Plan Code Rates
A Service Code allows only one Rate for billing purposes, except in cases of different Service Areas. Plan Codes can be added to Service Codes for Providers that want Service Codes to support multiple Rates.
Plan Code Rates are available to Enterprise New UI Providers only. Providers using the Enterprise Classic UI do not have access to this feature.
In the Payer Portal, you can add, change, deactivate Plan Codes. After Plan Codes are created, you can assign them to new or existing Service Codes in the Service group of Reference Table Management under Admin > Reference Table Management > Service group > Service Code.
When a Service Code with Plan Codes assigned to it is selected for use by a Provider in the Payer Portal Provider Setup feature under Admin > Provider Setup, the user can create Rates for each Plan Code assigned to the Service Code.
In states where Plan Code Rates are created and maintained by the Provider, the user must select the Payer Portal Provider Setup setting Allow Provider to Update Billing Rates.
-
From the Admin menu, select Reference Table Management.
-
On the Reference Table Management page, from the Service group, select Plan Code, and click Add Plan Code at top right.
-
On the Add Plan Code page, type a unique Plan Code name and an optional Description.
-
Click Save.
-
From the Admin menu, select Reference Table Management.
-
On the Reference Table Management page, from the Service group, select Plan Code, find the code you want to change, and click the Edit icon
.
-
On the Edit Plan Code page, make changes as needed, and then click Save.
-
From the Admin menu, select Reference Table Management.
-
On the Reference Table Management page, from the Service group, select Plan Code, find the code you want to deactivate, and click the Edit icon
.
-
On the Edit Plan Code page, change Status to Inactive, and click Save.