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Predetermination Report - Outstanding Predetermination By Company

The Outstanding Predetermination by Company displays outstanding predeterminations sorted by insurance company.

Outstanding Predetermination By Company - Filters
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  • Providers: Filters the report by the patient provider associated to the predetermination.
  • Offices: Filters the report by the office provider associated to the predetermination.
  • Insurances: Filters the report by the Insurance associated to the predetermination.
  • Date Updated Start/End Date: Filters the report by the date range in which the predetermination was updated.
  • Claims to Include: This menu filters the report by Paper, Electronic or Both types of claims.
  • Plan Type: Filters the report by Plan Type.
Outstanding Predetermination By Company - Results
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The report displays results in the following columns:
  • Insurance Company: The first column displays the name of each Insurance Company.
  • Phone #: This column provides the phone number of the Insurance Company as listed in the Insurance Company reference.
  • Claims: The Claims column shows how many claims exist for the specified Insurance Company.
  • Current: The next column displays the total of predetermination charges less than 30 days old.
  • 30+ Days: The 30+ Days column provides the total of predetermination charges 30-59 days old.
  • 60+ Days: This column shows the total of predetermination charges 60-89 days old.
  • 90+ Days: The next column displays the total of predetermination charges 90-119 days old.
  • 120+ Days: The 120+ Days column provides the total of predetermination charges 120 or more days old.
  • Timely Filing Limit: Finally, the last column displays the Timely Filing Limit in days, as entered in the Claims tab of the Insurance Company Reference.
To view additional details for a specific insurance company, twist down by clicking the triangle to the right of the Insurance Company. You may also choose to use the Expand All checkbox to view details for all companies.
 
Each record will display additional information in the following columns:
  • Plan Name: This column shows the Plan Name(s) for the selected Insurance Company.
  • Plan Type: The next column displays the Plan Type.
  • Claims: The Claims Column shows how many claims exist for the specified insurance plan.
  • Current: This column displays the total of predetermination charges less than 30 days old.
  • 30+ Days: The next column provides the total of predetermination charges 30-59 days old for the specified insurance plan.
  • 60+ Days: The following column shows the total of predetermination charges 60-89 days old for the specified insurance plan.
  • 90+ Days: This column displays the total of predetermination charges 90-119 days old for the specified insurance plan.
  • 120+ Days: Finally, this column provides the total of predetermination charges 120 or more days old for the specified insurance plan.
You may twist down one level further to reveal more information as displayed in the following columns:
  • Patient #: The first column displays the patient ID as displayed in the Patients ability.
  • Patient Last, First: The next column shows the patient's name (last name, first name).
  • Claim Charges: The Claim Charges column provides the total of predetermination charges for the designated patient.
  • Ins. Paid: This column lists the amount paid by the insurance company for a predetermination.
  • Pat. Paid: This column displays the amount paid by the patient for a predetermination.
  • Write-offs: The Write-offs column provides any write-off amounts from the insurance company.
  • Balance: The next column shows the current balance for the predetermination.
  • Days Open: The Days Open column displays the number of days the predetermination has been open.
  • Posted: This column shows the date the predetermination was posted to the ledger.
  • Type: The Type column displays the claim type, either paper or electronic.
  • First Proc Date: The next column provides the earliest procedure date included on the designated predetermination.
  • Birthday: This column shows the patient's birth date.
  • Subscriber: The Subscriber column lists the insurance subscriber ID as listed in the Patient tab.
  • Pr/Of: The next column displays the office and provider, as set in the Patient tab. If one or both of these options is set to None int he Patient tab, the office and provider will be pulled from the options selected in the Account tab.
  • Days to Timely File: Finally, this column shows how many days remain to meet timely filing timelines.
Finally, you can expand once more to see details displayed in these columns:
  • Procedure Date: This column provides the date the specified procedure was performed.
  • Procedure Code: The next column displays the procedure code.
  • Procedure Description: This column shows a description of the designated procedure.
  • Procedure Fee: The Procedure Fee column provides the fee associated to the procedure.
  • Allowed: The next column displays the allowed amount for the code, as entered in References > Insurance Companies > Plans > Allowed. If no allowed amount is entered, it will read 0.00.
  • Pat. Portion: This column lists the amount which the predetermination defined as patient responsibility.
  • Ins. Portion: The Ins. Portion column shows the amount which the claim defined as insurance responsibility.
  • Pat. Paid: The next column provides the amount which has been paid on the procedure by the patient.
  • Ins. Paid: This column shows the amount which has been paid on the procedure by the Insurance Company.
  • Write-Off: This column lists the Write-Off for the Procedure Code on the predetermination.
  • Balance: Finally, the Balance column displays the remaining predetermination balance.
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