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DATA FILES AND SETUP |
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| Database files (for example, CPT/HCPCS codes, referring physicians, fee schedules, etc.) may be viewed from any point in the system |
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| Authorized users may update the database files (for example, CPT/HCPCS codes, referring physicians, fee schedules, etc.) from any point in the system |
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| Database files (for example, CPT/HCPCS/ICD-9 codes, fee schedules, UPIN, etc.) may be updated by importing from excel file or other application |
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| Limited clinical information may be entered in designated data fields (for example, allergies, chronic conditions, maintenance medications, prescriptions, test results, etc. |
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| Notes entered into patient accounts may be searched by category (for example, financial, demographic, appointment, medical, etc. |
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| Transaction codes may be classified by type (for example charge, payment, refund, adjustment, debit, credit |
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| Procedure and diagnosis codes may be classified into groups or departments as defined by practice |
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| Unique practice defined codes may be created for diagnosis and procedure codes
Identify procedure code requirements by individual payer |
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| Identify procedure code requirements by individual payer |
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| Identify diagnosis code requirements for designated procedure codes by individual payer |
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| Alert when additional information is required (for example, referring physician, UPIN, purchase amount, etc.) for designated procedure codes |
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| Designate gender and/or age restrictions for applicable codes |
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| Identify modifier requirements for designated procedure codes |
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| Alert when type and or place of service is incompatible with procedure code |
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| Alert when CPT/HCPCS code is incompatible with payer |
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| Cross walk or link payer specific procedure codes for specified services |
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| RVU values may be designated for procedure codes |
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| Fee schedules may be assigned to individual insurance plans |
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| Using effective dates allows multiple fee schedules for a given payer |
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| Track payer allowed amounts on a per plan basis |
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| Update to practice fees may be done via RVU |
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| Updates to practice fees may be done via % increase/decrease |
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| Insurance plans may be classified into groups or departments as defined by practice (for example, PPO, HMO, Capitated, etc.) |
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| Insurance plans may be classified by type/class as defined by practice |
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| Links a payer's multiple plans to the payer's contract |
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| Defines managed care terms for each plan |
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| Flags plan as capitated |
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| Flags plan as fee-for-service |
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| Flags plan if inactive |
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| Captures effective dates |
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| Captures referring physician demographics |
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| Adjustments may be customized by and grouped into categories by insurance plan |
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