These Unit Tests are for Estimate Downgrades.

Test #60: Patient has a PPO plan which covers D2393 at 100%. UCR fee for D2393 is $300 and PPO is $120. D2393 downgrades to D2160 always. D2160 has a UCR fee of $100 and the PPO fee is blank. When adding a procedure for D2393 for this patient, the allowed amount should be $120, the writeoff should be $180, and the insurance estimate should be $120.

• UCR fee for D2393: $300
• PPO fee for D2393: $120
• D2393 downgrades to D2160 always
• UCR fee for D2160: $100
• PPO fee for D2160: Blank
• Add a D2393 for this patient
• Allowed amount: $120
• Writeoff: $180
• Insurance estimate: $120

Test #61: Patient has a PPO plan which covers D2391 at 100%. UCR fee for D2393 is $140 and PPO fee is $80. D2391 downgrades to D2140 always. D2140 has a UCR fee of $120 and a PPO fee of $100. When adding a procedure for D2391 for this patient, the allowed amount should be $80, the writeoff should be $60, and the insurance estimate should be $80.

• UCR fee for D2391: $140
• PPO fee for D2391: $80
• D2391 downgrades to D2140 always
• UCR fee for D2140: $120
• PPO fee for D2140: $100
• Add a D2391 for this patient
• Allowed amount: $80
• Writeoff: $60
• Insurance estimate: $80

Related Links:

• Payment Plan Unit Tests
• Repeating Charges Unit Tests
• HL7 Unit Tests