A price list is an Excel file that contains prices for all used codes agreed between a provider and a payer. A procedure price is unique for an insurance package, so the same code can have different coverage by the payer.
User The user can upload a price list on Price List Upload form (learn more). Both .xls and .xlsx formats are supported. The Excel file must have the following columns:
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Greenrain Facility retrieves these prices for the selected procedure codes in new authorization requests and e-claims. Patient The patient visit (encounter) date is compared with the effective date of the uploaded price lists: patient visit the encounter start date must be greater than or equal to the effective date. If several lists satisfy the condition, then the list with the greatest value of the effective date is taken.
Example 1 | Example 2 |
Prices loading works as follows.
Step 1. Click on Create New Prior Request button.
Electronic Prior Request - Authorization form opens. Patient Details tab is active.
Step 2. Set Payer ID and Cover Plan Insurance plan as for the uploaded price list (see details).
Step 3. Go to Request Encounter Details tab and set Visit Start > Effective Date Encounter start > the effective date of the list.
Step 4. Go to Procedure Details tab, set:
- Type = 3 – CPT;
- Procedure – from the price list.
All prices are auto-filled from the list:
- Unit gross price = Gross Price;
- Unit patient share = Patient Share;
- Unit net price = Net Price.
Step 56. Press Ctrl + N to add new procedure, set:
- Type = 5 – Trade Drug;
- Procedure – any drugmedication.
The following calculations are made:
- Unit gross price is auto-filled with Price value from Select Trade Drug dialog;
- Copay = Patient Share for drugs (%) from the price list;
- Unit patient share = Unit gross price x Copay / 100;
- Unit net price = Unit gross price – Unit patient share.
Note: The user still has an the ability to edit the prices if necessary.
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