New Membership Module (Includes Covered Services (CPTs) on Invoice/Receipt)
This is our new Membership Module that assigns CPTs to each membership. If you choose to associate the membership visit to the invoice, you'll need to manually click "Add Covered CPT Code(s)". This will also show the CPTs that are covered in the patients payment/membership.
This workflow is different from zHeath's legacy Membership Module in which memberships didn't have CPT codes associated with the membership (no charges were shown or payment per visit were taken) and visits were automatically associated with an invoice.
Introduction
When a patient has an active Membership Plan, any eligible CPT code(s) on their invoice can be automatically covered according to the plan's configuration. This help guide explains how membership coverage works, how the system applies membership coverage to invoices, and the complete workflow.
When a membership plan is created in the system, the practice should configure the Services/CPT codes and the corresponding units that are covered under this plan.
For more information, please refer to the following help article: [Click Here]
Step-By-Step Instructions
 1. Go to the encounter or invoice covered by the membership plan. |
 2. Choose the appropriate membership plan from the "Membership Applied" dropdown menu options, located in the upper-left section of the invoice screen. The plan you select will be used to cover the encounter or invoice. |
3. Once a Membership Plan is selected, the system will display the visit details associated with that plan. It shows two pieces of information:
Note: The Membership Plan selected in the Membership Applied field will not be counted or considered as applied until the user clicks the Add Covered CPT Code(s). button. |
4. When the user clicks the "Add Covered CPT Code(s)" button, the following actions occur immediately:
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5. When the Membership Plan is applied, a payment line item is automatically added. Key details include:
 Note: Users cannot delete or edit the automatically applied membership payment line item directly. To remove it, all CPT codes covered by the Membership Plan must be deleted from the invoice. Once those codes are removed, the system will automatically delete the associated membership payment line item. Note: If the user manually changes the price of any covered CPT code on the invoice, the membership payment line item's adjustment amount will automatically update to match the new total. |
6. The Payment Receipt, Invoice Printout, emailed invoice, billing statement, and etc, all include details of the invoice amounts covered by the Membership Plan, specifying which CPT code(s) were covered and by which plan. |
Active Membership Visit Count
1. A dedicated Membership Visit Count section is available on the Patient's File > Summary tab. This section only displays the patient's active membership plans making it easier for the practice to track all active membership plans and utilized visit counts. 2. It also displays the following key information:
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3. For each active Membership Plan on the Summary Page, clicking the "Details" icon displays information about the encounters or invoices that have been applied and covered under that plan. The following details are shown:
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4. The Summary page now flags recurring membership plans with payment issues by showing a red information icon next to the active membership. For example, an expired card that causes an auto-renewal charge to fail will trigger this alert. |
FAQ
Q. When does the system update a membership plan’s utilized visit count?
A. The utilized visit count refreshed or updates when the user clicks "Apply Covered CPT Code" in the invoice.
Q. If a membership has been applied to an invoice, can it be undone?
A. Yes, it is possible to undo an applied membership. To do so, simply delete the CPT codes (and units) covered by the membership plan from the invoice.
This will automatically:
This will automatically:
- Update and reduce the utilized visit count by 1
- Remove the membership payment line item from the invoice
Q. What do the CPT code and the number next to it represent in the invoice membership payment line item in the Note/Check field?
A. When a user clicks the "Apply Covered CPT Codes" button, the system adds a payment line item using the membership as the payment method. In the "Note/Check" field, it displays the CPT code along with the number of units covered by the membership plan in parentheses.
Q. What happens if I render a service/CPT code that isn’t covered by the membership plan and still need to bill it?
A. You can still bill any additional CPT code (and units) that is not covered by the membership plan. The amount for the uncovered CPT code will be added to the patient’s responsibility, while the covered CPT codes will be handled by the membership plan.
Simply add the non-covered CPT code to the CPT section of the invoice, and then click “Apply Covered CPT Codes” to automatically insert the membership-covered CPT codes.
Note: If the patient has active insurance on file, all CPT codes including those covered by the membership plan and will be billed to the payer, since the system populates every CPT code on the CMS-1500 claim form.
However, for membership visits, claims generally should not be submitted to the payer.
Q. What happens if I update an existing membership plan in the Membership master list to add or remove or change the CPT codes covered by the plan?
A. The system will continue using the original covered CPT codes for all invoices until the membership plan reaches its next billing cycle.
After the plan renews, the updated CPT codes will take effect.
Example: If a monthly membership plan originally covers 98940 and 98941 (1 unit each), and the plan is set to renew on the 1st of next month, any updates you make now such as removing 98940 or changing 98941 to 2 units will not affect the current cycle.
All invoices for the current month will still cover 98940 and 98941 (1 unit each).
Starting from the next renewal date, the plan will cover the updated CPT codes (e.g., 98941 with 2 units).
Q. What happens if I don't click the "Apply Covered CPT Codes" button on the invoice, even though a membership plan is selected in the "Membership Applied" field?
A. In this case, the visit/invoice will not be recognized as covered by the membership plan, and the Utilized Visit Count will not update.
To ensure the visit is counted and marked as covered, always click the "Apply Covered CPT Codes" button after selecting the membership plan in the Membership Applied field.
Q. Does the Membership Plan cover both CPT codes and supplements/supplies/miscellaneous items?
A. Currently, Membership Plans only cover CPT code(s). Any supplements, supplies, or miscellaneous items added to the invoice will be billed to the patient and reflected as a patient balance.
A. Currently, Membership Plans only cover CPT code(s). Any supplements, supplies, or miscellaneous items added to the invoice will be billed to the patient and reflected as a patient balance.
If you have any further questions, feel free to reach out to us at support@zhealthehr.com.
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