How to Add or Edit Fee Schedules in Insurances

How to Add or Edit Fee Schedules in Insurances

If you are in-network with an insurance company or you are just aware of what an insurance company agrees to pay for a particular procedural (billing) code, then you can use Maximum Allowed Rate to calculate patient responsibility as well as to make your Accounts Receivable more accurate.

What Is A Maximum Allowed Rate?

Maximum Allowed Rate refers to the predetermined price an insurance company allows for a particular procedural (CPT) code. Sometimes Maximum Allowed Rate is referred to as insurer ‘Contract Rates’ or ‘Fee Schedules’.

You must check what the insurer is going to pay for each CPT code and enter that amount as 'Rate' in your zHealthEHR's Insurances > Add/Edit CPT Rates section. Note that each billing code will have its own Maximum Allowed Rate box.

Note: You can add fee schedules for CPT codes in the Insurances section only when you have added CPT Codes and their Prices under Update Info > CPT Codes.

1. On the top right corner of the zHealthEHR application window, you will see Your Name (Provider Name). Hover the cursor over your name and a drop-down menu will open.

2. Click on the third option - Update Info - and a new window will open.

3. On the new window, click on the last option -‘ Insurances ’ - to view the list of insurance payers.

4. To add fee schedules for CPT codes for a payer, click on the ' Edit ' icon under Actions. A pop-up window will open.

5. Scroll down to the bottom of the pop-up window and click on the ' Add/Edit CPT Rates ' button.

6 (i). To Add Insurance CPT Rates One by One:

Click '
Add Insurance CPT Rate ' A pop-up window will open.

To add a CPT Rate
      a. Enter
CPT Code. Note: Enter the first few letters or numbers of the CPT code. Select the CPT code from the auto-populated results. This feature is helpful when you have multiple CPTs with the same code.
      b. Enter the 
      c. Click '
Add '
*Repeat the above steps for adding fee schedules for all CPT codes for the selected payer. Once you complete adding fee schedules for one payer, repeat step numbers 4-6(i) for other payers in your insurance master list.

6 (ii).  Upload Insurance CPT Rates At Once

Click '
Upload CPT Rates ' A pop-up window will open.
     a. To upload all
CPT rates at once , click browse to select a .csv file to upload
     b. Click '
Save '
*Note: The format of the file is CPT Code, Price (Max Allowed Rate).
*Repeat step numbers 4-5 and 6 (ii) to upload CPT rates of other payers in your insurance master list.

7. Edit CPT Rates
If the insurance payer changes/revises the maximum allowed rate for a particular CPT code, you can do that by:

Clicking the '
Edit ' icon as shown here. A pop-up window will open.

Enter the new revised rate and click '
Update '.

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