Page Description

Use this page to define which practices' patients need billing (or DFT) events, how to schedule the delivery of billing event messages, the content of the billing messages, and CPT rules.

If desired, you may set your startup file to have Copia populate DFT messages with an order's user defined fields' ZCF segment. Note that you must work with Orchard Software Technical Support to modify the startup file. When this option is enabled, Copia creates a ZCF segment all billing messages generated in the system.

For more help, click one of the following links:

• Accessing this Page
• Selecting Practices for Billing Events
• Scheduling Billing Event Message Delivery
• Defining the Content of Billing Messages
• Defining CPT Rules

Accessing this Page

• Click the Outbound DFT button in the Outbound Interface section on the Interface Configuration administration page.

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Selecting Practices for Billing Events

1. In order to send DFT, or billing, event messages, you must select one or more practices as recipients for billing events sent to this host.
2. To add a specific practice, enter one or more characters in the Practice field, and then click the Search button to select the practice in the Practice Search page. See the Admin: Practice Search topic. Repeat this search for each practice you wish to add. If you select one or more practices, you cannot define a system event to create billing settings for all practices (see below).
3. To add an event for all practices, click the Add System Event button. If you have selected one or more practices (see above), then this button is disabled. If you add a system event, you cannot define billing settings for individual practices. If necessary, you may remove selected practices (see below), and then click the Add System Event button.
4. For each practice, you may select what triggers a billing event by selecting an option from the Billing Event Trigger drop-down list.
   • When order choice result is final: Select this option to have Copia send billing information to the host when it receives final results for order choices.
   • When order is saved: Select this option to have Copia send billing information to the host when users save orders.
   • When the sample is collected: Select this option to have Copia send billing information to the host when users mark samples as collected in the Collect Samples page.
   • When order is complete: Select this option to have Copia send billing information to the host when orders are completed.
   • When inbound DFT is processed: Select this option to have Copia send billing information to the host when it parses inbound DFT messages. Note that the DFT messages that Copia will accept need to have an ORC and OBR segment for each FT1 segment.
5. For each practice, select or clear the Credit Cancelled Order Choices option to define whether or not Copia should create credit messages for cancelled order choices.
6. To remove a practice from the list, click the X button in the Remove column that corresponds to the practice. If you remove a practice, Copia will no longer send billing events for this practice to the host.
7. Click Cancel to return to the Interface Configuration administration page without modifying the DFT event settings, if desired.
8. If your modifications are complete, click OK to record all changes and return to the Interface Configuration administration page. Otherwise, complete the remaining sections, and then click OK.

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Defining Billing Event Message Delivery

1. Select when Copia should deliver billing messages. Copia will use the specified timing to send the billing event when the billing event trigger occurs (see "Selecting Practices for DFT Events" above).
   • Immediate: Select this option to have Copia queue the DFT message as soon as the billing event trigger occurs.
   • Manual: Select this option to have Copia hold the DFT message until you use the Billing administration page to manually designate the DFT messages to be delivered.
   • Scheduled: Select this option to have Copia place the DFT message in the queue for the next scheduled delivery time. When you select this option, Copia automatically displays one delivery time field. To add additional delivery times, click the Add Delivery Time button. You may then modify the hour, minute, and AM/PM values to create the appropriate delivery times. To remove a delivery time, click the X button that corresponds to the time you wish to delete. Using these settings, when a billing event trigger occurs, Copia finds the next scheduled time for delivery and queues the message to be delivered at that time. Note that Copia displays the hosts' time zone next to the time. This is the time zone that Copia uses to determine the scheduling for billing events.
2. Click Cancel to return to the Interface Configuration administration page without modifying the DFT event settings, if desired.
3. If your modifications are complete, click OK to record all changes and return to the Interface Configuration administration page. Otherwise, complete the remaining sections, and then click OK.

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Defining the Content of Billing Messages

1. Use the Billing Message Content section of the page to define what information Copia sends in billing messages.
2. Establish the settings for the following options:
   • Message content type: Select an option to define the HL7 segments that should be sent in DFT messages to this host. There are three schemes: "One FT1 and one PR1 segment per procedure code," "One FT1 and no PR1 per procedure code," and "One FT1 per order choice and a distinct PR1 for each procedure code in that order choice."
   • Message host code usage: Select an option to define where Copia will obtain the host codes for the order choices when this host is receiving DFT messages. You may select one of the following: to use the billing interface's order choice host code, to use the testing location's order choice host code, or to use the billing interface's order choice host code if it exists, but if it doesn't exist, then to use the testing location's host code.
   • If no insurance, send this as billing status: Enter the value that will act as an override for the billing status of orders with no associated insurance.
   • Signed ABN CPT code modifier: Enter the value Copia should use as the "Signed" ABN CPT code modifier.
   • Signed Don't Bill CPT code modifier: Enter the value Copia should use as the "Signed/Don't Bill" ABN CPT code modifier. The default value is GA. Note that when both "Signed" and "Signed/Don't Bill" use the same code, "Signed" takes precedence.
   • Unsigned ABN CPT code modifier: Enter the value Copia should use as the "Unsigned" ABN CPT code modifier.
   • Repeat CPT code modifier: Enter the value Copia should use as the repeat CPT code modifier. If there is more than one billing event for the order choice for the host within the number of hours specified for the billing frequency in the Order Choices administration page (see the Admin: Order Choices topic), then Copia considers it a repeat billing event, and, when sending the HL7 message, it appends the Repeat CPT code modifier to the Signed ABN CPT code modifier (see above).
   • Send one FT1 segment per message: Select this option to force outbound DFT messages to be split so that a single DFT message will only contain a single FT1 segment.
   • Send result segments: Select this option to populate DFT HL7 messages with ORC, OBR, and OBX segments.
     • Send any placer order number to this host regardless of the number's origin: Select this checkbox to cause ORC-2 and OBR-2 to be populated with the HostSpecimen.ID field's value if a value is not already found in the HostSpecimen.hostKeyPlacerIDArray for the host.
   • Suppress EVN segment: Select this option to prevent the EVN segment from being in the DFT message. Copia does not currently support this segment.
   • Suppress sending encounter information: Select this option to prevent encounter information from being in the DFT message.
   • Suppress sending insurance information: Select this option to prevent insurance information from being in the DFT message.
   • Send duplicate CPT codes: Select this option to send duplicate CPT codes in a DFT message for an order choice that has the same CPT code assigned to it more than once.
   • Send profile host code instead of individual order choice host codes: Select this option to allow Copia to send the profile host code for a profile to the billing destination rather than the CPT codes for the individual components of the profile.
   • Create billing message at billing event time instead of at the time of sending the message: Select this option to determine and store the billing message at the time of the billing trigger event instead of at the time of the DFT message generation. When this setting is turned on, the billing message will be created and stored at the time of the billing trigger event. When the setting is turned off (previous behavior), the billing message is not created and stored until the time the DFT message is sent out.
3. Select an option from the per Order Choice drop-down list to define DFT message generation. For each order, generate one DFT message ("per Order Choice," "per Sample ID," or "per Order"). This only applies when the billing event trigger is "when order is complete" and if billing messages are not created at billing event time.
4. Click Cancel to return to the Interface Configuration administration page without modifying the DFT event settings, if desired.
5. If your modifications are complete, click OK to record all changes and return to the Interface Configuration administration page. Otherwise, complete the remaining sections, and then click OK.

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Defining CPT Rules

1. Use the CPT Rules section of the page to view, add, or edit the CPT rules for the selected host.
2. Each rule is listed with a Description of the rule and the list of order choices it is a Rule For.
3. Select the Show Active Only checkbox to have Copia show only active CPT code rules.
4. Click the Add CPT Rule button to access the CPT Rule administration page, where you may create the settings for CPT rules. See the Admin: CPT Rule topic.
5. Click the link in the Description column to modify an existing rule in the CPT Rule administration page.
6. To remove a rule from the list, click the X button in the Remove column that corresponds to the rule. If you remove a rule, Copia will no longer evaluate order choices for those conditions when evaluating outbound billing messages.
7. Click Cancel to return to the Interface Configuration administration page without modifying the DFT event settings, if desired.
8. If your modifications are complete, click OK to record all changes and return to the Interface Configuration administration page. Otherwise, complete the remaining sections, and then click OK.

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