box to allow charges to generate for this program without a diagnosis on the client admission.

Make sure you click on the Update button or none of the changes will be saved and you could lose all the work that you just did.

Once you’ve successfully added the program, you will notice a Program Location tab has appeared. Click on the Program Location tab.

Add a row by clicking on the Insert button. Select the location of the program in the Hospital Location drop-down list. Click on the Primary Location checkbox if this is the primary location. Select the Facility Type to be used on electronic claims. Click on the Update button. Note, each program must have one and only one Primary Location. Other locations can be added as long as only one is marked as the Primary Location.

Click here for a training video on Program Maintenance

IV. Activity Classes

These are used to classify activity codes for scheduling and reporting. One Activity class is required on each activity. The Activity Class can be used to categorize a group of services into a category that you can select in report criteria and/or sort on to get convenient sub-totals. Until you go-live with Epitomax, just use the ‘Billable’ and ‘Non-Billable’ activity classes for all of your activities. Once you have real data in Epitomax and can try out the reports, you will have a much easier time identifying what you want for Activity Classes.

To enter the Activity Class perform the following steps:

From the administration menu select Code Table Maintenance, Select the letter A from the list of letters in the code table Maintenance page.
Select the Activity Class link.

You will then see the criteria screen that all code tables have within code table maintenance. From here just select Submit to return all rows in the table. There will be several pre-loaded activity classes.

If none of the activity classes fits your needs, select Insert Row and a blank row will appear and you can now enter your data (note that if you do not see the blank row hit the Page Last button. The blank row is inserted as the last row).

Enter the following for new Activity Class:

Activity Class – This is the name that will be displayed throughout the system.
Active indicator – Indicates if this is an active activity class that can be selected.

Make sure you click on the Update button or none of the changes will be saved and you could lose all the work that you just did.

Click here for a brief training video on Activity Classes

V. Discipline

Disciplines are used to classify staff and to specify the rate for an activity performed by staff having that discipline. They are also used to add discipline modifiers to procedure codes on claims. One Discipline is required on each staff.

To enter the Discipline perform the following steps:

From the administration menu select Code Table Maintenance, Select the letter D from the list of letters in the code table Maintenance page.
Select the Discipline link.

You will then see the criteria screen that all code tables have within code table maintenance. From here just select Submit to return all rows in the table. There will be several pre-loaded Disciplines.

If none of the Disciplines fits your needs, select Insert Row and a blank row will appear and you can now enter your data (note that if you do not see the blank row hit the Page Last button. The blank row is inserted as the last row).

Enter the following for new Discipline:

a. Description – This is the name that will be displayed throughout the system.

b. Revenue Account Code – This is only important if you are integrating Epitomax with your General Ledger system.

c. Payroll Expense Code – This is only important if you are integrating Epitomax with your Payroll system.

d. Active indicator – Indicates if this is an active Discipline that can be selected.

Make sure you click on the Update button or none of the changes will be saved and you could lose all the work that you just did.

Click here for a brief training video on Discipline setup

VI. Activity

Activities are used for entering services in the system. Every service requires an activity code. You can create activities billable services, such as Individual Therapy, and you can also create activities for non-billable services/events such as staff meetings, etc.

To configure Activities perform the following steps:

From the administration menu select Activity Maintenance.

Use the Generate Active Activity Report button to see the currently configured activities.

If generating a new Activity code select the “Add” button. If you are modifying an existing Activity code use Activity drop-down field (or the Picklist button if visible) to select your activity then click on the Edit button.

For new activities you now must enter in the base Activity code information

a. Activity Code – This is the code that will be displayed throughout the system. Use a short code that staff will recognize.

b. Activity Type – This is a required field that is used to classify a group of activity codes. This is a general classification that is used in several reports in the system as well as certain billing and charge functions.

c. Activity Description – This is the description of the activity.

d. Effective Date – This is the date that the activity code is effective. Users will not be able to select this activity code if the date of service is before this date.

e. Expiration Date – This date can remain blank to keep the activity code permanently active. If you no longer want users to use a particular code, set the expiration date and the code will not be valid after that date.

f. CPT Code – This is the corresponding CPT billing code that is associated with this activity code. The primary use for this is to help apply payments from 835 electronic remittance files to the correct charge when there are multiple charges on the same date of service.

g. Unit Rate Indicator / Duration – The unit rate indicator informs the system that the billing rate for this activity is determined by the duration that is entered. In this example (above) the activity code will bill $12.50 for every 15 minutes of service. So for a 30 minute session the system would generate a $25 charge.

h. Default Rate – The default rate for the activity code. If unit rate indicator is used, this is the default rate for the duration specified. This is the Usual and Customary Rate or Gross Rate. You can specify contractual rates by payor in Payor Plan Maintenance.

i. Earnings Code – Leave blank. Only used for Payroll integrations

j. Revenue Account – Leave blank. Only used for G/L integrations.

k. Client Must Have Form to Complete Staff Status – Indicator to prevent this service from being completed unless a clinical form is attached to it.

l. Agency Required – Indicator stating that this activity is only valid for services billed to agencies. (In Epitomax, an agency is a payor you bill on an invoice rather than using a claim.)

m. Form Required Indicator – Indicates that this service cannot be billed without documentation (a completed clinical form) attached.

n. Auto-Complete Client Activity when Adding Client to Activity – Indicator for services such as ad-hoc groups where you only add client who attended the group.

o. Billable Indicator – Indicator that this service is billable.

p. Allow after discharge – This flag indicates if the activity can be entered for a date of service which is after the client’s discharge date.

q. Primary Therapist Cannot be Cancelled if Client Signed-In or Has a Form – Used for a specific customer.

r. Self-Pay Indicator – If this flag is set then this activity will be billed directly to the client. Any payors on the episode will be bypassed if this checkbox is checked. The charge will be billable only to the client.

s. Only Primary Therapist Can Add Note – Check this box if when there are multiple staff involved in a service only the primary staff (the one you are billing under) can document the service.

t. Ignore this Activity when Checking for Double-bookings – Indicates this service can overlap other services. Check this box for add-on codes.

u. Client Must Sign-In – Indicates the client must sign-in electronically for this service.

v. Hide When Scheduling Indicator – Indicates that this service is not scheduled in advance. Check this box for add-on codes.

w. Activity is a Group Service – Indicates the service is a group service without the need to specify a Group Code on the service.

x. CPT Add-on Activity – Indicates that this service is an add-on code. Check this box for add-on codes.

y. Client Must Have the Default Form – Indicates that staff cannot change the form attached to this service to something other than the form specified in Activity Default Form Maintenance.

z. Validate Sign-In Sheet to Complete Day – Indicates that when completing the staff day the system should require that the Date of Service, Start Time, and End Time on the electronic sign-in sheet match the Progress Note form.

Once you have entered all the required information, click on the Update button and the new activity code will be added to your system and a set of tabs will appear for the remaining required information.

Click here for a training video covering the first tab in Activity Maintenance

Select the Activity Program tab.

Click on the Insert Row button to insert a new row and select a program from the drop down. Only programs that are listed are valid programs for this activity code. When entering services the program entered must be listed here. So make sure you list all programs that will be used for this activity.

If you need to delete a row that you have entered incorrectly or no longer use, select the row that you want to delete and then select the “Delete Row” button and then click on the Update button.

After all your updates make sure to click on the Update button or all or changes will be lost.

Click here for a training video regarding the Activity Program tab

Next select the Activity Locations tab. If you want to limit your activities by a particular location you can enter in all the valid locations here. If you do not enter in any locations the activity code is valid for all locations.

Click here for a training video regarding the Activity Location tab

Next select the Activity Discipline tab. If your activity has different rates based on your staffs discipline then you can enter that information here. If the system does not find a discipline then it defaults back to the default rate.

a. Discipline – This is the staff’s discipline in which the rate will be associated with for this activity.

b. Rate – This is the rate associated with the discipline and activity code. This allows you to specify a different rate by discipline. Enter zero here to use the Default Rate from the Activity tab.

c. Rate Effective Date – This is the date that the discipline rate becomes effective. If the service is before this date the default rate is used.

Click here for a training video regarding the Activity Discipline tab

Next select the Activity Class tab. You must select one activity class for the system to function properly. This code is used in reporting. This is not an optional entry for an activity code. Use ‘Billable’ or ‘Non-Billable’ until you are live and are running reports in Epitomax to see how this is used.

Click here for a training video on the Activity Class tab

Next select the Activity Agency tab. If your system bills agencies you may have a different agency rate vs public rate. If that is the case you can enter your agency rate here.

a. Agency – This is the Agency in which the rate will be associated with for this activity.

b. Rate – This is the rate associated with the agency and activity code.

c. Rate Effective Date – This is the date that the agency rate becomes effective. If the service is before this date the default rate is used.

Click here for a training video regarding the Activity Agency tab

VII. Transaction Subtypes

There are 4 Transaction Types in Epitomax: Payments, Allowances, Adjustments, and Refunds. The ones that typically have user-defined sub-types are Allowances. You must define at least one Allowance Transaction Subtype in order to use allowances (also called write-offs or contractual allowances) in Epitomax.

To enter the Transaction Subtypes perform the following steps:

From the Administration menu select Code Table Maintenance, then select the letter T from the list of letters in the code table Maintenance page.
Select the Transaction Subtype link.

You will then see the criteria screen that all code tables have within code table maintenance.

From here just select Submit to return all rows in the table. (The picture below shows examples of Allowance Transaction Subtypes.)

Or, you can select Allowance in the Transaction Type drop-down and click on the Submit button to see only the Allowance transaction sub-types.

From here select Insert Row and a blank row will appear.

Enter the same information as you see in the Write Off row except enter a different Transaction Sub Type Description.

Don’t forget to click on the Update button to save your changes.

Click here for a training video regarding Transaction Subtypes

VIII. Cash Sheets

A cash sheet, just like in a paper world, is a place to record all cash receipts at a given location by Cash Sheet Type. Using Cash Sheets allows you to restrict who can enter cash receipts. It also allows you to print Deposit Listings used to reconcile your cash receipts.

Cash Sheets are by Location and by Cash Sheet Type (Cash, Check, Credit Card, EFT).

From the Administration menu select Cash Sheet Maintenance.

Click on the Add button to add a new Cash Sheet.

Fill in values for the Cash Sheet Name, Cash Sheet Type, Location, and G/L Account fields. The Bank Account field is optional. Enter your bank account number if that field if desired.

Click on the Update button to save your changes.

Click here for a training video regarding Cash Sheets

IX. Care Giver Roles

Care Giver Roles clinical roles. They are used when defining the Treatment Team for each client admission. Earlier, we configured Disciplines, and those were billing related. Some staff may be able to assume multiple Roles depending on how you define your care giver roles. Required signatures on clinical forms are defined by Care Giver Role.

To enter Care Giver Roles perform the following steps:

From the Administration menu select Code Table Maintenance, then select the letter C from the list of letters in the code table Maintenance page.
Select the Care Giver Role link.

You will then see the criteria screen that all code tables have within code table maintenance.

From here just select Submit to return all rows in the table. Since there will not be many rows in your table initially, only a few will be returned. (The picture below shows examples of Care Giver Roles.)

From here select Insert Row and a blank row will appear and you can now enter your data.
Don’t forget to click on the Update button to save your changes.

Click here for a training video regarding Care Giver Roles

X. Staff

From the Administration menu select Staff Maintenance.

If adding a new Staff to the system select the “Add” button. If you are modifying an existing Staff person use the Picklist button to select the Staff person then click on the Edit button. (Depending upon how many staff you have, you may see a drop-down arrow instead of a picklist button.)

For new Staff you now must enter the following information

Required Fields

a. Legal Last Name – Staff’s legal last name

b. Uses Legal Name – Indicator to the system of what name should be used. If Uses legal last name is not checked than Last name and First name will be displayed throughout the system.

c. Employee Status – Select Active.

d. Email Address – Although this field is not required to save the staff in the system, without it the staff will not be able to reset their own password or receive email notifications from Epitomax.

e. For clinical staff, enter the following fields as well:

a. NPI No – Used for billing

b. Taxonomy No – Used for billing in some states with some payers

c. Primary Program – Defaults in on new appointments

d. Manager – Needed for functionality by Manager

e. Degree – Shows behind name on forms signature pages

f. Evaluator – Check this box

g. Uses Service Activity – Check this box

All the remaining fields can be filled in but are not required to add a new Staff person to the system.

Once you have entered all the required information, click on the Update button and the new Staff will be added to your system and a set of tabs will appear for the remaining information associated with a Staff person.

Click here for a training video regarding Staff Maintenance

Select the Payor Credentials tab.

Enter information on this tab for staff who are credentialed with payors. Staff Payor Credentials are used by Epitomax to properly handle Medicare “incident to” billing. The Schedule Appointment function will also use this information to find appointments with credentialed staff when the client’s payor requires credentialed staff.

Click here for a training video regarding the Staff Payor Credentials tab

Select the Certification tab. On this screen you can enter the staff certifications.

Click here for a training video regarding the Staff Certification tab

Next select the Discipline tab. This is where you enter all the valid disciplines for your Staff. Disciplines are used to add the correct modifiers when billing, compute the correct charge amounts for services, and validate that services are billable for staff. Note: Only one discipline can be classified as the primary discipline. If you enter more than one as the primary you may get an error when processing claims.

Click here for a training video regarding the Staff Discipline tab

Next select the Role tab. This tab defines the clinical roles for the staff. These roles are used throughout the system for things such as Internal Caregiver (Treatment Team), clinical reports, required signatures on clinical forms, etc. Enter in all roles that apply for the staff. (Note: roles are defined using Code Table Maintenance and selecting the Care Giver Role code table.)

Click here for a video training regarding the Staff Role tab

Next select the Specialty Tab. Specialties are not required and are only used by the Schedule Appointment function.

Click here for a training video regarding the Staff Specialty tab

Next select the Transaction Subtype tab. Only staff who will be entering Allowances (in other words write-offs) will need anything entered on this tab. Staff who have nothing on this tab cannot enter Allowances in Epitomax.

Click here for a training video regarding the Transaction Subtype tab

Next select the Support Batch Tab. This allows the staff member to do such things as print Charge Slips for a group of staff all at once. The current staff person is allowed to perform support batch activities for all batch members. Note: Most customers do not use Support Batches since printing Charge Slips is a deprecated paper function.

Next select the Cash Sheet tab. Staff who will be entering Receipts in Epitomax will need Cash Sheets in order to enter them. A cash sheet categorizes the receipt in a way that allows you to print a Deposit Listing to reconcile receipts by Location and Cash Sheet. Staff who will be receipting from multiple Locations will need Cash Sheets for each of those Locations.

Click here for a training video regarding the Staff Cash Sheet tab

Next select the EDI Notifications Tab. This tab can be left empty. This feature allows the staff to be notified when EDI transactions enter the system based on Financial Class and/or Type of care. The staff will be notified via e-mail when an EDI transaction is processed in the system.

Next select the Documents tab. Here, you can attach files to the staff record as desired.

Click here for a training video regarding the EDI and Documents tabs

XI. User Logins

After adding someone in the staff table, you can now add a login to Epitomax for that staff.

From the Administration menu select Security Maintenance.

Click on the Global User Search link at the top of the page.

Click on the Search button.

If the user you want to add is not listed, click on the Add New User button.

Enter the desired information into each field. Make sure you select the staff in the Employee No drop-down list. Click on the Update button. If you get an error, you may need to change the User ID to make it unique across all Epitomax customers.

Click on the User Roles link to the right.

Click on the Insert button.

Select General Access from the drop-down list and click on the Update button. Click on the Insert button again and add another Security Role that is appropriate for this user. After each new role, click on the Update button to save the information. Note: Always insert one row at a time and click on the Update button before adding the next one. Also, always add the General Access role first for each new user. Not following this process could cause the user to have difficulty logging into Epitomax.

Click here for a training video regarding Creating Epitomax Users

XII. Financial Classes

Financial Classes are used as a way to group like Payor Plans in the system. By grouping payor plans (and Ancestor Payor Plans) by financial classes the system then has the ability to generate claims and run several A/R Reports based on the Financial Class assigned.

From the administration menu select Code Table Maintenance, Select the letter F from the list of letters in the code table Maintenance page.
Select the Financial Class link.

Click on the Submit button on the criteria screen and you will get a list of all the Financial Classes in the system
From here select Insert Row and a blank row will appear and you can now enter your data.

· Financial Class Name – This is the name that will be used to classify your Ancestor Payor Plans and Payor Plans.

· Holding Account – This should be the unapplied cash account that receipts should go into for this financial class. If none is specified here, the default holding account as entered in Administration->A/R Control Maintenance will be used.

· Active – Indicates that the financial class is active and ready for use. Uncheck this box to make a Financial Class inactive and unavailable for future use.

· System Value – Not user editable.

Click here for a training video regarding Financial Classes

XIII. Organization Types

Organization Types are used to classify Organizations and determine where that organization should be available in Epitomax. Note: You should not make any changes to this code table. All rows have a System Value indicating that they are linked to programming in Epitomax. Adding new Organization Types would be of no benefit to you.

From the administration menu select Code Table Maintenance, select the letter O from the list of letters in the code table Maintenance page..
Select the Organization Type link.

Click on the Submit button on the criteria screen and you will get a list of all the Organization Types in the system.
From here select Insert Row and a blank row will appear and you can now enter your data.

· Organization Type – This is description you will see in the system.

· Active – Indicates that the Organization Type is active and ready for use.

· System Value – Not user editable.

Click here for a training video regarding Organization Types

XIV. Authorized Service Groups

Authorized Service Groups are used to give a name to groups of Activities and to group them the way the Review Organization (or payer) authorizes services. You create the group names (Authorized Service Groups) using Code Table Maintenance. You use the Authorized Service Groups in Organization Maintenance (shown later in the guide) to group the services together in the way that organization authorizes services.

From the administration menu select Code Table Maintenance.
Select the Authorized Service Group link.

Click on the Submit button on the criteria screen and you will get a list of all the Authorized Service Groups in the system.
From here select Insert Row and a blank row will appear and you can now enter your data.

· Authorized Service Group Cd – This is a short code to identify the group.

· Authorized Service Group Desc – This is the name of the group.

· Copay Only Ind. – If checked, this authorized service group will only be available when defining copay rules and not for authorizations.

· Active – Indicates that the authorized service group is active and ready for use.

Click here for a training video regarding Authorized Service Groups

XV. Organizations

Organizations are companies or agencies that you interact with. They can be payors, review organizations, billing organizations, employers, referral organizations, etc. Each organization can have multiple organization types.

Click here for a training video regarding Organization Maintenance

To work with Organizations, click on Organization Maintenance in the Administration menu section.

Use the picklist button (or drop-down) to select an Organization to view/edit or click on the Add button to add a new organization.

Enter demographic information on the Organization tab.

Enter as many Organization Types in the Organization Type tab as apply to this organization. If you will receive authorizations from this organization, make sure to enter Review Organization as one of the Organization Types.

Click here for a training video regarding the Organization Type tab

Enter the Referral Source Type(s) on the Organization Referral Type tab. If the organization is not a referral source, leave this tab empty.

Click here for a training video regarding the Organization Referral Type tab

Services are grouped on the Review Organization Authorization tab based on how the Review Organization authorizes services. For instance, one payor might authorize an outpatient visit as any service (Individual, Family, etc.) rendered as outpatient therapy. Others may authorize these separately. In this case, a separate Authorized Service Group should be created for each type of authorization the review organization authorizes. The Review Organization Authorization tab allows you to map the proper activity code(s) to the Authorized Service Groups you have created.

Authorized Service Group codes are setup using Code Table Maintenance.
If the organization is not a Review Organization, you can leave this tab empty.

Click here for a training video regarding the Review Organization Authorization tab

Use the Replacement Claims tab to indicate which claim form to use for corrected or replacement claims. (When you modify a service activity that has already been billed using Service Activity Corrections, Epitomax will create a Rebill Request. If this tab is populated for the Billing Organization that was originally billed for the charge, Epitomax will use it to put the correct claim form on the Rebill Request. If the claim form cannot be determined from the Replacement Claims tab, Epitomax will use the same claim form as originally claimed.)

Click here for a training video regarding the Replacement Claim tab

XVI. Ancestor Payor Plans

In order to minimize the amount of work needed to maintain payor plan information, each Payor Plan in Epitomax has an Ancestor Payor Plan. Payor Plans inherit the information from their Ancestor Payor Plan. You can override ancestor information at the Payor Plan level as needed. The main idea is to group your payor plans based on how you need to bill them and have a different Ancestor Payor Plan for each. Don’t worry about copays or payment rules (contract rates) at the ancestor level. These typically vary by Payor Plan. Instead, focus on the Claim Forms, Procedure Codes, and how those charges are grouped on the claims. Significant changes in any of these factors would most be a good reason to use a different Ancestor Payor Plan that matches your needs more closely or create a new Ancestor Payor Plan.

Epitomax comes with a number of pre-configured Ancestor Payor Plans. You can view these to see how they are configured. It is best to start out by using existing Ancestor Payor Plans until you are more familiar with Epitomax.

Click here for a training video regarding Payor Plans and Ancestors

To view or edit an Ancestor Payor Plan, click on Ancestor Payor Plan Maintenance under the Administration menu section.

Use the drop-down to select an Ancestor Payor Plan to view/edit or click on the Add button to add a new Ancestor Payor Plan.

Don’t be intimidated by the number of tabs. The only tabs to be concerned with at the ancestor level are Payor, Plan Claim Procedure, Procedure Unit Conv., Claim Forms Used, Claim Field, and Claim Charge Grouping.

The following tabs are described in detail in the corresponding Payor Plan section of this document.

Payment Rules
Co-Pay Rules
Provider No.
Plan Claim Procedure
Procedure Unit Conversion
Claim Forms Used
Claim Charge Grouping
Claim Location
Authorization Requirements
Discipline Modifiers
Location Modifiers

The following tabs are for information only at this time. There is no functionality linked to this information at this time. Refer to the corresponding Payor Plan sections for more information about these tabs.

Payor Responsibility
Contract Terms
Contract Coverage
Service Requirements
Lifetime Benefits
Valid CPT Location
Valid CPT

XVII. Payor Plans

Epitomax comes with a number of pre-configured Ancestor Payor Plans. You can view these to see how they are configured. You can also contact support for assistance on choosing the best Ancestor Payor Plan for the Payor Plan you are creating.

The Payor Plan Maintenance feature allows staff to modify existing information about a Payor Plan or add a new Payor Plan to Epitomax.

Adding a new Payor Plan

Select the Add button and then select an Ancestor Payor Plan that will be associated with the new Payor Plan. All Payor Plans must have an Ancestor plan.

Once you have selected an Ancestor Payor Plan hit ok to create the new plan.

All fields entered in the Ancestor are defaults for the Payor Plan and do not have to be re-entered

Financial Class must be supplied for the Ancestor. This is used to classify the payors. Multiple payors can have the same financial class.
Claim Filing Code is used for 837 billing for secondaries.
Insurance Type and Plan Code are used in 837 claims processing.
Plan Type Code is used for HC4 Reporting.
Plan Effective Date is used by the system to determine when the plan begins.
Plan End Date is used to determine when the plan is no longer valid. Leave this field blank until the plan is no longer valid.
NAIC Number is used for HC4 Reporting.
Group Number – If supplied this will copy down to the client level if no group number is supplied for the client subscriber information.
Collections – Indicates a collections payor (Financial Class must also be set to collections for collections processing)
Auto Allowance – Indicates that this payor can be auto allowanced. If this flag is not set auto-allowancing will not run on this payor.
Agency – Indicates that this payor is an Agency Payor and an A/R Account is automatically created. An agency payor in Epitomax is an organization you bill on an invoice rather than on a claim.

Invoice Per Patient – Indicates that for this Agency each client needs to be on a separate invoice.
Print Patient Name – Indicates that the client name will be printed on the invoice.
Invoice Summary – Only summary information will be shown on the invoice, otherwise the invoice will be printed in detail.

Statement to Client – Indicates if a statement can be sent to the client.
Requires Staff Credential – Indicates credentialing is required for staff to be scheduled with a client that has this payor as their primary payor. (This is only used in the Schedule Appointment function).
Authorization Required – Indicates that Authorizations are required by this payor. Authorization assignments are defined on Organization Maintenance. Finer requirements can be entered on the Authorization Requirements tab if this field is checked (set to Yes).
Group number not required / Policy number not required – If a payor does not use group and/or policy numbers these options can be checked to avoid pending charge errors. (If they are required, Epitomax will prevent billing when the information is missing for a client by producing pending charge errors.)
Payor Organization – This is the organization that administers the plan. Organizations are added using Organization Maintenance. The only ones used here are the ones having an Organization Type of ‘Payor’.

The following fields are currently for information only. These fields may be used in future releases of Epitomax:

· Plan Renewal Date

· Bill with (days)

· Payment Received within (days)

· Write off below amount

· Agency Billing Frequency

· Third Party TPL

· Referring Physician Required

Click here for a training video regarding the Payor tab

Payor (Contact Info)

The Payor (Contact Info) tab lists the valid Contacts & their address & phone # associated with the Payor including Eligibility/Benefits contact, Billing Org, Review Org, and Appeals Contacts.

The Review Organization will be defaulted in as the primary review organization when creating authorizations. Enter the Review Organization if the payor requires authorizations. If no review organization is selected nothing will be defaulted into the review organization for new authorizations.

The Billing Organization is used when generating 837 claims and in the receipting process. This field is used to identify what organization will receive the claims / paid the claim. This field is required to receipt third party payments.

1. Click the Payor (Contact Info) tab of the selected Payor Plan

2. Click to save the changes

Click here for a training video regarding the Payor (Contact Info) tab

Authorization Requirements

If the payor requires an authorization for everything or for nothing, you can ignore this tab. If the payor requires an authorization for most services and not for others, this tab is used to specify the exceptions. The information that defaults on this tab says that an authorization is required for everything.

Click on the Add button to add the exceptions that do not require an authorization.

Click here for a training video regarding the Authorization Requirements tab

Payment Rules

The Payment Rules tab defines the Payment Rules as they relate to payor contracts and Auto-Allowances. The payment rule will determine the contractual amount for a given charge. This is also where the Auto-Allowance function will look for its criteria to take the correct Auto-Allowance amount off of charges.

Payment rules can be as granular or as generic as needed. Payment rules can be broken down by the following fields:

· Activity

· Activity Class

· Discipline

· Type of Care

· Program

· Location

Payment rules can also have the sub-acute and residential rates supplied.

The Allowance Type specified will be the allowance type used for the auto allowance processing. Customers also now have the option to have Epitomax create contractual allowances based on the information returned in the 835 electronic remittance. This virtually eliminates the need to maintain payment rules and the need to run the old auto-allowance process. See the How To Configure Epitomax to Automatically Allowance From an 835 Remittance Advice File on the Administration->Getting Started with Epitomax menu item for more information.

The covered indicator and include allowances with prior payments are information only fields at this time and may be implemented in a later release of Epitomax.

Click the Payment Rules tab of the selected Payor Plan and click on the Add button (Edit link for existing payment rules)

The user can Add, Edit, or Delete Payment Rules.

You only can delete a Payment Rule that is created in the Payor Plan. You will not have a delete option if the Payment Rule was created in the Ancestor Payor Plan level.

The following fields are required fields: Effective Date, Contract Amount, and Contract Type.

Any Payment Rule added using the above screen will not be copied to the Ancestor Payor Plan Maintenance screen.

All Ancestor Payment Rules will show in gray and are view only.

If “Pay as Secondary” is checked, and this plan is a secondary payor on a charge, auto allowancing will not be processed for that charge because the system assumes the secondary payor will pay the remainder.

2. Click to save the changes

Click here for a training video regarding the Payment Rules tab

Co-Pays

The Co-Pays tab defines the amount of Co-Pay that is required for each TOC if any is required & when the Co-Pay becomes effective. This is most commonly used with Outpatient. The Co-Pay amount will print on the Charge Slip / Super Bill. The Auto Allowance function will also take into account the amount of Co-Pay entered here. Epitomax uses the copay amounts entered in Payor Plan Maintenance unless it is not entered. Then, copay information from the Ancestor Payor Plan is used. The user accesses the Co-pays tab under the Ancestor Payor Plan Maintenance or Payor Plan Maintenance functions and enters the Type of Care, Authorized Service Group (not required), Starting and Ending Visit No, Copay Amount and Copay Type.

Co-pays can also be defined at the client record level. When co-pays are defined at the client record level, that overrides any co-pays defined on the Payor Plan. Many customers choose to only define co-pays at the client record level (meaning they enter the co-pay roles per client rather than per payor plan). Defining co-pays and payment rules on the Payor Plan my require entering many more payor plans vs. entering co-pays per client and allowing Epitomax to do the contractual allowances from the 835 electronic remittance.

1. Click on the Co-Pays tab then select Add (Click the edit link for an existing co-pay rule)

2. Select the Type Of Care from the drop down menu

The Type of Care is a required field.

3. Select the Authorized Service Group(s) covered under this type of care from the drop down menu

Leaving this field blank and not selecting a specific Authorized Service Group will allow the payor to cover all services under the Type of Care selected

4. Enter the Starting Visit No:

5. Enter the Ending Visit No:

Enter the Copay Type

Copay Types can be entered as a percent of Responsible Amount, a Flat Rate or a Percentage of Charge.

7. Enter the Copay Amount

The copay amount is determined from the patient’s insurance card or verified by contacting the payor

Click here for a training video regarding the Co-pays tab

Provider No.

The Provider No. tab displays a unique # that a Payor assigns to a Provider (Your organization/agency). These may differ by TOC or they may all be the same. These Provider Numbers are used for claims, however these are legacy numbers and have been replaced by the Location NPI numbers. Location NPI numbers are entered using Code Table Maintenance.

1. Click the Provider No. tab of the selected Payor Plan

You can only delete Provider Numbers that are created in the Payor Plan. You will not have a delete option if the Provider Number was created in the Ancestor Payor Plan level.

The Ancestor Provider Numbers will only appear if a Payor Plan Provider Number for the same value does not exist.

The following fields are required fields: Type of Care and Provider Number.

Any Provider Number added using the above screen will not show in the Ancestor Payor Plan Maintenance screen.

All Ancestor Payment Rules will show in gray and are view only.

2. Click after making the necessary changes

Plan Claim Procedure

The Plan Claim Procedure tab is critical to the claims process. Each valid Service Activity Code needs to be defined by the Claim Form, what Claim Procedure code is needed on the Claim Form, what TOC is related to the Activity, % of each Charge to display on the claim (typically 100%). A Discipline with modifiers can be selected if needed. Certain codes require a modifier for certain disciplines. The Discipline Modifiers tab should be used to define situations when the modifier varies based on what staff performed the service.

The Plan Claim Procedure tab is the tab most often defined at the Ancestor Payor Plan level. If you need to override a row that was entered on the Ancestor Payor Plan, use the Edit link next to the row you want to override. Make sure to enter a value for every field even if it is already entered on the ancestor when overriding an ancestor row! You are overriding the ancestor when you Edit here, so you must enter values in all fields needed. To add a row needed by this Payor Plan but not needed by other payor plans sharing this same ancestor, click on the Add button.

1. Click the Plan Claim Procedure tab of the selected Payor Plan

The user can Add, Edit, or Delete features.

You can only delete a Plan Claim Procedure that is created in the Payor Plan. You will not have a delete option if the Plan Claim Procedure was created in the Ancestor Payor Plan level.

The Ancestor Plan Claim Procedure will only appear if a Payor Plan Claim Procedure for the same value does not exist.

The following fields are required fields: Claim Form, Form Ranking, Claim Procedure, Activity, Type of Care, and Percent of Charges Displayed on Claim.

Any Plan Claim Procedure added using the above screen will not show in the Ancestor Payor Plan Maintenance screen.

Click after making the necessary changes

Click here for a training video regarding the Plan Claim Procedure tab

Procedure Unit Conversion

The Procedure Unit Conversion tab is used when a payor wants to see different units than you have defined in Activity Maintenance. Each row here defines Low & High Durations of an Activity and converts it to Units for each specified Claim Form. If no Procedure Unit Conversion exists for a charge on a claim, the units will default to the way they are defined for the activity in Activity Maintenance.

1. Click the Procedure Unit Conversion tab of the selected Payor Plan

The user can access the Add, Edit and Delete features.

You can only delete a Procedure Unit Conversion that is created in the Payor Plan. You will not have a delete option if the Procedure Unit Conversion was created in the Ancestor Payor level.

The Ancestor Claim Field will only appear if a Procedure Unit Conversion for the same value does not exist.

The following fields are required: Claim Form, Claim Procedure, Duration Low, Duration High, and Units.

2. Click after making the necessary changes.

Click here for a training video regarding the Procedure Unit Conv tab

Claim Forms Used

The Claims Forms Used tab indicates the valid Claim Forms Used for this Payor. Only Claims forms listed will be processed by the claim generation process.

1. Click the Claim Forms Used tab of the selected Payor Plan

The user can access the Add, Edit, and Delete features.

You only can delete a Claim Form that is created in the Payor Plan. You will not have a delete option if the Claim Form was created in the Ancestor Payor Plan level.

The Ancestor Claim Forms Used will only appear if a Payor Plan Claim Forms Used for the same value does not exist.

The following fields are required fields: Claim Form.

Any Claim Forms Used added using the above screen will not show in the Ancestor Payor Plan Maintenance screen.

The following fields are view only: Claim Form (Ancestor).

2. Click after making the necessary changes

Claim Field

The Claim Field tab defines where a field will print on paper claims only and which fields will print on those claims. Care should be used when making changes to this information to make sure claims print properly. Customers typically do not make changes on this tab. If your paper claims are not printing properly, please enter a support ticket for assistance before trying to make changes yourself.

Claim Charge Grouping

The Claim Charge Grouping tab will allow for grouping of charges to be summarized on a claim for a specific TOC, Program, Activity Class, etc. If Summary box is not checked, it will print detail charges on the claim. Most paper claims require at least one row in this tab. Use the Claim Break On Group Indicator checkbox to cause charges to print on a separate claim page when the Claim Group By Field changes. Customers typically do not make changes on this tab. If your claims are not grouping/separating properly, please enter a support ticket for assistance before trying to make changes yourself.

Note: This function is an administrative function.

The following fields are required fields: Claim Form and Group By Order.

The user can access the Edit, Add and Delete features.

Any Claim Field added using the above screen will not show in the Ancestor Payor Plan Maintenance screen.

Claim Location

The Claim Location tab defines the Location and POS Code for a Payor. This is required for some Payors. This is a Code that prints on a Claim.

1. Click the Claim Forms Used tab of the selected Payor Plan

The user can access the Add, Edit, and Delete features

You can only delete a Claim Field that is created in the Payor Plan. You will not have a delete option if the Claim Field was created in the Ancestor Payor Plan level.

The Ancestor Claim Field will only appear if a Payor Plan Claim Field for the same value does not exist.

Any Claim Field added using the above screen will not show in the Ancestor Payor Plan Maintenance screen.

2. Click after making the necessary changes.

Click here for a training video regarding the Claim Location tab

Discipline Modifiers

The Discipline Modifiers tab should only be used if the modifier needs to be added to EVERY procedure code you bill when the service is provided by a particular staff discipline. This is typically not the case, and if not, the setup should instead be done on the Plan Claim Procedure tab.

Location Modifiers

The Location Modifiers tab should only be used if the modifier needs to be added to EVERY procedure code you bill when the service is provided at a particular Location.

XVIII. Security around Allowances and Adjustments

Staff cannot enter Allowances or Adjustments unless those Transaction Subtypes have been added in Staff Maintenance for that staff under the Transaction Subtype tab.

From the Administration menu select Staff Maintenance.
Use the Picklist button to select the Staff person then click on the Edit button.

Click on the Transaction Subtype tab.

Click on the Add button, select an Allowance Transaction Type from the drop-down list, and click on the Update button to allow the staff to enter that allowance type.
Repeat step 4 for as many Allowance Transaction Types as the staff should have available to them.

XIX. Ancestor Payor Plan Utility

The Ancestor Payor Plan Utility is used to copy configuration data from one ancestor payor plan to another or to copy data within the same ancestor payor plan from one Claim Form to another. If you have created your own Ancestor Payor Plan (or you find the one you are using is missing Claim Field data), you can use this utility to copy Claim Field data from an ancestor that has data for the UB-04 and/or 1500 paper claims to the ancestor you are using.

Be careful not to copy data to an ancestor payor that already has that data or the data will be duplicated!

To copy Claim Field data and the accompanied Claim Charge Grouping data from one ancestor payor plan to another, do the following.

First, be sure the payor you are copying from has the desired data. Go into Ancestor Payor Plan Maintenance, and Edit the desired Ancestor Payor Plan.

Click on the Claim Field tab. Select either the 1500 or UB-04 Claim Form from the drop-down list. Click on the Submit button.

If you see data (as pictured above), you can copy Claim Field data from this Ancestor Payor Plan.
Now, check to be sure that the Ancestor Payor Plan you wish to copy to does not have Claim Field data. To do this, go again to Ancestor Payor Plan Maintenance. This time, Edit the ancestor you wish to copy to. Go again to the Claim Field tab, select either the 1500 or UB-04 Claim Form from the drop-down list. Click on the Submit button.

If no data is displayed (as pictured above), then the ancestor payor plan has no data for that claim form and it is safe to copy data to it.
On the Administration menu section, click on the Ancestor Payor Plan Utility menu item.

Enter the data as shown below.

Click on the Submit button once you are sure the information is correct to complete the copy.

Click here for a training video regarding the Ancestor Payor Plan Utility