NCPDP Expected Reimbursements

DaisyBill automatically calculates Charge amounts using the fees set by California workers’ comp fee schedules. When the state changes reimbursement amounts, DaisyBill recalculates Charge amounts as of the effective date of service.

Use Expected Reimbursements to override DaisyBill’s automatic Charge calculations and create your own.

When a designated Procedure Code is assigned an Expected Reimbursement amount, the Expected Reimbursement amount automatically populates future Bills with the assigned code.

There are two ways to set your Expected Reimbursements:

  1. Import ‘Expected Reimbursements’
  2. Manually enter ‘Expected Reimbursements’

Step 1. On the navigation bar, click ‘Billing Providers,’ then click the ‘Gear’ icon

This will navigate directly to the specified Billing Provider.

Alternatively, select Manage All Billing Providers to view all the Billing Providers associated with your account.

The Manage All Billing Providers feature is limited to users with the Role of Organization Admin.

Step 2. Click the ‘Billing Provider’ name

For DaisyBill accounts with multiple Billing Providers, DaisyBill maintains separate Charges for each Billing Provider.

Step 3. Click the ‘Custom Settings’ tab

Step 4. Click the ‘Expected Reimbursements’ card

Step 5. To import ‘Expected Reimbursements’ from a spreadsheet, click ‘Add’, then select ‘Import’

Step 6. Enter the ‘Expected Reimbursement Name’, ‘Injury States’ ‘Effective DOS’, and ‘Expiration DOS’, then select the CSV file to import

From the Injury States dropdown menu, select the States where the Expected Reimbursement will be effective.

Effective DOS and Expiration DOS correspond to the DOS of the bill where the Expected Reimbursement is applicable.

Note: The CSV file MUST use the column headings ‘procedure_code’, ‘supplemental_data’, ‘modifier’, and ‘amount’.

Step 7. Click ‘Import’

Step 8. To manually enter ‘Expected Reimbursements’, click ‘Add Charges’, then select ‘Manual’

Step 9. Enter the ‘Expected Reimbursement Name’, ‘Injury States’ ‘Effective DOS’, and ‘Expiration DOS’, then select the CSV file to import

From the Injury States dropdown menu, select the States where the Expected Reimbursement will be effective.

Effective DOS and Expiration DOS correspond to the DOS of the bill where the Expected Reimbursement is applicable. Multiple Expected Reimbursements can be created with the same Effective DOS and Expiration DOS.

Step 10. Enter the ‘Procedure Code’, ‘Modifier’ (if applicable), and ‘Expected Per Unit’, then click ‘Add’

A single Procedure Code (or Procedure Code  and Modifier/Supplemental Data combination) can only exist on one Effective Expected Reimbursement at a time.

Step 11. To view an ‘Expected Reimbursement’, click its name

Step 12. To edit an ‘Expected Reimbursement’, click ‘Edit’

Step 13. Enter the changes, then click ‘Save Changes’

To disable an Expected Reimbursement, select No under Active.  The entire Expected Reimbursement will no longer be used.

Step 14. To view the Custom Charges History, click ‘History’

History displays the complete history of the creation and edits to the Expected Reimbursement.

Step 15. To add a ‘Procedure Code’, click ‘Add Procedure Code’

Step 16. Enter the information, then click ‘Add’

Step 17. To edit a ‘Procedure Code’, click the ‘Pencil’ icon

You can edit the Expected Per Unit, or deactivate the Procedure Code from your Expected Reimbursement.

Step 18. To view the changes made to a ‘Procedure Code’, click the ‘History’ icon

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