Table of Contents

Release Highlights

RCM Enhancements

Implement Discharge Date Selection for "Through" Field in UB04 Form

What’s New: A new feature has been added allowing Inpatient Facility Billers to automatically populate the "Through" field in Box 6 of the UB04 form with the discharge date instead of the last service date, which was previously used. This feature streamlines billing processes by accurately reflecting the discharge date, even though Inpatient Services, in most cases, cannot be billed on that specific date.

Why It Matters: This update aligns with certain Insurance Payer requirements to pay the claim, reducing denials and eliminating the need for billers to manually adjust the Through Date, as they have been doing. The feature helps ensure claims are processed accurately and efficiently.

Who It’s For: This feature is specifically designed for Inpatient Facility Billers who utilize the UB04 form for submitting claims to Payers that require the "Through" Date to reflect the discharge date.

How To Use It: To activate this feature:

1. Go to Manage Services > Service Business Rules.

2. Enable the feature flag titled "Use Discharge Date in Box 6".

3. A tooltip will appear providing guidance: "Enable this setting to automatically set Box 6 'Through' date to the patient’s discharge date, when available. If no discharge date is provided, the system defaults to the last date of service on the claim. If this setting is disabled, Box 6 will consistently use the last date of service as the 'Through' date."

4. When enabled, the system will automatically use the discharge date for Box 6, if available. If no discharge date is provided, the last date of service will be used instead.

Testing has confirmed compatibility with the Consolidate Claim Lines flag.

Implement "Exclude Service Date from Claim" Flag in UB04 Service Business Rules for Box 45

What’s New: A new flag titled "Exclude Service Date(s) from Claim" has been introduced in Manage Services > Service Business Rules for UB04 claims. This feature allows billers to exclude service date(s) from the claim lines for specific services, regardless of the settings configured at the insurance provider level.

Why It Matters: This feature empowers billers to configure claims by both service and payer, not just by payer alone. By allowing the exclusion of service dates on a claim line, this enhancement helps reduce claim rejections, ensuring that the configuration meets the precise requirements for each payer and service combination.

Who It’s For: This feature is designed for billers handling claims where specific insurance providers do not require service dates in the claim lines of a UB04 form for certain services.

How To Use It:
To utilize this feature:

1. Go to Manage Services under the UB04 section.

2. Enable the new flag "Exclude Service Date(s) from Claim".

3. A tooltip will appear providing guidance:
   "Select this option to exclude service date(s) from the UB04 claim lines for this service, regardless of the settings configured under Billing > Insurance Providers."

4. When this flag is enabled, the system will exclude service dates from the claim lines for the selected service, regardless of any other configurations in Billing > Insurance Providers.

Note: This flag takes priority over any other service date settings configured in Billing > Insurance Providers for the specific service and insurance combination.

Add Ability to Differentiate Box 74 and 74a on UB04 with Editable Fields

What’s New: A new flag has been introduced under Service Business Rules that enables billers to independently enter different codes for Box 74 and Box 74a on the UB04 form, while keeping the Admission Date fixed in both fields.

Why It Matters: This enhancement allows billers to manage claims more effectively by providing the flexibility to enter two different procedure codes in Box 74 and 74a, a requirement for certain insurance payers. This helps ensure accurate claim submissions and reduces the likelihood of claim rejections due to incorrect coding configurations.

Who It’s For: This feature is designed for billers who handle UB04 claims and need to differentiate between procedure codes in Box 74 and 74a for certain payers. It is particularly useful for billers working with insurers that mandate separate procedure codes in these fields for more accurate claims processing.

How To Use It:

To enable and configure this feature:

1. Navigate to Service Business Rules under the UB04 section.

2. Enable the flag labeled "Enable separate code entry for Box 74a."

3. A tooltip will provide guidance:
   "Check this box to enter different codes for Box 74 and 74a. When unchecked, Box 74 and the sequential boxes (74a–74e) will be auto-filled per your configuration."

4. Once enabled, a second set of fields identical to Box 74 will appear beneath it, allowing you to enter a different code for Box 74a.

5. The date fields for both Box 74 and 74a will automatically populate with the Admission Date. These date fields cannot be edited, ensuring consistency between them.

Add Box 76 Qualifier and Number for UB04 Claims

What’s New: A new feature has been added allowing billers to populate Box 76 of the UB04 form with the appropriate Qualifier and corresponding number tied to the attending provider’s state license or other identifiers. This ensures compliance with provider information requirements for claims submissions.

Why It Matters: This feature enhances claims accuracy by allowing billers to include specific provider identifiers, such as state license numbers or UPIN numbers, in Box 76 of the UB04 form. Ensuring the correct provider information is critical for claim approval and helps reduce the risk of claim denials due to missing or incorrect provider data.

Who It’s For: This feature is designed for billers who need to include provider-specific identifiers, such as state license numbers or commercial numbers, in Box 76 of the UB04 form. It is particularly important for those working with insurers that require this additional information for claims processing.

How To Use It:
To configure and use this feature:

1. Go to Practice Setup > Providers:

   • Add the relevant Qualifier for the attending provider from the dropdown list (options include: 0B - State License Number, 1G - Provider UPIN Number, and G2 - Provider Commercial Number).

   • Enter the corresponding Number tied to the selected qualifier in the free text field.

2. Navigate to Service Business Rules > Manage Services under the UB04 section:

   • Check the "Include Box 76 Qualifier Info" checkbox.

   • A tooltip will provide guidance:
     "Select this option to include the attending provider's qualifier and identification number in Box 76 of the UB04. Ensure that the qualifier and number are set up in Practice Setup > Providers."

3. Once enabled, Box 76 on the UB04 form will be automatically populated with the selected Qualifier and the corresponding number from the provider setup.

Allow Manual Addition of Inpatient Service on Discharge Day

What’s New: A new feature has been introduced, allowing billing administrators to manually add inpatient services on the day of discharge. This functionality provides greater flexibility in billing, ensuring that administrators can easily correct or add charges as needed, even when inpatient services are typically excluded on the discharge day.

Why It Matters: This enhancement helps ensure accurate billing by allowing administrators to manually input services that may have been excluded on discharge day. It prevents missed charges and gives users more control over the billing process for inpatient services.

Who It’s For: This feature is intended for billing administrators who manage census and inpatient services, specifically in cases where manual billing adjustments are required on the patient's discharge day.

How To Use It:

To manually add a service:

1. Navigate to Census.

2. Locate the service date for the patient you wish to bill on the discharge day.

3. Click on the day and select the inpatient service you want to add.

Add line_patient_mri Field to Payments Report API

What’s New: A new field, line_patient_mri, has been added to the Payments Report API. This field will correspond to the MRI of the patient listed in the line_patient_name field, ensuring that patients with matching names can be easily differentiated in the report.

Why It Matters: In cases where multiple patients have the same name, this enhancement provides a clear and accurate way to differentiate between them. By including the MRI number along with the patient name in the report, billing administrators can reduce confusion and ensure that payments are attributed to the correct patient.

Who It’s For: This feature is designed for users who work with the Payments Report API, particularly in scenarios where patients with matching names must be accurately distinguished to ensure correct payment allocation.

How To Use It:
The new line_patient_mri field will automatically appear in the Payments Report API alongside the line_patient_name field. The MRI number in this field will correspond to the patient listed in the line_patient_name field, providing an additional identifier for accurate reporting.

Additionally, the API documentation has been updated to reflect this new field. An example has been corrected to show a proper patient name in the line_patient_name field instead of “10.”

EMR Enhancements

Auto-populate Pre-Admission LoC Start Date with Admission Date for Patient New Admission

What’s New: Sunwave now auto-populates the Pre-Admission LoC start date when creating a new Admission for a client.

Why It Matters: This change helps reduce clicks during re-admission workflow.

Who It’s For: This feature is designed for facility staff who handle patient discharges, transfers and level of care changes without SunwaveCRM.

How to Use It: In a discharged patients chart, click the blue Menu button and select “New Admission”

Assign the Admission Date & Time

Will auto-populate into the Pre-Admission LoC Start Date

CRM Enhancements

Master Census Report - Export as CSV

What’s New: The Master Census Report has been modified to support exporting as a CSV

Why It Matters: Previously, the Master Census Report only exported as an excel file, complete with formatting and merged cells that poses formatting problems for users referencing the file.

Who It’s For: Any Sunwave user who extracts reports.

How to Use It: Navigate through CRM → Master Census report and reference the Download CSV button below the FROM date field.

Ticket Summary Table