Price Lists

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.

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:

• Type – procedure type (numeric value);
• Code – procedure code from the list of the corresponding procedure type;
• Gross – gross price of the procedure (can be decimal value);
• Net – net price of the procedure (can be decimal value);
• Patient Share – patient share of the procedure (can be decimal value).

The Excel file can contain any additional columns besides the required ones. Greenrain Facility ignores them.

Greenrain Facility retrieves these prices for the selected procedure codes in new authorization requests and e-claims. The patient visit (encounter) date is compared with the effective date of the uploaded price lists: 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.

Prices loading works as follows.

Step 1. Click New Prior Request. 
       Electronic Prior Request - Authorization form opens. Patient Details tab is active.

Step 2. Set Payer ID and Insurance plan as for the uploaded price list (see details).

Step 3. Go to Encounter Details tab and set Encounter start > the effective date of the list.

Step 4. Go to Procedure Details tab, set:

1. • 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 6. Press Ctrl + N to add new procedure, set:

1. • Type = 5 – Trade Drug;
   • Procedure – any medication.

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 the ability to edit the prices if necessary.

The algorithm is not applied in the following cases:

• if Electronic Prior Request form is opened after the request was sent; procedures prices become disabled for editing.
• if Electronic Claim form opened from the approved prior request; all prices are taken from those approved by the payer.