Dollar-Based Service Codes
In some states, Providers must use Dollar-Based Authorizations for specific services. Payers are only authorized to create Authorizations by Hours or Units, not by Dollars.
To accommodate this situation, Payers can create Dollar-Based Service Codes that Providers can use to create Dollar-Based Authorizations. The Dollar-Based Authorizations that Providers create are displayed in the Payer Portal in the same manner as Authorizations by Hour or Unit.
Payers still cannot create Dollar-Based Authorizations, but by creating Dollar-Based Service Codes, Payers can enable Providers to create their own Dollar-Based Authorizations (if the Provider is allowed by the system to create authorizations).
Dollar-Based Authorizations are available to Enterprise New UI Providers only. Providers using the Enterprise Classic User Interface do not have access to this feature.
In the Payer Portal, when a Home Health (Service Category) Service Code is created with a Rate Type of Visit, users can select to make the Service Code a Dollar-Based Service Code.
When editing an existing Service Code, do not change the Dollar-Based Service Code selection.
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If Dollar-Based Service Code has already been selected, do not deselect it.
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If Dollar-Based Service Code has not been selected, do not select it.
When Dollar-Based Service Code is changed on an existing Service Code, all existing Visits and Authorizations in the system that were generated from that Service Code are updated based on the changed Dollar-Based Service Code setting.
Dollar-Based Service Codes are integrated from the Payer Portal to the Enterprise Provider application, where they are used by Providers to create Dollar-Based Authorizations.
Dollar-Based Authorization Details and Usage are displayed in the Payer Portal.
