Use the Multiple Bills feature to calculate the reimbursement for several bills at once. Calculate across multiple Fee Schedules and Dates of Service. View and print a Detailed Explanation for each bill in addition to a handy summary of all bills.
Step 1. Select ‘Multiple Bills’
Step 2. Select appropriate Fee Schedule and enter required fields
For assistance choosing the correct fee schedule see the Help Article: How Do I Choose the Correct Fee Schedule?
For help entering the required bill fields for a particular fee schedule, view the appropriate Help Article:
Step 3. Click ‘Add Bill’
Step 4. Select appropriate Fee Schedule, enter next bill and click ‘Add Bill’
Repeat step as necessary until all bills are entered.
Step 5. When all bills are entered, click ‘Calculate’
Step 6. View Calculation Summary
Date of Service - The date services were rendered.
Fee Schedule - The Fee Schedule selected to look up Procedure Codes.
Place of Service Type - Where the face-to-face encounter occurred.
Provider Type - The type of Provider who rendered the services.
OMFS - The mandated reimbursement amount per California’s Official Medical Fee Schedule (OMFS). The OMFS is calculated using the fee schedules in effect for the entered Date of Service. The OMFS reimbursement amount incorporates fee-affecting workers' comp billing ground rule calculations (eg., surgical cascading, MPPR, NCCI, MUE) and modifiers. OMFS reimbursement amount does not calculate contracted or network discounts.
Allowed - The reimbursement amount allowed by the claims administrator as reported on an explanation of review (EOR) and entered in the Total Allowed field on the previous screen. If not provided, this optional field defaults to $0. The Allowed amount is used to calculate the Fee Schedule Percent.
Balance - The OMFS reimbursement amount minus the amount entered in the Allowed field. Balance represents the OMFS reimbursement amount minus the Allowed amount.
Fee Schedule Percent - Calculation of the amount in the Allowed field divided by OMFS reimbursement amount. Viewing Fee Schedule Percent helps quickly identify discounts being taken by the payer.
Step 7. Click ‘Download PDF’ to view the complete Detailed Explanation
For more information on Detailed Calculations see the Help Article: Detailed Explanation Explained.
Step 8. Click the date of service to view Detailed Explanation for a specific bill
For more information on Detailed Explanation see the Help Article: Detailed Explanation Explained.
To return to your calculation summary, follow the breadcrumbs at the top of the page.
Step 9. Click ‘Add Bill’ to add another bill to the calculation