Import Fee Schedules

With the Import Fee Schedules function you can import a Fee Schedule. Using this process saves large quantities of data entry time and ensures the accuracy of the data loaded. This function also provides the Load from File function so you can import fee schedules that are not pre-loaded in the existing Fee Schedules File list.

For information about the steps involved in setting up and using Fee Schedules and the update process, see Fee Schedule Setup Process.

This function loads the new fee schedule values for every procedure code stored in your Procedure Code Table into the Fee Schedule Code and Effective Date you select.
This function imports only the Facility and Non-Facility Fees for Participating and Non-Participating providers. It does not populate any Rate Schedules.
This function overwrites any fee schedule values that currently exist for the selected Fee Schedule Code and Effective Date, unless you are Importing Multiple Types of Medicare Fee Schedules (Physician, Lab and DME Fee Schedule files). Each of these files contain unique procedures code sets and will be 'added' to any existing procedure codes when they are imported into the same Fee Schedule Code and Effective Date.
You can import fee schedules from any workstation or the server. It works for all system types; self-hosting and subscription (ASP) clients.
CGM US receives the files directly from the insurance companies and is in no way responsible for the data contained in the files. These files are made available for importing as they become effective.

Upon accessing this function, the Import Fee Schedules screen displays. Each time you select a Fee Schedule Year and Fee Schedule State, the screen will refresh and the Fee Schedule File list will contain the most current available fee schedule files.

Data Field Information

Prompt	Response	Len
Fee Schedule Year	This field defaults to the current year. Select the year you want from the existing Fee Schedule Year list.	1
Fee Schedule State	This field defaults to the same state stored in Change Database Parameters (for this database), under System, Database Maintenance Menu. Select the state that applies to your practice. The list displays only the states that have files available for the selected year.	26
Fee Schedule File	Select the fee schedule file you want to import. The list displays only the files available for the selected year and state. If only one fee schedule file is available for the selected year and state, the field defaults to that file.	40
Effective Date	Type the date you want the fee schedule values to be effective or click the calendar icon to select a date.	10
Provider Status	Select the applicable Provider Status option.	1
Fee Schedule Code	Type the fee schedule code you want or select from the Fee Schedule list.	5

Importing Multiple Types of Medicare Fee Schedules
The Medicare Physician, Lab and DME Fee Schedule files are available for importing. If you want to load the Lab and/or DME Fee Schedules in addition to the Physician Fee Schedule, you must always use the same Fee Schedule Code and the same Effective Date that you use for the Physician Fee Schedule.

Note: Since the standard Medicare Physician Fee Schedule is updated quarterly, each time you import the updated Physician Fee Schedule with a new Effective Date, you will also have to re-import the Lab and/or DME Fee Schedules using that same Effective Date. This will allow the fee schedule to pull the correct allowed amounts in Payment Entry.

Load from File
If the fee schedule file you want to import is not included in the list, you can load it from a file (generally a spreadsheet) that you obtain from the insurance carrier. Click Load from File in the Action Column from the main Import Fee Schedules screen.

How to Prepare the .csv File

The file that you obtain from the insurance company must be saved as a .csv (comma separate values) file to your server on the same drive that Cache is located.
There can be only one worksheet in the workbook.
Remove any Headers and Footers.
Delete all Column and Row headings.
The only characters that can be used on the worksheet are numbers, letters, decimal points and asterisks. No other characters can be on the worksheet .
The worksheet columns must be in the following order:
- Column A = Type an F if the fee schedule and amounts are for a facility or type an N if they are non-facility.
- Column B = CPT Code Column
- Column C = Modifier Column (if a modifier exists in this column, the fee schedule will only load the amounts if there is a matching procedure code_modifier value in the Procedure Code Table. For example, if you have CPT Code J1071 and Modifier GL, there would need to be a "J1071GL" code in the procedure code table for the fee schedule amount to load from the file.)
- Column D = Blank Column
- Column E = Participating Amount Column (may be the only fee column-columns F-R are optional)
- Column F = Non-Participating Amount Column
- Column G = Limiting Fees (provided by some payers but is informational only and not imported)
- Column H = Rate Schedule A
- Column I = Rate Schedule B
- Column J = Rate Schedule C
- Column K = Rate Schedule D
- Column L = Rate Schedule E
- Column M = Alternate Fee
- Column N = Alternate Rate Schedule A
- Column O = Alternate Rate Schedule B
- Column P = Alternate Rate Schedule C
- Column Q = Alternate Rate Schedule D
- Column R = Alternate Rate Schedule E
Save the file after completing all of the steps above.

The path name in the function must match the location of the file on the server. For example, C:\FEESCHEDULES\CIGNA.csv.

Self-Hosted Clients: The file must be saved to your server on the same drive that Cache is located.
Hosted (ASP) Clients - You must e-mail the .csv file to customer service. After customer service receives the file from you, they will request to have it posted to the server and they will provide you with the path (e.g. C:\FEESCHEDULES\1095\CIGNA.csv). Then you can proceed with the Load from File function.

Proceed with loading the file.

Data Field Information

Prompt	Response	Len
Drive	Type the drive letter containing the file.	1
File Name	Type the name of the file/path. Include the file extension. For example FEES\CIGNA.CSV.	26
Effective Date	Type the date you want the fee schedule values to be effective or click the calendar icon to select a date.	10
Par or Non Par	Select the applicable option.	1
Fee Schedule Code	Type the fee schedule code you want or select from the Fee Schedule list.	5

When you click Save, the file will be loaded with the fee schedule values as indicated. A message displays if the file cannot be found. If this occurs, double check the Drive and File Name and try again.