Plans

Plans control virtually every aspect of MedSuite.  In fact, plans control so much of the fee calculation, claim filing, and payment determination features of MedSuite, that without plans, MedSuite would be a virtually useless product.  If you understand how plans work you will understand how MedSuite works.  Plans control:

MedSuite approaches Plan Setup with the idea of maximizing flexibility and reporting capabilities while at the same time minimizing the number of plans that need to be maintained.  We make this approach by utilizing the concept of the "generic" plan.  Conceptually, a "carrier" can be both at a "higher-level" than a plan and at a "lower-level" than a plan.  A practice usually has contracts with a number of carriers for one or more plans offered by those carriers.  In addition, some plans that the practice has no contracts for are widely purchased and many patients will have plans for these "high-volume" carriers.  For example, a practice may have contracts with Blue Shield for their Blue Shield HMO, Blue Shield PPO, and Blue Shiled 80/20 Plans.  Let's assume that all of these plans "report" to a single Blue Shield Carrier.

On the other hand, many patients have insurance that is realtively seldom seen and for which the practice has no contractual agreement.  These plans may comprise dozens if not hundreds of different carriers.  Having to maintain a separate plan for each one of these carriers is an onerous proposition.  MedSuite uses "generic" plans to bill these "low-volume carriers".  A generic plan is simply a single plan that supports all of the fee schedules, rate structures, and billing control information to be used for the low-volume carriers.

How are multiple carriers bill through this single plan?  Quite simply, the specific carrier for a patient is selected from the MedSuite carrier table while entering the insurance demographics.  For example, you can add a plan called "Commercial Insurance".  For each patient that is entered that has "low-volume" plan, select the "Commercial Insurance" plan when entering the insurance information for the patient.  Then select the carrier specific to that patient.  Using this method, you can have a single plan called "Commercial Insurance" billing for carriers such as Globe Life, Lumberman's Life, Steam Fitters Local 1234, etc.

The Blue Shield example above illustrates the concept of multiple plans billed under a single carrier.  The "Commercial Insurance" example illustrates the concept of multiple carriers billed under a single plan.  How then does this affect carrier reporting?  Patients with a carrier in their insurance demographic information ("low-volume" carriers) would report the carrier from the insurance demographic information.  Patients without a carrier in their insurance demographic information ("high-volume" carriers) would report the carrier associated with the plan in their insurance demographic information.

Plan maintenance is performed via a tabbed dialog made up of six (6) tabs:

General

Details

Claims

HCFA

HCFA-Medigap

ERA

Pricing

Anesthesia

ASA Overrides

Library Change Logs

The Change Log button at the bottom of any MedSuite Maintenance File will track the following:

$ Date Changed - The date the change was made to the file.

$ User Name - The name of the user that made the change.

$ Item Changed - The file name of the item that was changed.

$ Old Value - The system value before the change was made.

$ New Value - The system value after the change was made and saved.

NOTE:  Items not tracked are description fields such as degrees and titles.