This guide will help you configure billing codes, health plans, and related medical billing details in Luvelo. These settings enable accurate and efficient billing processes.
Key Terms
Billing Code: A unit of health service delivery that can be billed to a patient (e.g., consultation, lab test).
Health Plan: A payer for health services. Examples include self-pay, insurers, government plans, or donor-funded schemes.
Health Plan Code: A specific price for a billing code within a health plan. It can be based on a percentage of the base rate or a manually entered value.
Step 1: Create a Health Plan
Review existing health plans or click “Add” to create a new one.
Examples:
Self-Pay
Insurance Provider A
Government Health Plan
Donor Plan
Define the default percentage rate for this health plan compared to the base billing code rate.
For example, if the insurer pays 95% of the base rate, enter
95%.If there is no variation, use
100%.This default simplifies bulk calculations, but individual rates can still be customized.
To manually assign a specific rate for a health plan code:
Select a billing code to edit.
Set "Is Manual" to Yes, and then enter the custom price.
Step 2: Create a Billing Code
Click “Add” to create a new billing code.
Fill in the following details:
Name: The name of the service (e.g., "General Consultation")
Base Price: Standard price for this service
Charge or Credit: Indicate whether this is a charge (e.g., service fee) or credit (e.g., senior citizen discount)
Status: Set to Active to make it available for use
Description: A brief summary of the service
Code Type: Categorize the service (e.g., inpatient, outpatient, lab, diagnostic)
Applicable Health Plans: Select which health plans this billing code should be associated with
Once created, the system automatically generates a health plan code for each selected health plan, using the default percentage set in that health plan.