Copy of Setting Up Your Funders and Billing Codes

Adding funders into your Settings 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 Copy of Understanding Service Lines and Services .

Adding Funders

Step	Description	Helpful Knowledge
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		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
Select your Combine Rules based on your funder contracts		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 Some Funders want you to combine charges for the Same Day, Client, and Procedure & others 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 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 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
Select the Coverage Type (only applicable for insurance type funders)		Most commercial plans will be classified under “group health plan”
Select Service Facility (only applicable for insurance type funders)		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

CLICK "SAVE" when finished.

Adding Billing Codes to your Funder Profile

Step	Description	Helpful Knowledge
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 or building a Private Pay Funder 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		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
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		If you have selected one of the templated 9 codes, the unit type will default to 15 minutes
Rounding Rule: Insurance providers do not allow partial unit billing so you must choose a rounding rule		Please see the Rounding Rules chart below
Contract vs. Billing Rate		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		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: 97153

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

Rounding Type	Rule
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)