The following scenario outlines the procedures for changing a payor on a patient's Billing Matrix, as well as how the changes effect existing transactions.
The pharmacy is using a Payor entitled PEND on the Billing Matrix for the first few fills for a new patient. The Payor may be changed once the pharmacy is notified of third party coverage.
How does this effect existing transactions?
In this scenario, the PEND Payor has an Effective Date of 08/01/13. Therefore, any transactions after that date are associated with that Payor.
The facility Billing Matrix displays the Price Plan DC28 PENDED PLAN and the account DC28 PENDING ACCOUNT associated with the PEND Payor.
The transactions created for the prescriptions display that Price Plan and Charge Account.
The DC28 PENDING ACCOUNT displays the associated charges that were posted to the account through the Automatic Posting process.
Changing the Payor on the Billing Matrix
The facility supplies the pharmacy with information that the patient's third party coverage is effective 10/01/13. The pharmacy changes the Payor on the patient Billing Matrix to 3P (the Payor used by this pharmacy for patients covered by a third party).
Note: The Price Plan and Charge Account are blank, which means the system pulls the Price Plan from the patient's Insurance Record and the Charge Account from the Patient Record.
An entry is added to the patient Billing Matrix and 3P is selected with the effective date of 10/01/13. The system prompts whether to rebill the transactions. Yes is selected to rebill with the new payor for the transactions starting on 10/01/13.
The system prompts for a Rebill Start Date. In this example, the date 10/01/13 is being used to rebill transactions after that date.
The system prompts whether to rebill transactions on and after 10/01/13. In this example, Yes is selected.
The system prints an A/R Credits Created report that displays transactions that were reversed and resubmitted, along with the credits to the original accounts. The change only effected the transactions and charges associated with those transactions on or after 10/01/13.
The account originally associated with those transactions displays credits that the system issued during the rebill process for prescriptions on and after 10/01/13.
If one of the prescriptions associated with these transactions is selected, the new Price Plan and Charge Account on the transactions display.
Credits were issued to the original Charge Account. However, once the account on the transaction is changed during the rebill process, the system sets the Accounts Receivable Status to FLAGGED. Therefore, Automatic Posting needs to be run in order to move the charges to the associated account.