Office Therapy - Managing and Reporting Insurance and Provider Rates


Managing and Reporting Insurance and Provider Rates

Set  Allowed Benefits for Insurance company

  • Go to the Insurance View, select the company, and select the Rate Card tab.
  • Select the Service or CPT and enter the Allowed benefits (what the insurance company allows – e.g for a 90834 the allowed is $100 and the percentage paid is 80% or $80

Set the Provider’s Rates

  • Go to the Provider view, select the provider and select the Rate card tab.
  • Select the Service or CPT and enter the provider’s rate (e.g. for 90834, enter $120)

Setup the Client’s Standard Charge

  • Go to the Client view and select a client
  • Set the Provider and Primary Insurance for the client
  • Go to the Standard Charge tab
  • Select the Service or CPT (e.g. 90834). The Provider Fee and Fee Reduction, and distributions will auto-populate (e.g. Fee =$ 120, Fee Reduction $20, Allowed Fee = $100, Client responsibility = $20, Insurance responsibility = $80)
  • Enter a charge for the client and save

Report Showing Provider Fee / Allowed Difference

  • Select Report Essentials from the Reports menu
  • Expand the Insurance Management and then the Insurance Charge Detail reports
  • Select the "For Primary by Client" Report

-        Select a Date Range and then on the Clients tab, select Selected Clients Only and then select the client. You can select All Clients, All or a specific Insurance company, All or a specific Provider, and also filter on Charge Types.

The report will show the provider Fee, Reduction, Insurance Allocation, any Adjustments, Insurance Responsibility, Insurance Payments and the Total Due.