The Bundled Billing rule in the Claim Create Rule Engine is built to meet the specific KS OneCare billing requirements for the OCK Services.  This is designed to create claims that meet the criteria with or without a fee based on the configurations.

1. The HAP service
   • This is a stand-alone service that will be billed according to the Procedure Code Rate and configuration.  It will not be bundled with the Qualifying Services, and the rate will not be overwritten to $0.00
2. Qualifying Services
   • These are all services that can be performed during the month, but only one (1) should be billed with a fee.

This Rule will create individual claims for each Qualifying service in a month but only the first service will generate with a fee.  Any additional services for the month will generate as a claim, but with a $0.00 fee.

Example Claims for Qualifying Services:

If a HAP Service is provided in a month, the service will be created as a claim with the Fee that is listed on the Procedure Code.

Claim Create Rule Engine

The majority of the configuration is handed in the Claim Create Rule Engine accessed under

Billing>Maintenance>Rule Engine>Claim Create Rule Engine

• Effective Date – Enter the date the Rule should take effect
• Rule Type – Select “Bundled Billing”
• Parameters – Complete as applicable, all parameters listed need to be completed

The Procedure Codes for all the Qualifying services need to be configured as listed below.  This will allow the process to submit any of the claims that get created with a $0.00 rate due to the Bundled Billing requirements.

• Each Procedure Code needs to have a Guarantor Rate for the Guarantor selected in the Rule.
  1. In the Guarantor Rate configuration, the field “Submit claims zero fee” needs to be set to “Yes”.  This is on the Options 1 Tab of the Guarantor Rate window.

The client needs to have the following set up before services will be bundled according to the Rule.

• The Client needs to have a Guarantor entry in the Client Master for the Guarantor selected in the Rule.
  1. Please note, the dates of the Guarantor need to cover the dates of service for the services that should be Bundled.
• The Client needs to have an active Program in Client Status/Client Program form for the Program selected in the Rule.
  1. Please note, the dates of the Program need to cover the dates of service for the services that should be Bundled.
• The Client needs to has a Qualifying Service entered in the Chart for the dates when the Rule is effective.  This is done via Progress Notes.
  1. **Please note, the Program selected in the Rule Engine must be selected on the Note in order for the billing process to bundle the services together.

• Complete all configuration as listed above.
• Enter Progress Notes for the client.
• Pull notes into billing as normal.  This does not require once a month billing, the process will check for existing claims for the client for the same month and update the fee (s) accordingly.