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Go to your Company Account:
Select Funders from the menu on the left:
Click View for an existing Funder, then click EDIT to set up the Billing and Scheduling Rules for that Funder:
Once you click EDIT, make selections pertaining to the Insurance, Private Pay, or Other Funding Sources within this pop-up:
Add a Vendor ID (if applicable)
Set the Combining Rules: these will be based on your funder contracts.
Set Scheduling Rules: this allows you to decide if concurrent billing should occur or what type of warnings you will or will not receive when scheduling appointments.
Choose whether to allow staff verification on expired certification.
Restrict users from scheduling on specific dates (if applicable).
Select the Coverage Type (only applicable for insurance funders).
Select Service Facility (only applicable for insurance funders).
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Adding Billing Codes to your Funder Profile
Click View on your applicable funder, and then select your Service Line
Note: Billing-Claim/Invoice Submission Method not currently an active feature
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Click “+” to add Billing Codes to the Funder Profile:
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Add Service and Billing Code details (any fields marked with an " * " are required).
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Does NOT require Authorization: this field is not recommended to be selected unless you are an international customer. Selecting this option will break the system functionality to track service utilization later. Instead, there is an option to select “not required” under authorizations on the client profiles.
Restricting staff from providing a service or to bill multiple rates for a service: To restrict which staff credential can provide a service and bill multiple rates click "yes" then complete the required fields. This will prevent any staff who do not hold the appropriate credential from being scheduled with that service. If you select “no” any staff could be scheduled with that service.
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Select a Service and Choose a Template: to pair your services with the applicable billing code.
Note: if your billing code is not present in this templated list, select “custom” and manually type the code into the billing code for claims/invoices section.
Unit Type: Select the unit type that is appropriate for your billing code.
Rounding Rule: insurance providers do not allow partial unit billing so you must choose a rounding rule.
By default the System will bill at the contracted rate you entered for each service. It’s recommended to select contracted rate even if you bill a base rate as base rate is a beta feature in the system currently.
Here is how the Rounding Rules work: (Based on ABA recommendations)
Rounding Type | Rule |
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No Rounding | System Default: System will round unit to next 2 decimal place, not whole units |
Round to Nearest | 15 min unit (less than 8 min = 0 greater than 8 min =1 ) 30 min Unit (less than 16 min = 0 greater than 16 min = 1) 60 min Unit (less than |
Round Up | IF length of appointment breaks the threshold by at least 1 min into the next unit, the system will round up. |
Round Down | Any partial units are thrown out 15 min unit (less than 15 min = 0 greater than or =15 min =1 ) 30 min Unit (less than 19 min = 0 greater than or = 30 min = 1) 60 min Unit (less than 59 min = 0, greater than or = 60 min = 1) |