Procedure Downgrades Estimates Unit Testing

These Unit Tests are for Procedure 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.

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.

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