Insurance Management

Summary

This enhancement to Insurance Management adds support for configuration of a Minimum and/or Maximum age for which a PreCert or UM rule will be applied. This same capability is available for both PreCert Group and UM Authorization Rule configuration.

Background

Sometimes a patient’s age is a factor in whether PreCert or Utilization Management workflow is needed. For example, some DEXA billing codes require Utilization Management review or PreCert only for patients younger than 65. Previously, it was not possible to create PreCert Group or UM Coverage authorization rules that were handled differently depending on the age of the patient.

Feature Description

With this change, the PreCert Groups RIS Lookup Table Editor, has been updated to add Min Patient Age (Years) and Max Patient Age (Years) columns.  These columns behave in a similar fashion to the columns that were already available in the Conditional Tab and Forms and Labels editors.

In the UM Authorization Rules screen, the same columns have been added to the Rules section (on the right side).

Because it is common to add multiple billing codes to a rule at the same time (for example, a group of DEXA codes or pediatric ultrasound codes), it is also possible to put in a default Min/Max Age for the entire batch, which will appear in the columns of the Rules grid once the arrow is selected to create the new rule.

For both tables, it is possible to create multiple rules for the same billing code, as long as the Age settings do not overlap between rules.

Note that in the following example, three overlapping age ranges have been (incorrectly) configured as 1-16, 2-15 and blank-blank. Where a blank age means any age, RIS considers the blank-blank to overlap with the other two rows for CPT 21010, which is indicated via the red flags.

The following unresolved issues have been identified:

·         Age condition rules are only applied once and therefore the patient's age must be entered before scheduling the exam.

Configuration Instructions

System Administrators must complete the following actions to enable this feature:

RIS Client

Changes to Other RIS Lookup Table Settings

·         Configure the Min Patient Age (Years) and/or Max Patient Age (Years) columns in the PreCert Groups RIS Lookup Table Editor and/or UM Authorization Rules screen as needed for your organization.

Summary

This enhancement to Insurance Management introduces the ability to associate the scanned attachment of a patient's insurance card to its corresponding policy.

Cards may be associated at the time of scanning or after the fact. Multiple cards may be attached and associated to any existing policy.

This feature also introduces an easy way to view the attached images when working in the Manage Policies screen.

Insurance policies that have scanned attachments classified as an insurance card will initially display with a blank "document" icon. Once the card front or back has been identified, this will update to a "card" icon.

Background

It is very common for users to digitally scan a patient's insurance cards and associate the attachment to the patient's record in RIS. However, there was previously no way to associate an insurance card image to an insurance policy.

This means users must dig when trying to find an image of the insurance card, and it makes it difficult to use the insurance card images for AI training as there is no link between the image and the policy.

Feature Description

With this change, the new InsuranceCardScanType RIS System Configuration setting identifies which ScanTypes represent an Insurance Card. When a user classifies a scanned document with a ScanType that matches one of these types, they will be prompted to select an existing policy, although a selection is not required.

All available policies will be listed in the dropdown, with any policies marked as "Use" for the current appointment at the top of the list.

Users may also associate an Insurance Policy from the Attachments grid, anywhere it is displayed.

The new icons are also presented in the Manage Insurance Policies window if the Insurance policy is associated with insurance card attachment or if attachments are available to review.

Configuration Instructions

System Administrators must complete the following actions to enable this feature:

Changes to RIS System Configuration Settings

Complete the following steps to enable this feature:

• Configure the InsuranceCardScanType RIS System Configuration setting for your organization.