OnSTAFF 2000
INSURANCE/PAY PLAN
PAY PLAN MENU
Utility/Insurance/Pay Plan/PROCEDURE
The Procedure option allows you to carve out as fee for service per procedure (i.e., override the /Utility/Procedure <HMO Adjust> field entry of N, thus flagging a procedure as fee for service, as if <HMO Adjust> was X. In order to use this feature the /Utility/Insurance/Pay Plan/Pay Plan <Carve Out> field must be set to P or B.
Menu Options:
Add Add a new Procedure carve out.
Modify Modify an existing Procedure carve out.
View View existing Procedure carve out.
Delete Delete an existing Procedure carve out.
Copy Copy an existing Procedure carve out.
Exit Exit returns you to the Pay Plan Menu.
When the Add option is selected, On-Staff will display the following fields:
Pay Plan Code: Enter the code of the pay plan. After pressing [Enter], the cursor will move to the Name field which will display the name of this pay plan. Press [Enter].
Panel: Enter the panel code (/Utility/Procedure <Panel Code>) of the procedure which is to be carved out by this pay plan. After pressing [Enter] the cursor will move to the C (command) column, the Code C and Description columns will automatically display based on the procedure screen set up.
At this point you may either Add, Modify or Delete contractual procedure carve out information or press the Q or [End] key to move the cursor to the Pay Plan Code field to enter another pay plans’ procedure carve out information or press the [“] or [End] key to return to the /Pay Plan/Procedure Menu.
When posting charges, On-Staff will check the New Patient Insurance screen Pay Plan field for a plan code entry. If found, that pay plan screen’s Carve Out field is checked for a field entry.
a) When D is found, the /Pay Plan/Diagnosis screen is checked for the pay plan and diagnosis code. If one or more of the posted diagnosis(ses) is (are) found, On-Staff will flag all charges during that charge session as fee for service.
b) When P is found, the /Pay Plan/Procedure screen is checked for the pay plan and procedure code. If found, On-Staff will flag that procedure as fee for service.
c) When B is found, BOTH the /Pay Plan/Diagnosis AND /Pay Plan/Procedure screens are checked as noted in a) and b) above.
When none of the charge screen’s diagnosis or procedures are found, On-Staff will flag all charges per the /Utility/Procedure <HMO Adjust> field entry.
