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Medicaid / Flat Co-Pay Plans

Set up this type of Insurance Plan when the plan pays a flat fee instead of a percentage.  Insurance coverage will be 100%. Writeoffs are not tracked and production numbers may be inflated.

To track writeoffs, see HMOs/DMOs with Supplemental Payments and Copays.

On the Edit Insurance Plan window, select these options.

  • Plan Type: Medicaid or Flat Co-Pay. This will clear all percentages, maximums and deductibles, but a warning message will show first.
  • Use Alternate Codes: If applicable, check this box to show alternate codes and Provider fees on the claim. To associate alternate codes to procedure codes see Edit Procedure Codes, Alt Code. To show the procedure description on the claim, you must also add the alternate code, with description, to the Procedure Code List. Otherwise the description will be blank. See Add a Procedure Code.
  • Claims show UCR fee, not billed fee: Check this box.
  • Fee Schedule: The carrier's fee schedule.

If insurance does not cover a procedure for some reason, and you don't expect the patient to pay, you can enter it as a writeoff when you Enter the Insurance Payment, however these writeoffs are not tracked.


If a patient is required to pay a co-pay for procedures

  1. Create a co-pay Fee Schedule for the carrier.
  2. For each procedure code, enter the patient's co-pay amount. There can be just a few fees with the rest blank. If you only have the insurance co-pay fee schedule, not the patient co-pay amounts, use this equation to obtain the fee:  Carrier Fee - Insurance Co-Pay = Patient Co-Pay.
  3. On the Edit Insurance Plan window set the following:
    Fee Schedule: The normal fee schedule for the carrier.
    Patient Co-pay Amounts: The co-pay fee schedule for the carrier.

 

 

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