Day Club Options

Theralytics Day Club Options are a feature that will help prevent denials for duplicate claims. For example, if a client has two separate sessions scheduled for the same day with different providers for the same day, the Day Club feature will group these claims and submit them as one session to avoid any issues with denials. 

There are two options for dayclubbing claims: Day Club by Provider and Day Club by Provider w/ same DOS on one claim. Only one option can be enabled at a time to determine how your claims are dayclubbed. Both options are outlined below.

Day Club by Provider

1. To enable this feature, you will first need to go to the Manage Payers section and edit the payer profile. This feature must be enabled for each payer.

2. Under Manage Payer, navigate to the Payer Info tab and locate the checkbox for Day Club by Provider.

3. Once this box is checked, sessions that occur for the same client, date of service, service location, and service code will be grouped together when billing. The sessions will still appear separate on the schedule.

4. Next we will want to review how to verify if two claims have been combined via the Day Club feature. First, navigate to the Billing tab on the left and select Claims.

5. Once in the Ready to Bill tab, there will only be one claim ID for the claims that you are submitting. To view the session times for this claim, hover your mouse over the blue “i” icon.

6. When these claims are submitted, they will be submitted as one claim ID, instead of the two separate sessions.

Day Club by Provider w/ same DOS on one claim

1. In some cases, for example 2 separate sessions for the same client, same date of service, but different service codes, the payer may still deny the claim for being a duplicate claim. For these scenarios, you will want to enable the 2nd option, “Day Club by Provider w/ Same DOS”.

2. For this example we will consider two sessions on the same day for different services. The red appointment is an assessment and the blue one is for direct service.

3. Once rendered, here is how the two sessions will appear in the billing area. Note that there is one claim ID for both claims, but both service codes appear on their own separate lines.

4. Note that when this option is enabled (Day Club by Provider w/ same DOS) then it will also group claims for the same service code on the same day. 

Troubleshooting Day Club Issues

There are some scenarios where claims will not be grouped together. The system only checks to see if claims need to be grouped if the claims are unrendered. This means that if the day club option is turned on after a claim is rendered, the system will not group those claims

Day Club Feature Checklist

Here is a summarized reference guide to troubleshoot issues with claims that are not dayclubbed. Please follow the list in order from top to bottom

Claim Requirements:

• 

  Occur on the same day

• 

  Services are for the same client

• 

  Services occur at the same location

• 

  Services are billed for the same rendering provider

• 

  Day club option is turned on for the payer being billed

• 

  Once the above are complete each appointment must be rendered

For some payers (for example, Tricare) you may need to make sure that the day club option is turned off, as these payers require that each claim be submitted separately.

Please be aware that if the two sessions occur at different locations, they will not be day-clubbed/grouped.