creative plan building presented by: fred porter, yonette bowen and charleen mullaney
TRANSCRIPT
![Page 1: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/1.jpg)
CREATIVE PLAN BUILDING
PRESENTED BY: FRED PORTER , YONETTE BOWEN AND CHARLEEN MULLANEY
![Page 2: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/2.jpg)
AG E N DA
• Episode Records
• Pre-Certification Requirements
Benefit Plan Setup
Adjudication Logic Setup
• ICD9 and ICD10 Category Definitions
• Dental Logic
• Copay by DOS
• Out of Network payment options (Creatively!)
![Page 3: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/3.jpg)
EPISODE RECORDS
![Page 4: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/4.jpg)
E L I G I B I L I T Y / E N R O L L M E N T
![Page 5: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/5.jpg)
O P T I O N S / U T I L I T I E S
![Page 6: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/6.jpg)
I N D I V I D U A L / PAT I E N T E P I S O D E S
![Page 7: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/7.jpg)
I N D I V I D U A L / PAT I E N T E P I S O D E S
• If any exist a list will appear
![Page 8: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/8.jpg)
C R E AT I N G R E C O R D S• Select (A)dd to create new record. Patient
information will populate
![Page 9: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/9.jpg)
E P I S O D E R E C O R D H I G H L I G H T S
• Pricing methods
![Page 10: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/10.jpg)
P R I C I N G O P T I O N S
• NORMAL PRICING
Allows you to attach multiple Providers to a single
episode
• EVENT PRICING
Allows you to attach a single Provider to a single
episode
• CASE PRICING
No Providers are attached to the episode
![Page 11: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/11.jpg)
A D D I N G P R OV I D E R S
• Search for Provider to add.
![Page 12: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/12.jpg)
A D D I N G P R OV I D E R S• Can add single or multiple Providers. Depending
on Case Price Method
![Page 13: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/13.jpg)
AC T I O N S / R E A S O N• Exceed Except is most common. Will create EXC
when conditions of Pre-Cert are not met.
![Page 14: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/14.jpg)
P R OV I D E R VA L I DAT I O N• Can select all Providers with same TIN or a Single
Provider assigned by System ID
![Page 15: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/15.jpg)
N E T W O R K M ATC H I N G
• NOT for forcing In-Network
![Page 16: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/16.jpg)
P E N A LT Y O P T I O N S
• Network, Penalty or Force the Network?
![Page 17: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/17.jpg)
AC C E P TA N C E O F T H E R E C O R D• Exact matching or “some” matching
![Page 18: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/18.jpg)
R E V A N D D I AG N O S I S C O D E S
• Enter your codes required for this Episode
![Page 19: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/19.jpg)
I C D , H C P C S A N D C P T C O D E S• Add other necessary Service Codes here
![Page 20: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/20.jpg)
C O D E RA N G E S
• Always put “from” and “through”.
![Page 21: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/21.jpg)
O T H E R I N F O R M AT I O N• Authorized/Accumulated and Comments
![Page 22: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/22.jpg)
P R I C I N G O P T I O N S
• Command line options of pri(C)ing
![Page 23: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/23.jpg)
P R I C I N G O P T I O N S• Can price claim differently for each Episode
![Page 24: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/24.jpg)
AC C E S S I N C L A I M S• Can access Episode to view during Claims
Processing
![Page 25: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/25.jpg)
E X I S T I N G E P I S O D E R E C O R D S
• Can Identify Case Record vs. Manual Episodes
![Page 26: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/26.jpg)
PRE-CERT SETUP PLAN BUILDING
![Page 27: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/27.jpg)
P R E - C E RT V I A B E N E F I T P L A N• Per Benefit Plan setup. Plan details.
![Page 28: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/28.jpg)
D E F I N E D S E RV I C E S
• Can add multiple Categories requiring Pre-Cert
![Page 29: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/29.jpg)
C AT E G O RY D E F I N I T I O N S
• F4 will allow for searching Categories
![Page 30: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/30.jpg)
D E N Y N O N - P R E C E RT E D C L A I M S
• Can auto-deny if needed
![Page 31: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/31.jpg)
S E PA RAT E P R I C I N G O P T I O N S
• Can apply separate pricing if needed.
![Page 32: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/32.jpg)
P R I C I N G O P T I O N S
![Page 33: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/33.jpg)
C A N U S E S E PA RAT E S C H E D U L E
![Page 34: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/34.jpg)
S E PA RAT E B E N E F I T S C H E D U L E• If enter “Y”, will see different schedule option
![Page 35: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/35.jpg)
B E N E F I T E XC E P T I O N P E N A LT I E S
• Can apply Non-Precert Penalties
![Page 36: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/36.jpg)
B E N E F I T E XC E P T I O N P E N A LT I E S
• Can Penalize by percentage or flat dollar
![Page 37: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/37.jpg)
C A N P E N D AT E XC E P T I O N L E V E L• Can choose to Pend even if no Penalty set
![Page 38: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/38.jpg)
PRE-CERT SETUP ADJ. LOGIC
![Page 39: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/39.jpg)
A D J U D I C AT I O N LO G I C• Same Benefit Code can be set two ways
![Page 40: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/40.jpg)
A D J U D I C AT I O N LO G I C• Same code Pend if no Pre-Cert
![Page 41: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/41.jpg)
A D J U D I C AT I O N LO G I C
![Page 42: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/42.jpg)
ICD9/10 CATEGORIES
![Page 43: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/43.jpg)
C AT E G O RY D E F I N I T I O N S• ICD9 and ICD10 options on same Category
![Page 44: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/44.jpg)
I C D 9 D I AG N O S I S C O D E S• Same options for both codes
![Page 45: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/45.jpg)
I C D 9 C O D E E N T RY• Separate ranges for ICD9 codes
![Page 46: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/46.jpg)
I C D 1 0 D I AG N O S I S C O D E S
![Page 47: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/47.jpg)
I C D 1 0 D I AG N O S I S C O D E S• Separate ranges for ICD10 codes
![Page 48: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/48.jpg)
H C FA F O R M• Same options for HCFA form
![Page 49: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/49.jpg)
H C FA F O R M
• ICD9 Code ranges
![Page 50: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/50.jpg)
H C FA F O R M
• ICD10 code ranges
![Page 51: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/51.jpg)
DENTAL LOGIC
![Page 52: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/52.jpg)
W H AT C A N D E N TA L LO G I C D O ?
• Dental logic is by Group. If it is set up, it is used.
• Ability to do multiple things on one ADA code
• Ability to change ADA codes or use a particular Benefit
Code as in regular Adjudication Logic.
• Multiple variations on Tooth, Arch, Quadrant and Provider.
• Patient Age Limitations
• Limitations base on services Reported With, History of or
Without History.
![Page 53: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/53.jpg)
D E N TA L LO G I C
• All U/W, Groups within single U/W or single Group
![Page 54: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/54.jpg)
D E N TA L LO G I C
• Rules are set per ADA Code
![Page 55: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/55.jpg)
D E N TA L LO G I C• Multiple options for what to do with the Code
![Page 56: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/56.jpg)
D E N TA L LO G I C
![Page 57: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/57.jpg)
D E N TA L LO G I C
• Age based limitations without using Benefit Exceptions
![Page 58: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/58.jpg)
D E N TA L LO G I C• Multiple rules for same Code
![Page 59: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/59.jpg)
D E N TA L LO G I C
• Dental Claims Processing. Entered D1120
![Page 60: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/60.jpg)
D E N TA L LO G I C• Switches ADA Code to D1110
![Page 61: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/61.jpg)
D E N TA L LO G I C• Also ensures use of Benefit Code 902
![Page 62: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/62.jpg)
D E N TA L LO G I C
• Conditional exception without using Benefit Exceptions
![Page 63: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/63.jpg)
D E N TA L LO G I C
• One issue: Can’t use “Pay as MM” option in Group Master set up.
![Page 64: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/64.jpg)
COPAY BY DOS
![Page 65: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/65.jpg)
C O PAY D E F I N I T I O N S• Add Office Visit and Lab Categories and designate
Inpatient Codes
![Page 66: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/66.jpg)
TA B L E O F C O N T E N T S -B I L L T Y P E• Bill Type defines In-Patient Confinement
![Page 67: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/67.jpg)
B I L L T Y P E
• Control Flag equal to “I” for Inpatient
![Page 68: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/68.jpg)
C O PAY P L A N S E T U P
• Set at each Basic Policy Information screen
![Page 69: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/69.jpg)
C O PAY BY D O S• Warning will appear on initial set up
![Page 70: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/70.jpg)
C O PAY BY D O S
• Inpatient can be Day or Stay
![Page 71: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/71.jpg)
C O R E R E Q U I R E M E N T S
• Type of Service Code input for Inpatient and Office Visits
![Page 72: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/72.jpg)
C O R E R E Q U I R E M E N T S• F4 for list of 270/271 Service Types
![Page 73: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/73.jpg)
D E D U C T I B L E O P T I O N S
• New in 4.11.0!!
![Page 74: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/74.jpg)
L A B C L A I M O P T I O N S
• What to do when Lab claim comes in before Office Visit?
![Page 75: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/75.jpg)
C O PAY E XC E P T I O N S
![Page 76: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/76.jpg)
D E D U C T I B L E O P T I O N S• Exception options for Deductible
![Page 77: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/77.jpg)
OON PENALTY OPTIONS
![Page 78: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/78.jpg)
E X E M P T C AT E G O RY O P T I O N• Penalize…”except when…”
![Page 79: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/79.jpg)
E X E M P T C AT E G O RY O P T I O N• Can add categories such as Emergency or
Ambulance.
![Page 80: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/80.jpg)
E X E M P T P R I C I N G O P T I O N• Separate pricing if needed
![Page 81: CREATIVE PLAN BUILDING PRESENTED BY: FRED PORTER, YONETTE BOWEN AND CHARLEEN MULLANEY](https://reader038.vdocument.in/reader038/viewer/2022110304/551be507550346b9588b5fdb/html5/thumbnails/81.jpg)
Any Questions?