Diagnosis Billing Order Enhancements

Netsmart will be releasing diagnosis code enhancements that were announced back in March in the Production release scheduled for June 8th. As previously reported, some providers have had visits denied by payers due to an invalid primary billing diagnosis. Netsmart will be making additional enhancements to support the billing order (1-4) for ICD-10 codes, as well as any additional diagnosis codes that may need to be submitted for a recipient. The Recipient > Payer Subscription screen will be modified to separate out diagnosis codes as shown in the mockup below.

Open

When this release is implemented, the agencies that use the Mobile Caregiver+ mobile app will be required to set the correct billing order for their recipients since there was not a concept of billing sequence prior to this release. Diagnosis codes without a billing order will be displayed in the Additional Billing Diagnoses field. They will continue to be billed in a random order, which may not be the correct billing order and may require providers to update the ICD-10 codes with the correct bill order. When updating diagnosis codes, users will be prompted to save the changes to all unreleased claims that do not currently have a diagnosis code, so that each visit is not required to be updated.