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Adding funders into your company account is a critical component of your Rethink platform. In order to add funders to your account, you first want to ensure your Service Lines and Services are entered appropriately. For more information on this step please refer to our resource guide on Understanding Service Lines and Services.

Adding Funders

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Step	Description	Helpful

Information

Knowledge
Navigate to your Company Account and select Funders	Image Modified
Click

 View to edit an existing Funder, or select

Add Funder to

set up

add a new funder

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Set up requirements and any billing and scheduling rules for that funder.

Make selections pertaining to the Insurance, Private Pay, or Other Funding Sources within this pop-up:

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to your account. Click View for an existing Funder, then click EDIT to set up the Billing and Scheduling Rules for that Funder	Image Added
Once you click EDIT or ADD FUNDER, choose the Funder Type from the drop down	Image AddedImage Added	Insurance: Group Health Plans, Commercial Payers, Medicaid, Tricare Other: Schools, Regional Centers, etc. Private Pay: Self Pay Please note for Private Pay, you may have to enter some fake information to fulfill the requirements. You will also choose your scheduling rules based on what you want to allow
Add a Vendor ID

 

(if applicable)	Image Added	Used for California customers to appear on the Parent Verification Form and BHPN Invoices
Type out the Funder Name	Image Added
Enter Funder Address	Image Added	Phone, Email, and Fax are optional
Set the

Combining Rules: these will be

Billing Rules: These will be based on your funder contracts	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 appointment time on the claim line in your billing export The verified appointment time will be listed on the billing export regardless. If your Funders request it to be specifically in the claim line, select this
Select your Combine Rules based on your funder contracts

.  

Set Scheduling Rules

Choose whether to allow staff verification on expired certification.

Restrict users from scheduling on specific dates (if applicable).

	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 “Don’t combine charges” Some Funders want you to combine charges for the Same Day, Client, and Billing Code & others want you to combine charges only if it is for the same Day, Client, Billing Code, 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	Image Added	Select Don’t Allow, Allow, or Warn & Allow to the first few Scheduling Rules based on your Funder Contracts Warn & Allow will give you a soft warning when trying to schedule but will still allow you to save that appointment Select the Checkbox if you want staff to be able to verify appointments on expired certification Option to restrict users from scheduling on specific dates
Option to add Medicaid ID #	Image Added	This area would allow you to choose the applicable Medicaid ID # from the drop down to attach to the funder The drop down will be a list of the Medicaid ID#'s that are entered in the Company Account>Basic Information This information does not pull through into the Billing Export Report
Option to add Insurance Plans	Image Added	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 the Rethink Self-Billing product, your Self-Billing Implementation Specialist will train you on this area
Select the Coverage Type (only applicable for insurance type funders)

.

	Image Added	Most commercial plans will be classified under “group health plan”
Select Service Facility (only applicable for insurance type funders)

.

CLICK "SAVE" when finished.

Funder Types:

• Insurance - commercial payers, Medicaid, and Tricare.

• Private Pay - cash pay or self pay

• Other - can include regional centers or school districts.

Combining Rules: rules to determine if charges will combine or “roll up” together when billing your funder.

• Note:  This should be verified with the requirements of your specific funders.  

Scheduling Rules: allows you to decide on concurrent billing or what warnings will or will not appear when scheduling appointments.

Overlaps by service/client/time or by client/time/different service are typically determined by your specific funder rules

Allowing scheduling when Client's account is missing billing information or if appointment exceeds authorization is NOT RECOMMENDED as best practice.

It is not recommended as best practice to permission staff verification on expired certifications.

	Image Added	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
Select whether to Omit Session Note Header fields	Image Added Allows users to exclude the client-assigned facility/location, service, or service line from the header details on billable or non-billable session notes (with a selected service) saved to the client file cabinet.	When changing selections, existing session notes will not be impacted. The changes will take effect for new session notes Users will need to edit existing session notes if they desire the updated selections to be reflected on the saved session note in the client file cabinet This feature does not apply to non-billable appointments with no service selected.

CLICK "SAVE" when finished

Adding Billing Codes to your Funder Profile

Step	Description	Helpful

Information

Knowledge
Click View on your applicable funder, and then

select your 

scroll down to add a Service Line

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Note:

Billing-Claim/Invoice Submission Method is not currently an active feature Recommended to leave it as it is already selected

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)	Image Added	If you have funders authorizing units by specific modifiers for the same billing code you can do the following: Create Service names in your company account that include the modifier or add language to the service name that matches the authorization. Then when adding the billing code to your funder set up, make sure you select the restrict by credential option so you can add the modifier(s)

.Image RemovedSelect whether to restrict

for the matching staff credential.
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 and do not wish to track authorizations for scheduling/utilization purposes Selecting this option will break the 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
Restricting staff from providing a service or to bill multiple rates for a service

Choose Service: ties tothe service names that were inputted under the Service Lines and Services tab of the company account.Image RemovedChoose a Template:

	Image Added	To restrict which staff can provide a service and/or to be able to bill multiple different rates for this service click "yes" then complete the required fields. This will prevent any staff who do not hold the appropriate professional credential from being scheduled with that service If you select “no” any staff could be scheduled with that service You will want to select “yes” if you need to add in modifiers or telehealth services as well
Select a Service and Choose a Template to pair your services with the applicable billing code

. Note: if

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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

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Unit Type: Select the unit type that is appropriate for your billing code

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	Image Added	If you have selected one of the templated 9 codes, the unit type will default to 15 minutes
Rounding Rule:

insurance

Insurance providers do not allow partial unit billing so you must choose a rounding rule

.

Base Rate vs Contract Rate: It’s recommended to select contract rate even if you bill a base rate as base rate is a beta feature in the system currently.

Select applicable credential(s) (if restrictions are selected) and input contract rate/unit and any applicable modifiers.

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:

• Will prevent any staff who do not hold the appropriate credential from being scheduled with that service.

Rounding Rules:

• Refer to table below for details on the different rounding rules.

Telehealth Services:

• To set up telehealth services, duplicate the credential to populate a new service description field. Enter Telehealth into the description with the appropriate modifier. This will now be visible on the appointment level for scheduling.

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	Image Added	Please see the Rounding Rules chart below
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
Add Credentials and Rates	Image Added	Click “Add New +” to add all the professional credentials who can provide this service Option to add modifiers Option to add Telehealth Services by selecting the same credential more than once, entering in the modifier and the Service Description of “Telehealth” (See example below)

Example Service: Assessment, Billing Code: 97151

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Here is how the Rounding Rules work: (Based on ABA recommendations)