Billing Settings - Implementation

This article is for Billing Specialists or Consultants to enable a lab’s billing system using the Billing Settings: Administration Page(s). Use this guide for your OvDx implementation with your 3rd party Billing Integration and to confirm the responsibilities of your Billing Partners.

To learn how to add/edit/delete individual components of your billing settings after initial implementation, see our Billing Settings - Maintenance article.

The following sections are contained in this guide. Read the entire article or skip to your section of interest.

1. Add Insurance Providers/Carriers

- Import to Sandbox

- Export from Sandbox to populate Production

2. Add Physicians/Providers (3rd Party Integration Dependent)

- Import to Sandbox

- Export from Sandbox to populate Production

3. Add Billing Rules (3rd Party Integration Dependent)

- Import to Sandbox

- Export from Sandbox to populate Production

4. Check Billing Submission Log (Optional)

- Search Log

- Export Log

- Submit Batch of Billing Events

User Permissions

Roles and Permissions must be enabled in both OvDx LIMS Sandbox ( https://lab-sandbox.ovation.io) and OvDx LIMS Production (https://lab.ovation.io) environments for users to access the two Billing Settings: Administration Pages. Both Billing Settings: Administration pages are needed to complete the setup of a billing system.

Users must have the User Role of “Billing Consultant” to access Billing Settings: Administration Pages. Additionally, The Billing Consultant Role must have the Permission of “Billings Settings” set to the Permission Level of “Write” or “Admin”. 

Give appropriate users access to the Billing Settings: Administration Pages using the steps below. From any page in the OvDx LIMS…

1. Click on More > Settings > Users & Permissions

2. Click the Roles and Permissions tab

3. Type “Billing” into the Find Permission box

4. Type “Billing” into the Find Role box

5. Click on the green current Permission Level of the Billing Consultant Role (“None” shown below)

6. Change the Permission Level to “Write” or “Admin”  in the Permission Level ModalNote: Both “Write” and “Admin” Permission Levels grant the same access. The Permission Level of “Read” will allow the user to see the Billing Settings: Administration Page, but they will be unable to make any changes. 

7. Click the X in the top right corner

Recommended Setup

The recommended sequence for initial Implementation setup of billing systems is described below. 

     1. Add Insurance Providers (Required if not using Ovation Standard List)

  • Include ‘Groups’ in the Insurance Providers Import sheet to enable group-specific Billing Rules (Optional)

     2. Add Physicians/Providers (3rd Party Integration Dependent)

     3. Add Billing Rules (3rd Party Integration Dependent)

  • If using Groups, Billing Rules can be applied to a select Group (Optional)

     4.  Check Billing Submission log (Optional)

Note: A complete validation of the OvDx LIMS Sandbox environment is required prior to build-out of the OvDx LIMS Production environment

We recommend that users complete initial Implementation and testing in the Sandbox environment before exporting and populating the Production environment.  

Note: Depending on your 3rd Party Integration(s), you may not need to use all tabs on the Billing Settings: Administration Page. Users without 3rd Party Integrations may use the Insurance Providers tab to alter the list of available Insurance Providers displayed within their OvDx LIMS.

1. Add Insurance Providers/Carriers

Data populated under the Insurance Providers tab determines which Insurance Providers/Carriers are available for selection on Requisition Forms in your OvDx LIMS. The available Insurance Providers/Carriers can be selected in the  ‘Billing Information’ Insurance Section of a Requisition Form. 

Tip: You do not need to perform this step if you are using the Ovation Standard List for Insurance Providers/Carriers. Perform this step only if you want to adjust the Insurance Providers/Carriers currently listed in your OvDx LIMS

Import to Sandbox

The Import feature allows for the addition of multiple Insurance Providers/Carriers and Groups by CSV file.  

1. Login to your Sandbox environment at https://lab-sandbox

2. Navigate to More > Lab > Billing Settings

3. Click Sign In (top right corner) to enter your Ovation user name and password.

4. From the Insurance Providers tab, click Export to download a CSV template with all current Insurance Providers/Carriers

5. Fill in the template with the appropriate Insurance Providers/Carriers and save as a CSV file

Tip: Required formatting for the import template is shown below. Name of Insurance Provider/Carrier is the minimum data needed to create an entry. Billing to AMD requires the name of the Insurance Provider/Carrier and Payer Code to create an entry. Payer ID should be left blank, as Ovation will fill this in upon a successful return call.

Note: Uploading a non-CSV file type, or duplicate entries within the file, will cause the import to be rejected. Insurance Providers/Carriers or Payer IDs that are not synced with 3rd Party Integrations will cause Billing Errors. Payer Codes should be provided by 3rd Party Billing Integration Partners if not using Ovation’s default list of Providers/Carriers.

Note: We recommend adding Insurance Groups within the CSV import file to selectively group Insurance Providers/Carriers together. Groups can then be used to filter Insurance Providers/Carriers for export. Groups can also be used to apply different Billing Rules to separate groups. Common groups are “Commercial” and “Medicaid”.

Tip: Insurance Groups are not required and can be added later. Including a Group on the import sheet that does not already exist will create that Group. Additionally, if the import sheet contains a different Group than what is currently listed, the import file will overwrite the existing entry.

6. Click Import

7. Click “Choose file” and select your populated CSV file

8. Click Import

Export from Sandbox to populate Production

Following Sandbox Validation, the Insurance Providers 'Export' feature allows for quick migration of Insurance Providers/Carriers from Sandbox to Production.

1. From the ‘Insurance Providers’ tab in Sandbox, click Export

2. Navigate and login to your Production environment at https://lab.ovation.io/

Tip:  Use an incognito browser window to open your production environment

3. Click on More > Lab > Billing Settings

This will open the Production Billing Settings: Administration Page for your LIMS. 

Note: This is a separate webpage with a different url than your Sandbox Billing Settings: Administration Page, so you will need to Sign In again with your Ovation username and password.

4. In your Production Billing Settings: Administration Page, click Import

5. Click “Choose file” and select your downloaded CSV file from Sandbox

6. Click Import

The Insurance Providers from Sandbox will now be available in your Production environment

2. Add Physicians/Providers (3rd Party Integration Dependent)

Physicians/Providers must be added to BOTH the Billing Settings: Administration Page> ‘Physicians’ tab AND in the OvDx LIMS for proper billing mapping to 3rd Party Integrations. This step is dependent on your 3rd Party Integration requirements.

Note: Only Physicians/Providers with valid 10-digit National Provider Identifiers (NPIs) can be added to the Physicians tab.

Import to Sandbox

The Import feature allows for the addition of multiple Physicians/Providers using a CSV file. 

1. Login to your Sandbox environment at https://lab-sandbox

2. Navigate to More > Lab > Billing Settings > Sign In

3. From the Physicians tab, click Export to download a CSV template file with all current Physicians

4. Fill the template with the Physicians’ information and save as a CSV file

Import Sheet Formatting for Providers/Physicians

  • Name - Optional - (Populates automatically upon import via NPI# validation)
  • NPI - Required
  • Service Code - Required (Provided by 3rd Party Integration)
  • Service ID - Leave Blank (Populates automatically upon a successful return call)

Note: Uploading a non-CSV file type, or duplicate entries within the file, will cause the import to be rejected. Service Codes that are not synced with 3rd Party Integrations will cause Billing Errors. All Physicians/Providers will also need to be added to the OvDx LIMS under their appropriate Provider Accounts (see Adding a Provider Account)

5. Click Import

6. Click “Choose file” and select your populated CSV file

7. Click Import

Export from Sandbox to populate Production

Following Sandbox Validation, the Physicians/Providers 'Export' feature allows for quick migration of data from Sandbox to Production.

1. From the ‘Physicians’ tab, click Export

2. Navigate and login to your Production environment at https://lab.ovation.io/

Tip:  Use an incognito browser window to open your production environment

3. Click on More > Lab > Billing Settings

This will open the Production Billing Settings: Administration Page for your LIMS. 

Note:  This is a separate webpage with a different url than your Sandbox Billing Settings: Administration Page

4. In your Production Billing Settings: Administration Page, click the ‘Physicians’ tab, then Import

5. Click “Choose file” and select your downloaded CSV file from Sandbox

6. Click Import

The Physicians from Sandbox will now be populated in your Production environment

3. Add Billing Rules (3rd Party Integration dependent)

Macros populated under the Billing Rules tab by 3rd Party Integration representative(s) enable billing for test panels. This step is dependent on your 3rd Party Integration requirements.

Import to Sandbox

The import feature allows for the addition of multiple Billing Rules using a CSV file.

1. Login to your Sandbox environment at https://lab-sandbox

2. Navigate to More > Lab > Billing Settings > Sign In

3. From the Billing Rules tab, click Export to download a CSV template file with all current Billing Rules

4. Fill the template with the Billing Rules information and save the file

Import Sheet Formatting for Billing Rules

  • Test Panel Code - Must match the panel code that is listed in the OvDx LIMS Test Panels Page
  • Procedure Code - The name of the macro or the individual CPT Code associated with the Test Panel from the 3rd Party Integration
  • Code Type - Required for every Billing Rule with a Procedure code (macro or cpt)
  • Insurance Group - Applies a Billing Rule to a specific Insurance Group only. If no Insurance Group is listed, then the Billing Rule will apply to all Insurance Providers/Carriers
  • Max Units, Modifiers, and Profile ID -Defined by 3rd Party Integrations

Note: Uploading a non-CSV file type, or duplicate entries within the file, will cause the import to be rejected. Test Panel Codes that are not synced with 3rd Party Integrations and the OvDx LIMS will cause Billing Errors. 

5. Click Import

6. Click “Choose file” and select your populated CSV file

7. Click Import

Export from Sandbox to populate Production

Following Sandbox Validation, the Billing Rules 'Export' feature allows you to quickly migrate your list of Insurance Providers from Sandbox to Production.

Tip: Users may also use the export feature to obtain a list of current Billing Rules for communication and management with 3rd Party Integrations.

1. From the ‘Billing Rules’ tab, click Export

2. Navigate and login to your Production environment at https://lab.ovation.io/

Tip:  Use an incognito browser window to open your production environment

3. Click on More > Lab > Billing Settings

This will open the Production Billing Settings: Administration Page for your LIMS. 

Note:  This is a separate webpage with a different url than your Sandbox Billing Settings: Administration Page, so you will need to Sign In again with your Ovation username and password.

4.  In your Production Billing Settings: Administration Page, click the ‘Billing Rules’ tab, then Import

5. Click “Choose file” and select your downloaded CSV file from Sandbox

6. Click Import

The Billing Rules from Sandbox will now be available in your Production environment

4. Check Billing Submissions Log (Optional)

The Billing Submissions Log feature allows for monitoring Billing Submissions and resubmission of Billing Events. There is a more comprehensive Billing Event Log available within the OvDx LIMS. Read the entire section or skip to your section of interest…

Note: Checking the Billing Submissions Log is an optional part of Implementation. Use the feature depending on your billing monitoring, and your 3rd Party Integration(s), needs. 

Search Log

Users can use the Search Filters under Billing Submissions to locate records of interest

1. Enter all relevant Search Filters for your search

  • Use the Identifier Filter to narrow search for a specific, or partial, Requisition ID

  • Use the Select Project Filter to narrow search to a specific project

  • Use the Select Billing Status Filter to narrow search to a specific Billing Status

  • Use the Date Range Filters to narrow search to results obtained within the selected Date Range

2. Hit Search to apply all Search Filters

This will return only relevant results. The filtered data can then be exported.Tip: Clicking “Export” after filtering Billing Submissions will create a CSV file with only filtered results. 

Export Log

The Export function under the Billing Submission tab can be used to export records of Billing Submissions.

  • From the ‘Billing Submissions’ tab, click Export

  • The Export file will contain the following column headers

Submit Batch of Billing Events

The Submit Batch button allows resubmission of multiple requisitions for billing by bulk CSV import.

1. Click Submit Batch

2. Click “Choose file” and select your populated CSV file

Tip: Click Download Template file to get a CSV template 

3. Click “Submit” button

This will resubmit the requisitions. Users can then check the Billing Submissions tab to see the status for the resubmitted requisitions.

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