With some insurance plans (so far just United Concordia) certain procedures that have a downgrade allow the full UCR amount to be billed to the patient. This means that for those procedures the difference between the UCR and the Contracted/Max Allowed fee is not written off.
1. Determine the appropriate values for the UCR and max allowed fee for the procedures affected
2. Duplicate the Carrier fee schedule and identify to be used with the selected plans
3. Create alias codes for the original procedure codes
4. In the new fee schedule, enter in the UCR fee amount for the regular procedure code and alias code and the max allowed fee for the downgraded code.
5 setup a downgrade from the regular procedure code to the alias code
6. Setup an additional downgrade from the alias code to the downgraded procedure code
The calculations for insurance payments should now be based off of the max allowed fee for the downgraded procedure and the amount between that and the UCR should be in the patient portion.
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