Billing

Summary

This enhancement to Billing allows for the configuration of NPD/Fee schedule pricing retrieval for carrier codes not set with an Eligibility Payer ID and non-self-pay codes.

Background

Previously, the system could only retrieve NPD/Fee schedule pricing for insurances codes that were listed as self-pay or appointed an eligibility payer ID.

Feature Description

With these changes, non-self-pay codes and carrier codes that are not configured to run through eligibility can be set to retrieve NPD/Fee schedule pricing to return an Amount To Collect.

When enabled, the patient estimated responsibility for the primary insurance will be calculated based on 100% of the NPD/Fee schedule cost, similar to the Self-Pay pricing.

Patient financial responsibility override screen with 100% ATC displayed.

Configuration Instructions

No System Administrator actions are necessary to enable this feature; however, optional configuration is available:

·         Set  AmountToCollectSimilarToSelfpayFlag to Y for desired insurance codes within the Carrier lookup table

o    Ensure the carrier code has a fee schedule selected within the Fee Schedule lookup table

·         If 100% ATC is not wanted, the PaymentRules lookup table can be leveraged to refine the Amount To Collect further.