Plan Details General Tab Field Definitions

An asterisk (*) following the field name indicates a Required field in the Core SmartCare system. Your system may have been customized to require additional fields.

Field	Description
General Information
Active	Identifies whether the plan information is active in the system or not.
Information is Complete	Identifies whether the content for this plan is complete or not. Until the option is checked, the plan is not displayed in drop-downs throughout the system nor are claims created and sent to this plan.
Name*	Identifies the name of the plan.
Display As*	Identifies the name of the plan that is displayed throughout the system and on report. The first 20 characters of the Name are displayed. You can change the Display As name to the name you want to appear in drop downs and throughout the system.
Payer*	Identifies the entity which writes the checks. If the same payer is used by multiple plans, you can use that payer for services covered by those plans.
Type	The payer description selected in the Payer field is displayed here. The types are a Global Code set up to categorize payers into the group types.
Begin billing ICD10	Identifies the date when this plan will begin accepting billing using diagnosis codes from IDC10.
COB Priority	Coordination of benefits. Identifies the priority for this plan when a client is covered by multiple plans.
Send Allowed Amount on Claims	Identifies that only the allowed amount is included on claims to this plan.
Add-On Charges	The options identifies how to handle billing when add-on codes are added to the main procedure code selected on the service. Options are: · Do not bundle · Auto bundle · Bundle but Ignore Validations
Capitated Funding Source	Identifies that this plan is a capitated funding source. This means that the plan pays a set amount for each enrolled person for a period of time
This is a Medicaid Plan	Identifies that this plan is part of Medicaid.
This is a Medicare Plan	Identifies that this plan is part of Medicare.
Electronic Eligibility Verification	Identifies that this plan verifies a client's eligibility in the plan electronically at registration or admission.
Plan Does Not Allow Replacement Claims	Identifies that the plan does not allow corrections to previously submitted claims.
Service Areas
	Click the Add Service Areas button to add service areas to the plan. Tell me how...
Service Areas	Identifies the Service Areas that have been added to the Plan. Identifies the services area(s) that have been added to this plan. To delete a service area, click the next to the service area you want to delete.
Claim Information
Claims Address	Identifies the address where claims are sent for processing for payment.
Billing Diagnosis Type	Identifies whether billing is sent to this payer with DSM or ICD diagnosis codes.
Standard Electronic Claim Format	Identifies the electronic claim format that this payer uses. Either this format or the standard paper claim format must be selected for the system to generate claims.
Combine claims with other coverage plans for the same payer	Identifies whether or not you want claims from other plans combined if they are submitted to the same payer.
Advanced button	Click the Advanced button to enter advanced claim formats both electronic and paper for this plan. Tell me how...
Standard Paper Claim Format	Identifies the format the payer wants paper claims submitted to them. Either this format or the standard paper claim format must be selected for the system to generate claims.
Advanced button	Click the second Advance button to enter An Advanced Provider ID Definition for the Plan. Tell me how...
Provider Id	Identifies the Provider ID issued by the payer.
Provider Id Type	Identifies which payer issued the Provider ID.
Claim Filling Indicator Code	Identifies the claim filling indicator code used by the payer.
Electronic Claims Payer Id	Identifies the payer's ID for electronic claims.
Claim Office #	Identifies the payer's claim office phone number.
Comments
Comment	Enter comments as needed for this plan. You can enter unlimited characters.
Contact Information
Name	Identifies the name of the contact person at this plan.
Telephone	Identifies the plan's contact person's phone number.
Fax	Identifies the plan's contact person's fax number.
Utilization Management Organization
Organization Name	Identifies the organization that authorizes services for this plan.
Contact Name	Identifies the name of the contact person at the UM organization.
Telephone	Identifies the phone number of the contact person at the UM organization.
Fax	Identifies the fax number of the contact person at the UM organization.
Comments	Enter comments as needed for the UM organization. You can enter an unlimited number of characters.
Claims Address	Identifies the address where claims are sent for this UM organization.
Email Address	Identifies the email address for the contact person at the UM organization.
Options
Exclude From Reallocation Process If Charge Exists	Click the check box if you do not want the charge to be included in the reallocation process. The reallocation process looks at all completed services in the system and reviews the current coverage plan information. If the information has changed since the charges were created, the reallocation job applies transfers to the charges to put the charges to the correct coverage plans/client.