Adding Service Lines and Funders to the Company Account

1) First, Add or Edit your Services Lines: 

• High level programs or specialty your company provides such as ABA, OT, Early Intervention, Speech etc.)

** If for reporting purposes you would need to distinguish a certain Service Line from another then that would be reason to add a Service Line. For example, you may want to run reports for ABA only services or Speech only services. If you have questions about this please contact Rethink for assistance.

2) Click on Services to Add or Edit a Service:

• These are the services you will provide for ANY Service Line or Specialty you provide such as Assessments, Supervision, Direct Therapy etc.

TIP: Keep your service names to a minimum. The same service names can be used for different funders and billing codes. These service names will be what your staff select when scheduling.

3) Enter Service Name and add *Base Rate for that Service. (*If your company does not BILL by base rates then enter "0")

5) Click Add Funder to add a new funder.

5) a. OR Click View for an existing Funder, then click EDIT to set up the Billing and Scheduling Rules for that Funder:

6) Once you click EDIT or ADD FUNDER, 

• make selections pertaining to the Insurance, Private Pay, or Other Funding Sources within this pop-up
• Add a Vendor ID (if applicable-BILLING Customers)
• Set Combine Rules
• Set Scheduling rules
• If you have EVV enabled on your account, then you will need to select the EVV vendor from the drop box.

• Restrict users from scheduling on specific dates: Add in as many Non Service days as you need, which will prevent scheduling on these specific dates.

• For Insurance Funders, specific Insurance Plans can be added to the funder

• For Insurance Funders select the Coverage Type: System will default to "Group Health Plan"

• For Insurance Funders select Service Facility

• Please review Combine Rule Descriptions here:  https://rethinkautism.atlassian.net/l/c/W6ZsPjb1

  • Need your claim charges rolled up?  If yes, then "check" the box to the left of combine charges for same day, client, procedure(billing code), or combine charges for same day, client, procedure(billing code) and rendering provider.  Note:  This should be verified with the requirements of your specific funders.  

  • If you don't wish to combine charges, select the 'Don't Combine Charges' option.  

• Scheduling rules allow you to decide what type of warnings you will or will not receive when Scheduling appointments.  

  • Note:  Concurrent billing rules (overlaps by service/client/time or by client/time/different service) are typically determined by your specific funder rules

  • Note:  Allowing scheduling when Client's account is missing billing information or if appointment exceeds authorization is NOT RECOMMENDED as best practice.
  • Note: It is not recommended as best practice to permission staff verification on expired certifications.

• Required fields are
  • Name 
    • for Private Pay, we recommend a generic name, such as Private Pay.  Family or Client names should NOT be used as a Funder name as this name is visible across clients when adding funders to clients.
  • Address 
    • for Private Pay, we recommend that you enter a placeholder address or your office address, rather than a particular client or family address.
  • Combine Rule-one choice
  • Scheduling Rules

6) b. The field for ' Is this a DPH Funder?'

• a new field as of 2022 that would only be specific to a very small subset of customers in the Massachusetts service area.  This can be left blank, unless you have verified that this applies to your funder.  

8) Click View for an existing Funder or the newly added Funder

•  then click + sign next to Service Lines to add your Service Lines relevant to this funder.  Service Line options are based on what you created in Step 1 above.  

9) Billing-Claim/Invoice Submission Method:

• Select option from the drop down.

11) Add Service and Billing Code details. The fields marked with an " * " are required:

OPTION 1 *Recommended as best practice

• Do Not select the option "Does NOT require Authorization"
• To restrict which staff credential can provide a service and designate different billing rates for one billing code, click "yes"
  • If you do not want to require an authorization or limit by credentials, skip down to OPTION 2 & 3 below.

THEN

• Complete the remaining required fields:
  • Choose a Template (if needed billing code is not an option, leave field set to 'Custom' 
  • Billing Code for claims/invoices: If a template was selected in above field, then this field will auto-populate.  If above field was set to 'Custom' then enter your needed billing code 
  • Unit Type
  • Rounding Rule
  • Base Rate or Contract Rate: Contract Rate is most commonly selected so that the rate you enter on this popup will pull to billing.  If you select 'Base Rate', the rate on your Service Line page will pull to billing

IMPORTANT:  The same Service may be added multiple times to the same funder.  We strongly recommend not connecting the same service name to a different code set or  duplicate the same service/billing code combination unless you will be making the other service/code combination inactive. 

• By default the System will pull to the billing export at the  rate you entered for each service. Note:  You may have different rates per credential added to the service.  The correct rate will pull based on which staff with a relevant credential is scheduled for the service.

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

• Most common rounding rule is 'round to the nearest' for many funders, but this should be verified in your provider manual or funder contract.
• Please note that choosing 'no rounding' will result in partial units in your billing export.  

11) b. Users can add up to four Modifiers under Billing code, if needed, to each credential. 

• If you add the same credential a second time to a particular service, then one modifier is *required and a service description (like Telehealth) can be added.

• Users can add the same credentials multiple times but need to ensure the service description must be unique to each credential.
• Click on Add New button to add a new Credential to the list and click save after adding the required details.
• To remove a listed Credential click on the orange minus sign. In order to save your selection click on the Save button.
• Once Saved, credentials can be added or edited but not removed.  

11) c. Making Edits

• If there are connected appointments, the user will get a propagation message on making any edits.
  • Make the desired selection from the pop-up message, based on how you wish changes to be applied and reflected in the appointments as well as in the Billing Export Report.

• Please review the options before saving your changes.  

11) OPTION 2  To Add Billing Codes with NO Staff credential restrictions, then select "NO" on the second question on the popup screen

Complete all Required Fields marked with *

• Selecting this option will allow any staff to be scheduled for this service, regardless of presence/absence of License/Credentials entered on their profile
• Selecting this option will only allow for one rate to be billed for this service.  

11) OPTION 3  To not require an Authorization for scheduling, select 'Does NOT require Authorization' box and select a Rendering Provider  (NOT recommended as Best Practice)  

• Select whether to Restrict by credentials.
• Complete are Required Fields marked with *

12) To add additional/new Billing codes: Ensure you are under desired Service Line, then repeat Steps 10 & 11 above