Revenue Management Data

Revenue Management uses three databases internally and accesses either the Lytec or Medisoft practice Database:

  • CMDBlist.ADD - The Revenue Management Practice List Database
  • CM4.ADD  - The Revenue Management Practice Database
  • MCD.ADD - The Revenue Management Claims Edit Database

These databases are data dictionaries.  This means that all of the tables are bound to the data dictionary and cannot be copied from one database to another.  All databases that are a part of Revenue Management can be accessed using advantage data architect.  The databases can be accessed using the username of user and the password of password. 

CMDBList.ADD

The CMDBList is the practice list for Revenue Management.  The CMDBList must be on a location that is accessible from all computers using Revenue Management.  All computers using Revenue Management must use the same path to the CMDBList.  There is only one CMDBList for each installation.  The CMDBList contains the following tables:

  • AdjustmentCodes
  • Alias
  • Control
  • DefaultLYReceiver
  • DefaultMSReceiver
  • DefaultReceiver
  • IGElement
  • IGLoop
  • IGQuery
  • IGSegment
  • IGSubElement
  • IGuide
  • InsuranceRules
  • InterchangeLog
  • LYDefaultTransactionSet
  • MSDefaultTransactionSet
  • Practice
  • PracticeIG
  • RemarkCodes
  • Rule
  • RuleSet
  • Session
  • StatusCategories
  • StatusCodes
  • TransactionSet
  • Version

Revenue Management maintains an original version of the CMDBList database under the program files RCM directory.  It is in zipped file named DBList.zip.

 

AdjustmentCodes – The AdjustmentCodes table contains the remittance advice adjustment codes.  It is used when posting remittance advices.  This table is populated when the CMDBList is created.

 

Alias – The Alias table contains information that is used to identify which practice a post-able report(mainly 835s) belongs to.  This table is empty when the CMDBList is created.  If a report is opened and Revenue Management does not find an existing matching entry, the Alias window is displayed.  If a new entry is made in the Alias window, it is stored in the Alias table.

 

Control –

The Control table contains information that Revenue Management uses to locate the PMS practice list, the interchange number record, and group number record.  This table also stores the username, password, and server name for the PMS.  This table is empty when the CMDBList is created.   A record in the Control table is created the first time Revenue Management is launched; this is done after the CMDBList has been created.

DefaultLYReceiver – The DefaultLYReceiver table contains the receiver settings for the pre-configured receivers in Revenue Management that are needed for use with Lytec.  It is used anytime a new receiver is added or configured for Lytec.  This table is populated when the CMDBList is created.

DefaultMSReceiver - The DefaultMSReceiver table contains the receiver settings for the pre-configured receivers in Revenue Management that are needed for use with Medisoft.  It is used anytime a new receiver is added or configured for Medisoft.  This table is populated when the CMDBList is created.

DefaultReceiver - The DefaultReceiver table contains the receiver settings for the pre-configured receivers in Revenue Management that are the same for both Lytec and Medisoft.  It is used anytime a new receiver is added or configured for Lytec or Medisoft.  This table is populated when the CMDBList is created.

 

IGElement – The IGElement table contains all the information for ANSI elements for all implementation guides.  Most implementation guide mapping is stored in this table.  This table is populated when the CMDBList is created.

IGLoop - The IGLoop table contains all the information for ANSI loops for all implementation guides.  This table is populated when the CMDBList is created.

IGQuery – Not Used

IGSegment The IGSegment table contains all the information for ANSI segments for all implementation guides.  This table is populated when the CMDBList is created.

IGSubElement The IGSubElement table contains all the information for ANSI subelements for all implementation guides.  This table is populated when the CMDBList is created.

 

IGuide The IGuide table contains the list of implementation guides.  This table is populated when the CMDBList is created.

InsuranceRules – The InsuranceRules table contains a list of any insurance carrier that has a user define edits rule assigned to it.  This table is empty when the CMDBList is created.

InterchangeLog  - The InterchangeLog table contains a list of all transaction interchanges created. It is used to identify the correct file for displaying 997 reports. This table is empty when the CMDBList is created.  A record is added every time a file is built.

LYDefaultTransactionSet - The LYDefaultTransactionSet table contains the transaction set settings for the pre-configured receivers in Revenue Management that are needed for use with Lytec.  It is used anytime a new receiver is added or configured for Lytec.  This table is populated when the CMDBList is created.

MSDefaultTransactionSet - The MSDefaultTransactionSet table contains the transaction set settings for the pre-configured receivers in Revenue Management that are needed for use with Medisoft.  It is used anytime a new receiver is added or configured for Medisoft.  This table is populated when the CMDBList is created.

 

Practice – The Practice table contains a list of all practices configured in Revenue Management.  This table is empty when the CMDBList is created. 

PracticeIG – Revenue Management no longer uses this table.

RemarkCodes - The RemarkCodes table contains the remittance advice remark codes.  It is used when posting remittance advices.  This table is populated when the CMDBList is created.

Rule  - The Rule table contains the individual rules that are part of a rule set.  Every rule belongs to a rule set.  These rules are used when checking claims.  This table is populated with the common rules when the CMDBList is created.

 

RuleSet – The RuleSet table contains the records for each rule set.  A rule set is used to group individual rules.  Every time a new rule set is made, an entry is created in this table.  This table is populated with the common rule set when the CMDBList is created.

Session – The Session table contains all the communication information.  This table is populated with the pre-configured session information when the CMDBList is created.  Some of the information stored in this table consists of the username, password, phone number or website, and the communication scripts.  If any additional communication sessions are added, the information is stored in this table. 

StatusCategories – The StatusCategories table contains the category codes used with 277 reports (Claim Status Responses).  This table is populated when the CMDBList is created.

 

StatusCodes - The StatusCodes table contains the status codes used with 277 reports (Claim Status Responses).  This table is populated when the CMDBList is created.

TransactionSet – The TransactionSet table contains all of the information for every transaction set configured.  This table is empty when the CMDBList is created.

Version – The Version table contains the version information for the CMDBlist.  This table is empty when the CMDBList is created.

CM4.ADD

The CM4 database is the practice database for Revenue Management.  Each practice will have it’s own CM4 database.  The CM4 database must be on a location that is accessible from all computers using Revenue Management.  All computers using Revenue Management must use the same path to the CM4 database.  The CM4 database consists of the following tables:

  • ClaimHistory
  • Insurance
  • LytecDeposit
  • Options
  • PostingCodes
  • Receiver
  • Version

 

Revenue Management maintains an original version of the CM4 database under the program files RCM directory.  It is in zipped file named CM4.zip.

ClaimHistory – The ClaimHistory table contains all the history entries that are displayed in the Claims/Billings editor.  There is one record for each history item on a billing or claim.  This table is empty when the CM4 database is created.

Insurance – The Insurance table contains the record that tells Revenue Management which edits a particular insurance is set to use.  There is one record for each insurance carrier in Lytec or Medisoft.  This table is empty when the CM4 database is created.

LytecDeposit – The LytecDeposit table contains a record of each remittance posted with Revenue Management.  It is only used with Lytec.  It is used to warn the end users before posting a remittance advice twice.  This table is empty when the CM4 database is created.

 

Options – The Options table contains all the option settings selected in preferences.  It does not contain the posting codes, but does contain the remit posting options.  This table is empty when the CM4 database is created.

PostingCodes – The PostingCodes table contains the posting codes record for each receiver.  It will contain a record for each posting code configured.  This table is empty when the CM4 database is created.

Receiver – The Receiver table contains all of the receiver information that does not exist in Lytec or Medisoft.  The receiver editor in Revenue Management is made up of the CM4 receiver record combined with the Lytec or Medisoft receiver record.  This record does NOT include the transaction set information.  There is one record for each receiver that has been configured in Revenue Management.  This table is empty when the CM4 database is created.

Version – The Version table contains the version information for the CM4 database.  This table is empty when the CM4 database is created.

MCD.ADD

The MCD database is the claims edit database for Revenue Management.  Each installation will have only one MCD database.  The MCD database is in the CM4.MCD folder, which is located in the Revenue Management root data path.   The MCD Database contains all of the information that is used for the subscription-based edits.   This information is also used with the MasterCode portion of Revenue Management, which is available with an active subscription.  This database is updated every time a claims edits update is downloaded and installed.   Refer to the Edits course (201) for more information regarding the data in the MCD database.

When a claims edit update is downloaded, it is copied to the MCD.UPDATE folder, located in the root data path.  When the update is installed, several things happen.

  • The contents of the CM4.MCD folder are deleted.
  • The contents of the MCD.UPDATE folder are copied to the CM4.MCD folder. 
  • Once the update is installed, the MCD.UPDATE folder is set back to the original claims edit database with a version of July 2008.

Revenue Management maintains an original version of the claims edit database under the program files RCM directory.  It is in zipped file named MCD.zip.

Tables used from Medisoft

Revenue Management accesses data from a wide variety of tables in Medisoft.  Some of the tables used are:

MWADD – Facility information

MWBSP – Billing Service information

MWCAS – Patient Case information

MWCCD – Patient Case Custom information

MWCLA – Claim Information

MWDEP – Deposit Information

MWDIA – Diagnosis Code list

MWECR – EDI Receiver Information

MWERC – Claim Level posting information

MWERT – Service Level Posting information

MWINC – Insurance Class Information

MWINS – Insurance Information

MWPAT – Patient Information

MWPAX – Payment – Charges Cross Reference

MWPCL – Provider Class Information

MWPHY – Provider Information

MWPINS – PINs Information

MWPRA – Practice Information

MWPRO – Procedure Code List

MWRPH – Referring Provider Information

MWTRN – Serviceline Information

 

Tables used from Lytec

Revenue Management accesses data from a wide variety of tables in Lytec.  Some of the tables used are:

Address – Facility and Referring Provider information

Billing Detail - Serviceline Information

Billing Header - Claim Information

Diagnosis – Diagnosis Code list

EDI Receiver – EDI Receiver Information

Guarantor – Guarantor Information

History Detail – Serviceline History information

History Header – Claim History information

Insurance – Insurance Information

Patient – Patient Information

Practice – Practice Information

Provider – Provider Information

Remittance Tracking – Claim – Claim Level posting information

Remittance Tracking – Transaction – Service Level Posting information

Transaction Code – Procedure/Transaction Code List