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Accounts

An account represents a payer that will be reimbursing your organization for services you provide to clients. Essentially, these are the insurance companies that your organization works with.

Payer Information​

The following fields and settings on an account should be set:

  • Account Type – Payer
  • Name – The payer’s name
  • Phone – Payer’s phone number – if entered here, you will be able to make calls to the payer directly from Dynamics (if you have a connected phone), and the basic call details can be automatically tracked in the related phone call record.
  • Fax, Website, Address – These are optional fields that will make it easier in the long run for your employees to contact the payer in any way.

Once the Payer record is saved, you can add Insurance Plans.

Claim Settings​

  • Rendering Provider – This is a general setting to specify which provider should be entered as the rendering provider (Box 24J) for each service line on all claims with this payer. (The setting can be overridden on an individual authorization or authorization service if necessary.)
    • Practitioner on Authorization - Some payers request the BCBA that is overseeing the Behavior Technician and responsible for the patient in general to appear on each claim service line.
    • Practitioner on Encounter Service - Some payers request the provider who conducted the session (e.g., the behavior technician) to appear on the claim service line.

Ghost Payers​

One generic payer account and insurance plan ("ghost insurance") can be created per organization to use in the case where an organization elects to service a patient that has not (yet) been authorized for services by their insurance.

Since all services that are scheduled for a patient are validated against an authorization, and ‘Plan’ is a required field on an authorization, this generic plan would enable the patient to be serviced under the organization’s authorization.

For example, when a BCBA was late in submitting a reassessment, causing a delay in receiving the patient’s reauthorization, the organization may decide to continue servicing the patient for those days (even though they won’t be able to bill insurance), to fill the gap between authorizations. In such a case, an authorization would be created with the organization as the authorizing payer/plan, for the exact services that the organization is authorizing, and encounters can be scheduled for the patient, against this authorization.

Other scenarios can include a patient that has a lapse in coverage while switching from one payer and plan to another.