Medicaid Roll Up Integration

With the Medicaid Roll Up Integration function, you can complete the roll up settings that apply to Medicaid claims for a specific Roll Up Group Code. The settings stored here determine how charges are rolled up onto Medicaid claims when the claim's Doctor, Location, and Insurance Carrier codes match a Roll Up Group Code defined in Maintain Roll Up Groups.

NOTE: Before completing this function, you must first create a Roll Up Group Code using the Maintain Roll Up Group Codes function and define the associated Doctor, Carrier, and Location codes using the Maintain Roll Up Groups function.

Selecting a Roll Up Group Code

Type or select the Roll Up Group Code you want from the Roll Up Group Code list.

Selecting an Effective Date

An Effective Date is required for the Roll Up Group Code. You can select an existing date from the Effective Date list, or create a new effective date by selecting New Effective Date.

If you selected New Effective Date, the screen refreshes and the Effective Date field is displayed. Type or select the date you want using the calendar icon.

Medicaid Roll Up Integration Setup Screen

The detailed Medicaid Roll Up Integration setup screen for the selected Effective Date and Roll Up Group Code is displayed. Complete the roll up setting fields based on the requirements of your practice.

Data Field Information

Prompt	Response	Req
Effective Date	This field is for display purposes only. This date controls when the selected Integration settings will become effective for the selected Roll Up Group Code.
Roll Up Group Code	This field is for display purposes only. The selected Integration settings will only be applied to claims that meet the requirements defined for this Roll Up Group Code in Maintain Roll Up Groups.
Collapse Charges Into	Select one of the following options: First Procedure – select this option if you want all the charges rolled up into the first procedure code on the claim. First E/M Code – select this option if you want all the charges rolled up into the first E/M procedure code on the claim. Fixed Procedure – select this option if you want all the charges rolled up into a Fixed Procedure code, which you will select in the Fixed Procedure Code field below. Do Not Collapse – select this option if you do not want the charges collapsed or rolled-up.
Fixed Procedure Code	If you selected Fixed Procedure above, this field is required. Type or select the Procedure Code you want to use for rolled-up claims.
Amount Billed	Select one of the following options: Contracted – select this option if your practice is contracted to bill a designated amount for rolled-up claims. If you select this option, the Contracted Amount field is required. Accumulated – select this option if you want the accumulated total of all the charges to be submitted for the rolled-up charge on the claim.
Contracted Amount	If you selected Contracted above, this field is required. Type the contracted amount to be billed for rolled-up claims.
Include all Procedures on the Claim	A rolled-up claim will only contain a single procedure code (based on the option selected for the Collapse Charges Into field) unless you select to include all procedures. If you select this option, the additional procedures will be included on the rolled-up claim and the dollar amounts for the procedures will show as $0.00 amounts.
Write-off Adjustment Code	This field is not currently active.
Termination Date	Type or select the date on which the Integration settings should stop being applied for the selected Roll Up Group Code.

How Claims are Rolled Up

During the Insurance create process, the Doctor, Location, and Insurance Carrier codes on the claim are checked first to see if they match the codes set up in a Roll Up Group Code. If a matching Roll Up Group Code exists, a check is then performed to see if there is a corresponding Roll Up Integration setup for that Roll Up Group Code.

If a matching Roll Up Integration is stored, the claim is rolled up based on the beginning service date for the claim – if the service date falls on or after the Effective Date stored in the Roll Up Integration function.

If more than one Roll Up Integration matches all the requirements for the claim, the most current Roll Up Integration settings based on the Effective Dates stored will be applied when the claim is rolled up.

Notes

5010 Rolled-Up Claims Only – When you review the Transaction History for a patient and select Encounter view, any claim that has been rolled up displays the Roll-Up icon, the insurance carrier code, and the words Rolled-Up in the claim tab for the Encounter.
In the Claim Preview function, if a rolled-up claim was generated in the electronic format and you click the Paper tab, a message displays at the bottom of the claim preview window stating: "This rolled-up claim has been generated electronically. The paper representation of the claim has been generated only as a courtesy and may not reflect the rolled-up procedure code." A similar message displays in reverse if the claim was generated in the paper format and you click the Electronic tab.
The rolling up of the claim is only present on the claim image and in the claim file after the claim has been sent.
All reports (Transmission File, Transmission Journal, Exception Report, and Insurance Filing report) show the procedures from the Encounter and do not show as 'rolled-up'. This mimics the setup of roll up billing in the 4010 claims and provides details for the claim that relate to the specific procedures.

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