Insurance Management

Summary

This enhancement to Insurance Management introduces the ability to configure the amount to collect calculation behavior to specify the order in which copay and deductible are applied.

Background

The order in which deductible and copay are applied impacts the calculation of the amount the patient owes.

Previously, when determining the Amount to Collect, the inconsistent order in which insurance payers process these components was causing variances when reporting on the time-of-service payments within RIS.

Feature Description

With these changes, the order of operations for the calculation of the Deductible and Copay components will be consistent. As a result, Time of Service reporting will become more accurate with fewer reportable variances.

A new ATC Calculation Behavior column has been added to the AvailityPayers, EligiblePayers, and Carrier lookup tables. Note the column functionally differs from Payer ID to Carrier.

The Carrier lookup's new ATC Calculation Behavior column dropdown menu displays the following options:

·         Collect copay first, then collect deductible up to the visit’s cost, when deductible is met apply co-insurance

·         Collect deductible first, then collect copay up to the visit’s cost, when deductible is met apply co-insurance

Use the tooltip to review the full text of the field.

The AvailityPayers and EligiblePayers lookup's new ATC Calculation Behavior column opens a dialog box with the same values as the Carrier table.

Additionally, the dialog box contains a grid displaying the Carriers associated to that particular Payer ID, and allowing the Amount to Collect configuration to be overridden on a per-carrier basis.

Configuration Instructions

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

RIS Client

Changes AvailityPayers, EligiblePayers & Carrier Lookup Tables

·         Configure the ATC Calculation Behavior column and overrides as desired for all three tables.