Placement with Monthly Rate

Details

• The rate is associated to 1 plan/contract.
• All care day services that use this rate will consolidate into one claim for the entire month.
• Separate claims will produced in periods where the client changes facilities
• The rate details say the following... "Effective 01/01/2006, for clients who are between the ages of 0 and 18, the contract agency and plan rates will be $1000.00 for the entire month. The procedure code on the claim produced will be 99995.  Claim Modifiers will be added to 837 transactions"
• Client is enrolled 13 days of the period (July). Calculation is 1000/30.424 * 13 = $427.2942 ($427.29) for that month.
• Client is enrolled 29 days (93%) of the period (July). No calculation, bill for $1,000.
• Client is enrolled 27 days (87%) of the period (December). Calculation is 1000/30.424 * 27 = $887.45727 ($887.46) for that month.
• Placement Disruption Rules may affect any claims produced for days billed. However, the below does NOT demonstrate placement disruptions billed at a different rate.