Aliases (V2)

Plan Info

Flag: Accepts Secondary (v2)
HCFA Place Of Service Blacklist (v2)

UB

UB 76 - Override List - List of providers who always use their NPI
UB 76 - Override List - List of providers who always use the billing office NPI
Textarea: UB "Remarks" override (default to payer name+address)?
UB: Service Type <-> Revenue Code mapping / Medicaid always uses 0529, but UHC uses 0731 for PT and something else for OT, Molina has 0920 for Speech

Business Logic (v2)

Service-Type Warning list? (e.g. Vision) // some insurances specifically do NOT cover some service types
Diagnosis Warning List // Rules engine should throw a warning if trying to bill for one of these
Procedure Warning List // Rules engine should throw a warning if trying to bill for one of these
Primary-ICD Blacklist (e.g. Fidelis H52.xx) ?
Referral Reqd for specialists (e.g. United Healthcare)
Only PCP allowed for non-specialist (per patient rather than payer?)
Flag: Unique ID per pt // some insurances (e.g. medicaid) give a different number to every family member. if so, every number must be unique. Others have a suffix per fmaily member - again every number must be unique
For later - Plan Class Limits? (Medical, Dental, Vision, Mental Health, LTC, Hospital)

Authorizations (v2)

// Some insurances allow a certain number of Therapy visits before requiring an authorization
Flag: Require Authorization Before Evaluation // some insurances don't even pay for the Eval without an authorization
Flag: Use Last Visit In Auth For Eval // some insurances don't pay for the Eval after an authorization so we want to do the eval in the last visit of the previous auth
Flag: Evaluations are unpaid
Flag: Authorizations by unit (default: False - i.e. by visit)
# Allowed Visits Before Authorization - OT, PT, Speech // sometimes the allowances are PER therapy type
# Allowed Visits Before Authorization_Combined // sometimes the allowances are across all therapy types

Networks (v2)

Network/Plan list
per-network overrides of every field above?