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Customize Plan Section - Cal-PM

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Customize the billing plan to meet individual client requirements.

  1. In the Billing Plan Assigned table, click Add New Item.

  2. In the Level Start Date field, enter the first coverage date.

  3. In the Level End Date field, enter the last coverage date.
    Note:  If no levels remain, the latest date (if earlier) overwrites the date entered in the Coverage Expiration Date field (Guarantor Selection section). Liability will not be distributed to the guarantor.

  4. The Level Number field displays the guarantor level.

  5. In the Deductible Type field, select the deductible collection frequency.

  6. In the Deductible Amount field, enter the deductible amount. A deducible amount is deducted once during liability distribution.

  7. In the Per Diem Rate field, enter the per diem rate. This is the contracted dollar amount per day for rendered services (contract benefit plans). The difference between this amount, and the service amount is written off during contractual allowance.

  8. In the Per Diem Percentage field, enter the per diem percent. When values are entered in both the Per Diem Rate and Per Diem Percentage fields, the lower value is used.

  9. In the Insurance Dollar Limit field, enter the total dollar amount covered by the guarantor (if applicable). This amount cannot exceed the Maximum Covered Dollars field (Guarantor Selection section).

  10. In the Insurance Dollar Limit Per Day field, enter the maximum daily dollar amount covered by the guarantor (if applicable). Used for non-contract plans.

  11. In the Maximum Units Per Day field, enter the maximum number of units covered per day.

  12. In the Percentage of Coverage field, enter the percentage of the total charge covered. Multiplying the service fee by this percentage determines the service amount covered by the guarantor. The remainder (if any) is used by the next guarantor. Used for non-contract plans.

  13. In the Insurance Dollar Limit R&B Per Day field, enter the daily maximum room and board charge. The value applies when a per day limit is set. Used for non-contract plans.

  14. In the Maximum Amount Per Service field, enter the maximum service dollar amount. Remaining liability (if any) is used by the next guarantor. Used for non-contract plans.

  15. In the Covered Charge Categories field, select the charge categories for coverage. All services in the selected charge categories are covered by the guarantor. Services must be associated with an insurance charge category (Service Codes form).

  16. In the Maximum Covered Days field, enter the maximum number of room and board covered days. Used for non-contract plans.

  17. In the Maximum Covered Partial Days field, enter the maximum number of days covered.

  18. In the Maximum Covered Ancillary Charges field, enter the maximum dollar amount for ancillary charges.

  19. In the Maximum Covered Visits field, enter the maximum number of visits covered. These are services defined as visits (Service Codes form).

  20. In the Monthly Maximum Responsibility field, enter the maximum monthly dollar amount covered (if applicable). Used for self pay guarantors.

  21. In the Practitioner Categories Necessary For Coverage field, select the practitioner categories a practitioner must be associated with to provide services. If a practitioner is not included, the service is evaluated in the next benefit plan level.

  22. In the Other Subscriber Secondary Identification (837 Electronic Billing) field, enter a value to append to the Other Subscriber Secondary Identification (2320A-REF-02) field (from Guarantor/Program Billing Defaults).

  23. When finished, click Submit.