Member Service Code Bundles
Some Payers group a set of Services that a Provider can perform under a single Service Code known as a Service Code Bundle. The Payer Portal supports the creation and use of Service Code Bundles for Placements and Authorizations.
Use of a Service Code Bundle means that a separate Authorization doesn’t need to be created for every Service Code allowed for a Visit.
When a Service Code Bundle is assigned to an Authorization, the Caregiver/Provider can use any one of the Allowed Service Codes to record and bill for the Service performed on the Visit.
A Service Code Bundle can also be assigned with an Authorization to a Placement on the Add Placement page under Member > Search > select Member > Provider Info > Add Placement.
In the Provider application, a stack icon next to the Authorization’s Service Code designates a Service Code Bundle. Hovering over the icon displays the Allowed Service Codes that the Caregiver/Provider can use.
In the Payer Portal’s Reference Table Management, when you select Service and Service Code Bundle, Service Code Bundles are displayed along with the Allowed Service Codes included in each bundle.
Users can add, change, and deactivate Service Code Bundles using the Reference Table Management feature.
Any existing Service Code can be designated as a Service Code Bundle with one or more Service Codes serving as Allowed Service Codes associated with it.
If an existing Service Code used to create a Service Code Bundle is already in use on existing Authorizations, those existing Authorizations are not affected. The Service Code continues as is for those existing Authorizations.
A Service Code Bundle can be assigned to an Authorization on the Add Authorization page under Member > Search > select Member > Authorization > Add Authorization.
From the Service Code/Service Code Bundle list, select the Service Code Bundle you want to use.
In the list, Service Code Bundles are labeled as such and are listed first, followed by Service Codes.
Service Codes included in the bundle are listed in Allowed Service Codes.
When a Service Code Bundle is used for an Authorization, the Provider and Caregiver must use an Allowed Service Code associated with that Service Code Bundle to identify services performed for the Member.
Users can view an Authorization’s Service Code Bundle and the Service Codes included in the bundle (Allowed Service Codes) on the Authorization page under Member > Search > select the Member > Authorization.
The Authorization’s Service Code Bundle and the Service Codes included in the bundle (Allowed Service Codes) are also displayed in the Authorization details under Member > Search > select the Member > Authorization > select the Authorization.
The Authorization’s Service Code Bundle can be changed in Edit Authorization, and the Service Code Bundle and the Service Codes included in the bundle (Allowed Service Codes) are displayed in Deleted Authorizations History, View Placement (Authorization section), and the Member Calendar page (Active Authorizations).
A Service Code Bundle can be assigned with an Authorization to a Placement on the Add Placement page under Member > Search > select Member > Provider Info > Add Placement.
From the Service Code/Service Code Bundle list, select the Service Code Bundle you want to use.
In the list, Service Code Bundles are labeled as such and are listed first, followed by Service Codes.
Service Codes included in the bundle are listed in Allowed Service Codes.
When a Service Code Bundle is used for a Placement Authorization, the Provider and Caregiver must use an Allowed Service Code associated with that Service Code Bundle to identify services performed for the Member.
When Providers are selected for a Placement Authorization that uses a Service Code Bundle, the system notifies the user if any of the Allowed Service Codes are not supported by the selected Provider.
If none of the Allowed Service Codes is supported by a Provider, that Provider is not listed as a selection for the Placement Request.