PatientManager_TM

How Is PatientManager_TM Organized?

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• Insurance Plan Functions - There are 100 insurance plan slots. Each insurance plan can have an unlimitted number of insurance policies. An insurance plan contains an Approved Fee Schedule. Insurance Policies within a plan share the Approved Fee Schedule of the mother Plan but have their own settings for parameters such as copay Due, copay amount, Authorization requirements, Refraction Coverage and Balance Billing policy.
  •  Required Entry Fields - these fields are critical to providing the most accurate billing functions and must be set for each insurance policy
    • Plan Name
    • Plan Name for listing
    • Exam Authorization Required
    • Referring MD ID To Use
    • Preauth/Referral For Sx
    • Copay Required / Amount
    • Copay Deducted from Payment
    • Accept Assignment
    • Pays For Refraction
    • Balance Billing Permitted
    • % of Approved Paid
    • Deductible Applies
    • Approved States
    • Print HCFA w/ "Signature on File"
    • Provider name on HCFA 31
    • Provider Digital Signature on HCFA 31
    • Plan is Medicare Plan
    • MD HCFA 25 SS# Vs Tax ID
    • Charge Mode HCFA
    • Pmnt Mode- how is payment made - self pay, HCFA submission, Capitated, none
    • Office Address HCFA 33 - select the office address to be used with the plan
    • Secondary Crossover is Manual
    • Electronic Billing Enabledcov
  • Enter Approved Procedure Fees - for each plan
  • specify Uncovered Procedure for selected insurance plan
  • Specify Procedure for Alternate Code This Insurance Plan - some procedures have a HCPCS code that some plans prefer to a CPT Code. PatientManager allows you to list two procedure codes for each procedure and select the "Alternate" code when the CPT code (the primary code) is not accepted.
  • View Downcoding Adjustment window - accesses the downcoding algorithms
  • Specify Patient Form Printing for This plan - in the event that you want special forms to print for patients with a specific plan, you have the option of setting this up to print either for the initial exam at checkin or annually at checkin.

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As always, additional customization is possible.

As always, we welcome your comments.

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