Local Allowable Categories

 

On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Local Allowable Categories

 

 

Note: The lists of insurance reporting categories, product types, and insurance packages on the Local Allowable Categories page include information only for payers that have at least one member registered as a patient in your practice and payers listed under "Most Used Standard Policies" on the Add Policy page.

1. Display the Local Allowable Categories page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Fee and Allowable Schedules, click Local Allowable Categories.
2. Name — Enter a short, descriptive name for the local allowable category.
3. Insurance Reporting Category — To include specific insurance reporting categories in the local allowable category, click Selected and then select the insurance reporting categories from the list.
   Note: To select more than one insurance reporting category, hold down the Ctrl key and click each category in the list.
4. Product Type — To include specific insurance product types in the local allowable category, click Selected and then select the product types from the list.
   Note: To select more than one insurance product type, hold down the Ctrl key and click each type in the list.
5. Insurance Package — To include or exclude specific insurance packages in this local allowable category:
1. Click one of these options:
• Selected — Include only the specified insurance packages in the local allowable category.
• All Except — Exclude the specified insurance packages from the local allowable category (all unselected packages are included in the local allowable category).

Note: The Insurance Package list shows only insurance packages that have at least one member registered as a patient in your practice.

 

2. Find insurance package — Enter text in the field to locate the packages that you want to include or exclude in the local allowable category.
   Note: If more than 5000 insurance packages are available, the message Too many packages to show appears. You must enter text in the Find insurance package field.
3. Sort by — By default, the insurance packages in the list are sorted by package name. To sort the list by package ID, select the Insurance Package ID option.
4. Select one or more packages from the list.
   Note: To select more than one insurance package, hold down the Ctrl key and click each insurance package in the list.
6. To include or exclude additional insurance packages in the local allowable category, enter text in the Find insurance package field again.
   Note: Packages that you already selected were saved.
7. Notes — Enter any notes about this allowable category.
8. Click Save.
   Any overlaps or conflicts between allowable categories are displayed.

Resolve conflicts

 

A single insurance package can appear in only one allowable category, global or local. If a global allowable category contains an insurance package that is also included in a local allowable category, you must update the local allowable category.

athenahealth recommends that you resolve these overlaps as soon as possible to avoid problems with the Payment Mismatch Tracking report (see also Allowable Schedules and Payment Mismatch).

9. If you receive an alert message to review and reassign insurance packages, click the update link for the new local allowable category to make changes. You can click the Show Deleted Local Allowable Categories link to display deleted entries.

Here are two examples of conflicts or overlaps that can occur as you create local allowable categories.

 

Example 1

Two local allowable categories include the same insurance package.

• Allowable Category 1 is defined as IRC = Aetna and Product Type = PPO.
• Allowable Category 2 is defined as Insurance Package = 12345, where Insurance Package "12345" is classified as an Aetna PPO and has not been excluded from the set of insurance packages covered by Allowable Category 1.

One way to resolve this conflict is to update Allowable Category 1 to exclude Insurance Package "12345."

 

Example 2

athenahealth created a new allowable schedule using local allowable categories. An allowable schedule that references a global allowable category that includes the same insurance package already exists. To resolve this type of conflict, you should update the original allowable schedule to point to the new local allowable category.

 

Name	Enter a short, descriptive name for the local allowable category.
Insurance Reporting Category	To include specific insurance reporting categories in the local allowable category, click Selected and then select the insurance reporting categories from the list. Note: To select more than one insurance reporting category, hold down the Ctrl key and click each category in the list.
Product Type	To include specific insurance product types in the local allowable category, click Selected and then select the product types from the list. Note: To select more than one insurance product type, hold down the Ctrl key and click each type in the list.
Insurance Package	To include or exclude specific insurance packages in this local allowable category, click one of these options: Selected — Include only the specified insurance packages in the local allowable category. All Except — Exclude the specified insurance packages from the local allowable category (all unselected packages are included in the local allowable category). Note: The Insurance Package list shows only insurance packages that have at least one member registered as a patient in your practice.
Find insurance package	Enter text in the field to locate the packages that you want to include or exclude in the local allowable category. Note: If more than 5000 insurance packages are available, the message Too many packages to show appears. You must enter text in the Find insurance package field.
Sort by	By default, the insurance packages in the list are sorted by package name. To sort the list by package ID, select the Insurance Package ID option.
Notes	Enter any notes about this allowable category.
Local Allowable Categories (Column Headings)
ID	System-generated ID number of this local allowable category.
Name	Name of the local allowable category.
Insurance Reporting Category	Insurance reporting categories included in this local allowable category.
Product Type	Product types included in this local allowable category.
Insurance Package	Insurance packages included in this local allowable category.
Notes	Notes about this local allowable category.