Coverage Allowance

It is possible to assign a coverage allowance to an invoice grouping.

What does the coverage allowance is used for?

The functionality “Coverage Allowance” allows you to define an eligible coverage offered by the insurance company or any third-party payer to the patient. This is offered to the clinic to track the patient’s claims consumption and help the clinic to avoid bad surprises when exceeding the coverage’s limit.

According to the insurance plan, the patient may benefit of certain types of services offered by the clinic. Therefore, it can be complicated for the clinic and the patient to track the remaining patient’s coverage. The Coverage allowance allows you to have a clear overview of the claimed treatments and the amount or number of the appointments remaining in the insurance plan. 

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.


To create a coverage allowance, you have to assign a value to allow Medexa to calculate adequately the remaining amount of the coverage. Here are the available values:

  • Amount: Assign the total authorized amount for the coverage
  • Number of appointments: Assign the total number of appointment covered by the third-party payer
  • Duration: Assign the total duration in minutes that the third-party payer authorize in the coverage plan
  • End date: Assign the end date of the coverage disclosed by the third-party payer

Create a coverage allowance

To create a coverage allowance, you have to access to the existent invoice grouping or create a new invoice grouping.

On an existent invoice grouping 

From the “Clients” section on the left, look for the patient in question.

  1. Open the patient’s file
  2. Click on the “Billing” tab
  3. Click on the pencil’s icon by passing over the invoice grouping’ title (located between the patient’s file tabs and the coverage detail section)
  4. From the window “Edit invoice grouping”, in the section “Coverage allowance”, select the value that will determine the coverage’s limit:
    1. Amount: Type in the amount and the third-party payers associated with this coverage
    2. Number of appointments: Type in the maximum number of appointments covered
    3. Duration: Type in the maximum duration (in minutes) covered 
    4. End: Type in the date when that coverage will end
  5. Fill out the other fields, if desired
  6. Click on “Save changes”

On a new invoice grouping 

From the “Clients” section on the left, look for the patient in question.

  1. Open the patient’s file
  2. Click on the “Billing” tab
  3. Click on the + in the header (located between the patient’s file tabs and the coverage detail section)
  4. Type in the invoice grouping’s title and start date

    * the invoice grouping’s title is determined by the clinic according to the clinic’s theme. Refer to the first section of this article to help yourself to determine the invoice grouping’s organization: Invoice grouping
  5. In the “Coverage allowance” section, select the value that will determine the coverage’s limit:
    1. Amount: Type in the amount and the third-party payers associated with this coverage
    2. Number of appointments: Type in the maximum number of appointments covered
    3. Duration: Type in the maximum duration (in minutes) covered 
    4. End: Type in the date when that coverage will end
  6. Fill out the other fields, if desired
  7. Click on “SaveChanges”

Note: The coverage allowance is optional at the invoice grouping’s creation. If you find this functionality is not useful for your clinic, you can just skip its set up.


How does the coverage allowance work?

  • Once the coverage allowance is created, this one indicates the used and remaining coverage.
  • For these two data to adjust as the patient comes to be treated at the clinic, the employees of the clinic must assure to associate the appointments and/or payments in the invoices adequately.

Here the steps to be made according to the value chosen to make sure the coverage allowance adjusts automatically:

Amount

  • Invoice the appointments affected
  • Associate the invoices for these appointments with the invoice grouping’ coverage allowance
  • Apply the payment in the invoice and make sure that the third-party payer associated is the same as the one in the invoice grouping.

Attention! : If the third-party payer billed is not the same as the one assigned to the invoice grouping, the coverage allowance won’t adjust automatically.

Note: Therefore, can be interesting to add the name of the third-party payer to the invoice grouping’s name to avoid potential mistakes.

Number of appointments

  • Invoice the appointments affected
  • Associate the invoices for these appointments with the invoice grouping’s coverage allowance

Duration

  • Invoice the appointments affected
  • Associate the invoices for these appointments with the invoice grouping’s coverage allowance

Attention! : If the service’s duration is configured properly, the remaining coverage allowance will be affected. 

Note: It is recommended to validate the duration of all your services from the “My Clinic” section before typing in the coverage allowance with the “Duration” value.

End date

       No adjustments will be done if this value is chosen. The end date will be displayed to ease the clinic to check the coverage allowance’s tracking.


Can we consult the coverage allowance’s details?

  • Once the coverage allowance created from an invoice grouping, the count of claims made and the remaining available will be displayed in different places.
    • “Billing’ tab in the patient’s file: By clicking on an invoice grouping, if a coverage allowance is associated, the coverage detail will be displayed at the top of the page.
    • Schedule > Employees: In the window creation or edition of an appointment, the coverage allowance’s details associated with the patient will be displayed at the top of the page.
    • Schedule > Rooms: In the window creation or edition of an appointment, the coverage allowance’s details associated with the patient will be displayed at the top of the page.
    • Calendar: In the window creation or edition of an appointment, the coverage allowance’s details associated with the patient will be displayed at the top of the page.

Note: This count of claims is used to have a visual overview and can’t be manually changed. 
To edit the coverage allowance’s total, you have to edit this information in the invoice grouping associated. Refer to this article for more detail 
Invoice grouping