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Step | Description | Helpful Knowledge |
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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 | Image RemovedImage Added | |
Add a Vendor ID (if applicable) | Image RemovedImage Added | 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
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Type out the Funder Name | Image RemovedImage Added | |
Enter Funder Address | | |
Set the Billing Rules: These will be based on your funder contracts | Image Removed | Recommended to review your Funder contracts before filling out this area Image Added | 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 Choose your combine rules
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Select your Combine Rules based on your funder contracts | Image Added | These are not the combining of appointments, this is on the backend for billing purposes and will dictate how appointments are seen on the Billing Export Report pulled from the Reporting Dashboard Oftentimes Self/Private Pay will choose not to combine charges on their billing export - Most commercial funders
Some Funders want you to combine charges for the Same Day, Client, and Procedure Some Funders & others only want you to combine charges if it is for the same Day, Client, Procedure, AND Rendering Provider
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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 Option to restrict users from scheduling on specific dates, if applicable
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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 If you have signed up for our Self-Billing product, the Self-Billing Implementation Specialist will train you on this area
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Select the Coverage Type (only applicable for insurance type funders) | You just want to verify that the coverage type is correct | |
Select Service Facility (only applicable for insurance type 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 Please note that the service location is pulled from the location assigned to the client in Rethink, this area is just for documentation purposes as of now
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CLICK "SAVE" when finished.
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Step | Description | Helpful Knowledge |
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Click View on your applicable funder, and then scroll down to add a Service Line | | |
Click “+” to add Billing Codes to the Funder Profile: | | |
Add Service and Billing Code details (any fields marked with an " * " are required). | Image Added | |
Does NOT require Authorization | Image Added | This field is not recommended to be selected unless you are an international customer . or building a Private Pay Funder 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.authorization functionality and you would no longer be able to utilize authorizations for billing or tracking purposes You can mark on the individual client authorization page if an authorization is not required but marking it here would break that functionality for all clients with that funder
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Restricting staff from providing a service or to bill multiple rates for a service | Image Added | To restrict which staff credential can provide a service and/or 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. | Image Added | |
Unit Type: Select the unit type that is appropriate for your billing code. | Image Added | |
Rounding Rule: insurance 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 | Image Added | |
Contract vs. Billing Rate | Image Added | This feature holds no functionality as of right now so it is recommended to leave it set as contract rate The rate you enter is whatever you want to see on your Billing Export whether that be your Funder Contract Rates or your Company’s Rates
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Add Credentials and Rates | Image Added | |
Example Service: Assessment, Billing Code: 97153
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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 31 min = 0, greater than 31 min = 1) |
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) |