Con res mbpayors ins view.php MENU
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Freemed-YiRC: con_res_mbpayors_ins_view.php Menu Help Page
Contents |
Summary
This is the Resident Contact Insurance/Private-Pay Information page.
Menu Sections
This page is divided into two sections, Insurance/Private-Pay Info and Insurance/Private-Pay Service Info.
Insurance/Private-Pay Info
Information relating to a contacts insurance, and private-pay (if applicable) goes here. This information is used when billing insurance and/or private-pay (if applicable). If private-pay is applicable, then be sure to check the Private-Pay Applicable item!
If the Patient Control Number is left blank, the system will automatically assign this.
The Medicaid Number is REQUIRED! This is a twelve digit number.
Insurance Enrollment Form
An Insurance Enrollment Form has been created for a specific agency. It may or may not be applicable for your agency. If you wish to show or hide this option (and the associated fields), go to the FMYiRC Module Manager, modify the module settings for the MedBill module, and Enable or Disable the enable_ins_enroll_form setting.
Insurance/Private-Pay Service Info
NOTE: Private-Pay service items will not show up here unless Private-Pay Applicable is CHECKED in the above section!
This section helps to keep track of session allotments for the different services. Some insurance companies cap the number of allowed sessions for certain services for a given date range. The number 9999 will be used automatically for the allotments number.
Start Date and End Date are not required and may be omitted if not applicable.
Which will be used to bill, insurance or private pay?
So, when it comes time to bill insurance, how does the system know which to bill, insurance or private pay?
When the insurance billing program runs for a given resident with active insurance, the program will first look to see if the Private-Pay Applicable field is marked. If it is not, then insurance will be the only option.
If Private-Pay Applicable is checked, then the program will look at the insurance record for a given clinical service. It will look at the date range, if there is one. If a given clinical note is within that date range, or there is no date range, it will then look at the allotment to see if they've been used up. If not, insurance will be used.
If the clinical note date is not within the date range (if applicable) or the allotment is used up the program will then attempt to bill using private pay. However, if there is a date range for self pay and the clinical note does not fall within it, the note will not be billed.
What if I only want to bill insurance and not use private pay?
For a given resident for all clinical services, you can make sure the Private-Pay Applicable field is not marked. If you only want to exclude certain services from being billed to private pay, then you can set the End Date for a client to the client's Date of Entry (DOE) (or one day before, to be safe).
What if I only want to bill private pay and not use insurance?
For each clinical service, set the Allotment to zero. You do not need a date range.
