Shadow Billing Macro
| Macro Name | Code: SHADOW, Description: Shadow Billing Macro; (Maintain -> Templates -> Macros) |
| Date Created | Prior to 2010 |
| Last Updated | November 21 2024 |
| Last Updated By | Scott Kellman-McFarlane |
Sometimes MSP claims are created only for administrative/reporting purposes, not for financial billing (so the payee does not actually get paid anything), and this is called "Shadow Billing".
IMPORTANT: This macro is still necessary, List of Service Codes and POS's used in this macro MUST BE MAINTAINED. |
How it Works
The Macro is triggered every time a claim is created or updated. If the claims meet the following required criteria, the Shadow Macro ensures the claim amount is set to $0:
1. If Provider Specialty (from PPPU.PPPU_TYPECONCEPTID & PPPU.PPPU_SPECIALTYCONCEPTID) = "Nurse Practitioner"
-----
2. Service Codes. All Service Codes by default participate in Shadow Billings except the excluded listed below (i.e. Claim Amount is Unchanged) from the shadow billings:
| Service Codes | |
| 3333 | NO CHARGE REFERRAL |
| 19918 | WCB REPEAT CONSULT WITHIN 2 - 4 MONTHS OF 19917 |
| 19920 | Med Review Panel "Enabling Certificate" - bill directly to WCB |
| 19923 | WCB FIRST REPORT OF INJURY(FORM 8 HOSPITAL)W/N 5 D |
| 19924 | WCB FIRST REPORT OF INJURY(FORM 8 HOSPITAL)W/N 6-7 |
| 19925 | WCB PROGRESS REPORT(FORM 11 HOSPITAL) W/N 5 WORKIN |
| 19926 | WCB PROGRESS REPORT(FORM 11 HOSPITAL)W/N 6-7 WORKI |
| 19939 | WCB TELEPLAN E-FORM 8 REC'D WITHIN 10 DAYS OF FAX |
| 19951 | WCB RE-FILING DUE TO AN UNREPORTED CLAIM |
| 96400 | MSDSI MONTHLY NUTRITIONAL SUPPLEMENT FORM PART B |
| 96501 | MSDSI FORM PERSON WITH DISABILITIES DESIGNATION |
| 96502 | MSDSI SECTION 3 ASSESSOR REPORT |
| 96503 | MSDSI MED RPRT-PERSONS WITH PERSIST MULTI BARRIERS |
| 96504 | MSDSI MEDICAL REPORT EMPLOYABILITY FORM |
| 96505 | MSDSI MEDICAL REPORT, CHILD |
It is up to an user to notify our team to update the list with a Service Codes if the code is missing.
-----
3. All Patients with a BC PHN.
-----
4. Participating POS is in the following list:
| POS's | |
| ADP | Assisted Dying Program |
| BVD | Boulevard Youth Clinic |
| CPS | BCCDC – Clinical Prevention Services |
| DCH | Downtown CHC |
| FRC | Foundry Richmond |
| GSP/GSO/GSG | Groundspring Primary Care |
| HIM | HIM Health Centre |
| ICR | Indigenous Crisis Response Team |
| IHO | Intensive Health Outreach Team (IHOT) |
| INO | Indigenous Health Outreach Team |
| IYC | Inner City Youth |
| KYC | Knight Street Youth Clinic |
| MOD | Mobile DeEscalation |
| RAB | Raven Song PC BLU |
| RAG | Raven Song PC GRN |
| RAY | Raven Song PC YLW |
| RSG | Raven Song Clinic |
| SWY | Sheway |
| SHS | Sexual Health Clinic - Sunshine Coast |
| THC | Texada Health Centre |
| TBR | Three Bridges |
| YPP | Youth Pregnancy & Parenting Program |
-----
| Note: In the Shadow Billing Macro code there is another variable called "Is_Karen_Stancer", but Dr. Stancer has not created a claim in the EMR since 2009 so it is ignored in this documentation. (FYI, if the provider was "Karen Stancer" and the POS was "YPP" then the Claim Amount was unchanged.) |
Testing
Shadow billing macro needs to be tested in a non-anonymized environment.