Summary
Enhancement Details
Enhancement Source: This is one of the 2024 Health Billing Enhancements
Enhancement Release: 6.4.2.7
Enhancement Area: Accounts Receivable – Customer Record
Enhancement Programmer: Craig Ralph
Enhancement TFS Ticket: Product Backlog Item 75357: HB: Splitting Cost between multiple payees
Enhancement Overview
The System 5 Health Billing Module will be enhanced to enable the use of multiple payees—specifically two payees—on a single line item. This improvement will streamline billing processes for customers with dual insurance coverage, allowing for more efficient management of payments. Users will be able to easily assign and adjust payee order directly within the customer record, ensuring compliance with insurance guidelines while enhancing overall user experience. This enhancement aims to reduce billing errors and improve workflow efficiency in the healthcare billing process.
Business and Customer Details
Customer
This enhancement is beneficial to all System Five customers with Health Billing Module in their System Five Licensing.
Industries: Healthcare
Business Cases
Case #1
Problem:
The current System 5 Health Billing Module lacks the functionality to support multiple payees on a single line item, complicating billing processes for customers with dual insurance coverage. This limitation requires users to handle billing for two payees separately, leading to inefficiencies and potential errors in payment allocation.
Additionally, the absence of a streamlined method for prioritizing payee order creates challenges, as insurance companies have specific rules dictating who pays first. Users may encounter difficulties in managing customer records with more than two payees.
Furthermore, the inability to easily remove unused payees from the list can clutter the interface, and previously authorized payees reappearing after deletion adds to the confusion. Overall, these challenges hinder efficient billing practices and can lead to billing discrepancies, impacting customer satisfaction and compliance with insurance regulations.
Solution (Workflow):
The System 5 Health Billing Module is enhanced to allow for multiple payees (2 payees) to be used on one line item. On the customer record Authorizations tab you can select the primary order of the payees. The insurance companies have rules about how to apply who pays first. A customer may have more than 2 payees but there is a maximum of only 2 payees that can be added to a single invoice. Use the Up or Down arrows to change the order. If there was a payee that is no longer used and it is showing up in the list, you can use the delete key to delete the payee. If there is however an authorization for that payee, it will reappear.
Assumptions:
The customer should have a Health Billing Module in their System Five Licensing. The user is expected to have a foundational understanding of the Health Billing functionalities and processes. The user will be required to update the customer record, specifically within the Authorizations tab, and must be able to select the appropriate order of payees as part of the billing process.
Enhancement Visuals
On the Customer record Authorizations tab, you can select the primary order of the payees. Use the Up or down arrows to change the order. If there was a payee that is no longer used and it is showing up in the list, you can use the delete key to delete the payee. If there is however an authorization for that payee, it will reappear.
Make sure to press the SAVE button to the right to save that order. You should save the order even if you did not change it.
For this example, there are two payees for a part.
- Payee One 75%
- Payee Two 50%
If Payee Two is the priority then,
- Payee two pays 50% of 3000 = 1500
- Payee One pays 75% of 3000 or what is left = 1500
Customer Care and Maintenance Transition
Implementing the Enhancement
- This enhancement requires a Health Billing Module with the latest version of System Five. Contact your Account Manager for more details.
- Contact Support for System Five update to use this functionality.
Enhancement Requirements and Dependencies
Hardware Requirements
a. None. Must be able to install and run 6.4.2.7.
System 5 Requirements and Dependencies
- Health Billing Module is required.
- Available in Private Release.
3rd Party Service Dependencies
a. None.
Other Requirements and Dependencies
a. None.
