Ir al contenido principal
Todas las coleccionesNPHIES ApprovalUpdates
Discount Factor and Patient Type Filters in Claim Document
Discount Factor and Patient Type Filters in Claim Document

10/30/23 Added filters for Patient Type and Discount factor limits in Claim Document

R
Escrito por Rubén Mosqueda Herrera
Actualizado hace más de un año

We added two new features that will allow users to manage Claim Document requests more easily and to filter them according to their needs.

First, you will be able to see a new Patient Type filter, where when creating a new claim document, you will be allowed to filter the results to any of the following patient types :

  • Outpatient

  • Inpatient

  • Emergency

    You can also leave this field blank in order to view every type of patient that meet the TPA, Customer, Minor Company or Date range filters.

In addition to this, we added a new field in Business Partner window called Discount factor. This field can be configured by customer (insurer) and will help users to view only those results in Claim Document that have contractual discounts under this discount factor (in percentage), this in order to exclude those remissions with very high levels of discount such as 99-100% from the Claim Document search process.

Here, you can set a discount factor between 0 and 100 percent. When the discount of a charge exceeds the value that is set up, the charge will not appear in the claim document and therefore will not be sended to nphies, also if all charges are not valid the encounter will not show up.

If discount factor is 0 (zero) or blank, then every charge will appear.

In our example, we configured discount factor and selected an outpatient encounter with this same amount of discount. See charges example :

In Claim Document window document, we applied the Outpatient filter to display only outpatients. Since our patient charges are equal or under the configured factor for this business partner, charges must appear. On the other hand, if the charges have a discount higher than the allowed discount factor, then these patient charges will no longer appear (see demo) :

Demo :

We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it.

Date: October 30, 2023.

¿Ha quedado contestada tu pregunta?