Estimates – Estimator tab

When adding and editing insurance profiles, use the Estimates-Estimator tab to set estimator options for an insurance profile.

·        Estimator – Select one of the following options:

·        Use estimate in estimator – To enter the amount insurance allows and/or pays per procedure code.

·        Calculate percent of allowable – To calculate a percentage of the insurance allowable entered into this profile’s estimator table OR, if a UCR group is attached to the profile, that UCR group’s allowable fee.

·        Do not use estimator – To turn off the estimator feature.

·        Update estimator from payments – To automatically add and update the amount insurance allows or pays in the estimator table.

Note: This option is used ONLY if Use estimate in estimator or Do not use estimator is selected.

·        UCR Group – Select a UCR group from the list to link this profile to other insurance profiles that use the same allowables.

Note: This is usually used for plans, such as Metlife, that have one set of allowables and many different groups, each with different maximums and deductibles, and that pays a percentage of those allowables. This feature allows you to enter the Metlife allowables once and link together ALL the Metlife profiles that use those same allowables.

·        Office visit – This office visit amount is an additional charge that is separate from the procedure codes charges. The office visit amount is set up in the estimator table. Select one of the following to specify how the program charges office visit’s for plans:

·        Choose the highest – To charge the highest office visit for all procedures posted.

·        Choose the lowest – To charge the lowest office visit for all procedures posted.

·        Choose all – To charge ALL the office visits associated with all procedures posted.

·        Office visit – Enter an amount greater than zero to charge that amount every time a patient has a procedure code posted that is designated as an office visit code (this is set up for each code in the fee schedule). This co-pay amount is an additional charge that is separate from the procedure codes.

·        Update office visit amounts to estimator table? – Select this check box to have the program automatically update the office visit amount in each code in the estimator table based on the office visit amount entered in the profile and the codes that are set up in the fee schedule as office visit codes.

 

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