Insurance Plans
Every payer and plan this client bills. A patient’s coverage points at one of these, and a claim inherits the payer, the filing indicator and the filing limit from it.
Who Can See It
Section titled “Who Can See It”User only, when the client is licensed for insurance plans.
The List
Section titled “The List”| Column | What it shows |
|---|---|
| Name | The plan as billers refer to it |
| Payer ID | The identifier the payer is addressed by on an 837 |
| Location | The service location it belongs to, where it is scoped to one |
| Filing Limit | Days from service before the payer stops accepting the claim |
| Phone | Who to call |
Filing Limit is what drives the deadline countdown on a claim, so a wrong value here shows up as a wrong deadline on every claim billed to the plan.
Actions
Section titled “Actions”| Action | What it does | When it is offered |
|---|---|---|
| Create | Adds a plan | Always |
| Edit | Changes one | From the row menu |
| Delete | Removes one | From the row menu |
Editing a plan does not revisit claims already built from it.
Payer Groups
Section titled “Payer Groups”A payer group is a name you put over several plans so reporting can talk about them together - every Medicaid plan as one line, or a network billed under one contract. Payer Groups in the sidebar lists them, with a Name and when it was Created, and offers Create, Edit and View History.
A plan belongs to at most one group, set when the plan is created or edited. Grouping changes nothing about how a claim is billed: it only gives Analytics a coarser axis, where Payer Scorecard and Collections Statement can break down by Payer group instead of by individual plan.
States
Section titled “States”- Empty - a client with no plans says so. Claims cannot be billed until one exists.
- Blocked - without the insurance plans module the screen is not in the sidebar, and a saved link to it says the module is not part of your plan.
Related: Patients · The Claim Page · Analytics