RCM Enhancements

Ability to take ACH Payments through Manage EOBs

What’s New

You can now collect ACH payments from patients directly within Billing > Manage EOBs.
A new option — “ACH from Patient” — has been added to the New Remit dropdown, allowing you to securely process bank transfers through Stripe.

• New “ACH from Patient” option in New Remit dropdown

• Integrated Stripe ACH portal for secure bank account entry

• Ability to load or add patient ACH details

• Updated EOB and payment screens to reflect ACH payment details

Why It Matters

This enhancement gives billing teams more flexibility and convenience in collecting payments.
By supporting ACH transfers, you can:

• Offer lower processing fees compared to credit card payments

• Provide patients with an additional, familiar payment method

• Maintain a streamlined payment allocation process (same as card/check payments)

• Keep all transactions secure and compliant through Stripe integration

Who It’s For

• Billing and Payments staff using Manage EOBs

• Facilities integrated with Stripe

• Administrators managing patient payments or refunds

How to Use It

Step 1: Start a New ACH Payment

1. Go to Billing > Manage EOBs

2. From the New Remit dropdown, select ACH from Patient

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Step 2: Enter Payment Details

• A window titled “New ACH Payment from Patient” will appear

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• Enter the payment information, then click Next to Save and Start Allocation

• Note: The billing facility must be set up with Stripe

Step 3: Process Payment

• The Patient Payment window will display Patient ACH Payment Details

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• Click the new Process with New Account button at the bottom to open the Stripe ACH portal

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• Enter the patient’s bank routing and account number

Step 4: Use Saved ACH (Optional)

• If the patient has a saved ACH account, it will load using the LOAD Saved Account button.

Step 5: Allocate and Confirm

• Once payment is processed, the EOB opens for allocation

• Allocate ACH payments the same way as card or check

• Payment details now display with updated labels:

  • Charged by: [Processor Name]

  • Charged on: [Date/Time]

Enhanced Outpatient Billing Based on Level of Care

What’s New

We’ve enhanced Standard OP Automated Billing to support accurate outpatient billing based on Level of Care (LOC) and combined minutes across same-day forms.
Billing now works correctly with or without the Service Type form component.

Key improvements include:

• Summation of minutes from multiple same-day forms tied to the same service

• Unit calculation based on Service Business Rules using the combined total minutes

• Full compatibility with Service Type (previously only worked when Service Type was not present)

• LOC-based allowed services that do not require authorization

Why It Matters

These enhancements ensure:

• More accurate automatic billing for outpatient services

• Correct unit generation even when several forms are completed on the same day

• Elimination of under-billing or missed billing due to split documentation

• Less manual correction, saving time for billing teams

• Consistency between documentation and billing rules configured in the system

The result: cleaner claims, fewer denials, and more reliable revenue capture.

Who It’s For

This improvement benefits:

• Revenue Cycle Management (RCM) teams

• Billing administrators and OP billing specialists

• Clinical teams completing OP service documentation

• Organizations using LOC-based service setup

• Any site using Service Business Rules for unit calculation

How To Use It

To enable and use Standard OP Automated Billing, complete the following setup:

1. Enable OP Billing

Go to:
Manage Realms → Standard OP Automated Billing

2. Configure Allowed Services by Level of Care

Navigate to:
Left Menu → Master Data → Level of Care Services

For each Level of Care:

• Add all services allowed for that LOC

• Authorization is not required

3. Confirm Service Configurations

Ensure the following are fully configured:

• Service Types

• Minutes Table (e.g., thresholds for 15/30/45/60 minutes, etc.)

• Service Business Rules (unit mapping)

• Procedure Codes

4. Document Services Normally

Providers complete forms as usual—whether one form or several:

• If multiple forms for the same service are completed in one day,
  ➜ The system adds all minutes together.

• The combined minutes determine the number of units based on your minutes-to-unit rules.

Example

Case Management – In Person
Procedure code: 1 unit per 15 minutes

Unutilized Authorizations Report: Discharge Type Added

What’s New

The Unutilized Authorizations Report now includes a Discharge Type column. This field is visible directly within Billing → Unutilized Authorizations Report and appears in all standard report outputs.

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Why It Matters

Previously, the report did not show the client’s discharge type, making it difficult to understand why certain authorizations remained unused.
By adding this field, billing and operational teams gain clearer insight into whether unutilized authorizations were tied to specific discharge reasons—reducing manual investigation and improving reporting accuracy.

Who It’s For

• Billing teams reviewing unused or aging authorizations

• Operations and compliance teams analyzing service utilization

• Administrators responsible for audit preparation and financial reporting

How to Use It

1. Go to Billing → Unutilized Authorizations Report.

2. Run the report as usual.

3. Review the new Discharge Type column alongside existing authorization details.

4. Use this data to identify trends, follow up with teams, or reconcile authorizations more efficiently.

ACH Payment Storage

What’s New

We’ve expanded payment capabilities by introducing ACH (bank account) storage and management directly within the Patient Chart. This enhancement allows organizations using Stripe to securely store, manage, and select ACH accounts for patient payments.

Key updates include:

• Manage Realms Update:
  Activation of ACH is now linked to “Service to Billing Facility Link & Secure Card Storage.”

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• Patient Chart Enhancements:
  A new Saved Bank Account/ACH option has been added to the Patient Chart menu.

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• ACH Management Window:
  When selected, a popup displays all saved ACH accounts (Stripe Only), including:

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  • Facility Name

  • ACH Bank Account

  • Last Updated By

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• Stripe ACH Interface Integration:
  Clicking the “+” button opens Stripe’s Save Bank Account/ACH interface.

  • Users can select an existing bank account saved in Patient Engagement or add a new one.

  • Email and full name are required.

  • Users can select from existing bank accounts or set up a new account via Stripe’s interface.

• Confirmation:
  After saving, a “Payment Saved” message appears and the ACH account is listed under Saved ACH.

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Why It Matters

This feature gives billing and administrative teams a faster, more secure, and more compliant method for managing bank-based payments.
It removes manual steps, reduces payment friction, and enables facilities to:

• Save ACH accounts directly during patient interactions

• Improve payment accuracy and reduce processing time

• Streamline workflows with Stripe’s secure and compliant collection process

Who It’s For

• Billing teams needing quick access to stored payment methods

• Front office and intake staff capturing payment details

• Organizations using Stripe for payment processing

• Administrators managing secure payment method storage across facilities

How to Use It

1. Enable ACH in Manage Realms
   Ensure the realm has Service to Billing Facility Link & Secure Card Storage enabled.

2. Open the Patient Chart
   Click the menu button and select Saved Bank Account/ACH.

3. View Saved ACH Accounts
   A popup displays all existing ACH accounts tied to that patient and facility.

4. Add a New ACH Account

   • Click the “+” icon for the desired service facility.

   • The Stripe Save Bank Account/ACH interface opens.

   • Enter required fields (email, full name).

   • Select an existing bank account or add a new one through Stripe’s secure flow.

5. Save the ACH Account

   • Complete the authentication steps.

   • Click Save ACH.

   • A confirmation message (“Payment Saved”) appears, and the new ACH account becomes visible in the list.

EMR Enhancements

Configure Alerts - Lookback Limits

What's New
A new Lookback Period field has been added to Form Alert configuration under Practice Setup → Configure Alerts. This field allows admins to define how far back in time a rule should apply when evaluating patients for alerts.

Why This Matters
Previously, form alerts could trigger retroactively for all historical patients (e.g., patients discharged years ago), leading to alert queue clutter and inefficiencies. This update prevents irrelevant alerts by enforcing a lookback window, enabling more accurate and context-aware rule execution.

Who It's For

• Clinical directors configuring documentation compliance alerts

• Quality, compliance, or operations teams managing form completion metrics

• Realms introducing new forms (e.g., BPS V2) that should only apply moving forward

How it works

Navigate to through Practice Set-Up → Configure Alerts and edit an existing alert or create new. View the configuration and scroll down to see the “Lookback Period” field.

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Setting Lookback Period = 0 means the system evaluates all patients (back to beginning of time) which is current functionality. If Lookback Period = 180 or some other specific value, the rule only considers patients with relevant activity (e.g., discharge, admission, form completion) within the last x days.

The value impacts all alert types, including:

• Since Admission

• Since Discharge

• Since Last Form

• Since Level of Care Change

Alerts will only fire for patients whose events fall within the defined lookback period.

HIE Reporting - New York - PAS-48N

What's New
A new New York State PAS-48N State Report has been added to the Reports → State Reporting section. This report supports New York’s regulatory compliance requirements by aggregating and presenting all data points required for the PAS-48N dataset directly within Sunwave.

Why This Matters
Previously, facilities in New York were forced to manually extract and compile information across forms, services, and assignments to meet state reporting standards. This process was not only time-consuming but also prone to error and compliance risk. With this enhancement, Sunwave enables direct generation, segmentation, and export of the required data for state reporting — including drill-down functionality for transparency and validation.

Who It's For

• Providers operating in New York State

• Compliance officers and billing administrators

• Staff responsible for generating or submitting PAS-48N data to state systems

How It Works

This report requires manual configuration at a form level. For a form to be considered as reportable it must be opted into the reportable set from form builder AND have a new reportable component placed in it.

Standard Forms

1. Navigate through Form Builder and identify the first form to be included in PAS-48N reporting. Check the “Reportable Data Set” to on and select PAS-48N from the drop down option.

   1. Verify that Requires Service Date and Requires Service Duration are checked on

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2. Open the form itself to add a new component “Reporting Type”

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View in the form:

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Be sure to save on exit!

3. Add this form to a Patient Chart and view the categories available for reporting.

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To access and view the report after configuration, navigate through Reporting → Monthly State Reporting

Sample (YTD)

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Clicking a number opens modal showing patient, MRI, service date, and linked form.

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Notes:

• Group Notes are configured in the same way as standard forms, however use V14 as the Reporting Type selection.

• Sunwave segments V13 and V14 by signature placed on the form. Compare the user associated to the signature and the service date of the form and check against the Healthcare Team.

  • Primary

    • Signing user is the assigned Primary Counselor as of the service date on the form

  • Non-Primary

    • Signing user is NOT the assigned Primary Counselor as of the service date on the form but is a Primary Counselor

  • Other Clinical Care Staff

    • Signing user is NOT the assigned Primary Counselor and is not a Primary Counselor.

Ticket Summary