ICD-10 Post-Deployment Update #1
Dear valued SMART partners,
As we all begin to process and comply with ICD-10, we here at SMART want to make sure that we communicate and provide our customers with helpful tips on a frequent basis.
The first area focuses on items presented in our training sessions that we believe warrants revisiting and reminding our partners about. For comprehensive services, it is important that you have a clear understanding of the related functionality in SMART. Please see below for some key items to verify.
We continue to follow extensive quality assurance protocols and have recently become aware of some partners experiencing issues with recently released versions of SMART. Some of the issues reported have been related to performance, such as when users initially log in.
We ask for your patience at this time and we want to assure you that we are working hard to resolve these unforeseen issues.
Thank you for your continued support.
In the comprehensive billing screen, there are 4 options at the bottom of the window
“Comprehensive Service start and end dates should use”:
“Service Week start and end dates” - This is the default selection for nearly all carriers.
“Service week START for BOTH start and end dates” - Should be selected for any insurance carrier has the service week start date as service start and end date.
“Service week END for BOTH start and end dates” - Should be selected for any insurance carrier has the service week end date as service start and end date.
“Episode dates override service dates” - Causes the start date to be modified to be the patient’s admission date if admitted mid-week
the end date to be modified to be the patient’s discharge date if discharged mid-week.
• In the CMS-1500 tab in the Edit Carrier Detail section, an option must be selected as to what should appear in box 31 of the form. If no option is selected, box 31 will be blank. This is the default selection in the settings.
Every carrier requires different information in box 31 so it needs to be set by the user for each individual carrier.
• In the "Submitter" tab of the Edit Carrier Detail screen, another setting which should be edited in the carrier submitter info is the version of CMS 1500 form that will be used. It defaults to version 08/05 and should be changed to 02/12 to support ICD10 information.
Troubleshooting red-lined items in the claims grid
First, verify whether the issue is coverage or diagnosis related:
Coverage-related: Indicates that they may not have been covered by that carrier during that billing cycle. Make sure that the date of coverage for that carrier is within the billing cycle.
If the patient was not covered by that carrier for the dates of invoices which are red-lined, the carrier should be credited for those invoices in the SMART software. Once credited, the red lines will be removed.
Diagnosis-related: Make a list of the patients who have a diagnosis-related red-line. Someone with clinical or administrative privileges will need to add the diagnosis in the Problems tab. They will then need to exit the SMART software, log back in, go to third-party billing, and there will no longer be red-lines on the claims grid indicating they are available to bill.