Coverage Allowance
It is possible to assign a coverage allowance to an invoice grouping.
What does the coverage allowance is used for?
The "Cover Allocation" feature allows you to assign eligible coverage offered by the insurer or other payer to the patient. This tool allows clinics to track the consumption of their patients' claims to help them avoid unpleasant surprises when the coverage limit is exceeded.
Depending on the insurance plan, the patient may be entitled to several types of services offered by a clinic. It can therefore become difficult for the patient and the clinic to keep track of the patient's remaining count of coverage. The coverage allowance provides a clear overview of the treatments performed claimed and the amount or number of remaining appointments that will be eligible for coverage.
Attention:
A coverage allowance is an estimation tool; Medexa and the clinic can’t be held responsible for the validity of this data since the two parties don’t have control over the claims made by the patient at other institutions.
Create a coverage allocation
To create a coverage allocation, you must navigate to an existing billing episode or create a new one.
On an existing billing episode
Via the "Clients" section on the left, search for the patient in question.
- Open the patient file
- Click on the tab "Billing episode"
- Choose a billing episode
- In the "Information" section, click on the pencil icon
- From the "Edit Billing Episode" window, in the "Coverage" section, select the variable that will define the coverage limit:
- Limit Amount: Enter the amount and third party payer associated with payments for this coverage
- Third-party payer: The third-party payer to be selected
- Number of appointments limit: Enter the maximum number of appointments covered
- Duration limit: Enter the maximum duration (in minutes) covered
- End Date: Enter the date coverage ends
- Complete the other fields, if desired
- Click on "Save Changes"
On a new billing episode
Via the "Clients" section on the left, search for the patient in question.
- Open the patient file
- Click on the tab " Billing episodes"
- Click on the (+) in the header (located between the patient file tabs and the coverage section)
- Enter the title and the start date of the billing episode
- The title of a billing episode is determined by the clinic according to the theme of the grouping. Refer to the first section of the following article to help you determine the organization of your billing episodes
- From the "Edit Billing Episode" window, in the "Coverage" section, select the variable that will define the coverage limit:
- Limit Amount: Enter the amount and third party payer associated with payments for this coverage
- Third-party payer: The third-party payer to be selected
- Number of appointments limit: Enter the maximum number of appointments covered
- Duration limit: Enter the maximum duration (in minutes) covered
- End Date: Enter the date coverage ends
- Fill in the other fields, if desired
- Click on " Save Changes"
Note: Coverage allowance is optional when creating a billing episode. If this feature is not useful to you, you can simply omit setting it.
How does the coverage allocation work?
To create a coverage allocation, you must assign a variable to it to allow Medexa to properly calculate the remaining coverage count.
- When the coverage allocation has been created, it indicates the coverage used and the remaining coverage.
- In order for these two data to adjust as the patient comes to the clinic for treatment, the clinic staff must make sure to associate the appointments and/or payments on the invoices adequately.
Here are the things to do depending on the chosen variable to ensure that the coverage allowance tally automatically adjusts:
| Limit Amount | Allows you to assign the total amount allowed for coverage Points:
Warning! If the third party payer associated with the bill payment does not coincide with the third party payer assigned to the bill grouping, the coverage allocation will not adjust. Note: It may therefore be interesting to put the name of the third-party payer in the title of the grouping of invoices to avoid potential errors. |
| Third party payer | Allows you to select the third-party payer |
| Number of appointments limit | Allows you to assign the total number of appointments covered by the major organization. Points:
|
| Duration limit | Points:
Attention ! : If the duration of the services billed is incorrect, the calculation of the coverage allowance will be affected. Note: It is recommended to validate the duration of all your services via the " My Clinic " section before registering coverage allowances with the " Duration " variable. |
| End date | Assigns the end date of coverage disclosed by the major organization. Points:
|
Where can the details of a cover allowance be viewed?
- Once the coverage allocation has been created via a billing episode, the counts of the claims made and the remaining available will be displayed in different places.
- "Billing episode" tab of the patient file: By clicking on a billing episode, if a coverage allocation is associated with it, the detail of the coverage will be displayed at the top of the page.
- Schedule > Employees: In the window for creating and editing the appointment, the coverage details of the coverage allocations associated with the patient will be displayed at the top of the page.
- Schedule > Rooms: In the window for creating and editing the appointment, the coverage details of the coverage allocations associated with the patient will be displayed at the top of the page.
- Calendar: In the window for creating and editing the appointment, the coverage details(s) of the coverage allocations associated with the patient will be displayed at the top of the page.
Note: These counts are for visual purposes and cannot be manually edited. To edit the total of a coverage allowance, you must edit the invoice grouping the allowance is associated with.
See this article for more details: Invoice Groupings.