Plan Coverage Definition Section - MSO

Use the Plan Coverage Definition section with the Plan Definition form in myAvatar to define plan coverage levels.

Prerequisites:

• The Set Associated Codes form can be used to define groups of CPT, revenue, or diagnosis codes.

1. In the Plan Covered Services table, select Add New Item.
   • You can also select an existing item in the table and choose Edit Selected Item.
2. The Plan Coverage Level field displays the coverage level number.
3. In the Eligibility Reason Code (Aid Code) field, select the eligibility codes.
4. The following fields use code groups defined in the Set Associated Codes form.
   • In the Revenue Code Coverage Grouping field, select the revenue code groups.
     • Codes associated with the group display in the Revenue Code field.
   • In the CPT Code Coverage Grouping field, select the CPT code groups.
     • Codes associated with the group display in the CPT Service Code field.
   • In the Revenue Codes field, select the revenue codes.
   • In the CPT Service Codes field, select the CPT codes.
   • In the Diagnosis Groups Which Disallow Coverage of this Plan field:
     • Select diagnosis code groups to exclude from the plan coverage level.
     • Codes associated with the group display in the Diagnosis Codes Which Disallow field.
     • The codes available in the diagnosis-related fields are populated via the diagnosis_code_table located in myAvatar PM. Additional codes can be added via File Import in PM for Diagnosis Table.
   • In the Procedure Code Group Definitions field, select procedure code group definitions.
     • Procedure code groups are setup in the Procedure Code Group Definition form.
   • In the Only Diagnosis Groups Permitted for Coverage on this Plan field:
     • Select diagnosis code groups to include in the plan coverage level.
     • Codes associated with the group display in the Diagnosis Codes Permitted field.
   • In the Diagnosis Codes Which Disallow Coverage of this Plan field, select the diagnosis codes.
   • In the Only Diagnosis Codes Permitted for Coverage on this Plan field, select the diagnosis codes.

► Additional Sections

• Plan Definition
• Plan Liability Definition