To see how to create a patient estimate click here.
This article will help you make advanced changes that did not auto-populate in the estimate you are running. This includes:
Changing coverage guidelines
Changing procedure code description
Overriding system allowable rate
For making more advanced changes to your patient estimate - specifically, when you want to add custom values- click on the 'Advanced' gear button to the right of the 'Codes' fields.
Once you've clicked 'Advanced', a pop-up modal will appear within this window where you can enter custom values. The contracted rate for a procedure (shown in purple) will also populate as an additional reference. You can click on this rate to see the fee schedule the rate is pulled from.
In these fields, you can specifically customize any or all of the features described below. These include:
Code: this will populate with the codes you have entered, in the main estimate view. Should you need to, you can edit these pre-existing codes and/or add additional codes in this view
Description: here, you change the name of the procedure that appears in the patient estimate
Modifier: this will populate with the modifier you have entered in the main estimate view as they are associate with the specific codes. You can edit these pre-existing modifiers and/or add additional modifiers in this view
Quantity: Number of code occurrences
Allowed: Here you can manually enter the correct allowed amount, should the listed allowed amount require a change.
Coverage: Clicking on the dropdown arrow to the right of the coverage field, you can select the correct benefits coverage type that should be applied to the specific patient estimate
There are 4 major coverage types:
Standard: All benefits will be applied in a waterfall order starting with Copay, then Deductible until that has been hit, and then moving into Coinsurance and Out-of-Pocket Maximum.
Copay only: Some visits are covered by just a copay, regardless of how large the contract rate may be. This benefit will "ignore" all deductible and coinsurance benefits and apply just a copay.
Full Covered: For procedures that may be covered 100% by insurance, such as preventive care.
Not Covered: This bypasses all patient benefits and drops 100% to patient responsibility. A typical example of this is an elective or non-covered procedure.
* If the patient is covered by multiple payers, you will be able to select a coverage type for each payer.
Once you've selected all relevant custom information, you can click the 'Submit' button in the bottom right-hand side of the modal. You will see your manual changes applied to the patient estimate.
