Editing exceptions in coverage table templates

You can edit exceptions in any of the coverage table templates.

To edit an exception

1. On the Coverage Table Setup page, select a coverage table template.

   

   The options for editing a coverage table template display.

   Insurance Coverage, %

   

   Patient Copayment, $

   

2. ClickTap Manage Exceptions to display the Manage Exceptions for [name of coverage table template] window.

   

3. Select an procedure code and select an exception.

   

   The options for editing the exception become available.

   

   Note: The Add Bulk Procedures button is disabled on this window. It's only enabled when you add a new Not covered exception type.

4. Edit the options on the tabs as necessary:

   • Exception Type

     • Select an option:

       • Not covered - Procedures are not covered.

       • Downgrade - Procedures require a downgrade.

       • Coverage with age limit - Procedures have an age limitation.

       

   • Select Procedure(s)

     • Select all procedure(s) that the exception will apply to from the Add Procedure(s) table.

       

       Tip: You can use the search field to enter a specific procedure's code/description and select from the search results.

       

       Notes:

       • For a Not covered exception, you can only select procedures that do not have any exceptions. For a Downgrade exception, you cannot select procedures that have a Not covered or Downgrade exception. For a Age limitation exception, you cannot select procedures that have a Not covered or Age limitation exception. Incompatible procedures will display with an icon to prevent you from accidentally selecting them.

         

       • You can select multiple procedures for Not covered and Age limitation exception types, but you can only select one procedure code for Downgrade.

   • Specific Options

     1. Complete one of the following:

        • For a Not covered exception, there are no options on this tab.

        • For a Downgrade exception, enter the code/ description of the substitute procedure in the Downgrade to search field, and select the codes.

          

        • For an Age limitation exception, configure the following options:

          

          • Age limitation - Enter a minimum and maximum age limit to specify that the insurance carrier covers this procedure only for patients whose age is within the specified limit. You can also adjust the range by moving the sliders as necessary.

            Note: If a patient's age is not within the age limit, the percentage or copayment in the coverage table is used.

          • Coverage, %, Copayment, $ , or Downgrade to - Specify a coverage percentage, copayment, or a downgrade.

            • For a coverage percentage, select the Coverage, % radio button and enter the percentage of the charged fee that the insurance carrier covers for this procedure.

            • For a copayment, select the Copayment, $ radio button and enter the co-pay that the patient pays for this procedure.

            • For a downgrade, select the Downgrade to radio button. In the Search for procedure field, enter and select the substitute procedure's code/description.

            Note: The Coverage, % radio button displays for coverage tables that are based on insurance coverage percentages while and the Copayment, $ radio button displays for coverage tables that are cased on fixed patient copayments.

          • Deductible Type - If a patient must pay a deductible for this procedure, select the check box and select the deductible type the patient must pay for this procedure from the drop-down list.

            Note: The check box is only enabled if the Coverage, % or the Copayment, $ radio button is selected.

     2. ClickTap Next.

   • Reason for Exception

     • Enter the reason for the coverage exception in the Reason for exception field.

       

5. ClickTap Done.

   Note: This button is available only if the Reason for Exception tab is selected.