Q2 2019 Newsletter

Assigning Insurance Plans into Payor-Classes

  • The process of assigning insurance plans into payor-classes is relatively straightforward. Most practice management/billing computer systems have an “insurance set-up” function that is usually a screen that allows the user to assign characteristics to each insurance plan.
  • Each contract written by an insurer has its own characteristics. For instance, Acme Insurance Company may have Acme Choice PPO as well as the Acme Choice PPO contract with Ace Machine Tool with a $10 co-payment. Or, there may be a contract with Zero Hardware requiring $5 co-payments which also includes refractive surgery. It is obvious that the insurance for the employees of these two employers, although both Acme Choice PPO, must be entered into the computer as separate plans even though they are in the same class.

It makes no difference if the plan is a PPO or an HMO, as long as the payment expectations are similar.