Editing exceptions in coverage table templates

You can edit exceptions in any of the coverage table templates.

Tip: You can edit exceptions in a coverage table that is attached to an insurance plan.

To edit an exception

1. On the Settings menu, under Production, click (or tap) Coverage Tables.

   The Coverage Table Setup page opens.

   

2. Select a coverage table template.

   The options for editing the coverage table appear.

   

   Insurance Coverage, %

   

   Patient Copayment, $

3. Click (or tap) Manage Exceptions.

   

   The Manage Exceptions dialog box appears.

   

4. In the Exceptions list, expand a Code to view the corresponding exceptions, and then select an exception.

   Notes:

   • To search for a procedure code, begin entering a code in the Search for a procedure by code box, and continue typing as needed to narrow the list.

   • If at least one Code is expanded, to quickly collapse them all, click (or tap) Collapse All. If they are all collapsed, to expand them all, click (or tap) Expand All.

   The Edit Exception dialog box appears.

   

5. Set up the options on the following tabs as needed:

   • Exception Type

     1. Select one of the following options:

        • Not covered - To specify which procedures are not covered.

          

        • Downgrade - To specify which procedure requires a downgrade.

          

        • Age limitation - To specify which procedures have an age limitation.

          

     2. Click (or tap) Next.

   • Select Procedure(s)

     1. Do one of the following:

        • For a "Not covered" exception type, select the check boxes that correspond to the procedure codes that are not covered. To remove the exception from a particular procedure code, clear the corresponding check box.

          

          Notes:

          • Only the procedure codes that do not have exceptions appear in the list.

          • To quickly select or clear all check boxes, select or clear the check box in the header at the top of the list.

          • To quickly select or clear a range of check boxes, click (or tap) the first check box of the desired range, and then, while pressing the Shift key, click (or tap) the last check box of the desired range.

        • For a "Downgrade" exception type, to change which procedure code requires a downgrade, select the radio button that corresponds to the correct procedure code.

          

          Note: Only the procedure codes that do not have exceptions appear in the list.

        • For an "Age limitation" exception type, select the check boxes that correspond to the procedure codes that have an age limitation. To remove the exception from a particular procedure code, clear the corresponding check box.

          

          Notes:

          • Only the procedure codes that do not have exceptions appear in the list.

          • To quickly select or clear all check boxes, select or clear the check box in the header at the top of the list.

          • To quickly select or clear a range of check boxes, click (or tap) the first check box of the desired range, and then, while pressing the Shift key, click (or tap) the last check box of the desired range.

        Notes:

        • To search for a procedure, begin entering the code or its description in the Search for procedure box, continue typing as needed to narrow down the procedure code list.

        • After searching for and selecting a procedure, to return to viewing the entire procedure code list, delete the search text from the Search for procedure box.

     2. Click (or tap) Next.

   • Specify Options

     1. Do one of the following:

        • For a "Not covered" exception type, there are no options on this tab.

          

        • For a "Downgrade" exception type, to change the substitute procedure, in the Downgrade to search box, click (or tap) the Clear icon to clear the search box, begin entering the code or description of the procedure, continue typing as needed to narrow the results, and then select the correct code.

          

        • For an "Age limitation" exception type, set up the following options:

          • Age limitation - Enter a different minimum age limit (as young as 0 years) and/or a maximum age limit (as old as 110+ years) to specify that the insurance carrier covers this procedure only for patients whose age is within the specified limit. Also, you can use the left slider to change the minimum age and the right slider to change the maximum age.

            Note: If the patient's age is not within the specified limit, the percentage (%) or copayment ($) in the coverage table is used.

          • Deductible Type - Select the type of deductible that the patient must pay for this procedure. This list is available only if the Coverage, % or Copayment, $ option is selected.

          • Coverage, % or Downgrade - Do one of the following:

            • Specify a coverage percentage - Select the Coverage, % option if it is not already selected. In the box, enter or change the percentage of the fee charged that the insurance carrier covers for this procedure.

              

              Note: The Coverage, % box is available only for coverage tables that are based on insurance coverage percentages.

            • Specify a downgrade - Select the Downgrade to option if it is not already selected. In the Search for procedure box, click (or tap) the Clear icon to clear the search box if it contains a procedure, begin entering the code or description of the substitute procedure, continue typing as needed to narrow the results, and then select the correct code.

              

          • Copayment, $ or Downgrade - Do one of the following:

            • Specify a coypayment - Select the Copyament, $ option if it is not already selected. Enter or change the co-pay that the patient pays for this procedure.

              

              Note: The Copayment, $ box is available only for coverage tables that are based on fixed, patient copayments.

            • Specify a downgrade - Select the Downgrade to option if it is not already selected. In the Search for procedure box, click (or tap) the Clear icon to clear the search box if it contains a procedure, begin entering the code or description of the substitute procedure, continue typing as needed to narrow the results, and then select the correct code.

              

     2. Click (or tap) Next.

   • Reason for Exception

     Edit the reason for the exception in coverage for this procedure.

     

6. Click (or tap) Done.

   Note: This button is available only if the Reason for Exception tab is selected.