Page Comparison

Go to Settings

Select Funder from the menu at the top

Click Add Funder to add a new funder to your account. Click View for an existing Funder, then click EDIT to set up the Billing and Scheduling Rules for that Funder

Once you click EDIT or ADD FUNDER, make selections pertaining to the Insurance, Private Pay, or Other Funding Sources within this pop-up

• Insurance based funders are group health plans, Private Pay is used for Self Pay, and Other is commonly used for schools/regional centers

Add a Vendor ID

(if applicable)

• A Vendor ID is like a Payor ID

• Please note, if you are a Self-Billing customer, you are required to enter in the Vendor IDs for each funder. You can find this information from the TriZetto Clearinghouse

Type out the Funder Name

Enter Funder Address

• Phone, Email, and Fax are optional

Set the Billing Rules:

These will be based on your funder contracts

• Recommended to review your Funder contracts before filling out this area

• Select the checkbox if you want to convert session times to military times on your billing export

• Select the check box if you want the referring provider to show up on the billing export

• Select the check box if you want the appointment time on the claim line in your billing export

  • The verified appointment time will be listed on the billing export regardless

• Choose your combine rules

  • Oftentimes Self/Private Pay will choose not to combine charges on their billing export

  • Most commercial funders want you to combine charges for the Same Day, Client, and Procedure

  • Some Funders only want you to combine charges if it is for the same Day, Client, Procedure, AND Rendering Provider

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.

• Select Don’t Allow, Allow, or Warn & Allow to the first few Scheduling Rules based on your Funder Contracts

• Select the Checkbox if you want staff to be able to verify appointments on expired certification

• Optional to restrict users from scheduling on specific dates

• , if applicable

Option to add Insurance Plans

• This area would allow you to keep track of the different plans within that funder such as if the funder had a Platinum or Silver plan option

• When you set up your clients you can then assign which insurance plan they have according to that funder

Select the Coverage Type (only applicable for insurance funders)

• You just want to verify that the coverage type is correct

• Most commercial plans will be classified under “group health plan” but if you have Tricare or Medicaid you would want to make sure that is appropriately selected

Select Service Facility (only applicable for insurance funders).

• If you only have one location than that would obviously be your only available option. Otherwise, if you have more than one location available you would want to choose your main office location/the location your funders have on file for billing purposes

Click View on your applicable funder, and then scroll down to add a Service Line

• Billing-Claim/Invoice Submission Method and Billing Provider Options are not currently active features

Click “+” to add Billing Codes to the Funder Profile:

Add Service and Billing Code details (any fields marked with an " * " are required).

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

Select a Service and Choose a Template: to pair your services with the applicable billing code.

• 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