Service Matrix
The Service Matrix module is utilized to setup and create new procedure codes and update current codes. This is also
where procedure code mappings are created and modified. Here you will map attributes such as license groups, age
groups, place of service, diagnosis groups and service definitions.
In order to access the service matrix, you will need be assigned the appropriate User Role which grants various levels of
access provided by your MIS department.
Then, click on Menu → Master → Service Matrix
Module View
After clicking on Service Matrix from the Master Menu, the default list of services will load. From here you’ll be able
to Filter, Review, Modify and Add (create) a service.
Adding a Service
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Service Matrix
Service Tab
Step 1: To add a new service to the matrix, first load the module. Once the loading bar completes, choose Add.
Key Adjudication Attributes
Is DRG:
Is ED:
You will mark this in conjunction with Is R&B for IP R&B codes to roll up to 0101. If this is marked
and R&B is not, then this service will deny for an ancillary service and treated as a service outside
of the overnight stay.
This is marked to indicate an emergency room service.
Is R & B:
This is marked to indicate IP services. This will not be marked alone but with DRG for codes 0101
and up (except for 183) to pay correctly at the hospital rate.
Is Billable:
This will will be marked for services that need to be in Alpha but are not reimbursed by the MCO.
Is CABHA:
Marked for CABHA services (reporting purposes only).
Is Auth Allowed:
Is Clinician Based:
If this is service is typically authorized (reporting purposes only).
This is marked when the service can only be performed by a licensed individual. AlphaMCS will
look for a clinician NPI as the rendering and a clinician’s license mapped to the service.
Session to Unit:
This is used in basic unit consumption. For example, if set to 4 then every 4 units billed by a
provider will count as 1 towards units consumed.
Local Modifier:
When marked, the modifier for service will be stripped out of the 837 to State/Medicaid. This is
used by the MCO for custom Provider to MCO rates.
Benefit Plan Tab
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Service Matrix
Step 2: After choosing NEXT in the Service section you will then be taken to the next step in the setup which is
choosing the benefit plan or plans that will cover this service.
Key Attributes
Cap Service:
This will identify if a service is purely capitated for this BP.
Always FFS:
This will identify if a service well always be Fee for Service (not capitated).
Auth Allowed:
Auth Required:
Manual Review Req:
Is Basic:
Pass through Days:
Daily Limit:
This will identify if the service for this BP is typically authorized.
When marked, the service will become auth required in ALL provider contracts for the selected
benefit plan. (Please note unchecking will remove auth required from ALL provider contracts)
When marked, the service will always pend for manual review under this BP.
When marked, then the service will be eligible for the consumption of basic units.
When selected, the number of days set for pass through will apply for this service + BP combo.
So if set to 30, then a provider can bill for a consumer for 30 consecutive days from the first DOS
without requiring an Auth.
Max number of units that can be billed for in a day.
Weekly Limit:
Max number of units that can be billed for in a week.
Monthly Limit:
Max number of units that can be billed for in a month.
Yearly Limit:
Max number of units that can be billed for in a year.
Lifetime Limit:
Max number of units that can be billed in a lifetime.
Place of Service Tab
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Service Matrix
Step 3: The next mapping in to complete is the Place of Service. Notice the available BP check boxes under the POS
field. This is contingent on what BPs you mapped to the service in step 2
Definitions Tab
Step 4: of the Service Matrix is adding a definition for the service:
Licenses Tab
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Service Matrix
Step 5: Next step in the Service Matrix is for you to add your Licenses if the service you are adding or modifying is a
Clinician based service. First you will want to select the License you are adding and the BPs you want to add it to. If
you are adding one license, choose NEXT to proceed. If you need to add multiple licenses, choose SAVE, then ADD to
add the next license group.
Age Group Tab
Step 6: Next, you will advance to the Age Group mappings. Follow suite with previous steps in adding Age groups and
selecting the appropriate BP(s).
Diagnosis Group Tab
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Service Matrix
Step 7: The next step is adding the eligible DX Groups for each benefit plan. Remember the same concepts used to
add previous mappings apply here.
Service ByPass Tab (Optional)
Step 8: The last step is deciding if the service will bypass Medicare or TPL edits. When checked claims will not deny
for not including insurance information for payers other than medicaid or IPRS. Remember the same concepts used to
add previous mappings apply here.
Mappings Complete
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Service Matrix
Now that you have gone through the mapping process, and if you have mappings setup for each group and a mapping
for each BP attached to the service, then the Service will be identified as complete with no “Incomplete” indicators:
Modifying a Service
To add additional mappings or modify current ones are as easy as creating a service. For example, if I need to add a POS
to this existing service, first I’ll filter for the Service, then choose the Place of Service tab.
Once complete, I can SAVE to complete the update, or choose NEXT to add additional mappings or to simply review
what is currrently mapped.
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©2015 Mediware Information Systems, Inc. All Rights Reserved. Confidential and Proprietary.