Intro to CareLogic€¦ · Proprietary Information: For Use by Qualifacts and Our Customers Only...

Introduction to CareLogic Guide

OVERVIEW OF CARELOGIC

What is CareLogic? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

CareLogic Process Flow with Sub‐Process Flows . . . . . . . . . . . . . . . . . . . . . 7

Logging in to CareLogic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Automatic Logoff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Changing Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Proprietary Information: For Use by Qualifacts and Our Customers Only

COMPONENTS OF CARELOGIC

The Navigation Bar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Managing Alerts 13Managing the Dashboard 14Setting Up User Preferences 16Changing Passwords and Signatures 16Using Internal Messaging 17Accessing Online Help 17Logging Out of CareLogic 18

The Shortcut Bar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Adding Shortcuts 19Deleting Shortcuts 20Searching Client Records 21Selecting Menu Options 22

The Status Bar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

CareLogic Basics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Dates 24Required Fields 24Descriptor Fields 25Sorting Tables 26


STANDARD PROCESS FLOWS

Point of Entry Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Scheduling Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Front Desk Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Claim Engine Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Billing Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Accounts Receivable Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

General Ledger Export Process Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36


ADDITIONAL RESOURCES

CareLogic Connect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

CareLogic User Guides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Contacting Technical Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39


Overview of CareLogic• What is CareLogic?

• CareLogic Process Flow with Sub-Process Flows

• Logging in to CareLogic

• Automatic Logoff

• Changing Organizations

What is CareLogic?

Qualifacts’ web‐based electronic health record (EHR), CareLogic, is designed specifically for behavioral health and human services organizations. CareLogic simplifies complex business needs and extends its users ability to serve. Using CareLogic, organizations streamline business pro‐cesses and can access and analyze uniform client, payer, and organizational information through an Internet browser. It is a complete solution that enables users to capture and integrate the criti‐cal information needed to run an organization efficiently.

CareLogic links the delivery of care to the business of care at every level of an organization, improving efficiency, increasing revenues, and freeing staff to focus on their important work.

What will CareLogic do for your organization?

• Improve care coordination with a single source for client data ‐ The cornerstone of CareLogic is a single and complete behavioral health record for each client. The electronic client record (ECR) gives staff immediate and secure access to crucial client data and financial information, dramatically improving care coordination, clinical outcomes and agency efficiency.

• Increase agency transparency and resource utilization ‐ Intuitive, flexible front desk tools match the natural check‐in workflow, simplifying and streamlining tasks in an often‐hectic environ‐ment. Agencies manage referrals for all programs and locations from a single call center or use the module for individual, program‐specific referral processes. Our point of entry module ensures every request for service starts with standard client data, which reduces errors and duplications. The system then recognizes the proper process to follow based on the type of service needed and location.

• Maximize Reimbursements ‐ Claims are automatically generated when a service is kept and all client information and documentation automatically flows into the billing engine once the cli‐nician completes the service without any manual intervention.

• Make informed, data‐driven decisions with real‐time reporting ‐ Powerful, integrated reporting capabilities give agency executives a quick assessment of the financial, operational and clini‐cal health of the organization.

The purpose of this guide is to serve as a high level overview of CareLogic, to point out some overarching functionality that is used throughout the system, and also, to serve as a primer for the following CareLogic User Guides:Point of Entry Guide ‐ Learn to enter new clients into CareLogic.


Front Desk Guide ‐ Learn to manage client appointments, collect co‐payments, and schedule cli‐ents’ next appointments.

Schedule Guide ‐ Learn to add, maintain, and status activities (services).

Billing, Accounts Receivable, and General Ledger Guide ‐ Details the modules and processes used to batch claims, bill payers, receive payments, collect outstanding balances, and record financial information.

Client Guide ‐ Learn to view and manage clinician caseloads, alerts, and client groups. Learn about the Electronic Client Record (ECR) used to access individual client information.

Employee Guide ‐ Learn to track address information, contact information, employment informa‐tion, employee credentials, employee benefits, staff programs, and staff assets for employees in CareLogic

System Administration Guide ‐ Learn to set up, configure, and administer CareLogic for end users.

CareLogic Process Flow with Sub-Process Flows

Point of Entry (POE) ‐ Clients are entered into the system through Point of Entry. Demographic information, guarantors, payer information, payer authorizations, and co‐pay information can be entered for new clients. More information can be found in the Point of Entry Guide.

Front Desk ‐ Scheduling and billing functions necessary for front desk personnel to operate can be provided here without giving complete access to either one of those systems. More informa‐tion can be found in the Front Desk Guide.

Schedule ‐ The Schedule is the inception point in the CareLogic system. Without a service placed on the Schedule, no claim will be automatically generated. More information can be found in the Schedule Guide.

Click the blue boxes in the picture below to view workflows for the subprocesses online.


http://connect.qualifacts.com/page/user-guides-2-0-1




http://api.ning.com/files/YRUjCQ7F68QX01K5Z3sk4XDYab*65Nmi5GwwoS6VrdvBGP6crZslHMDTjesJ3DNY3TQhMSWW*D8VmN*z7ULjoTGFPY6qDJgc/CareLogicProcessFlowWithDetailedSubProcessFlows.pdf

Client ‐ Generally, services are delivered and recorded in the Client tab of CareLogic. Treatment information is recorded and maintained in the client’s Electronic Clinical Record (ECR). More information can be found in the Client Guide

Claim Engine ‐ Checks are performed by the Claim Engine as it attempts to convert activities (ser‐vices) into claims that can be sent out for billing. More information can be found in the Billing, Accounts Receivable, and General Ledger Guide.

Billing ‐ Involves claims being batched and sent to payers. Client Statements can also be gener‐ated and sent. More information can be found in the Billing, Accounts Receivable, and General Ledger Guide.

Accounts Receivable ‐ Payments are entered, processed, and adjusted during the accounts receivable process. They are matched to open claims and approved. More information can be found in the Billing, Accounts Receivable, and General Ledger Guide.

General Ledger - Keeps a financial record and allows the export of data to external accounting software. The GL Export module is the tool used to close accounting periods. More information can be found in the Billing, Accounts Receivable, and General Ledger Guide.

Employee ‐ The Employee tab is designed to control employee related information. It can be used to add new staff members, assign system privileges, or assign supervisors to staff members. It also manages employee information such as credentials, shifts, and training records. More information can be found in the Employee Guide.

System Administration ‐ The Administration tab is privileged out to only the highest level supe‐rusers at an organization. It allows the configuration and customization of nearly every facet of CareLogic. More information can be found in the System Administration Guide.

Logging in to CareLogic

A valid user account is required to log in to CareLogic. User accounts are set up by the system administrator. (See the System Administration Guide.) Each organization using CareLogic has its own database whose Account and Login information rules are controlled by system administra‐tors. Account and Login information for end users can be provided by system administrators.

1. Open a web browser window and navigate to https://login.qualifacts.org/carelogic/.

Currently, Internet Explorer is needed to access CareLogic. See the Configuring CareLogic for Internet Explorer Guide for more information.


https://login.qualifacts.org/carelogic/














2. Fill out the Account, Login, and Password fields then click Submit in the status bar. The Dashboard appears. It is a configurable display of relevant information that can be organized by system administrators, but can also be customized by the end user. (See Managing the Dashboard.)

It is recommended to add the URL to the list of Favorites in the web browser.


Automatic Logoff

When logged in to CareLogic, the system will monitor the session for activity. To ensure that unauthorized people do not gain access to the system in the event the session is left unattended, CareLogic monitors for inactivity and will log a user off if inactive for an extended period. Simply entering text in a form without submitting the data is not considered activity by the system.

Changing Organizations

CareLogic can be set up in a hierarchy of organizations, or n‐ tier. Parent and child organizations are set up to accommodate organizations with multiple clinics, multiple programs, or multiple entity organizations with multiple programs and clinics arranged beneath them in a myriad of combinations.

Different modules can be configured to appear or not appear in each tier of the hierarchy. Organi‐zations can be configured to use specific program workflows. System Administrators and their organizations can control the use of CareLogic functionality greatly through the set up of this hierarchy.

When users login to CareLogic, they log in to the parent organization that is set up in the Employ-ment History module (see the Employee Guide). Child organizations of the user’s primary organi‐zation, and any additional organizations that have been defined in the Employment History module can be accessed.

1. The name of the organization in the top‐right corner of the screen is a hyperlink that allows users to switch organizations.

The first time a user logs on to CareLogic, their password will be password.

Be sure to click Submit often when working on documentation. Simply entering text in a form without submitting the data is not considered activity by the system.

System Administrators can set the intervals for Automatic Logoff by navigating to Administra-tion > Show Menu > Security Management Rules.




2. Click the hyperlinked organization name.

3. Pick the desired organization and click Submit. The organization has been changed.


Components of CareLogic• The Navigation Bar

• The Shortcut Bar

• The Status Bar

• CareLogic Basics

The Navigation Bar

The navigation bar is used to access menu systems in CareLogic. When a button in the navigation bar is clicked, the corresponding menu system is loaded. For example, if the Schedule button is clicked, the Schedule is loaded and its menu can be accessed by clicking the Show Menu link in the Shortcut Bar. (See The Shortcut Bar.)

The right side of the navigation bar contains icons.

When the Show Menu button is pushed and the menu is displayed, it becomes a Hide Menu button.

The menu systems available to each user are based on the privilege level associated with the users’ account. Depending on the privilege level, all menu systems may not be available.


Some icons can be set‐up or changed by System Administrators. However, there are several func‐tional icons that are normally included in CareLogic. These icons are used to perform the follow‐ing:

• Managing Alerts

• Managing the Dashboard

• Setting Up User Preferences

• Changing Passwords and Signatures

• Using Internal Messaging

• Accessing Online Help

• Logging Out of CareLogic

Managing Alerts

Alerts indicate that user action is needed. They can be generated by the system or by users and can include alerts for items such as:

• Activities with status None, In Session, or Checked In.

• Call Log Status

• Configured Alerts

• Custom Alerts

• Expiring Patient Assistance

• Group Referrals

• Informational Alerts

• Failed Activities

• Overdue Notices

• Pending Rx Authorizations

• Plan of Care Reviews

• Missing, Rejected, or Unsigned Service Documents

• Signed Documents Requiring Additional Signatures

• Staff to Staff Alerts

• Unsigned Orders


There are two general types of alerts: Informational Alerts and Action Alerts. An Informational Alert provides information to the end user and can be resolved by clicking its Remove button. An Action Alert requires that action be taken in order to be resolved. More on Alerts can be found in the Client Guide.

1. To check Alerts, click the Flag icon on the Navigation Bar.

2. Select the alert type from the side menu.

3. Click the Select button for the alert needing resolution. After resolving the condition causing the alert, click Submit in the status bar. Once the alert is resolved, it is removed from the Alerts page.

Managing the Dashboard

The Dashboard is the landing page when a user first logs in to CareLocic. The Dashboard displays various graphical charts that provide a visual representation of operational and financial data in the system. Users have the ability to set up their dashboard in the manner that they prefer.



1. Click the House icon on the Navigation Bar.

2. Click Configure On.

3. Configure mode allows users to add modules and change the order in which they appear on the page. It also allows users to add supplementary dashboards.

The default settings for the dashboard are configured in the Dashboard Administration module. (See the System Administration Guide.)



Setting Up User Preferences

CareLogic allows users to define some configurations that are specific to their session.

1. Click the People icon on the Navigation Bar.

2. Fill out the needed information and click Submit.

Changing Passwords and Signatures

CareLogic makes it easy to change passwords and electronic signatures. Passwords and signa‐tures can be updated to mitigate risk and increase security at the discretion of the system admin‐istrators.

1. Click the Lock icon on the Navigation Bar.

Passwords and electronic signatures will conform to the password rules defined by the system administrator.


2. All fields are required. Fill them out and click Submit.

Using Internal Messaging

CareLogic provides an in‐application Internal Message Center that allows users to send messages within the system.

1. Click the Envelope icon on the Navigation Bar.

2. The Internal Message Center works very much like most web‐based email services, except that it only functions for users within CareLogic.

Accessing Online Help

CareLogic provides in‐application help through Online help. It provides easy‐to‐use help in 3 sim‐ple formats:

External Messaging can be configured in CareLogic, but requires special set up and charges, please contact Qualifacts Support for more information.

The Envelope icon will appear to be closed when there is unread mail present in the user’s mail‐box.


Contents ‐ Provides the information by topic, like a table of contents.

Index ‐ Provides the information in alphabetical order, like the index of a book.

Search ‐ Provides information related to what the user provides in the search box, like a search engine.

1. Click the Question Mark icon on the Navigation Bar. A new browser tab is opened outside the CareLogic instance.

2. Use the Content, Index, and Search features to find the information needed.

Logging Out of CareLogic

It is recommended that users log out of CareLogic rather than close the browser window in which it is running. Otherwise, it is possible to remain logged in, even when the browser window has been closed.

1. Click the Door and Arrow icon.


2. The user is logged out of CareLogic and the Login screen is displayed.

The Shortcut Bar

The Shortcut Bar is designed to provide faster access to the menu items that are used most often. Users can specify which menu items appear on the shortcut bar for each menu system, in the order they choose.

The shortcut bar allows the following tasks to be performed:

• Adding Shortcuts

• Deleting Shortcuts

• Searching Client Records

• Selecting Menu Options

Adding Shortcuts

Frequently used menu items can be added to the shortcut bar under each tab in CareLogic. This allows the user to quickly access modules that they use on a regular basis. The process of adding a shortcut is the same regardless of the menu system in which it is added.

1. Click the tab that needs a shortcut, Front Desk in the example below.


2. Click Show Menu.

3. Click and drag the desired menu item (Bed Whiteboard) into the Shortcut Bar. A plus sign (+) will appear when the item is dragged over a space where it can be doc

Deleting Shortcuts

Shortcuts can be deleted if there are too many or they are no longer in use. In the rare event that there are so many shortcuts that the Client Search field is crowded out, deleting shortcuts can be used to alleviate the problem.

1. Access the menu system that contains the shortcut needing deletion.

Deleting a shortcut will remove it from the Shortcut Bar. It will not remove the module from the system.


2. Drag the shortcut needing deletion, and drop it on the trash can icon. The main link will remain in Show Menu, this only deletes the shortcut

Searching Client Records

The Client Search feature is used to search for clients. Once the Client Search results page appears, clients’ clinical records, schedules, and basic information can be viewed.

The Client Search field allows users to search for a client based on the way in which the name is pronounced. When a search is initiated, the system returns literal matches and those with similar pronunciations.

The entry should be in one of the following formats:

• A full or partial first, middle, maiden, or last name.

• A combination of a full or partial first, middle, maiden, or last name.

• A full client ID number.

• A full social security number entered in the following format: 999‐99‐9999. Dashes are the only separators allowed in the social security number.

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

1. In the Client Search field, enter the client’s full or partial name, client ID number, social secu‐rity number, or date of birth.

If a name combination is entered out of order (for example, Doe John instead of John Doe), the system will not locate the requested clinical record.


2. Press Enter.

Selecting Menu Options

1. Click the tab in order to view the desired menu system. The Schedule tab is used in the below example.

CareLogic offers the ability to update and track client name information. If a client who appears in the search results has had a name change recorded in the system, a dialog box will appear and display the name history for the client when the cursor is hovered over the client name. In the following example Cathy Client’s name was changed to Claudia Client sometime in the past:


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

3. Click the desired option. The corresponding page appears. For example, if the New Client Activity option is selected, the Schedule a Client Activity page appears.

The Hide Menu button can be clicked to reduce the menu.

The Status Bar


The Status Bar is located directly below the Navigation Bar and contains two types of informa‐tion:

Buttons ‐ The buttons on the status bar are used in conjunction with the page that is displayed and appear on the right side of the Status Bar. Some common buttons seen throughout the sys‐tem are: Submit, Return, Reset, Add, and Delete.

System Messages ‐ Where applicable, system messages and warnings appear on the left side of the

Status Bar.v

CareLogic Basics

The following topics describe functionality that users will see throughout CareLogic. They are meant as a high‐level overview of CareLogic’s basic functionalities.

Dates

Date entries should be in mm/dd/yyyy format and can be manually typed, or the Calendar icon can be clicked to pick a date.

Required Fields

Required fields are identified by a highlight in their user entry fields. When a highlight is seen, information must be populated in the field or the page will not be able to be submitted.

Red messages indicate a hard stop in the system and will need to be corrected to proceed. Blue messages are informational only.


Descriptor Fields

The List Modifier page is used to maintain descriptor fields, sometimes called list modifiers. Administrators see a D at the end of descriptor fields. This means that the list of answers to the field is configurable. When the D is hovered over, a descriptor is displayed. The descriptor is the name by which the field is identified in the List Modifier page. For further information see Setting Up Descriptors in the System Administration Guide.

System administrators can add, update, and delete descriptors. When a system administrator hov‐ers over the D, the descriptor name is displayed. This is the name by which the field is identified in the Descriptors module. See the System Administration Guide for instructions about setting up descriptors.

Descriptor fields are recognizable to system administrators only.




Sorting Tables

In various parts of the system, information is displayed in a table with column headings. In most cases, the sort order of the data can be changed by clicking a column heading. Click the column heading name, and it will sort by that criteria first. When the Client heading is clicked, the infor‐mation is sorted by client name in alphabetical order.


Standard Process Flows

The following diagrams provide a visual representation of standard CareLogic workflows. They are meant to provide a depiction of a steps in an idyllic CareLogic process. Because of its highly configurable nature, no two CareLogic implementations are exactly alike and the following is not meant as a guide to set up these systems. Rather, the following diagrams are meant to illustrate and provide deeper understanding of how individual CareLogic systems work together to facili‐tate the business of behavioral health care.

• Point of Entry Process Flow

• Scheduling Process Flow

• Front Desk Process Flow

• Claim Engine Process Flow

• Billing Process Flow

• Accounts Receivable Process Flow

• General Ledger Export Process Flow

Point of Entry Process Flow

The Point of Entry (POE) tab is used to enter new clients into the system. The process of admit‐ting new clients involves completing the POE Wizard. This allows the collection of basic informa‐tion about the client such as demographic information, guarantors, payers, payer authorizations, and client co‐pay information. Once the POE Wizard is complete and the client is admitted into the system, all of the client’s data is moved to the Electronic Clinical Record (ECR) module. POE is used only to gather the initial client data and then admit clients into the system.


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

2. Client Search ‐ The POE module is used to admit new clients into the system. A client search is performed in order to confirm that a client does not already exist in the system.

• If the client is found in the system as active, the POE Wizard does not need to be completed. Instead, the ECR module can be used to add the client to a new program if needed, then the Schedule module should be used to schedule new services for the client.

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

• If the client is found in the system as inactive, 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 information about the client such as demo‐graphics, guarantors, payers, and payer authorizations.

4. Admit to Program ‐ There are several ways to admit a new client to a program:

• Program Admission ‐ Assigns the client to a program and caseload, making them active in the system. It also allows the user to notify staff by alert that a person was added to the program.

The POE Wizard can be customized to meet the specific needs of any organization. If desired, a service document can be set up to appear in the POE Wizard.


• Schedule Appointment ‐ Assigns the client to a treatment program while scheduling an appointment. Once an appointment is marked as Kept, the client is assigned to a staff mem‐ber's caseload.

• Assign to Caseload ‐ Assigns the client to a treatment program while placing them on a staff member's caseload. This is particularly useful if the clinician is adding the client to their own caseload or if one clinician provides all services in a program, like music or art therapy.

• Bed Search ‐ For inpatient or residential services, assign the client to a treatment program using the bed search. Once a bed is located, the client is admitted to the bed, and an appoint‐ment is scheduled. 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 activities (services) and to view the activities on the schedules of other staff members and clients. The Schedule tab allows client, group, and staff activities to be scheduled. Activities can be statused as they progress. If the activ‐ity is marked as Kept, it will be processed by the nightly run of the Claim Engine. If the activity is marked with Error, CBC (Cancelled by Client), CBT (Cancelled By Therapist), or DNS (Did Not Show), the activity will not be processed by the Claim Engine because the activity is not billable.

1. Schedule Appointment - In order to schedule an appointment, the client is entered into an active episode through Point of Entry. Appointments can be scheduled through Point of Entry, the Front Desk, or the Schedule itself.


2. Client or Group Arrives for the Appointment ‐ Once the appointment time arrives, the client or group comes in to meet with the clinician.

3. Status the Appointment ‐ During the session, the appointment status can be marked as Checked In or In Session. After the session, the appointment should 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 an Error, the process ends because there is no activity to bill.

‐ Kept ‐ This status is used to indicate that the clinician and the client met for the appoint‐ment. If the appointment is marked as Kept, it will be processed during the nightly run of the Claim Engine.

‐ Co-Staff ‐ This status is used to indicate that an employee is involved in an activity but is not the primary staff member involved. The primary staff member would mark the same activity Kept and would appear on the subsequent claim.

‐ CBC (Canceled By Client) ‐ Unless the system is set up to bill activities that are marked CBC, the process ends at this point because there is no activity to bill.

‐ CBT (Canceled By Therapist) ‐ The process ends at this point because there is no activity to bill.

‐ DNS (Did Not Show) ‐ Unless the system is set up to bill activities that are marked DNS, the process ends at this point because there is no activity to bill.

Front Desk Process Flow

The Front Desk schedule is used to manage appointments, collect co‐payments, and schedule cli‐ents’ next appointments. The Front Desk schedule is linked directly to the Schedule. Changes made in the Front Desk schedule affect the corresponding components in the Schedule, and vice versa.

If an appointment is marked as CBC, CBT, or DNS, a memo can be added to the client’s chart to further explain if needed.


1. A client or group activity is scheduled either through the Front Desk schedule or the Sched-ule.

2. When the client arrives for the appointment, their demographic information is verified.

3. If the system is configured for real‐time eligibility, it is confirmed that the client is currently covered under their insurance policy.

4. If a client co‐pay is required, the co‐pay is collected, and the payment is posted to the Cash Sheet.

5. The client is marked as Checked In when they are ready to see the clinician.

6. The appointment status is marked as In Session when the client meets with the clinician. This allows the clinician to start documentation, but still update the start and stop time as needed.

7. After the client completes the session the appointment status is marked as Kept.

8. If necessary, the client’s next appointment is scheduled.

9. Clinicians access their schedule to review changes made by front desk staff members. If required by the activity, clinicians will enter the service documents related to the activity.

Claim Engine Process Flow

The Claim Engine process transforms activities (services) 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 paid in a timely manner, the Claim Engine performs Activity Validation and Claim Validation checks.

Activity Validation ‐ If errors are found, the activity does not become a claim, and the error must be resolved or overridden before it can pass activity validation. Activities that fail during activity validation are moved into Failed Activities. The Failed Activities module is used to review, resolve, and process failed activities.

Claim Validation ‐ If the activity passes Activity Validation but billing errors are found, the activity becomes a claim, but it cannot be billed until the error is resolved or overridden. The Claim Engine moves claims that fail during claim validation into Failed Claims.

Billing Process Flow

The goal of the CareLogic billing system is to produce complete claims that are accepted by third‐party payers. The Billing System is what allows CareLogic to get viable claims to payers. Using the Billing System, the results of the nightly run of the Claim Engine can be monitored, and failed activities and failed claims can be resolved.


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

2. Claim Engine Runs ‐ The Claim Engine performs activity validation, checking for service requirements related to the activity. If the activity passes the activity validation process, it becomes a claim and is moved to claim validation. During this phase, the Claim Engine checks for financial requirements related to the claim. If the claim passes the claim validation pro‐cess, it is moved into Claim Approval.

3. Claim Approval ‐ This step gives the billing staff an opportunity to review the claims before they are sent out to payers. By reviewing the claims, the organization can improve the likeli‐hood that the claims are successfully paid.

4. Claim Maintenance ‐ After claims are approved, they are moved into Claim Maintenance. Once in Claim Maintenance, the billing staff can make adjustments to claims and reverse claims, as necessary.

Because non‐activity invoices are not associated with scheduled services, they bypass the Claim Engine.


5. Batch Claims ‐ When batching claims, the system allows the definition of criteria to use for the batching process. For example, a batch can be created that includes claims falling within a date range or claims associated with a particular billing type, EDI type, payer, payer type, organization, program, client number, or claim number.

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

7. Send Claims to Payers ‐ After claim batches and client statements are created, they are sent out for billing. For paper claims, a HCFA file can be created and printed. For electronic billing, an 837 file can be created.

8. Send Statements to Guarantors ‐ Statements can be downloaded from CareLogic then uploaded to payers or printed and given to clients in person or by mail.

Accounts Receivable Process Flow

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


1. Receive and Enter Payments:


‐ Electronic Payments ‐ Electronic payments are received as 835 files and uploaded through the EDI Upload module. Once the payments are uploaded, the system creates a deposit and a payment record for each payer plan in the file. The system automatically processes payments and attempts to apply them to open claims.

‐ Mail Payments ‐ These payments are received by mail and are entered manually through the Payment Entry module. When manually entering payments, it is possible to make adjust‐ments and define the next action in the billing process.

‐ Front Desk Payments ‐ These payments (generally co‐pays) are received from clients and are entered through the Cash Sheet module. At the end of each day, an electronic signature is required to close out and approve the Cash Sheet. Each night an automated process runs that posts the client co‐payments against the approved co‐pay claims. (See the Front Desk Guide.)

2. Payment Maintenance Module

‐ Make Claim Adjustment ‐ When a claim adjustment is made, an adjustment transaction rea‐son is selected. For each adjustment reason, a unique general ledger code can be assigned in the GL Code Admin module.

‐ Take Next Action ‐ Possible choices include Bill Next Payer, Bill Guarantor, Re‐bill Payer, or Leave Open.

3. Payment Approval Module ‐ Provides an opportunity to review the payments applied to claims before they are posted to the General Ledger.

‐ Unpost or Unapply ‐ If a payment was applied to an open claim in error, it can be un‐posted or un‐applied and sent back to the Payment Maintenance module.

‐ Refund ‐ If a payment is received in error, it can be refunded.

4. Export to General Ledger - After the payments are approved, the accounting period is closed by exporting the General Ledger data to a file.

General Ledger Export Process Flow

After setting up general ledger administration, the system will book financial transactions to the defined GL codes. The GL Export module is used to successfully close accounting periods. Typi‐cally, accounting periods are closed on a monthly basis. However, CareLogic gives flexibility to define the accounting period date range needing to be closed.

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







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 financial transactions for the defined date range.

2. Errors Exist ‐ If the system encounters errors when generating the GL export file, 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:

‐ Review Errors ‐ If the accounting period contains errors, click the Errors button to open a spreadsheet file with a list of errors for the GL export file created.

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

‐ Reprocess GL Export File ‐ After the errors have been corrected, click the Reprocess button to back out the GL export file and recreate the same file again, this time without errors.

‐ Back Out File ‐ Use the Backout button if the accounting period closing needs to be backed out for any reason. 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.

3. Download File ‐ Once the GL export file is created without any errors, it can be downloaded in the following formats:

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

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


‐ GL Detail ‐ For each GL code, the detail file lists the accounting period begin and end dates, the post date, the debit account, the debit receivable amount, the credit account, the credit receivable amount, the transaction type, the transaction reason, the transaction ID, the reversal transaction ID, the organization, the client name, the client ID, the account date, the claim ID, the deposit ID, the provider, the payer name, the program, the procedure code, and the activity code.

‐ GL Detail (CSV) ‐ CSV (comma separated value) files can be opened in any text editor. For each GL code, the detail file lists the accounting period begin and end dates, the post date, the debit account, the debit receivable amount, the credit account, the credit receivable amount, the transaction type, the transaction reason, the transaction ID, the reversal trans‐action ID, the organization, the client name, the client ID, the account date, the claim ID, the deposit ID, the provider, the payer name, the program, the procedure code, and the activity code.

4. Import File ‐ After downloading the GL file, it can be imported into an external accounting software system.


Additional Resources

CareLogic Connect

CareLogic users can request access to QSI Connect (connect.qualifacts.com). This site provides CareLogic users a venue to share ideas and foster collaboration. In addition to User Guides and Training Videos to help you better understand CareLogic and it's functionalities, QSI Connect offers State User Groups and Forums where CareLogic users can collaborate with each other.

CareLogic User Guides

User guides are available online in PDF format and can be viewed or printed.

Contacting Technical Support

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

• Customer Support Portal: https://sf105.soffront.com/QualifactsPortal/Login.aspx

• Support Line: 1‐866‐386‐6755, option 1




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