Introduction to CareLogic - Ningapi.ning.com/files/...Na3sxWUbSX5oT*Jc7Wv3BBG8oHfyPyfswvi9-r/... · Deleting Shortcuts 32 Searching Client Records 32 Understanding the Status Bar

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Introduction to

CareLogic

Introduction to CareLogic

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Table of Contents

Overview of CareLogic ................................................................................................................................................................... 5

Recommended Settings for Internet Explorer ................................................................................................................................ 5

Configuring Internet Explorer Settings 5

What is CareLogic? ...................................................................................................................................................................... 12

Automatic Session Terminations 16

Understanding Client Statuses ..................................................................................................................................................... 17

Components of CareLogic ............................................................................................................................................................ 19

CareLogic Title Bar 20

Using the Navigation Bar 20 Configuring the Dashboard 21 Set Up User Preferences 26 Changing Your Password 27 Viewing Real-Time Eligibility Transactions 28

Using the Shortcut Bar 29 Adding Shortcuts 30 Selecting Shortcut Options 31 Deleting Shortcuts 32

Searching Client Records 32 Understanding the Status Bar 35 CareLogic Page Area 35

Selecting Dates 36 Required Fields 37 List Fields 38 Sorting Columns 39 Package Information 39

Logging Out of CareLogic ............................................................................................................................................................. 40

Standard User Workflows ............................................................................................................................................................ 41

Admitting Clients 41

Maintaining POE Records 42

Treatment Professional Workflows .............................................................................................................................................. 43

Delivering Services in an Out-Patient Setting 43

Delivering Services in an In-Patient Setting 44

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Delivering Services without Continual Access to CareLogic 44

Maintaining Bed Whiteboards 45

Front Desk/Receptionist Workflows ............................................................................................................................................ 45

Checking In Clients 45

Maintaining Cash Sheets 46

Billing/AR Workflows .................................................................................................................................................................. 47

Processing Claims 47

Billing Payers 48 Accepting Payments 48

Accounting/Finance Workflows ................................................................................................................................................... 49

Prerequisite to Closing an Accounting Period 49 Closing an Accounting Period 51

Adding New Staff Members 52

Maintaining Staff Information 53 Maintaining Employment Information 54

Organization Administration 55

Clinical Administration 55

Billing Administration 56 Human Resources Administration 58


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Standard Process Flows ............................................................................................................................................................... 59

Scheduling Process Flow.............................................................................................................................................................. 61

Billing Process Flow ..................................................................................................................................................................... 63

Accounts Receivable Process Flow ............................................................................................................................................... 64

General Ledger Administration Setup Process Flow...................................................................................................................... 66

General Ledger Export Process Flow ............................................................................................................................................ 69

Payer Staging Process Flow .......................................................................................................................................................... 70

Facility Billing Process Flow ......................................................................................................................................................... 72

Grant Payers Process Flow ........................................................................................................................................................... 74

Further Information and Support ................................................................................................................................................ 76

User Guides 76

Online Help 76 Displaying the Navigation Pane 79

Contacting Technical Support ...................................................................................................................................................... 82

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Overview of CareLogic This guide provides an overview of CareLogic. It is designed for all users of the system. The first chapter explains the recommended settings for Internet Explorer, outlines the benefits of CareLogic, includes a diagram of the CareLogic process flow, the basic features of the system, and instructions for logging in to and out of the system. The second chapter includes a set of standard CareLogic work flows. The third chapter contains a set of standard process flows that support the standard work flows. The fourth chapter describes the CareLogic documentation set and provides information for contacting Technical Support.

This chapter contains the following topics:

• Recommended Settings for Internet Explorer

• What is CareLogic?

• CareLogic Process Flow

• Logging in to CareLogic

• Understanding Client Statuses

• Changing Organizations

• Components of CareLogic

• Logging Out of CareLogic

Recommended Settings for Internet Explorer This section describes recommended settings for all customers who are running CareLogic in Internet Explorer version 7 or 8.

In an effort to improve security, Microsoft has added new functionality to Internet Explorer. While the security enhancements are necessary to protect your network while browsing the Internet, they can impact the performance of a secure Web application, such as CareLogic. Because Qualifacts Systems is a trusted site, it is safe for you to set it to a low security level so the application is free to deliver dynamic content. When you are running CareLogic, you want to ensure that you are receiving the latest content each time you access a page.

Configuring Internet Explorer Settings This task describes the recommended security settings that should be configured for Internet Explorer by all customers who are running CareLogic on Windows XP.

Note: CareLogic has been certified on Windows XP and Vista Operating Systems.

To configure Internet Explorer settings:

1 Open Internet Explorer.

2 Select Tools>Internet Options.

The Internet Options dialog box appears. By default, the General tab is displayed.


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3 In the Browsing History section, click the Settings button.

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The Temporary Internet Files and History Settings dialog box appears.

4 In the Check for new versions of stored pages section, select the Every visit to the page radio button.

5 Click OK.

You return to the General tab of the Internet Options dialog box.

6 Click the Security tab.


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The Security tab is displayed.

7 In the Select a Web content zone to specify its security settings section, highlight the Trusted sites icon.

8 In the Trusted sites section, click the Sites button.

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The Trusted sites dialog box appears. To add a Web site, enter the address (URL) in the Add this Web site to the zone field and then click the Add button.

9 Add the following Web sites to this zone:

• http://*.qualifacts.com

• https://*.qualifacts.com

• http://*.qualifacts.org

• https://*.qualifacts.org

Once you click the Add button, the address is moved to the Web sites section, which indicates it has been successfully added. All four of the Qualifacts Web sites listed above should appear in the Web sites section.

10Click Close.

You return to the Security tab of the Internet Options dialog box.

11In the Security level for this zone section, click the Custom Level button.


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12In the Security Settings - Trusted Sites Zone dialog box appears.

13Find the following settings and ensure they are set to Enable:

• Allow script-initiated windows without size or position constraints

• Automatic prompting for the file downloads

• File download

• Front download

14Find the Enable XSS Filter setting and set the value to Disable.

15In the Reset custom settings section, use the drop-down list in the Reset to field to select Low.

16Click the Reset button.

A warning prompt appears.

17Select Yes to indicate you want to change the settings for this zone.

The settings become effective and the Reset button becomes disabled.

18Click OK.

The security settings are saved.

19If your system is configured to use e-prescription, complete the following tasks.

a Click the Privacy tab.

The Privacy tab is displayed.

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b Click the Sites button.

The Per Site Privacy Actions dialog box appears. To add a Web site, enter the address (URL) in the Address of website field and then click the Allow button.

c Add emdeon.com to this list to allow Emdeon to always access cookies on your browser.

d Add https://*.drfirst.com to this list.


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Note: Once you click the Allow button, the address is moved to the Managed websites section, which indicates it has been successfully added.

e Click OK to save your changes.

20For IE8 users, select Tools>Compatibility View Settings to add CareLogic Web sites to the list of compatibility view sites.

21Add the following Web sites to this compatibility view section:

• http://*.qualifacts.com

• https://*.qualifacts.com

• http://*.qualifacts.org

• https://*.qualifacts.org

Once you click the Add button, the address is moved to the Websites in Compatibility View section, which indicates it has been successfully added. All four of the Qualifacts Web sites listed above should appear in this section.

22Click Close.

The compatibility view settings are saved.

23Close all Internet Explorer windows that are currently open. You do not have to restart your computer. The next time you open Internet Explorer, the security settings will be applied.

What is CareLogic? CareLogic is a Web-based, enterprise-management system specifically designed for behavioral health care service organizations. CareLogic is a complete solution that enables you to capture and integrate all of the critical information you need to run your organization efficiently. CareLogic supports the way organizations operate on a daily basis by integrating key workflow functions, such as Intake, Clinical Record, Case Management, and Enterprise Management.

Using CareLogic, organizations can access and analyze uniform client, payer, and organizational information through an Internet browser. CareLogic links the delivery of care to the business of care at every level of your organization, improving efficiency, increasing revenues, and freeing staff to focus on their work.

CareLogic enables organizations to achieve the following benefits:

• Integrate information management for all core operating functions and service programs onto a single, scalable, and flexible IT platform.

• Increase the capture of revenue through fuller, more accurate, and more efficiently processed client information with real-time, automated billing, auditing, and accounts receivable modules.

• Eliminate the current IT costs associated with purchasing, maintaining, and operating existing hardware, software, and network infrastructure.

• Reduce communication costs associated with remotely connecting facilities and personnel to mission critical applications.

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• Increase back-office efficiency through integration of applications, such as Human Resources, Accounts Receivable, Training, Credentialing, and Electronic QI Audit functions.

• Greater and more streamlined information access for caregivers and managers to improve the coordination and effectiveness of services among all programs.

CareLogic Process Flow The following diagram illustrates the high-level CareLogic process flow. An outline of the process flow is also provided.

1 Intake/Referral. All clients are entered into the system through the Point of Entry module. The following information can be entered for new clients: demographic information, guarantor information, payer information, payer authorizations, and co-pay information.

2 Schedule Services. After gathering client information through the Point of Entry module, you must schedule the client for an intake assessment. Once the intake assessment is complete, the client can be assigned to the appropriate treatment program.

• For out-patient services, the client can be scheduled for an appointment. The process of scheduling an appointment automatically puts the client on a staff member’s caseload.


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• For in-patient or residential services, the client must be assigned to a bed. The process of assigning a client to a bed automatically schedules an appointment and puts the client on a staff member’s caseload.

3 Deliver Services. All treatment information is recorded and maintained in the client’s electronic clinical record (ECR). At a minimum, the following information is included in each client’s ECR: an intake assessment, a diagnosis, a treatment plan, and progress notes.

4 Billing System Checks. The billing system checks are performed by the Claim Engine. Each night when the Claim Engine runs, it attempts to convert activities (services) into claims that can be sent out for billing. When processing activities, the Claim Engine performs two major checks: activity validation and claim validation.

• Activity Validation. If errors are found during activity validation, the activity does not become a claim and the error must be either resolved or overridden before the activity can pass the activity validation. Failed activities are caused by service errors, such as no primary staff credential, service document not found, service document not signed, or missing or incomplete client address information. The Claim Engine moves all activities that fail during the activity validation check into Failed Activities.

• Claim Validation. If errors are found during claim validation, the activity becomes a claim, but it cannot be billed until the error is either resolved or overridden. Failed claims are caused by financial errors, such as no activity/procedure crosswalk, standard fee is less than contracted rate, or no fee matrix setup for procedure, licensure, or payer. The Claim Engine moves all claims that fail during the claim validation check into Failed Claims.

• Claim Approval. If no errors are found during the activity validation and claim validation checks, the activity becomes a claim and is moved into Claim Approval.

5 Approve Claims/Bill for Services. Once a claim passes all of the billing system checks, it must be approved before being sent out for billing. After a claim is approved, it can be billed to the following types of payers.

Public Payers. Public payers, such as counties, states, and the federal government, can be sent bills in any of the following formats: electronic, paper, or proprietary.

Private Payers. Private payers can be sent bills in any of the following formats: electronic, paper, or proprietary.

Self-Pay. Self-pay includes the client or the client guarantor. These bills are sent in paper format as billing statements.

6 Enter/Process Payments. Payments received in paper format must be manually entered into the system. Payments received in electronic format can be uploaded into the system. If the payment amount matches the expected amount (contracted rate), the payment is instantly processed and applied to an open claim. If the payment amount differs from the expected amount, you must make an adjustment to the claim or identify the next action in the billing process.

Make Claim Adjustment. When making claim adjustments, you must select an adjustment transaction reason. Some example adjustment reasons are Adjustment Error, Automatic Adjustment, Automatic Reversal, Back Check Fee, Contractual Co-payment, Deductible Not Satisfied, Insurance Cancelled, Medicaid Write Off, No Authorization, Non-credentialed Staff, and Out of Timely Filing. If desired, your organization can set up a unique general ledger code for each adjustment reason.

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Take Next Action. If the claim contains a balance amount greater than $1.00, you must take one of the following next actions:

Bill Next Payer. If the client has additional payers set up in the system, you can select which payer you want to bill next. The amount on the new claim is the payer’s contracted rate minus the payment received for the initial claim.

Bill Guarantor. If you select this option, the system automatically generates a self-pay claim for the client. The name that appears on the new claim is the name of the guarantor record that is marked as self-pay in the ECR. The new claim is sent to the guarantor record that is marked to receive statement in the ECR.

Rebill Payer. If you select this option, the system automatically generates a new claim by making a copy of the existing claim. The new claim is sent to the same payer.

Leave Open. Select this option if a balance remains on the claim but you do not want to take any action. If you select this option, you are leaving an open balance on the claim.

7 Approve Payments/Export to GL. After the payments are successfully processed, you must manually approve them. Once the payments are approved, you can export the data from CareLogic and import it into your accounting software application. CareLogic allows you to export your general ledger data to a format that is compatible with your accounting software application.

Logging in to CareLogic Note: CareLogic includes a configuration that allows your organization to limit the number of distinct,

concurrent users who are logged into the system at a given time. If your organization is interested in using this configuration, contact a member of Technical Support for assistance.

In order to log in to the system, you must have a valid user account. All user accounts are set up by your system administrator. If you have questions about your user account, contact your system administrator.

To log in to CareLogic:

1 Open your Web browser.

2 Enter the following URL in the Address field: <company designator>.qualifacts.org.

Note: Your specific company designator is defined during implementation. If you do not know your company designator, contact your system administrator. After entering the URL for CareLogic, it is recommended that you add it to the list of Favorites in your Web browser.

The Login page appears.


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Note: The Login ID and Password fields are case sensitive. These fields can consist of characters, numerals, and non-alphanumeric characters, such as !, #, $, and %.

In the Account field, enter your system friendly name. If you are unsure of this field, contact your system administrator.

In the Login field, enter your user account name.

In the Password field, enter the password associated with the user account.

Click Submit in the status bar.

The Dashboard page appears. See Configuring the Dashboard for information about the components of the system.

Note: If you forget your user name or password, contact your system administrator. You are given three attempts to log in to the system. If you fail to successfully log in after three attempts, your user account is disabled for two minutes. After two minutes, you are given three additional attempts to log in to the system. This process continues until you successfully log in to the system.

Note: If your account is not active you will be unable to access CareLogic. Contact your system administrator for assistance.

Automatic Session Terminations Once you have successfully logged in, the system automatically monitors your session for activity. The purpose of this feature is to ensure that unauthorized people do not gain access to the system in the event you leave your session unattended. If your session remains inactive for 15 minutes, the system prompts you to resume the session or be logged out.

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If you respond to the prompt within 60 seconds, your session is resumed. At this point, the system check is reset and your session is monitored again for a period of inactivity.

If you do not respond to the prompt within 60 seconds, your session is terminated and any unsubmitted data is not saved. Once your session terminates, you are taken back to the Login page.

Important: From the system’s perspective, inactivity is when you are not interacting with the database (for example, accessing a menu link or submitting a form). If you are simply entering text in a form without submitting the data, the system considers this inactivity. If you spend 15 minutes on a page without submitting data, the logout prompt appears.

Automatic Session Terminations with Emdeon’s Clinician Note: If the E-Pharmacy/E-Lab configuration is enabled for your organization, you should be aware of the

termination logic used for CareLogic and Emdeon’s Clinician.

If your organization is using the E-Pharmacy/E-Lab configuration, then the following logic is used for session terminations.

If the Emdeon Clinician session times out during a CareLogic instance, then the Emdeon session will close but the CareLogic session will remain open.

If the CareLogic session times out while an Emdeon Clinician session is open, then both sessions will close.

Understanding Client Statuses In order to check a client’s status, you must access the client’s Face Sheet through the ECR. For every client in the system, CareLogic uses one of the following statuses: Referral, Active, TSO (Telephone Service Only), Un-enrolled (only when using Un-enrolled configuration), and Discharged. Each of these statuses is triggered by certain user actions, as shown in the following chart. This chart also shows where to manage the client’s record based on the status, and when and how the program start date is set. The Comments column contains additional information about the client status.

Action in CareLogic Client Status (Face Sheet)

Where to Manage

Program Start Date Comments

POE is Started Referral Incomplete POE

N/A No program record exists in Program History.

Intake Appointment is Scheduled

Active ECR Not Set Program record exists in Program History, but the start date is not set.

Intake Appointment is Cancelled

Referral Incomplete POE

N/A Program record is removed from Program History.


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Intake Appointment is Kept

Active ECR Set to Service Date of Intake Appointment

The program start date is set once intake appointment is Kept.

Client is Directly Assigned to Caseload

Active ECR Set to Admission Date

Admission date is the date the POE record was created.

POE is Terminated TSO N/A N/A New POE record will appear as a duplicate.

Client receiving services at your agency but not an active client

Un-enrolled ECR N/A To move the client from Un-enrolled to Active status, the client must be discharged and readmitted with an Active status.

Client is Discharged from all Programs

Discharged N/A N/A New POE record will appear as a duplicate.

Changing Organizations Each time you log into CareLogic, you log into the primary organization that is set up in your Employment History record (see page 51 the Human Resources Guide). If your primary organization has child organizations, or if additional organizations have been defined for you in the Employment History module, you can use this task to log into these organizations. Once you are logged into the system, you can change organizations at any time.

To change organizations:

1 Log in to the system (see Logging in to CareLogic).

The right side of the Title Bar lists your user name and the organization you are currently logged into. The organization name is a hyperlink that enables you to change organizations.

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2 Click the hyperlink on the organization name.

The Change Organization page appears. The Current Organization field lists the organization you are currently logged into.

3 Use the drop-down list in the New Organization field to select the organization you want to log into. This drop-down list, which is sorted alphabetically, includes all of the child organizations to your primary organization and all of the additional organizations you have been given permission to log into through the Employment History module (see page 51 the Human Resources Guide).

Note: If your primary organization does not have child organizations and if you have not been given permission to log into additional organizations, this drop-down list will be empty, which means you cannot log into a different organization.

4 Click Submit in the status bar.

The browser window is refreshed and you are automatically logged into the new organization. To confirm a successful login, check the organization name that is listed in the Title Bar. It should display the organization name you selected in Step 3.

Components of CareLogic CareLogic consists of several dynamic components. Although these components are always present, they are referred to as dynamic because the information they contain varies depending on where you are in the system. As shown below, CareLogic contains the following components:

CareLogic Title Bar

Using the Navigation Bar


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Using the Shortcut Bar

Understanding the Status Bar

CareLogic Page Area

CareLogic Title Bar The title bar, which is located at the top of the CareLogic application, contains the following information.

Database and Time Zone. The left side of the title bar lists your organization’s short name followed by the database you are logged into, and the time zone defined for your organization.

User Login and Organization. The right side of the title bar lists the login name of the current user who opened the session and the full name of the organization they logged into. The Organization name is a hyperlink that can be clicked to change organizations. See Changing Organizations for more information.

Client/Staff. When a clinical record or staff record is selected, the middle of the title bar displays the client’s or staff member’s name and ID number. In the following example, the client John Galt is selected. Because an allergy record has been setup for this client, the Allergy link appears in red text beside the client’s name. This provides a visual clue that the client has allergies. When you click the Allergies link, a pop-up window appears which displays the type of allergy, a description, and any related comments

Using the Navigation Bar The navigation bar is used to access the menu systems that exist in the system. When you click a button in the navigation bar, the corresponding menu system is loaded. For example, if you click the Schedule

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button, the Schedule menu system is loaded and can be accessed by clicking the Show Menu link in the shortcut bar (see Using the Shortcut Bar). The following menu systems are available: Schedule, Front Desk, Point of Entry, Client, Employee, Billing/AR, and Administration.

Note: The menu systems available to each user is based on the privilege level associated with the user account. Depending on your privilege level, you may not see all of the available menu systems.

The right side of the navigation bar contains five icons. These icons are used to perform the following tasks:

Configuring the Dashboard

Set Up User Preferences

Changing Your Password

Viewing Real-Time Eligibility Transactions

Accessing Online Help

Logging Out of CareLogic

Configuring the Dashboard The following standard modules can be displayed on the Dashboard page: Alerts, Claim Engine Information, Recent Payments, System Messages, Upcoming Appointments, and Clinician (for e-prescription users). With the exception of the System Messages module, you can specify which module appear on your Dashboard page.

Important: Some of the dashboard charts require the latest version of Flash to be installed on your machine. If you do not have Flash 10 or above, an error message displays on that chart and instructs you to download the latest version of Flash.

There are also various graphical charts that provide you a visual representation of operational and financial data in your system. It is best practice to create multiple dashboards to house your various dashboard modules because these graphs and charts are dynamically generated each time the dashboard is loaded to provide you the most up-to-date data. Because of this dynamic generation of content, trying to load one, single dashboard with all modules may slow down your page when loading.

Note: Dashboard charts are set at 320x468 resolution for optimized, on-screen viewing.

The following graphs and charts are available for display on your Dashboard:

Operational Modules:

Consumers Seen vs. Scheduled

Last Seen (Active Clients)

No Shows by Activity

Schedule Summary

Program Capacity


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Average Signature Time (My Staff)

My Avg Signature Time

Financial Modules:

Adjustments by Type

Revenue by Month

Cash Collections

Payer Mix

To view the Dashboard:

1 Click the Dashboard icon in the navigation bar.

The Dashboard page appears for the current user.

Note: If it is your first time logging in and configuring your Dashboard, your Dashboard view is blank, and you must create a dashboard and add modules to configure your view.

Below is a description of each module that can be displayed on your Dashboard.

Adjustments by Type. This module provides a pie chart view of all adjustments for the current month and breaks them down by the entered adjustment types.

Alerts. This module lists all of the system-generated, informational alerts for the current user. These alerts are generated when you need to review something, such as the employee record of a new staff member who reports to you. Once the alert is reviewed, you can remove it from the Dashboard.

Avg Signature Time (My Staff). This module provides a bar chart of the 5 staff members for whom you are set up as a clinical supervisor who have the highest average time to sign documents. Average time to sign document is calculated from the day the document was created until the first signature is completed. For documents requiring additional signatures, the time is calculated from the time of the first signature until the second signature is complete.

Cash Collections. This module provides a bar chart view of the total amount of collections for the last 12 months. The chart also breaks down the amounts into Applied, Unapplied, and Unposted.

Claim Engine Information. This module lists information about the last Claim Engine run, such as the number of activities processed, the number of activities that failed, the number of claims that failed, and the number of activities that were successfully processed and are awaiting approval.

Consumers Seen vs. Scheduled. This module provides a parallel line graph view of the total number of client appointments that have been scheduled vs. the appointments that have been statused as Kept.

Last Seen (Active Clients). This module provides a pie chart view of the total number of clients who have been seen at your organization for the following intervals: 0-30 days, 31-60 days, 61-90 days, and 90+ days.

My Avg Signature Time. This module provides a bar chart that shows the average number of days it takes you to sign documents. Average time to sign document is calculated from the day the document was created until the first signature is completed. For documents requiring additional signatures, the time is calculated from the time of the first signature until the second signature is complete.

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No Shows by Activity. This modules provides a pie chart view of all scheduled appointments that have been statused as DNS in the past 90 days and breaks them down by activities into percentages.

Payer Mix. This module provides a pie chart of the total percentages of payer types for the current month. For example, the chart would display all Medicaid, Commercial, and Self-Pay payments collected during the current month.

Performance Target. This module is used in conjunction with the Performance Targets module to display and track staff productivity based upon the total number of hours of services they are targeted to provided based on a certain date range in a line graph format (see the Human Resources Guide).

Program Capacity. This module is used to provide a bar chart view of the program capacity for all programs where the configuration is turned on to limit the number of clients admitted to a specific program.

Recent Payments/Last Deposits Entered. This module lists the last 10 payments entered by the current user. For each payment, this module lists the entry date, deposit ID, deposit amount, the amount of unposted payments, the amount of unapplied payments, the amount of applied payments, and refunded amounts. If desired, you can access the details about the payment by clicking the Select button. Once the payments are completely applied and approved, they are removed from the Dashboard.

Revenue by Month. This module provides a bar chart view of total billed amounts for the last 12 months.

Schedule Summary. This modules provides a pie chart view of the total number of scheduled appointments in CareLogic. The scheduled appointments are broken down into Kept, None, and Other. You can click the Other sliver of the pie chart to see the other values and a breakdown of the number of other status values.

Note: Errored and Reversed activities are not included.

System Messages. This module lists all of the system messages that were set up through Administration (see page 261 the System Administration Guide).

Upcoming Appointments. This module lists all of the appointments you have scheduled for today. For each appointment, this module lists the appointment time, the name of the client or group, and the activity associated with the service.

Note: If your organization is using the E-Pharmacy/E-Lab configuration, the Clinician module is displayed on the Dashboard, with the link, ‘Today’s Status’. By clicking this link, you can view statistics about medication orders, reports, and the medication order statuses.


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Configuring your Dashboard Note: The default settings for the Dashboard are configured in the Dashboard Administration module

(see page 259 the System Administration Guide). If you want to override the default settings, you can do so by using the instructions in this task.

This task includes instructions for configuring the optional modules on the Dashboard page.

To configure the Dashboard:

1 Access the Dashboard page.

2 Click Configure On in the button bar.

The Dashboard page changes to configure mode. This mode allows you to change the order in which the modules appear on the page. In the top right corner of each module, the following direction links appear: Left, Up, Down, and Right. Depending on the current position of the module, only certain direction links are available. All available direction links are highlighted. For example, in the following example, the Alerts module can be moved either Down or to the Right.

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Note: If you are configuring your Dashboard for the first time, this page is blank until you have added your Dashboard and Modules.

3 Use the direction links to move the modules to the desired location.

4 Click Add Dashboard in the status bar.

The Add Dashboard page appears.

5 In the Name field, enter the name of your Dashboard.

Note: Best practice is to create a Default dashboard for the standard modules listed above and Operations and Financial dashboards for the graphs and chart modules.

6 In the Mark as default Dashboard? field, indicate if this is the Dashboard you want to appear first every time you access your dashboard.


The Dashboard Configuration mode page appears.

8 Click Add Module in the status bar to add modules to your currently selected dashboard.

The Add Dashboard Modules page appears, which lists all of the optional and mandatory modules that can be displayed on the Dashboard page. By default, all of the modules are displayed.


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9 In the Category drop-down field, select the category of the module you wish to add to your dashboard. Your selection here filters the options available in the Module drop-down.

10In the Module drop-down field, select the module you wish to include on the currently selected dashboard.

11The Preview column gives a description of the dashboard module and provides an image that depicts how the graphical dashboards appear on your dashboard.

12Click Save in the Save/Edit column to add the module to your dashboard.

Note: Once saved, you have the option to Edit or Remove the select module from the dashboard.

13Repeat Steps 9 and 12 until all modules you want included on this dashboard have been added.

14Click Return in the status bar.

The configurations are saved and the Dashboard page appears in configure mode. Click Configure Off in the button bar to return to the Dashboard page.

Set Up User Preferences CareLogic allows each user to define certain configurations that are specific to that user’s session. This task includes instructions for setting user configurations.

To set up user preferences:

1 Click the User Preferences icon in the navigation bar.

The User Configurations page appears for the selected user. This page is divided into four sections: Global, Payment, Point of Entry, and Schedule. Each section contains at least one sub-section.

2 In the Global section, you can change any of the following user preferences.

a The Color Scheme option is used to define the color scheme associated with your CareLogic session. The following options are available: Blue (which is the default), Burgundy, Green, and Silver.

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Note: After selecting a color scheme, you must refresh your Browser window in order for the setting to become effective.

3 In the Payment section, you can change the following user preference.

a The Number of Payment Entry Lines option allows you to define the number of payment entry lines that appear on the Entry tab of the Payment Entry module. By default, this number is set to 5. The maximum number of payment lines you can enter is 50.

4 In the Point of Entry section, you can change the following user preference.

a The Maximum Open Times option allows you to define the maximum number of intake times to show per page when attempting to schedule an intake assessment through the Point of Entry. By default, this number is set to 25. The maximum number of open intake times to show is 100.

5 In the Schedule section, you can change any of the following user preferences.

a The Schedule Batch Lines option allows you to define the number of data entry lines on the Batch Activity Entry form. By default, this number is set to 10.

b The Schedule Filter Default: CBC option allows you to specify if you want activities with the status CBC (cancelled by client) to appear on the Schedule. By default, CBC activities are shown on the Schedule.

c The Schedule Filter Default: CBT option allows you to specify if you want activities with the status CBT (cancelled by therapist) to appear on the Schedule. By default, CBT activities are shown on the Schedule.

d The Schedule Filter Default: Co-Staff option allows two staff members to schedule and keep the same service. By default, Co-Staff activities are shown on the Schedule.

e The Schedule Filter Default: DNS option allows you to specify if you want activities with the status DNS (did not show) to appear on the Schedule. By default, DNS activities are shown on the Schedule.

f The Schedule Filter Default: Error option allows you to specify if you want activities with an error status to appear on the Schedule. By default, Error activities are shown on the Schedule.

g The Schedule Filter Default: Kept option allows you to specify if you want activities with a status of Kept to appear on the Schedule. By default, Kept activities are shown on the Schedule.

h The Schedule Filter Default: No Status option allows you to specify if you want activities with no status to appear on the Schedule. By default, activities with no status are shown on the Schedule.

i The Schedule Time Increment option allows you to define the length of activities on the Schedule. By default, the length of activities is set to 30 minutes. You can use the drop-down list to select any of the following options: 5, 10, 15, 20, 25, 30, 45, 60, 75, and 90.

j The Show Client Names option allows you to specify whether the Schedule shows client names or just the client ID. Default status is Yes, which shows client names. Selecting an option other than default will override the organization configuration.


The user preferences are saved. The next time you log in to the system, the user preferences will be applied.

Changing Your Password This task is used to change your password and electronic signature. All passwords and electronic signatures must conform to the password rules defined by your system administrator.


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To change your password:

1 Click the Change Password icon on the navigation bar.

The Change Password/Electronic Signature page appears for the selected user.

2 In the Change Password section, enter the following information.

a In the Existing Password field, enter your current password.

b In the New Password field, enter a new password.

c To confirm the new password, you must re-enter it in the Confirm New Password field.

3 Electronic signatures provide a second level of security for authenticating users in the system. Typically, electronic signatures are used in the clinical system to lock completed documents. In the Change Electronic Signature section, enter the following information.

a In the Existing Signature field, enter your current electronic signature.

Note: The Existing Signature field is used only when you are changing an electronic signature. If you are creating an electronic signature for the first time, ignore the Existing Signature field.

b In the New Signature field, enter a new electronic signature.

c To confirm the electronic signature, you must re-enter it in the Confirm New Signature field.


The password and electronic signature are saved for your user account.

Viewing Real-Time Eligibility Transactions If your system is set up to use real-time eligibility, an additional navigation icon appears in the Navigation Bar to allow you to view all real-time eligibility checks as they are processed. This task includes instructions for viewing current real-time eligibility checks.

To view real-time eligibility transactions:

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1 Click the Transfers icon in the navigation bar.

The Active Transfers pop-up window appears, displaying all current Real-Time Eligibility transactions in process or completed.

The 5 possible real-time eligibility transaction types you can potentially see in this list are described below:

Green checkmark. This icon indicates that Emdeon returned a client eligibility status. Click the client name to access the client’s Eligibility Status list page to see the most eligibility check results (see the Clinical Record Guide for more information).

Red X. This icon indicates the client is not eligible for services through the payer plan submitted for a real-time eligibility check. Click the client name to access the client’s Eligibility Status list page to see the most eligibility check results (see the Clinical Record Guide for more information).

Red Exclamation Point. This icon indicates there is an Emdeon or CareLogic setup error. Click the client name to view the error popup.

Important: Be sure to record the Error Code from the pop-up to inquire about the issue.

Blue Transmission Signal. This icon indicates the real-transaction is currently in transmission.

Yellow Hazard Sign. This icon indicates an error was returned in the eligibility response.

Check/Cancel Buttons. These buttons indicate that the selected client’s eligibility has been checked in the past 30 days.

Important: Before resubmitting the real-time eligibility transaction, first access the client’s Eligibility Status list page to see the client’s most recent eligibility check results. If needed, click the Check button to submit a new eligibility transaction request. Click the Cancel button if the most recent eligibility check from the client’s Eligibility Status list page was recent enough to not require a new submission (see the Clinical Record Guide for more information).

Using the Shortcut Bar The shortcut bar is designed to provide faster access to the menu items you use most often. The options on the shortcut bar are specific to the menu system selected. The shortcut bar is completely


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customizable, which means you can specify which menu items appear on the shortcut bar, and in what order, for each menu system.

The shortcut bar allows you to perform the following tasks:

Adding Shortcuts

Rearranging Shortcut Options

Selecting Shortcut Options

Deleting Shortcuts

Searching Client Records

Selecting Menu Options

Adding Shortcuts For each CareLogic menu system, you can add the most often used menu items to the shortcut bar. In the following task, a shortcut is added to the Schedule menu system. The process of adding a shortcut is the same regardless of the menu system in which you are adding it.

To add shortcuts:

1 Access the menu system you want to add a shortcut to.

Note: As shown in the example, the shortcut bar for the Schedule menu system contains four menu items.

2 Click the Show Menu arrow on the right of the shortcut bar.

The menu items appear in the drop-down list for the selected menu system. In the example, the menu items appear for the Schedule menu system.

3 Click the menu item you want to add to the shortcut bar, and drag and drop it on the shortcut bar.

Note: Menu items cannot be dropped on top of existing shortcuts. Menu items must be dropped in between existing shortcuts, at the beginning of the first shortcut, or at the end of the last shortcut. When your cursor is in one of these positions, the target area turns red, and a plus sign appears at the end of your cursor, which indicates the menu item can be added to that position on the shortcut bar.

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The selected menu item is copied to the shortcut bar. At this point, the menu item is available on the shortcut bar and in the drop-down list for the selected menu system. In the following example, the Batch Activity Entry menu item was added to the shortcut bar.

4 Click Hide Menu arrow.

The menu items for the selected menu system are hidden.

Note: Repeat this task for each menu system until you have customized CareLogic to display all of the desired shortcuts.

Rearranging Shortcut Options After adding the menu items you use most often to the shortcut bar, you can use this task to rearrange them in the order you prefer.

To rearrange shortcut options:

1 Access the menu system that contains the shortcut options you want to rearrange.

Note: In this example, the shortcut options in the Schedule menu system will be rearranged.

2 Click the shortcut option you want to move, and drag and drop it in the desired location on the shortcut bar.

Note: Menu items cannot be dropped on top of existing shortcuts. Menu items must be dropped in between existing shortcuts at the beginning of the first shortcut, or at the end of the last shortcut. When your cursor is in one of these positions, the target area turns red, and a plus sign appears at the end of your cursor, which indicates the menu option can be added to that position of the shortcut bar.

In the following example, the Batch Activity Entry item was moved to the third position on the shortcut bar.

Note: Repeat this task for each menu system until you have arranged the shortcuts in the order you prefer.

Selecting Shortcut Options After adding menu items to the shortcut bar and arranging them in your desired order, you can use this task to select items on the shortcut bar.


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To select shortcut options:

1 Access the desired menu system.

In the following example, the Schedule menu system is displayed with four options on the shortcut bar.

2 Click the item on the shortcut bar you want to access.

The corresponding page appears. For example, if you click the New Client Activity shortcut, the Schedule a Client Activity page appears.

Deleting Shortcuts Once a menu item is added to the shortcut bar, you must use this task to delete it.

To delete shortcuts:

1 Access the menu system that contains the shortcut you want to delete.

Note: In this example, a shortcut will be deleted in the Schedule menu system.

2 Click the shortcut you want to delete, and drag and drop it on the trash can icon.

Note: When your cursor is over the trash can icon, the trash can icon is highlighted in red, and a plus sign is displayed at the end of your cursor, which indicates the shortcut can be deleted.

The shortcut option is instantly removed from the shortcut bar.

Note: Repeat this task for each menu system until you have customized CareLogic to display only the shortcut options you use most often.

Searching Client Records Note: This task is used to access clinical records by using the Client Search feature. If you want to access a

clinical record by using the Client Search module, see page 8 the Clinical Record Guide.

The Client Search feature is used to access both clients who have been admitted to programs (active clients) and clients who have not been admitted to programs (inactive clients). This search feature allows you to access the clinical records of the clients in your current organization branch (this includes the clients in your current organization as well as the clients in organizations above and below your current organization). The Client Search feature does not include the clients that are in different organization branches. Once the Client Search results page appears, you can access a client’s clinical record, view a client’s schedule, and view basic information about a client.

The Client Search field uses a soundex search feature, which means you do not have to know the exact spelling of a client’s name in order to access the clinical record. The soundex feature allows you to search for a client based on the way in which the name is pronounced. When you initiate a search, the system

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returns all literal matches and all phonetic matches (those with similar pronunciations). For example, if you search for Jo Cambel, the search will locate the client Joe Campbell.

To search client records:

1 In the Client Search field, enter the client’s full or partial name, client ID number, social security number, or date of birth. Depending on the search criteria you enter, your entry must be in one of the following formats:

The client name must be in one of the following formats.

Full or partial first, middle, maiden, or last name.

A combination of a full or partial first, middle, maiden, or last name (for example, d thompson).

Note: If you enter a name combination in any other order (for example, last name followed by first name), the system will not locate the requested clinical record.

The full client ID number must be entered.

The full social security number must be entered in the following format: 999-99-9999. Dashes are the only separators allowed in the social security number.

The full date of birth must be entered in the following format: mm/dd/yyyy. Forward slashes are the only separators allowed for date entries.

In the following example, the partial name ‘da’ is entered. The system will locate all clients with either a first name, middle name, maiden name, or last name that begins with ‘da’.

2 Press Enter.

The Client Search Results page appears, which lists all of the clinical records that match your search criteria. The client search feature searches for matches in your current organization, as well as the organizations above and below your current organization. In the example, the search criteria matched three clients (the last names Davidson and Davis, and the first name David).

Note: CareLogic offers you the ability to update and track client name information. If a client who appears in your search results has had a name change recorded in the system, you will see an asterisk next to the client name, notifying you that if you hover over the client name, a dialog box will appear and display the name history for the client.

Note: CareLogic offers you the ability to update and track client name information. If a client who appears in your search results has had a name change recorded in the system, you will see an asterisk next to the client name, notifying you that if you hover over the client name, a dialog box will appear and display the name history for the client.


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This page contains the following buttons.

ECR. Click this button to access the client’s clinical record. When you click this button, the Client Demographics page appears in the ECR. See page 20 the Clinical Record Guide for more information.

Episodes. Click this button to access the selected client’s episodes of care list and view information about the client’s episodes of care such as episode type, admission date and program, and discharge date.

Schedule. Click this button to view a client’s schedule. See page 11 the Scheduling Guide for more information.

Info. Click this button to access basic information about the client without entering the ECR menu system. This button allows you to verify you have selected the desired client before entering the ECR.

Note: In various parts of the system, such as the Schedule a Client Activity page, the Failed Activity Search page, and the Failed Claims Search pages, a Client search field exists, as shown below. This field contains a text entry field followed by a drop-down list. The text entry field adheres to the same search constraints as the Client Search field described in Step 2. After entering your search criteria in the text entry field, press the Tab key or click off of the field to filter the drop-down list and then select the desired client.

Selecting Menu Options This task includes instructions for displaying the menu items for the selected menu system.

To select menu options:

1 Access the menu system for which you want to display the menu items.

In the following example, the Schedule menu system is displayed.

2 Click the Show Menu arrow on the right of the shortcut bar.

The menu items appear for the selected menu system. In the example, the menu items appear for the Schedule menu system.

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3 Click the option you want to select.

The corresponding page appears. For example, if you select the New Client Activity option, the Schedule a Client Activity page appears.

4 Click Hide Menu.

The menu items for the selected menu system are hidden.

Understanding the Status Bar As shown in the following example, the status bar contains two types of information:

System Messages. Where applicable, system messages and warnings appear on the left side of the status bar. In the following example, the Front Desk Schedule is displaying a system message.

Buttons. The buttons on the status bar are used in conjunction with the page that is displayed. In the following example, the Front Desk page contains three buttons: Submit, Reset, and Print as Report.

Note: The Submit and Reset buttons are common buttons that are used throughout the system. The Submit button is used to save the data on the page or to initiate a search. The Reset button is used to refresh the page back to its default settings.

CareLogic Page Area


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Depending on the menu item (see Selecting Menu Options) or shortcut (see Selecting Shortcut Options) selected, the corresponding page is displayed. In the following example, the POE Wizard menu item is selected in the Point of Entry menu system and the Client Name Information page is displayed. The following features are common to the page area throughout the system.

Selecting Dates

Required Fields

List Fields

Sorting Columns

Package Information, see page 46.

Selecting Dates In every date field throughout the system, you can either manually enter a date or click the Calendar icon to select a date. All date entries must be in the following format: mm/dd/yyyy.

To select a date:

1 Access a page that contains a date field.

2 Click the Calendar icon.

The popup Calendar page appears. By default, the current month and year are displayed with the current date selected.

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3 Navigate to the desired month and year by using one of the following buttons.

Previous Year. Click this button to access the selected month for the previous year. For example, if you are viewing January 2005 and you click this button, the Calendar displays January 2004.

Previous Month. Click this button to access the previous month. For example, if you are viewing January 2005 and you click this button, the Calendar displays December 2004.

Next Year. Click this button to access the next month. For example, if you are viewing January 2005 and you click this button, the Calendar displays February 2005.

Next Month. Click this button to access the selected month for the next year. For example, if you are viewing January 2005 and you click this button, the Calendar displays January 2006.

4 After accessing the desired month and year, click the desired date to select it.

When you select a date, the Calendar popup page closes and the selected date is listed in the date field (in the correct format: mm/dd/yyyy).

Tip: Once a date is selected, you can use the Up and Down arrow keys on your keyboard to change the date. Each time you press the Up arrow key, the date increases by one day. Each time you press the Down arrow key, the date decreases by one day.

Required Fields Required fields appear on various pages throughout the system. In order to complete a page with required fields, you must make an entry in all of the required fields. If you omit a required field, the system prompts you to complete it after you click Submit in the status bar.

Required fields are identified by a highlight in the user entry field. In the following example, the Schedule a Client Activity page contains the following required fields: Service Date, Time From, Time To, Staff, Client, Client Program, Activity, Location, and Contact Location. The Description field (Show on Front Desk) is not a required field.


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List Fields Note: List fields are recognizable to system administrators only. If you have administrative rights, you will

see a bold D at the end of list fields, as shown in the Benefit Type field in the example below. If you do not have administrative rights, then you will not see a bold D at the end of list fields, which means you will not be able to distinguish list fields from other drop-down and check box fields in the system.

While most list fields contain drop-down lists, they can also include fields with check boxes. A system administrator can add, update, and delete the options that appear in the drop-down lists of list fields. When you hover over the bold D, the descriptor name is displayed. The descriptor is the name by which the field is identified in the List Modifier module. See the System Administration Guide for instructions about setting up the List Modifier.

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Sorting Columns In various parts of the system, information is displayed in a list with column headings. In most cases, you can change the sort order of the data by clicking a column heading. In the following example, the Activity Codes page is shown. By default, the information on this page is sorted by activity code name.

To change the sort order of a list, click the column heading name that you want to sort the list by. For example, if you want to sort the activity codes list by type, click the Type column heading. When you click Type column heading, the Type column is highlighted and the list is resorted by type, as shown in the following example. If you want to reverse the sort, click the column heading again.

Package Information Note: The package information is visible to system administrators only. If you do not have administrative

rights, then the package information described in this section is not visible to you.

In the lower right corner of every page in the system, package information is listed. This information includes the package name and version number of the package. In the following example, the Client Name Information page is shown. As indicated in the lower right corner of the page, this page is created by the intake_wizard$ package, version 5.1.x.


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Logging Out of CareLogic Important: It is recommended that you follow the instructions in this task to logout of the system. By

following this task, you will properly close your current session. If you close the browser window without following the steps in this task, your session remains open and your session data remains in the database.

This task is used to logout of the system. It is recommended that you follow this task each time you end a session.

To log out of CareLogic

1 Click the Log Out icon on the navigation bar.

A confirmation prompt appears.

2 Click OK to confirm you want to log out of the system.

Your current session is closed and the CareLogic Login page appears. At this point, you can close your Browser window.

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Standard User Workflows Behavioral healthcare treatment facilities consist of a diverse set of user workflows (employee roles). This chapter provides a set of standard user workflows that will help your organization obtain the maximum value from CareLogic. By reviewing these user workflows, you can determine the best way to incorporate CareLogic into your normal business environment.

This chapter contains workflows for the following user types:

• Point of Entry/Intake Workflows

• Treatment Professional Workflows

• Front Desk/Receptionist Workflows

• Billing/AR Workflows

• Accounting/Finance Workflows

• Human Resources Workflows

• System Administrator Workflows

Point of Entry/Intake Workflows Note: Point of Entry is a general term that encompasses, but is not limited to, the following types of staff

members: Intake, Referral, Pre-Admissions, Central Access, Access, and Inquiry.

The POE staff is responsible for admitting new clients into the system. This process involves collecting basic information about the client, such as demographic information, guarantor information, payer information, payer authorizations, and co-payment information. The final step of the POE Wizard is to schedule an intake assessment.

In addition to the user workflows defined in this guide, the Point of Entry Guide includes detailed instructions for performing POE tasks.

CareLogic supports the following standard workflows for the Point of Entry/Intake staff:

• Admitting Clients

• Maintaining POE Records

Admitting Clients In order to admit new clients into the system, the POE staff must use the POE Wizard. This wizard is used to collect demographic and financial information about the client.

The following workflow is recommended for admitting clients:

1 Client Search. When entering a new client, the first step is to perform a client search. The purpose of the client search is to ensure that the client does not already exist in the system.


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Tip: When searching by client name, you can enter partial first and last names. In some cases, this will increase the chances of finding existing client records. For example, if you enter John Smith, the system will only return client records that were entered as John Smith. However, if the client was previously entered into the system as Jonathan Smith, the system would not find the record. In this scenario, it is recommended that you change the search criteria to J Smith.

2 Demographic Information. This module allows you enter general information about the client, such as full name, date of birth, Social Security number, physical and mailing address, and telephone numbers.

3 Client Guarantors. A guarantor is the person who is listed as the policy subscriber on the insurance plan that covers the client. By default, every client in the system is automatically set up as his own guarantor. In some cases, additional guarantor records must be created for the client’s spouse, parent, or guardian. The guarantor is responsible for paying the portion of the bill that is not covered by the payer plan.

4 Client Payers. The client’s insurance provider is known as a payer. In addition to setting up the name of the payer, you must also set up information about the payer plan, which is the particular benefit plan that covers the client.

5 Payer Authorizations. Some payer plans require an authorization before services can be provided to clients. If a payer plan requires an authorization, the Claim Engine runs a check to confirm that an authorization number exists before the claim is created. If the authorization number is missing, a Claim Engine error occurs.

6 Client Co-Pays. If the client’s payer plan requires a co-pay amount, it can be based on either a fixed dollar amount or a percentage of the bill.

7 Schedule Intake Appointment. The final step of the POE Wizard is to schedule the client for an intake assessment. Once the intake assessment is complete, the client is enrolled into a treatment plan, which assigns the client to a staff member’s caseload. In-patient treatment facilities can assign clients to beds through the Bed History module in the ECR after they complete the intake assessment.

Note: When clients come to in-patient treatment facilities in need of emergency care, they can be assigned directly to a bed through the POE Wizard. Once they are in bed, they can be scheduled for an intake assessment and assigned to the appropriate treatment program.

Maintaining POE Records Once POE records are created, the POE staff must maintain them by reviewing the scheduled appointments and completing incomplete records.

The following workflow is recommended for maintaining POE records:

1 Schedule POE Records. On a periodic basis, the POE staff should review the scheduled appointments to verify the appointment status. If an appointment is scheduled in the past and the status has not been marked, the POE staff must check with the appropriate staff member before canceling the appointment.

2 Incomplete POE Records. Incomplete POE records have been started through the POE Wizard but the clients have not been scheduled for an intake assessment, which means they have not been admitted into your treatment facility. POE records can be incomplete for a variety of reasons, such as waiting on a payer authorization. The POE staff is responsible for either completing or closing the POE records. If the outstanding information has been provided, the POE record can be completed and an intake assessment can be scheduled. If the client has been referred to another treatment facility, the POE record can be terminated.

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Treatment Professional Workflows Note: Treatment professional is a general term that encompasses, but is not limited to, the following

type of staff members: therapists, doctors, nurses, case managers, and resource coordinators.

Treatment professionals are responsible for providing services to clients and completing any related service documentation. In addition to the user workflows defined in this section, the Clinical Record Guide and the Schedule Guide include detailed instructions for performing these tasks.

Tip: In addition to the workflows described in this chapter, treatment professionals should also review their alerts on a regular basis. At a minimum, treatment professionals should check their alerts at the beginning of their shifts and then periodically throughout the day. For example, MDs should review their alerts continually throughout the day if their organization has medication orders.

CareLogic supports the following standard workflows for Treatment Professionals:

Delivering Services in an Out-Patient Setting

Delivering Services in an In-Patient Setting

Delivering Services without Continual Access to CareLogic

Maintaining Bed Whiteboards

Delivering Services in an Out-Patient Setting The following workflow is designed for treatment professionals who treat clients in organizations that have a Front Desk staff.

The following workflow is recommended for delivering services in an out-patient setting:

1 Verify Client is Checked In. As clients arrive for appointments, the Front Desk staff marks the status of the appointment as Checked In. Once this status appears on the Schedule, Treatment Professionals can meet clients.

2 Meet with Client or Group. All treatment information is recorded and maintained in the client’s ECR (electronic clinical record). At a minimum, the following clinical modules are required: an intake assessment, a diagnosis, a treatment plan, and progress notes.

Note: Your system administrator is responsible for configuring the service documents that are used by your organization.

3 Update Appointment Details. In some cases, it may be necessary to modify the appointment details after meeting with the client or group. Some of the details that may need to be modified are the appointment start and stop time, the activity code, or the service location.

4 Mark Appointment Status. For every client and group activity (service) your organization provides, you must mark the appointment status. An activity can have any of the following appointment statuses: Kept, Co-Staff, Checked In, In Session, CBC (cancelled by client), CBT (cancelled by therapist), DNS (did not show), or Error. Once the appointment status is marked as Kept, it is automatically processed by the nightly run of the Claim Engine.


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5 Complete Service Documentation. After an activity is marked as Kept, the system checks to see if a service document is required for the service. If a service document is required, the document must be completed and signed before the service can be successfully processed by the Claim Engine.

6 Schedule Next Appointment. If necessary, the client’s next appointment can be scheduled. The system allows recurring appointments to be scheduled on either a weekly or monthly basis. Recurring appointments give you the flexibility to accurately set up your schedule to match your appointments.

Delivering Services in an In-Patient Setting The following workflow is designed for treatment professionals who deliver services in an in-patient or residential setting.

The following workflow is recommended for delivering services in an in-patient setting:

1 Meet with Client or Group. All treatment information is recorded and maintained in the client’s ECR (electronic clinical record). At a minimum, the following clinical modules are required: an intake assessment, a diagnosis, a treatment plan, and progress notes.

Note: Your system administrator is responsible for configuring the service documents that are used by your organization.

2 Update Appointment Details. In some cases, it may be necessary to modify the appointment details after meeting with the client or group. Some of the details that may need to be modified are the appointment start and stop time, the activity code, or the service location.

3 Mark Appointment Status. For every client and group activity (service) your organization provides, you must mark the appointment status. An activity can have any of the following appointment statuses: Kept, Co-Staff, Checked In, In Session, CBC (cancelled by client), CBT (cancelled by therapist), DNS (did not show), or Error. Once the appointment status is marked as Kept, it is automatically processed by the nightly run of the Claim Engine.


5 Schedule Next Appointment. If necessary, the client’s next appointment can be scheduled. The system allows recurring appointments to be scheduled on either a weekly or monthly basis. Recurring appointments give you the flexibility to accurately set up your schedule to match your appointments.

Delivering Services without Continual Access to CareLogic The following workflow is designed for treatment professionals who provide services to clients in the field or do not have a stable daily schedule.

The following workflow is recommended for treatment professionals who provide services without continual access to CareLogic:

1 Batch Activity Entry. This module is used to enter multiple activities (services) into the system. After meeting with clients, treatment professionals can use this module to enter the activities into the system. Once the activities are entered, their status is automatically marked as Kept.

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Tip: Each organization can specify the number of batch lines to display on the Batch Activity Entry page. Contact the Qualifacts Professional Services team for assistance.


Maintaining Bed Whiteboards The Bed Whiteboard is maintained by the Nursing staff. The Bed Whiteboard provides a view of the bed occupancies by organization. The Nursing staff can use the Bed Whiteboard to change a client’s length of stay, add notes about a client in a bed, view the history of a bed, and swap clients in beds.

The following workflow is recommended for maintaining Bed Whiteboards:

1 Verify Census. Each day the Nursing staff is responsible for verifying the correct client is physically in the bed he has been assigned.

2 Check for Clients Overdue for Discharge. Clients who are overdue for discharge appear in red text on the Bed Whiteboard. When the Nursing staff encounters a client who is overdue for discharge, they should update the client’s discharge date accordingly.

Tip: It is important to maintain accurate discharge dates because the Bed Search module in the Point of Entry includes the beds that are soon to be available.

3 Check for Clients with Upcoming Discharge. Clients who are scheduled to be discharged within 24 hours or less appear in blue text on the Bed Whiteboard.

Note: Follow the existing workflow that has been defined by your organization to process and prepare a client for discharge.

4 Make Notes About Clients in Beds. As needed, notes can be made about clients who are assigned to beds. The staff member who enters the note must electronically sign it. A notes history page is created for each bed.

5 Swap Clients Between Beds. As needed, clients can be swapped between beds directly from the Bed Whiteboard.

Front Desk/Receptionist Workflows The Front Desk staff is responsible for checking in clients when they arrive for appointments and maintaining the Cash Sheet. In addition to the user workflows defined in this guide, the Front Desk Guide includes detailed instructions for performing Front Desk tasks.

CareLogic supports the following standard workflows for Front Desk/Receptionist staff:

Checking In Clients

Maintaining Cash Sheets

Checking In Clients


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When clients arrive for appointments, the Front Desk staff is responsible for checking them in.

The following workflow is recommended for checking in clients:

1 Verifying Demographic Information. Each time a client comes in for an appointment, the Front Desk staff must verify the demographic information. This includes confirming the client’s physical address and telephone numbers. If necessary, the Front Desk staff can update the client’s demographic information.

Note: A client’s payer information can be verified only if the Front Desk staff has the appropriate ECR privilege level. To verify payer information, click the hyperlink of the client’s name to access the ECR, and then select the Client Payer module.

2 Collecting Co-Payments. If a client is responsible for a co-payment, a button with a dollar amount appears in the Co-Pay column of the Front Desk Schedule. Once the co-pay amount is entered into the system, the payment is posted to the daily Cash Sheet. If the Co-Pay column on the Front Desk Schedule is blank, the client is not responsible for a co-payment.

Note: The system only shows the co-pay amount owed by client; it does not show the total balance amount owed by client.

3 Marking Status as Checked In. When clients arrive for appointments, the Front Desk staff must mark the status of their appointment as Checked In. This status signifies to treatment professionals that the client has arrived and is ready for the appointment.

4 Schedule Next Appointment. If the treatment professional has given instructions for a follow-up appointment, the Front Desk staff must schedule it. In addition to selecting an appointment date and time, the Front Desk staff must also select such information as the staff member who will meet with the client, the appropriate treatment program, the activity code, and the service location.

Maintaining Cash Sheets The Cash Sheet is used by the Front Desk staff to enter client payments into the system.

The following workflow is recommended for maintaining Cash Sheets:

1 Creating Daily Cash Sheets. Each day a Cash Sheet must be created by each organization in your business unit that receives payments directly from clients. In addition to including the date, each cash sheet record can also include a unique name, the organization it is associated with, and any notes or comments.

Tip: When creating a Cash Sheet, you can either create one Cash Sheet per organization or one Cash Sheet per Front Desk staff per organization.

2 Entering Co-Pay Amounts. As clients provide co-payments, the Front Desk staff is responsible for posting them to the Cash Sheet. All payments must be posted to the daily Cash Sheet before it is closed. Once the daily Cash Sheet it closed, you cannot add payments to it.

3 Closing Cash Sheets. After applying all the day’s payments to the Cash Sheet, the Front Desk staff must close it by electronically signing it. When a Cash Sheet is closed, the system records the date, time, and name of the staff member who closed it.

Note: Follow the existing workflow defined by your organization to close the daily Cash Sheet.

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Billing/AR Workflows The Billing and Accounts Receivable staff is responsible for processing claims, billing payers, and accepting payments. In addition to the user workflows defined in this guide, the Billing and Accounts Receivable Guide includes detailed instructions for performing Billing/AR tasks.

Note: In larger organizations, the Billing and AR staff may be two separate groups. In smaller organizations, they may be one group. This chapter section provides the workflows that are necessary to perform all billing and accounts receivable functions in the system.

CareLogic supports the following standard workflows for the Billing/AR staff:

Processing Claims

Billing Payers

Accepting Payments

Processing Claims Each night when the Claim Engine runs, it attempts to convert activities (services) into claims that can be sent out for billing. When processing activities, the Claim Engine performs two major checks: activity validation and claim validation. If errors are found during activity validation, the activities are moved into Failed Activities. If errors are found during claim validation, the claims are moved into Failed Claims.

The following workflow is recommended for processing claims:

1 Resolving Failed Activities. The system allows you to use a variety of different strategies for working failed activities. For example, you could work the failed activities within a given date range, associated with a particular treatment program, or that contain a particular error code. Follow the process that has been defined for your organization when working failed activities.

Tip: In organizations with multiple Billing/AR staff members, it is recommended that you take the following additional steps to ensure that the same failed activities are not being worked by multiple staff members. 1) Periodically, refresh the Failed Activities Results page by resubmitting the search criteria. 2) Reprocess individual failed activities before attempting to resolve them.

2 Resolving Failed Claims. The system allows you to use a variety of different strategies for working failed claims. For example, you could work the failed claims within a given date range, associated with a particular payer plan, or that contain a particular error code. Follow the process that has been defined for your organization when working failed claims.

Tip: In organizations with multiple Billing/AR staff members, it is recommended that you take the following additional steps to ensure that the same failed claims are not being worked by multiple staff members. 1) Periodically, refresh the Failed Claims Results page by resubmitting the search criteria. 2) Reprocess individual failed claims before attempting to resolve them.

Note: If you notice inaccuracies on claims, such as incorrect standard fees or procedure code, take the following steps. 1) Backout the claim. 2) Notify your supervisor so the issue can be corrected. 3) After the next nightly run of the Claim Engine, verify the claim was successfully processed.


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3 Approving Claims. After claims have been successfully processed, they must be manually approved. This step gives the Billing/AR staff an opportunity to review the claims before they are sent out to payers. By reviewing the claims, your organization can improve the likelihood that the claims will be successfully adjudicated by payers.

Tip: All claim items that relate to a rollup rule must be approved at the same time. Claims in blue text can be reviewed for approval because they contain the minimum number of services to satisfy the rollup rule. Claims in red text are not ready to be reviewed for approval because they do not contain the minimum number of services to satisfy the rollup rule. Claims in green text are ready to be reviewed for approval because they contain the maximum number of services to satisfy the rollup rule.

Billing Payers After the claims have been processed, they can be sent out for billing.

The following workflow is recommended for billing payers:

1 Batching Claims. The system allows claim batches to be created based on user-defined criteria. Each time you create a batch, you can define the criteria for the claims you want to include, such as the claims that fall within a date range, the claims associated with a particular payer plan, billing type, EDI type, or payer type. Follow the workflow defined by your organization to batch claims.

Note: Electronic and paper claims cannot be mixed in the same batch. They must be batched separately.

2 Generating Claims. Claim batches can be generated for either electronic claims or paper claims. Follow the standards defined by your payer plans. After the claim batch is created, you can open it to review the claims associated with it.

3 Printing Client Statements. Client Statements are used to bill guarantors. You can either print client statements for an individual client or for multiple clients that meet your user-defined criteria. For example, you could generate Client Statements for all clients who have a balance greater than $100.

Tip: The system also allows you to print Client Statements with a zero balance. This means your organization can send Client Statements as curtsey bills.

Accepting Payments This section includes a workflow for entering payments into the system.

Tip: You do not have to create a deposit on the day you receive the payment. When entering payments, the system allows you to enter two different dates: Receive Date and Transaction Date. The Receive Date is the date you physically receive the check. The Transaction Date is the date the deposit is created in the system (this date can be back dated).

The following workflow is recommended for accepting payments:

1 Create Payment Deposits. A deposit can consist of either a single payment or a group of payments. Once a deposit is entered into the system, it is automatically assigned a system-generated ID number, which is used to track the payments within the deposit. Payments can be entered in the following forms.

a Load Electric Files. Electronic files (835 files) must be uploaded into the system. Once an 835 file is uploaded, the system automatically creates a deposit.

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b Manually Create Deposit. Payments received through the mail must be manually entered into the system. When manually entering payments, the control amount and the control balance must be consistent in order to create the deposit.

2 Enter Payments. After a deposit is created, you must enter the payments associated with it. Each payment record includes the payer name, the organization it is associated with, the received date, the payment type, and the dollar amount. Once the payments are entered, the system attempts to apply them to open claims.

3 Make Claim Adjustments. If the payment amount is less than the allowed amount (contracted rate), you must either make an adjustment to the claim or select a next action for the claim (bill next payer, bill guarantor, rebill payer, or leave open).

Note: Payment adjustments can be made in either the Payment Maintenance or Claim Maintenance modules. Follow the workflow defined by your organization.

4 Takeaways. Takeaways are requests from payers for refunds. The system treats takeaways as negative payments. Takeaways must be performed at the deposit level.

5 Refunds. If an unapplied balance remains after a payment has been applied to an open claim, your organization may elect to refund the payer. Refunds must be performed at the deposit level.

Note: When performing a refund, the system does not generate a check. The refund process only creates a transaction record which can be exported to the GL. You must manually generate the check.

6 Approve Payments. After the payments have been successfully applied to claims, the payments must be approved by the Billing/AR staff. This step gives the Billing/AR staff an opportunity to review the payments before they are exported to the general ledger.

Accounting/Finance Workflows The Accounting/Finance staff is responsible for closing accounting periods. Prior to doing this, you must confirm that as many transactions are complete as possible.

In addition to the user workflows defined in this guide, the Billing and Accounts Receivable Guide includes detailed instructions for performing Accounting/Finance tasks.

CareLogic supports the following standard workflows for the Accounting/Finance staff:

Prerequisite to Closing an Accounting Period

Closing an Accounting Period

Prerequisite to Closing an Accounting Period Prior to closing an accounting period, you should verify that as many transactions are complete as possible. In order to do this, you should follow the workflow described in this section.

The following workflow is recommended prior to closing an accounting period:

1 Enter Ancillary Charges. Ancillary charges, such as transportation costs and fees for returned checks, must be manually entered into the system as non-activity invoices. Once a non-activity invoice is created,


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it is automatically moved into Claim Approval. All non-activity invoices must be approved before they can be sent out for billing. The system processes ancillary charges differently from billable services because they are not based on activity codes and they have not been scheduled.

2 Run Activities No Status Report. This report, which should be based on the date range of your accounting period, includes information about the activities in the system that do not have a status. For the selected organization, this report lists the staff member name and ID number associated with the service date, the activity code, the client name and ID number associated with the activity, and the status.

a Schedule Module. If this report includes billable services with no statuses, contact the necessary staff member to mark the appointment statuses in the Schedule module. Once the appointment status have been marked, the service will be processed by the nightly run of the Claim Engine. If the service is successfully processed by the Claim Engine, the claim must be approved before it can be included in the account period closing.

3 Run Failed Activities Report. This report, which should be based on the date range of your accounting period, includes a list of failed activities for a user-defined date range. The information in the report is sorted by error code. For each failed activity, this report lists the client name, the staff member associated with the activity, the organization where the service was provided, the program associated with the activity, the service date, the activity code, the begin and end time of the activity, and the total duration, in minutes, of the activity. The last page of the report includes summary information, which is sorted by error code, organization by error code, and program by error code.

a Failed Activities Module. If this report includes failed activities, contact the necessary staff member to resolve the failed activities. Once the failed activities are resolved, they are processed by the nightly run of the Claim Engine. If the services are successfully processed by the Claim Engine, the claims must be approved before they can be included in the account period closing.

4 Run Failed Claims Report. This report, which should be based on the date range of your accounting period, includes a list of failed claims for a user-defined date range. The information in this report is sorted by payer plan. For each failed claim, this report lists the payer plan, the claim ID, the client name, the staff member associated with the claim, the organization where service was provided, and the service date range. For each service date, this report lists the error code description, the billed amount, the expected payment amount, and the procedure code. The last page of the report includes summary information, which is sorted by error code and organization by error code.

a Failed Claims Module. If this report includes failed claims, contact the necessary staff member to resolve the failed claims. Once the failed claims are resolved, they are processed by the nightly run of the Claim Engine. If the claims are successfully processed by the Claim Engine, they must be approved before they can be included in the account period closing.

5 Run Claim Approval Report. This report, which should be based on the date range of your accounting period, includes a list of the claims that are pending approval. This report allows you to review the claims before they are sent out to payers. For each payer plan, this report lists the claim ID number, the client name, the staff member associated with the claim, the organization where the service was provided, the procedure code, the service date range, the amount billed, the expected payment amount, the number of units, and the client co-pay amount.

a Claim Approval Module. If this report includes claims awaiting approval, contact the necessary staff member to approve the claims. After the claims are approved, they can be included in the account period closing.

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6 Run Cash Sheet Report. This report, which should be based on the date range of your accounting period, includes detailed information about the cash sheet for a user-defined date. For each cash sheet, this report lists the staff member who signed it, the staff member who approved it, and the payment totals by payment type. For each payment on the cash sheet, this report lists the client on whose behalf the payment was made, the person who made the payment, the receipt number, the payment type, the check or authorization number associated with the payment, and the amount of the payment.

a Cash Sheet Approval Module. If this report includes Front Desk payments that are awaiting approval, contact the necessary staff member to approve the cash sheet. Once the payments are approved, they can be included in the account period closing.

7 Run Deposit Report. This report, which should be based on the date range of your accounting period, includes information about the deposits that were entered into the system during a user-defined date range. For each deposit, this report lists the deposit ID number, the control date, the control count, the amount of the payment, the amount of the payment that has been applied to claims, the amount of the payment placed on account, and the control amount.

a Payment Entry Module. If there are deposits that are missing from this report, contact the necessary staff member to enter the payments and make any necessary adjustments. Once the payments are approved, they can be included in the account period closing.

8 Run Revenue Report. This report, which should be based on the date range of your accounting period, includes a list of revenue records during a user-defined date range. This report can be generated in either summary or detail format.

In summary format, this report lists the payer plan, the program name, the amount of the claim items, the amount of adjustments, and the balance amount.

In detail format, this report lists the program name, the revenue type, the amount of each claim item, the amount of each adjustment, the date the revenue was posted, the claim number, the claim item number, the payment amount expected, the billed amount, the balance amount, and the service date.

a Payment Entry Module. If there is revenue missing from this report, contact the necessary staff member to enter the payments and make any necessary adjustments. Once the payments are approved, they can be included in the account period closing.

9 Run Write Offs Report. This report, which should be based on the date range of your accounting period, includes a list of claim write offs that occurred during a user-defined date range. For each write-off record, this report lists the reason code, the payer plan, the client name, the claim ID number, the service date, the transaction date, the account date, the program name, the accounting period, and the write off amount.

a Payment Entry Module. If there are write-off amounts that are missing from this report, contact the necessary staff member to make any necessary payment adjustments. Once the payments are approved, they can be included in the account period closing.

10Approve Payments. After the payments have been applied to open claims, and all the necessary adjustments have been made, you must use this task to approve the payments. This step gives the Billing and Accounts Receivable staff an opportunity to review the payments before they are posted to the general ledger. Once the payments have been approved, they can be included in the account period closing.

Closing an Accounting Period


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After verifying that as many transactions are complete as possible, you are ready to use the GL Export module to close an accounting period. Typically, the GL export is run on a monthly basis. However, each time you close an accounting period, the GL export includes all of the transactions in the system that have not been previously closed in an accounting period, regardless of their transaction date.

The following workflow is recommended for closing an accounting period:

1 Create GL Export File. When the GL export runs, the system creates a file that contains all of the financial transactions for the defined date range. This GL export file is configured according to the format you defined in the Account Numbers module. Once the GL export is complete, you can import the file into your organization’s external accounting software system.

a Backout File. If the system encounters errors when creating the GL export file, the errors are listed at the bottom of the GL export list page. The transactions associated with the errors are not included in the export file. Before attempting to correct the errors, you should backout the GL export file.

b Correct Errors. After backing out the GL export file, contact the necessary staff members to correct the errors.

c Recreate File. Once the transactions are corrected, create the GL export file again and confirm that no errors exist.

2 Download GL Export File. Once the GL export file is created without any errors, you can download it in any of the following formats:

• GL Summary

• GL Summary in CSV Format

• GL Detail

• GL Detail in CSV Format

Human Resources Workflows The HR staff is responsible for maintaining all employee information. This process involves adding new employees, maintaining employee information (such as demographic information, contact information, and emergency contact information), and maintaining employment information (such as staff credentials, staff treatment programs, performance reviews, and staff assets).

In addition to the user workflows defined in this guide, the Human Resources Guide includes detailed instructions for performing HR tasks.

CareLogic supports the following standard workflows for the HR staff:

• Adding New Staff Members

• Maintaining Staff Information

• Maintaining Employment Information

Adding New Staff Members The following workflow should be used to add new employees.

The following workflow is recommended for adding new employees:

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1 Perform Staff Search. Prior to adding a new employee, you must perform a staff search to confirm the employee does not already exist in the system. After confirming the employee does not exist, you can create a new staff record.

Note: The staff search uses a soundex search features, which means you can search for existing records based on the way in which the name is pronounced as well as the exact spelling.

2 Demographic Information. Demographic information includes such information as the employee’s full name, date of birth, Social Security number, gender, race, marital status, and primary language.

3 Employment History. Each employee must have an active employment record in order to bill for services. The employment record includes such information as the date range, the employment type, the primary organization, the supervisor group, and whether the staff member is allowed to multi-book appointments on the Schedule.

Tip: It is recommended that you multi-book staff members. This allows you to schedule overlapping appointments. The status of the overlapping appointments must be marked manually. The overlapping appointments cannot be marked as Kept unless a System Administrator has set up the activities to allow overlapping.

4 Credentials. In order to bill for services, staff members must have a primary credential set up in their HR record. The Claim Engine uses the staff members primary credential when calculating fees for services. Although an employee can have multiple credentials, there can only be one primary credential for each employee.

5 NPI. The federal government has mandated that National Provider Identifier (NPI) numbers will replace provider ID number on all electronic and paper claims. A unique NPI number is assigned to each treatment professional and treatment facility. When claims are created for professional charges, the staff member’s NPI number is included on the claims. When claims are created for facility charges, the organization’s NPI number is included on the claim.

Important: Each employee must have an active user account in order to access CareLogic. User accounts are set up and maintained by system administrators.

Maintaining Staff Information This section includes workflows for maintaining general staff information.

1 Address Information. For each employee, you can enter a physical, mailing, and work address. For each address type, an employee can have only one active address at a given time. In order to create a new address record, you must end date the existing one and then create the new one.

2 Client Relationships. This module is used to maintain the employee’s caseload. Although a client can have an unlimited number of staff relationships, there can be only one primary staff relationship for each client, for a given date range.

3 Emergency Contacts. For each employee, you can maintain a list of emergency contacts. For each emergency contact, you can track address, telephone number, and relationship to staff.

4 Employee Dependents. This module is used to maintain a list employee dependents. For each dependent, you can track the name, relationship to staff, gender, birth date, Social Security number, and whether the dependent is covered by the staff member’s health, dental, and vision insurance.


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5 Leave of Absence Events. This module is used to track when an employee takes a leave of absence. For each leave of absence, you can track the start date, return date, number of hours used, and any comments regarding the leave of absence.

Maintaining Employment Information This section includes workflows for maintaining employment information for staff members.

1 Hire Checklists. This module contains a list of forms that must be given to new employees. As the forms are completed, they must be returned to the HR department and the date received must be recorded on the Hire Checklist.

2 Employee Benefits. This module is used to track the benefits that are available to employees. For each employee, you can track the medical, dental, vision, 401K, and any other optional benefit information.

3 Staff Programs. This module is used to set up to way in which employees are allocated to treatment programs. For each employee, you can define either the percentage of time or the number of hours the staff member will devote to each program.

4 Staff Organizations by Day. This module is used to set up the employee’s availability. For each day of the week, you can define the organization and hours the staff member is available to provide services to clients. Once you set up the organizations by day, you can schedule appointments for the employee.

5 Employee Training. This module is used to set up a record for each training session in which the employee enrolls. For each training record, you can track a description of the training, the training date, the number of days the training requires, and the number of CEUs associated with the training.

6 Performance Reviews. This module is used to track the performance review that are given to employees. For each performance review, you can record such information as the review date, the type of review, any review comments, and the date of next scheduled review.

7 Employee Driver Information. This module is used to maintain a record of each employee’s driving status. For each employee, you can track the driver’s license number, the state issued, the expiration date, whether the staff member is cleared to drive clients, and whether the staff member’s job requires driving clients.

8 Staff Assets. This module is used to maintain a record of all the assets your organization has assigned to employees. For each company asset, you can track the asset type, the asset number, the date issued, a description of the asset, and the date returned.

9 Staff Terminations. If an employee is terminated, this module is used to track a record of the event. For each record, you can enter the termination date, the date the staff member’s benefits expire, and whether the employee is eligible for rehire.

System Administrator Workflows System administrators are responsible for performing organization administration (menu management, list modifier, service locations, etc.), clinical administration (service documents, service document crosswalks, medications, etc.), billing administration (activities, procedures, payers, etc.), and human resources administration (user logins, supervisor groups, etc.).

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In addition to the user workflows defined in this guide, the System Administration Guide includes detailed instructions for performing System Administrator tasks.

CareLogic supports the following standard workflows for System Administrators:

• Organization Administration

• Clinical Administration

• Billing Administration

• Human Resources Administration

Organization Administration Before your organization can use CareLogic, the administration modules described in this section must be set up. All organization settings apply to your current organization and any child organizations.

The following workflow is recommended for organization administration:

1 List Modifier. Throughout the system, there are many descriptor lists that can be set up by system administrators. In most cases, the descriptor lists are used to populate drop-down lists. In other cases, they are used to populate check boxes.

2 Organizations. This module is used to set up all of the organizations in your business unit that are licensed to use CareLogic. Whether your business unit consists of a single organization (a flat organization structure) or multiple organizations (a multi-tier organization structure), the Organizations module allows you to set up an organizational structure to meet your specific needs.

3 Service Locations. Every service that is billed in the system must occur at a service location. This module contains a nationally standardized list of service locations.

4 Menu Management. The menu management system is used to configure the CareLogic navigation bar and the options that are available in the Show Menu list in the shortcut bar. A different menu system can be set up for each organization, if desired.

5 Dashboard Administration. The Dashboard is the first page a user sees when logging into CareLogic. This module allows you to configure the following modules on the Dashboard: Alerts, Claim Engine Information, Recent Payments, System Messages, and Upcoming Appointments.

6 Bed Administration. This module is used by in-patient and residential treatment facilities to manage the availability of the beds in your treatment facility. In addition to adding beds, this module allows you to set up the programs for which the beds are used.

Clinical Administration Before your organization can provides services to clients, the administration modules in this section must be set up.

The following workflow is recommended for clinical administration:

1 Service Documents. CareLogic gives you the flexibility to build your own service documents. By using the standard clinical modules and clinical orders that are built into the system, you can configure the service documents to meet the specific needs of your organization.


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2 Service Document Crosswalks. A service document crosswalk defines what service documents are required for a service. Each time an activity (service) is marked as Kept, the system checks to see if a service document is required. If a service document is required, the service cannot be billed until the service document is complete. If a service document is not required, a record must be created to map the activity to None.

3 Point of Entry Mappings. This module is used to link activities (services) to programs. When a new client is assigned to a program through the POE module, this mapping is used to automatically schedule the client for the related activity.

4 Groups. All of the group services that your organization provides must be set up in the system. Each group must have a leader defined as well as a roster of all the clients who participate in the group.

Note: Once treatment professionals are defined as the leaders of groups, they can maintain the groups by defining the group roster.

5 Treatment Plan Grid. This module is used to set up all of the problem types that your treatment facility addresses. For each problem type, this module also allows you to set up treatment goals and objectives.

6 Medications. This module is used to maintain a list of medications that can be prescribed to clients. The medications that are set up in this module are used to populate all of the Medication drop-down list fields that appear in the ECR module. A treatment professional can only prescribe the medications that are set up in this module.

7 Clinical Orders. This module allows in-patient and residential treatment facilities to track the clinical orders requested by doctors. System administrators can set up and maintain all of the order statuses that will be used during the order workflow life cycle. In addition to a wide variety of non-billable orders, the system also contains the following billable orders: Medication, Lab, Radiology, EKG, and Durable Medical Equipment (DME).

8 Referral Sources. This module is used to maintain a list of the referral sources your organization uses. This list includes the sources that have referred clients to your organization and the sources that your organization has referred clients to.

Billing Administration Before your organization can produce claims for services, the administration modules in this section must be set up.

The following workflow is recommended for billing administration:

1 Licensures. Licensures are the billing categories that are used by payer plans to determine the amount to reimburse for services. Some example licensures are MD, LCSW, and QP.

2 Modifiers. Modifiers are nationally standardized codes that are attached to procedure codes to provide additional information about the billed procedure. For example, if you are billing for an office visit, you could use the procedure code 99213 and the modifier HE to indicate that it was related to a mental health program.

3 Payer Panels. Payer panels are used to assign staff members to groups that can be attached to specific payer plans. All of the staff members who are part of the payer panel are authorized to perform services for the payer plan. Payer panels are useful when you have a staff member who is authorized to perform services for multiple payer plans.

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4 Default Fee Matrix. The default fee matrix serves as a template for the fee matrices that are set up for specific payer plans.

5 Procedures. Procedure codes are nationally standardized codes that describe the type of service provided by your organization. For each procedure code, you must set up a standard fee. An example procedure code is 90806 – Individual Therapy (45-50 minutes).

6 Payers. Payers are umbrella insurance plans that contain individual payer plans. By themselves, payers do not offer specific benefit plans. Some example payers are Medicare, Medicaid, and Blue Cross/Blue Shield.

7 Payer Plans. A payer plan is a particular benefit plan that is provided by the payer. Payer plans are the entities to which you submit claims during your billing cycle. For example, the payer Blue Cross/Blue Shield could have the payer plan Blue Cross/Blue Shield of Tennessee.

8 Payer Plan Fee Matrix. The fee matrix defines the contracted rates the payer plan will reimburse for each procedure code, based on the credential of the staff member who provides the service.

9 Programs. Every treatment program your organization provides must be entered into the system. When setting up per-diem programs, you must define the activities (services) you want to associate with them. Once the activities are set up, the system automatically generates the services each day clients are enrolled in the program.

10Activities. Activities are the services that your organization provides. An activity code must be set up for every billable event your organization provides. This includes services provided to client and groups, as well as billable orders. An example activity is Individual Therapy. Activity codes can also be used to record the delivery of non-billable events.

11Activity/Procedure Matrix. The activity/procedure matrix contains the user-defined parameters that tell the system which procedure code to use for a particular activity. Activity/procedure mappings can be used for both billable and non-billable events.

12Activity/Program Matrix. The activity/program matrix defines which services can be provided to clients in a particular program.

13Account Numbers. This module is used to configure the format of the account numbers that will be used in your GL export file.

14GL Code Admin. General ledger codes are used to track all of the financial transactions in the system. CareLogic allows you to assign GL codes to activities (services), organizations, payers, programs, and program/organization mappings.

15DRG Codes. DRG (diagnostic related groupings) codes are diagnosis codes that are used by inpatient and residential treatment facilities. By default, the DRG module contains a list of all the nationally standardized codes. As a system administrator, you have the ability to activate and inactivate DRG codes. All of the active DRG codes can be used by clinicians to diagnosis clients. The inactive DRG codes will not be available to diagnosis clients.

16PPS Admin. The PPS Admin module enables organizations to comply with the federal mandate for billing psychiatric services to Medicare. This module is used to define the criteria that the Claim Engine uses to calculate per diem charges for inpatient and residential services that are provided to Medicare clients. PPS billing enables CareLogic to accurately forecast expected revenue and it eliminates the need to make adjustments for each day of an inpatient stay.


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Human Resources Administration This section includes a workflow for setting up HR administration.

The following workflow is recommended for Human Resources administration:

1 Privilege Groups. By default, the system includes several privilege groups that can be assigned to users. This module allows you to create new privilege groups that are specific to your organization. Each of the privilege groups is based on the standard privilege levels that are available in the system.

2 Staff Login Information. Each staff member who uses CareLogic must have a user account and electronic signature set up. This user account and e-signature is used to track the activities performed by the staff member in the system.

3 Supervisor Group Admin. This module is used to set up and maintain Admin, Clinical, and Incident To supervisor groups. In addition to defining the group’s active date and the organization to which it belongs, this module allows you to assign staff members to the group.

4 Staff Benefits. This module is used to set up all of the staff benefits offered by your organization. Once these staff benefit records are created, they can be assigned to individual staff members by the Human Resources staff.

5 Staff Training. This module is used to set up all of the staff training classes available to the staff members in your organization.

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Standard Process Flows This chapter supports the CareLogic standard workflows discussed in the previous chapter. The process flows in this chapter provide an overview for understanding how CareLogic can be incorporated into your business environment.

This chapter contains the following standard process flows:

• Point of Entry Process Flow

• Scheduling Process Flow

• Billing Process Flow

• Accounts Receivable Process Flow

• General Ledger Administration Setup Process Flow

• General Ledger Export Process Flow

• Payer Staging Process Flow

• Facility Billing Process Flow

• Grant Payers Process Flow

Point of Entry Process Flow The Point of Entry (POE) module is used to enter new clients into the system. The process of admitting new clients involves completing the POE Wizard, which allows you to collect basic information about the client, such as demographic information, client guarantors, client payers, payer authorizations, and client co-pay information. The last step of the POE process is to schedule the client for an intake assessment. In emergency situations, in-patient/residential facilities can admit the clients directly to a bed.

Once the POE Wizard is complete, and the client is admitted into the system, all of the client’s data is moved to the ECR (Electronic Clinical Record) module. This means you must use the ECR module, rather than the POE module, to modify a client’s data once he is admitted into the system. The POE module is used only to gather the initial client data and then admit clients into the system.


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The following diagram shows the process flow for the Point of Entry module. An outline of the process flow follows the diagram.

1 Contacted by Client. Clients generally make contact with a treatment facility through a referral source or by calling directly.

2 Client Search. The POE module is used only to admit new clients into the system. In order to confirm that a client does not already exist in the system, you must perform a client search.

If the client is found in the system as active, you do not need to complete the POE Wizard. Instead, you must use the ECR module to add the client to a new program (if necessary), and then use the Schedule module to schedule new services for the client.

If the client is not found in the system, you must use the POE Wizard to add the client (Step 3).

If the client is found in the system as inactive, you must use the POE Wizard to create a new intake/referral for the client (Step 3).

3 POE Wizard. The POE Wizard is used to collect the following information about the client.

Note: The POE Wizard can be customized to meet the specific needs of your organization. The following options are the default modules that are included in the POE Wizard.

Demographics. This option is used to enter general information about the client, such as the date of first contact between the client, the client’s name, contact telephone numbers, physical and mailing addresses, and social security number.

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Guarantors. A guarantor is the person who is listed as the policy subscriber of the insurance plan that covers the client. By default, every client in the system is automatically set up as his own guarantor. In some cases, additional guarantor records must be created for the client’s spouse, parent, or guardian. The guarantor is responsible for paying the portion of the bill that is not covered by the payer. When sending out bills, the system allows you to bill both payers and guarantors. For example, if a payer only pays a percentage of the bill, you can bill the guarantor the remaining percentage.

Payers. The client’s insurance provider is known as a payer. In addition to setting up the name of the payer, you must also set up information about the payer plan, which is the particular insurance plan that covers the client.

Payer Authorizations. Some payer plans require an authorization before services can be provided to clients. If a payer plan requires an authorization, the Claim Engine runs a check to confirm that an authorization number exists before the claim is created. If the authorization number is missing, a Claim Engine error occurs. The Payer Authorizations module is used to set up and maintain payer plan authorization records.

Co-Pay. If the client’s payer plan requires a co-payment, this option is used to enter the co-pay amount. The client is responsible for paying the co-pay amount at the time your organization provides a service.

4 Admit to Program. The final step in the POE process is to assign the client to a treatment program.

Schedule Appointment. For out-patient services, you assign the client to a treatment program when you schedule an appointment. Once an appointment is marked as Kept, the client is automatically assigned to the staff member’s caseload.

Bed Search. For in-patient or residential services, you assign the client to a treatment program when you perform a bed search. Once a bed is located, the client is automatically scheduled for an appointment. Once the appointment is marked as Kept, the client is assigned to the caseload of the default per diem staff member (contact Qualifacts for assistance setting up this configuration).

Scheduling Process Flow The Schedule is a flexible tool that is used to add and maintain the activities (services) on your schedule and to view the activities on the schedules of other staff members and clients. The Schedule module allows you to schedule the following types of activities: client, group, and staff. Education activities can be scheduled if you have the Education module set up for your organization. Once an activity has occurred, you must mark its status. If the activity is marked as Kept, it is automatically processed by the nightly run of the Claim Engine. If the activity is marked with another status (such as Error, Cancelled by Client, Cancelled by Therapist, or Did Not Show), the activity is not processed by the Claim Engine because the activity is not billable.


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The following diagram shows the process flow for the Schedule module. An outline of the process flow follows the diagram.

1 Schedule Appointment. In order to schedule an appointment, the client must be active and entered into the system through the Point of Entry module. Appointments can be scheduled either through the Schedule module or the Front Desk Schedule. Prior to scheduling an appointment, the client must be enrolled in a treatment program.

2 Meet with Client/Group. Once the appointment date and time arrives, the clinician meets with the client or group for the session. In order to bill for the service, the clinician must have a primary credential set up in his employment record.

3 Mark Appointment Status. During the session, the appointment status can be marked as Checked In or In Session. After the session, the appointment must be marked with one of the following statuses.

Error. This status is used to indicate the appointment was scheduled in error. If the appointment status is marked as Error, the process ends because there is no activity to bill.

Kept. This status is used to indicate the clinician and the client met for the appointment. If the appointment is marked as Kept, you must complete any required service documentation for the activity. Once the activity is marked as Kept, it is automatically processed during the nightly run of the Claim Engine.

CBC, CBT, DNS. Select one of these statuses to indicate the appointment was cancelled by the client (CBC), cancelled by the therapist (CBT), or if the client did not show (DNS) for the appointment. If the appointment is marked as CBC, CBT, or DNS, you can add a memo to the client’s chart. Unless the system is set up bill activities that are marked CBC or DNS, the process ends at this point because there is no activity to bill.

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Billing Process Flow The goal of the CareLogic billing system is to produce complete claims that are accepted by third-party payers. The Claim Engine, which is at the heart of the billing system, is the process by which activities (services) are transformed into claims. On a nightly basis, the Claim Engine processes each activity that has been marked with a status of Kept. To ensure the claims are created with the best chance of being adjudicated in a timely manner, the Claim Engine performs two sets of checks. The first check is to ensure the activity is complete by checking for any missing information, such as 'No Primary Staff Credential Entered' or ‘Service Documentation Not Found.’ After the activity validation is complete, the Claim Engine performs a claim validation. The purpose of this check is to reduce the number of rejected claims due to insufficient information, such as 'No Activity Procedure Crosswalk Exists' or 'No Authorization'. Once the claims pass this validation process, they are flagged as successful and ready to be sent out for billing.

The following diagram shows the process flow of the billing system. An outline of the process flow follows the diagram.

1 Activities Marked As Kept. Once the status of an activity is marked as Kept through the Schedule or Front Desk module, the activity is automatically processed by the nightly Claim Engine run.


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Note: Because non-activity invoices are not associated with scheduled services, they bypass the activity and claim validations.

2 Process Activity Validation. The first step of the Claim Engine is to perform activity validation. During this phase, the Claim Engine checks for all service requirements related to the activity.

If the activity passes the activity validation process, it becomes a claim and is moved to the next step.

If the activity fails the activity validation process, it is moved into Failed Activities and an error code is assigned. At this point, you must resolve the error. Depending on the type of error, you may be able to override it. Once the error is either resolved or overridden, the activity is reprocessed by the next run of the Claim Engine, where it goes through the activity validation process again. If desired, you can also manually reprocess an activity once the error is resolved or overridden.

3 Process Claim Validation. The next step of the Claim Engine is to perform claim validation. During this phase, the Claim Engine checks for all financial requirements related to the claim.

If the claim passes the claim validation process, it is moved into Claim Approval where you must manually approve the claim before sending it out for billing.

If the claim fails the claim validation process, it is moved into Failed Claims and an error code is assigned. At this point, you must resolve the error. Depending on the type of error, you may be able to override it. Once the error is either resolved or overridden, the claim is reprocessed by the next Claim Engine run where it goes through the claim validation process again.

4 Approve Claims. After the claims have been resolved or overridden, you must manually approve them. This step gives the Billing staff an opportunity to review the claims before they are sent out to payers. By reviewing the claims, your organization can improve the likelihood that the claims are successfully adjudicated by payers.

5 Claim Maintenance. After the claims have been approved, they are moved into Claim Maintenance. Once in Claim Maintenance, the Billing staff can make adjustments to claims and backout claims, as necessary.

6 Batch Claims/Generate Client Statements. When batching claims, the system allows you to define the criteria to use for the batching process. For example, you can create a batch that includes the claims that fall within a date range, or the claims associated with a particular billing type, EDI type, payer, payer type, organization, program, client number, or claim number.

Guarantor bills must be generated using the Client Statement module. If a client has multiple guarantors set up in the system, you can generate a Client Statement for each guarantor whose record is marked to receive statements.

7 Send Claims to Payers/Guarantors. After the claim batches and client statements are created, you can send them out for billing. For paper claims, a HCFA file can be downloaded and then printed. For electronic billing, an 837 file can be created.

Accounts Receivable Process Flow The Accounts Receivable module is used to enter payments into the system, make any necessary adjustments to the payments, and then approve the payments. When the system processes payments, it attempts to match them to open claims. Payments must be approved before an accounting period can be closed and the general ledger data can be exported from the system.

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The following diagram shows the accounts receivable process flow. An outline of the process flow follows the diagram.

1 Receive Payments. Payments are received in the following forms.

Electronic Payments. Electronic payments are received as 835 files.

Mail Payments. Mail payments are received by the Accounts Receivable department.

Front Desk Payments. Front Desk payments are received from clients at the Front Desk. This form of payment typically includes client co-pays.

2 Enter Payments. The way in which payments are entered into the system is determined by the way in which they are received.

Load 835 File. 835 files must be uploaded into the system. Once the payments are uploaded, a deposit is automatically created and a payment record is created for each payer plan in the file. For each payment record, the system automatically processes the payments and applies them to open claims.

Manually Enter Payments. Manual payments are entered into the system through the Payment Entry module. When manually entering payments, you have the ability to make adjustments and define the next action in the billing process, if necessary.

Approve Cash Sheet. Front Desk payments are entered into the system through the Cash Sheet module. At the end of each day, an electronic signature is required to close out and approve the cash


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sheet. Each night an automated process runs that posts the client co-payments against the approved co-pay claims.

3 Adjustment Necessary. If the payment amount matches the allowed amount (contracted rate), the payment can be processed and applied to an open claim. If the payment amount is less than the allowed amount, you must make an adjustment to the claim or identify the next action in the billing process.

Note: You also have the ability to adjust co-pay claims. If the front end amount is different than the co-pay amount on the EOB, you can manually adjust the co-pay claim.

4 Make Claim Adjustment/Take Next Action. If the payment amount is less than the allowed amount, you must perform either one, or both, of the following actions: make a claim adjustment or select a next billing action.

Make Claim Adjustment. If you make a claim adjustment, you must select an adjustment transaction reason. For each adjustment reason, you can assign a unique general ledger code in the GL Code Admin module (see page 28 the General Ledger Guide).

Take Next Action. If the claim contains a balance amount greater than $1.00, you must take one of the following next actions:

Bill Next Payer. This option allows you to select the client’s next payer that you want to bill. Once a payer is selected, the system automatically creates a new claim. The amount on the new claim is the payer’s contracted rate minus the payment received for the initial claim.

Bill Guarantor. If you select this option, the system automatically generates a self-pay claim for the client. The name that appears on the new claim is the name of the guarantor record that is marked as self-pay in the ECR. The new claim is sent to the guarantor record that is marked to receive statement in the ECR.

Rebill Payer. If you select this option, the system automatically generates a new claim by making a copy of the existing claim. The new claim is sent to the same payer.

Leave Open. Select this option if a balance remains on the claim but you do not want to take any action. If you select this option, you are leaving an open balance on the claim.

5 Process/Apply Payments. After the payments are entered into the system, and all necessary adjustments have been made, the payments can be instantly processed. When a payment is processed, it is applied to an open claim.

6 Backout/Reverse Payment. If a payment was applied to an open claim in error, you can either backout or reverse the payment. If the payment has not been exported to the general ledger, you can back it out. If the payment has been exported to the general ledger, you must reverse it.

Note: If a payment that was originally a part of an 835 file is backed out, it must be manually re-entered into the system.

7 Approve Payments. The Payment Approval module gives the Accounts Receivable staff an opportunity to review the payments applied to claims before they are posted to the general ledger.

8 Export to GL. After the payments are approved, you must close out the accounting period by exporting the general ledger data to a file. Once the GL export file is created, you can import it into your accounting software system.

General Ledger Administration Setup Process Flow

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System administrators are responsible for setting up the general ledger account codes that will be used to track all of the financial transactions in the system. CareLogic allows you to assign unique GL codes to organizations, payers, programs, program/organization mappings, and activities.

GL codes for payers are defined by accounting group name, such as Commercial Insurance, Medicare, and Medicaid. For each GL accounting group, you can assign a unique GL code for billed revenue, accounts receivable, payments that were denied or written off, and transaction reason mapping. After defining the GL codes, you can use them to configure the format of your GL export file.

The following diagram shows the relationship between the two GL administration modules: GL Code Admin and Account Numbers.

1 GL Code Admin. All of the GL codes must be set up in the GL Code Admin module. This module allows you to assign GL codes to activities, organizations, programs, programs/organizations, and payers.

a GL Codes for Activities. If you want to track activity information in your GL export file, you must assign GL codes to activities. After setting up the activity GL codes, you must include the Activities string when formatting the account numbers in your GL export file (Step 2).

b GL Codes for Organizations. If you want to track organization information in your GL export file, you must assign GL codes to organizations. After setting up the organization GL codes, you must include the Organizations string when formatting the account numbers in your GL export file (Step 2).


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c GL Codes for Programs. If you want to track program information in your GL export file, you must assign GL codes to programs. After setting up the program GL codes, you must include the Programs string when formatting the account numbers in your GL export file (Step 2).

d GL Codes for Programs/Organizations. If you want to track program/organization information in your GL export file, you must assign GL codes to program/organization mappings. After setting up the program/organization GL codes, you must include the Programs/Organizations string when formatting the account numbers in your GL export file (Step 2).

e Account Types for Payers. GL codes for payers are defined by account types, such as Commercial Insurance, Medicare, and Medicaid. GL account types must be assigned to each payer record in the system. For each GL account type, you can assign a unique GL code for billed revenue, accounts receivable, payments that were denied or written off, and transaction reason mapping.

Revenue. If you want to track the billed revenue generated by payers, you must assign a GL code for revenue. After assigning revenue GL codes, you must include the GL Map Revenue string when formatting the account numbers in your GL export file (Step 2).

Accounts Receivable. If you want to track the accounts receivables collected by payers, you must assign a GL code for receivables. After assigning receivable GL codes, you must include the GL Map Receivable string when formatting the account numbers in your GL export file (Step 2).

Write-Offs/Denials. If you want to track the payments that were written off or denied by payers, you must assign a GL code for Write-Offs/Denials. After assigning the write-off/denial GL codes, you must include the GL Map Write-Offs string when formatting the account numbers in your GL export file (Step 2).

Reason Mapping. If you want to track transaction reason mapping for payers, you must assign a GL codes for reason mappings. Transaction reason mappings are user-defined and can be set up for such reasons as Adjustment Error, Contract Allowance, Insurance Cancelled, Medicaid Write Off, and No Authorization. After assigning reason mapping GL codes, you must include the Mapped Accounts string when formatting the account numbers in your GL export file (Step 2).

2 Account Numbers. This module is used to configure the format of the account numbers in your GL export file. For each of the account types you define (such as Cash, Payment on Account, Receivable, Revenue, and Write Off), you can also define a corresponding format string. The format string consists of the GL codes that were set up for organizations, programs, program/organization mappings, activities, billable revenue, accounts receivables, write-off/denials, and transaction reason mappings.

Activities. If GL codes were set up for activities (Step 1), you must include this format string in your GL export file.

Organizations. If GL codes were set up for organizations (Step 1), you must include this format string in your GL export file.

Programs. If GL codes were set up for programs (Step 1), you must include this format string in your GL export file.

Programs/Organizations. If GL codes were set up for programs/organizations (Step 1), you must include this format string in your GL export file.

GL Map Revenue. If GL codes were set up for billed revenue (Step 1), you must include this format string in your GL export file.

GL Map Receivable. If GL codes were set up for accounts receivables (Step 1), you must include this format string in your GL export file.

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GL Map Write-Offs. If GL codes were set up for write-offs/denials (Step 1), you must include this format string in your GL export file.

Mapped Accounts. If GL codes were set up for transaction reason mappings (Step 1), you must include this format string in your GL export file.

General Ledger Export Process Flow After setting up general ledger administration, the system will book all financial transactions to the defined GL codes. The GL Export module is used to help your organization successfully close accounting periods. The GL export process is the means by which your organization closes an accounting period. Typically, accounting periods are closed on a monthly basis. However, CareLogic gives you the flexibility to define the accounting period date range you want to close.

The following diagram shows the process flow for the GL export.

1 Create GL Export File. The GL Export module is used to close an accounting period. When the GL export runs, the system creates a file that contains all of the financial transactions for the defined date range. This GL export file is configured according to the format you defined in the Account Numbers module.

2 Errors Exist. If the system encounters errors when generating the GL export file, the transactions associated with the errors are not included in the export file. Some example errors are the GL code mapping was not set up for the payer or the reason mapping was not set up for the payer. If errors exist, you must complete the following steps.


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a Backout File. If the accounting period closing contains errors, you must backout the GL export file. Once the file is backed out, the account period closing file is removed from the system and the transactions that were a part of the closing can be modified in the system.

b Correct Errors. Contact the necessary staff members to correct the errors.

c Recreate GL Export File. Recreate the GL export file again.

3 Download File. Once the GL export file is created without any errors, you can download it in any of the following formats.

Summary File. For each GL code, the summary file lists the account type and the debit receivable or credit receivable amount.

Summary File (CSV). CSV (comma separated value) files can be opened in any text editor, such as NotePad. For each GL code, the summary file lists the account type and the debit receivable or credit receivable amount.

Detail File. For each GL code, the detail file lists the reference type, the payer name, the transaction type, the service date, and the debit receivable or credit receivable amount.

Detail File (CSV). CSV (comma separated value) files can be opened in any text editor, such as NotePad. For each GL code, the detail file lists the reference type, the payer name, the transaction type, the service date, and the debit receivable or credit receivable amount.

4 Import File. After downloading the GL file, you can import it into your external accounting software system.

Payer Staging Process Flow Note: By default, the payer staging configurations are disabled, which means your organization cannot

set up staging records. If your organization wants to use payer staging, contact Qualifacts for assistance. The payer staging configurations, along with all other organization configurations, must be enabled by a member of the Professional Services team.

Payer staging allows your organization to set up payer information in the system without affecting live billing. The benefit of payer staging is that it enables your organization to verify the accuracy of the data before moving it into a Production environment. Payer staging also prohibits staff members from modifying data ‘on-the-fly’. When using payer staging, all data changes must be approved before they can be moved into a Production environment.

For example, suppose a staff member in your parent organization is responsible for negotiating the contracted rates for all of the payer plans used by your child organization. In this scenario, a staff member in the child organization would set up the staging records for the payer plan’s fee matrix, and then the staff member at the parent organization would review the accuracy of the data. Once the accuracy of the data is confirmed, it is approved by the staff member at the parent organization. At this point, the data is automatically moved into your Production environment by the nightly run of the Claim Engine.

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The following diagram illustrates the process flow for creating staging records. An outline that describes the process follows the diagram.

1 Create New Staging Records. All staging records must be entered into the system through the Payer Staging module. Staging records can be created for payer panels, procedure codes/standard fees, payers/payer plans, and GL codes. In order to add staging records, users must have the ‘Create Staging Records’ privilege level.

2 Lock Staging Data. After a staging record is created, it must be electronically signed by the staff member who created it. Once a staging record is signed, it is locked and cannot be modified.

3 Select Staff to Approve Staged Data. Depending on your needs, you can select either a single or multiple staff members to approve the staging data before it can be moved into your Production environment. Each staff member who is selected to approve the staging data will receive a system alert and an e-mail notification.

4 Staff Approves Staged Data. Once the appropriate staff members are notified that staging data is ready, they must review the data to confirm that it is accurate.

If the staging data is accurate, then it is accepted and will be moved into a Production environment.


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If the staging data contains inaccuracies, then it is rejected and the reason for the rejection must be noted in the staging record. Because the rejected staging record has been electronically signed and locked, it cannot be modified. This means you must re-create the staging record (see Step 1).

5 Staged Data Moved into Production. Once the staged data is approved by the appropriate staff member, it is moved into your Production environment by the nightly run of the Claim Engine.

Facility Billing Process Flow Note: By default, the facility billing configuration is disabled, which means your organization can produce

Professional claims only. When this configuration is enabled, your organization can produce both Professional and Institutional claims. This organization configuration, along with all other organization configurations, must be enabled by Qualifacts. In addition to enabling the facility billing configuration, your organization must also enable the revenue code/fee configuration in order to use facility billing. In order to enable the facility billing configuration, contact a member of the Professional Services team.

Facility billing enables organizations to split one service into two billing codes for the purpose of creating two separate claims: a professional claim and an institutional claim. The professional claim is based on the procedure code and the institutional claim is based on the revenue code.

The following diagram explains the logic used by the Claim Engine to allow facility billing.

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1 Once the status of an activity is marked as Kept, it is automatically processed by the nightly run of the Claim Engine.

2 The first check by the Claim Engine is to determine the type of facility (outpatient or inpatient) that provided the service. In order to do this, the system uses the service location associated with the activity. Each service location is designated as either outpatient or inpatient.

Note: For outpatient services, the Claim Engine generates bills according to Steps 3 and 4. For inpatient services, the Claim Engine generates bills according to Step 5.

3 For outpatient services, the next check is to verify that the organization and payer plan are both set up to allow facility billing. In the Organization module, this flag is set in the Organization Facility Bills field. In the Payer Plan module, this flag is set in the Reimburses Facility Fees field.

If both the organization and payer plan are set up to allow facility billing, then the payer plan’s fee matrix is used to determine the type of claim that is created (Step 4).

If either the organization or the payer plan is not set up to allow facility billing, then a Professional claim is created based on the procedure code and fee.

4 The last step for outpatient services is to determine what the payer plan reimburses. This is done by checking the payer plan’s fee matrix.


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If the payer plan’s fee matrix contains a dollar amount for the procedure fee only, then a Professional claim is created based on the procedure code and fee.

If the payer plan’s fee matrix contains a dollar amount for the revenue fee only, then an Institutional claim is created based on the revenue fee and the code format defined for the payer plan (Procedure only, Revenue only, Procedure-Revenue, or Revenue-Procedure).

If the payer plan fee matrix contains a dollar amount for both the procedure and revenue fees, then two claims are created: a Professional and an Institutional. The Professional claim is based on the procedure code and fee. The Institutional claim is based on the revenue fee and the code format defined for the payer plan (Procedure only, Revenue only, Procedure-Revenue, or Revenue-Procedure).

5 For inpatient services, the Claim Engine checks to determine the type of service being processed. The following options are possible.

Professional services include such things as Individual Therapy and Office Visits. For professional services, a Professional claim is generated based on the procedure code and fee.

Observation services occur during pre-admission. Organizations use observation services to assess clients for less than 24 hours to determine if they should be admitted for treatment. For observation services, an Institutional claim is generated based on the procedure and revenue codes and fees.

Institutional services include per diem services, such as Room & Board and Food. For institutional services, an Institutional claim is generated based on the revenue code and fee.

Grant Payers Process Flow Note: By default, the grant payer configuration is disabled, which means your organization cannot track

grant payer transactions. When this configuration is enabled, your organization can track grant payer transactions. This organization configuration, along with all other organization configurations, must be enabled by Qualifacts. In order to enable the grant payer configuration, contact a member of the Professional Services team.

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If your organization receives grant payments, you can use CareLogic to track the grant payer financial transactions. Once a claim associated with a grant payer has been approved, the system uses the following logic to apply it to grant payments.

1 Once the claim is approved, the system attempts to apply it to a payment.

2 The first check is to determine if there is a grant payment available in the system.

If there is a grant payment in the system at the time of claim approval, the claim is automatically attached to the grant payment (see Step 3).

If there is not a grant payment in the system at the time of claim approval, the claim is left open (see Step 4).

3 After applying the claim to the grant payment, the system determines if there is a remaining balance on the claim.

If there is a remaining balance, the claim is left open with a balance. At this point, your organization can wait for another grant payment. If a grant payment is not received, the claim must be manually written off.

If there is no remaining balance, the claim is closed.

4 If there is no grant payment in the system at the time of claim approval, the claim is left open. At this point, the system checks to see if you have set up the claims to be automatically written off.

If you marked the payer plan to automatically write-off claims when no grant payment is found and set up a GL offset account, then the system will automatically write-off the claim to the transaction reason code you selected.


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If you did not set up the payer plan to automatically write-off claims, then the claim is left open. At this point, your organization can wait for another grant payment. If a grant payment is not received, the claim must be manually written off.

Further Information and Support After implementing CareLogic, there are several resources that are designed to help maximize your use of the system. This chapter includes information about the CareLogic documentation and provides details for contacting Technical Support.

• CareLogic Documentation

• Contacting Technical Support

CareLogic Documentation As a CareLogic user, you are provided with the complete documentation set. The CareLogic documentation set is available in two formats: softcopy guides and online help.

User Guides User guides are available in PDF (portable document format) format. The CareLogic user guides were developed to be either viewed online or printed. To view the user guides, you must have a PDF Reader.

The CareLogic user guide set includes the following:

• Introduction to CareLogic

• CareLogic System Administration Guide

• CareLogic General Ledger Guide

• CareLogic Human Resources Guide

• CareLogic Point of Entry Guide

• CareLogic Scheduling Guide

• CareLogic Clinical Record Guide

• CareLogic Front Desk Guide

• CareLogic Billing and Accounts Receivable Guide

• CareLogic Standard Reports Guide

• CareLogic Ad Hoc Reports Guide

• CareLogic State-Specific Clinical Record Guide

• CareLogic Emdeon Clinician Guide

Online Help

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The CareLogic online help system can be viewed on any platform and by any Web browser (Internet Explorer, Netscape). The online help system contains instructions for using all of the functionality in CareLogic. Once the help system is open, you can use the navigation pane to access any other help topic. The navigation pane contains of a Table of Contents, Index, and Search function.

To access online help:

1. Click the Help icon in the navigation bar.

The online help system appears.

A. Table of Contents. This button displays the Table of Contents, which is similar to Windows Explorer. Instead of containing folders and files (as does Windows Explorer), the Table of Contents contains books and pages which function in the same manner.

When you select a book or page, the corresponding page is displayed. Books can be expanded and collapsed to access the desired page. In the previous example, the Scheduling System Help book is expanded and the Introduction book is selected, as indicated by the highlight. As a result, the Introduction page is displayed.


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B. Index. This button displays the Index, as shown below. The top half of the Index contains the letters that have index entries. Click the letter of the index entries you want to view. In the example, the letter ‘A’ has been selected and all of the index entries that begin with the letter ‘a’ are listed.

C. Search. This button displays the Search engine, as shown below. Enter the full or partial text string on which you want to base your search and click Go. The Search pane is refreshed and the pages that contain the text string you entered are listed by rank. When you click on a page, the page is displayed and the text string you entered in highlighted. In the following example, the text string ‘ECR’ appears three times in the topic ‘Accessing a Client’s ECR’.

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D. Show in Contents. This button is used to highlight the book or page in the Table of Contents that is currently displayed in the topic pane.

E. Previous Page. This button is used to access the previous page in the help system.

F. Next Page. This button is used to access the next page in the help system.

G. E-mail. This button is used to e-mail feedback about the help topic that is currently displayed to the Qualifacts Documentation department. When you click this button, a new e-mail message appears with the To and Subject fields automatically populated. The To field is populated with the e-mail address to the Documentation department, and the Subject field is populated with the name of the HTML page that is displaying the current topic. Your feedback and input is valued by the Documentation department. Please use this feature only to communicate documentation-related information about the online help system.

H. Print. This button is used to print the help topic that is currently displayed.

I. Bookmark. This button is used to add the help topic that is currently displayed to your list of Favorites in Internet Explorer.

Note: In order to select the bookmark from the Favorites list, the CareLogic online help system must be open. If the CareLogic online help system is not open and you select the help topic from the Favorites list, an error occurs.

Displaying the Navigation Pane If you open an individual HTML page without clicking the Help icon in the system, the HTML page is displayed but the navigation pane is not. This task includes instructions for displaying the navigation pane, which includes the Table of Contents, Index, and Search buttons.


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To display the navigation pane:

1 Double-click the HTML help page you want to open.

The selected help page opens, without the navigation pane.

2 Click the Show Navigation button.

The browser is refreshed and the navigation pane is displayed along with the help topic.

Note: After you display the navigation pane, the Show Navigation button changes to Show in Contents.

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3 Click the Show in Contents button.

The table of contents pane is refreshed and the help topic that is displayed in highlighted in the navigation pane.


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Contacting Technical Support At Qualifacts Systems, our goal is to provide an intuitive software application accompanied by comprehensive documentation. However, if you have a question that cannot be answered with the tools provided, please use the following information to contact our Technical Support department:

• Support Line: 1-866-386-6755; option 1 during business hours, option 3 after business hours

• Jira: http://jira.qualifacts.com

• Email: [email protected]