Setting Up Your Funders and Billing Codes

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 to your Company Account

Step

Description

Helpful Information

Navigate to your Company Account and select Funders

Click View to edit an existing Funder, or select Add Funder to set up a new funder.

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:
Add a Vendor ID (if applicable)
Set the Combining Rules: these will be 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).
Select the Coverage Type (only applicable for insurance funders).
Select Service Facility (only applicable for insurance 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.

Adding Billing Codes to your Funder Profile

Step

Description

Helpful Information

Click View on your applicable funder, and then select your Service Line

Note: Billing-Claim/Invoice Submission Method not currently an active feature

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

Add Service and Billing Code details (any fields marked with an " * " are required).
Select whether to restrict staff from providing a service or to bill multiple rates for a service
Choose Service: ties to the service names that were inputted under the Service Lines and Services tab of the company account.
Choose a Template: to pair your services with the applicable billing code.
1. 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.
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.

Rounding Rules: (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)