Overview:

Once you have updated your Service list with all required changes and fees, you should confirm whether these new codes require fees to be entered in any your Payor fee schedules. This will depend on whether your Payors are releasing a new fee schedule for July 2022 containing the new item codes.

The majority of practices will have Payor files for Payors such as DVA and hospital voucher schemes, and many more will also have health fund Payor files if they are a preferred provider.

If your Payors are not using the new item codes for 2022, refer back to this guide once they do.

Steps:

Go to File > Payors

Open

Use the Search box to select a Payor

Open

Click the Fee Schedule button

Locate the item code and double click on it

Scenario A: The Payor uses the ‘Combination Rule’

For new codes that do not have a price dictated by the Payor, just leave the fees alone, and ensure they have been given a price under your default prices in the Service list. (Configure > Services) This is because the Combination rule (used for newer practices) only requires you to actually update the Payor’s fees, leaving the other fees to automatically reference the Service list.

For new codes the Payor is dictating a price for, double click the code and update the price in the Fee field only.

Scenario B: The Payor uses the ‘This Payor sets both service fees and payor’s portion' rule

Once you double click on the item code, update the price. To ensure the fees will work correctly, it is important you update them with the same approach used for other item codes in the fee schedule. If you are unsure, double click a code that already has a price, and take note of how it has been set.