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SIMG_CFMENUNMO3ON87 - Determine Billing Catalog

TXBHW - Original Tax Base Amount in Local Currency   General Data in Customer Master  
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In this IMG activity, you define which service catalog is to be used for billing in relation to the parameters and rules that apply for the different cases. If you bill for services using a service catalog other than your in-house service catalog, you have to re-map the services that are to be billed for. In this case, specify which assignment type is to be used for service re-mapping.

You can define the following criteria for determining the billing catalog (in some cases using the wildcard character *):

• The service category, or also individual services

• The insurance provider or insurance provider type

• The billing type

You can specify a validity period for these rules for billing catalog determination. The rules are used especially by the insurance verification and patient billing programs.

The following example specifies that billing catalog 2 is to be used for all services billed for with billing type WT (workers' compensation association treatment) and insurance provider type WC (workers' compensation association). Billing catalog 01, which is also the in-house service catalog, is used for all other cases:

Inst	RT	SC	Srv	SCat	IP	IPT	BT	BC	AsgtTyp
1	BL	01	*	*	*	*	*	01
1	BL	01	*	*	*	WC	WT	02	-->

02

You need to have already created the

• Institution

• Service catalogs

• Service categories

• Insurance providers or insurance provider types

• Billing types

• Assignment types (with indicator C for conversion)

you want to use in the configuration table.

To be able to use individual services as a criterion, you need to have specified this in the separate IMG activity Set Up Service-Based Service Catalog Determination.

02

You create a new rule for billing catalog determination either by choosing New Entries, or by selecting then copying an existing entry.

Enter values in the following fields:

• Institution

• Rule Type BL (= billing)

• Service Catalog (identification of the in-house service catalog)

• Service, if required, otherwise the wildcard character *

• Service Category, if required, otherwise the wildcard character *

• Note that you cannot specify both the service and service category for the same rule.

• Insurance Provider, if required, otherwise the wildcard character *

• Insurance Provider Type, if required, otherwise the wildcard character *

• Self-Payer

• Billing Type, if required, otherwise the wildcard character *

• Billing Catalog

• Assignment Type to be used for service re-mapping.

Do not make an entry in this field if your in-house service catalog and billing catalog are identical.

• Valid From (rule valid from 01/01/1900, for example)

• Valid To (rule valid to 12/31/9999 - indefinitely, for example).

02

• When you delimit the validity of a rule, note that otherwise identical rules are defined without overlaps or gaps.

Example:

It would be illegal to specify a rule with two periods from 01/01/2002 to 06/30/2002 and 06/01/2002 to 12/31/2002 or a rule with two periods from 01/01/2002 to 05/30/2002 and 07/01/2002 to 12/31/9999.

It would be correct to specify a rule with the periods 01/01/2002 to 06/30/2002 and 07/01/2002 to 12/31/9999.

• You can enter either a service or a service category for any one rule. You cannot enter both. You have to enter a * in the field in which you have not made a specific entry.

• You can only specify either an insurance provider or an insurance provider type or flag the self-payer checkbox for any one rule. You have to enter a * in the fields in which you have not made a specific entry or do not flag the self-payer checkbox.

• A wildcard entry comprising a * is permitted for a number of fields. You have to enter either a specific value, or only a * in these fields. Generic specifications (e.g. LAB* in the Service Category) are not allowed.

When maintaining your entry, take into account how the system accesses these rules: Documentation on Access Steps.

Also note the link with the rules for billing type determination. Specifying the admission or visit type in the corresponding Customizing table determines the billing type with which a service is to be billed for. You can now link a billing catalog with the billing type. You specify the relevant column of the service catalog for each billing type and billing catalog in the IMG activity for determining catalog columns.

ROGBILLS - Synchronize billing plans   CPI1466 during Backup  
This documentation is copyright by SAP AG.

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