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Create Split Billing Rules

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Path: Patient>General>Split Billing Rules

Prerequisites:

  • You must have full access to this window assigned to you in Administration>Configuration>Operators, and the Allow Split Billing check box must be selected in Administration>Financial>Insurance Codes for the necessary payer.
  • The patient must have a primary insurance and at least one eligible insurance for you to be able to create split billing rules.
  1. Go to Patient>General>Split Billing Rules.
  2. Click the Add New tab to add a new split billing rule. The primary payer is highlighted by default on the left side of the window. Click a different payer to select it as the primary.
  3. Enter a start date for the coverage to include split billing rules in the Coverage Start Date field.
  4. Enter an end date for the coverage in the Coverage Start Date field or click the ellipsis button to calculate the end date if you know the duration of the split billing rule (see CCalculate end date for Split Billing rule).
  5. Enter an effective date for the split billing rule.
  6. Enter an end date for the split billing rule or click the ellipsis button to calculate the end date if you know the duration of the split billing rule but not an end date.
    1. This field may be left empty if an end date is unknown.
  7. n the Discipline column, select a discipline to apply the split billing rule to it.
  8. In the Days of Week column, select the days of the week that pertain to the split billing rule. Select All to apply the split billing rule to all days of the week. Click the ellipsis button to select the particular days of week for which the split billing rule will be applicable (see Select billable days of week).
  9. In the Billed (Hrs.) column, enter the number of hours for the visit that will be billed to the selected payer.
    1. For example, if a payer indicates that they will only pay for 2 hours of a home health aide visit, and the visit consists of 4 hours, you can split the billing between carriers. You would enter 2 in the Billed (Hrs.) column for the primary payer and the balance would be billed to the payer defined in the Eligible Payer field.
  10. In the Eligible Payer column, select a secondary eligible payer from the list to determine where the balance of the hours split is submitted after submitting to the primary.
  11. Enter any notes in the Comments field as appropriate.
  12. To add a split billing rule with different parameters within the same coverage date range, add a new line and repeat the above steps.
  13. Save your changes.