Pay Control – Liability tab

Date

This field displays the pay control date entered on the Payers tab.

Type

Select the Deductible, SpendDown, or Patient Paid Amount liability type to be calculated.

The default value can be set in the Liability Type field of the Administration > Financial > Insurance Codes > Liability/Spend Down tab.

Amount

Enter the Spend Down or deductible dollar amount for this pay source.

These options are used in relation to Medicaid and the dollar amount the patient is responsible for prior to Medicaid beginning reimbursement. This amount is applied to services according to the specified term in the Per field.

From

Select the pay source to which the application applies the SpendDown or deductible amount.

This field is used to identify from which payer to deduct the dollar amount indicated in the Amount field for billing purposes. The only payer type that is available for selection in From is a Medicaid insurance code type.

To

Select the pay source from which the application subtracts the SpendDown or deductible amount.

This field identifies the payer who should be billed for the dollar amount indicated in the Amount field. The valid payer type for this field is a payer with a Self-pay insurance code type.

Per

Time duration over which the Spend Down or deductible amount is administered to the patient. The default value can be set in the Liability Per field of the Administration > Financial > Insurance Codes > Liability/Spend Down tab.

Select the appropriate period for which the patient will pay the specified amount of money: Day, Month, Year, or Period (based on the effective period of the pay control line associated with the Liability line).

For example, if you select Day, Month, or Year, the patient has to pay the amount every day, month, or year to be eligible for the program.

If you select Period, the beginning date is the effective pay control date specified in the line of the Pay Control tab associated with the liability (the check box in the Liability field should be selected). The end date is the day before the effective date of the subsequent pay control line.

For example, if the pay control line associated with the liability has an effective date of 06.20.2007 and the subsequent line has an effective date of 08.28.2008, your period will be from 06.20.2007 to 08.27.2008.

Roll Over

Select to apply the roll over function whenever the patient's share of cost exceeds the service amount. The check box can be selected as a default on the Administration > Financial > Insurance Codes > Liability/Spend Down tab.

Select the check box to bill any residual Spend Down amount to the patient on the subsequent claim. For example, if patient's Spend Down amount is 50$ and the service cost is 40$, then the 10$ will be shifted to the next claim within the defined liability period.

Payment Order

This field defines the order in which payments are applied to the claim. The default value can be set in the Payment Order field of the Administration > Financial > Insurance Codes > Liability/Spend Down tab.

Select from the following options:

• Prior Payments First – To apply the primary payer's payment to the claim first.
• SpendDown First – To apply the patient's Spend Down amount to the claim first.

Non-Covered Charges

Select to exclude noncovered charges from the claim. Leave the check box clear to include noncovered charges in the claim. The check box can be selected as a default on the Administration > Financial > Insurance Codes > Liability/Spend Down tab.

Noncovered items are additional items that provide comfort to the patient and are charged.

SIA

Select to include an Service Intensity Add-On (SIA) amount that is calculated for accounts receivable in the claim total before subtracting the spend down amount. This setting includes replacement claims that contain a SIA amount.

This check box is available only for Medicaid benefit payers.