The Filopto Billing Rules can cover a multitude of combinations to cover all the possible payments related to a policy. First decide how to organize your Inventory (items, categories and groups) to reflect the different combinations to select from. Inventory categories and groups can assist you in grouping the various inventory items into groupings, that can then be used for insurance claim processing purposes. The following examples make use of categories, groups, items and types to illustrate that by combining these options, you can create powerful rules that can cover all your needs.
Inventory item: is the specific item being tracked by the inventory system. It is a specific item given a unique inventory item number.
Inventory Types: this is the overall grouping saved by Filopto for item types contained in the inventory. Items types are Services, Frames, Ophthalmic Lens, Soft contact lens etc...
Inventory Category: this is a custom grouping of a selection of inventory items. In these examples we use the exam category to regroup all services that are covered under the insurance company heading of procedures covered as an exam type.
Inventory Group: This is a second type of grouping for a selection of inventory items. In these examples we use the group as a sub grouping of a category. For example we could have a category of inventory items called Materials. This category can be further refined by creating various groups that contain specific items. A Group in these examples could include a group for bifocal lens, a group for single vision lens etc.. which also have a category of Materials.
Here are some Policy Billing Rule examples:
1. Rule type: Patient Pays
Example Rule name: Exam co-pay
Example Rule: Patient Pays a fixed amount of $15.00 of the wholesale price for the following Inventory Category: Exam.
2. Rule type: Policy Pays
Example Rule name: Exam payment
Example Rule: Policy Pays a fixed amount of $ 56.50 for the following Inventory Category: Exam.
3. Rule type: Practice write-off
Example Rule name: New Exam write-off
Example Rule: Practice writes-off for the Insurance company a fixed amount of $ 44.80 for the following Inventory Item: Exam-Comprehensive, New
4. Rule type: Practice write-off
Example Rule name: Established Exam write-off
Example Rule: Practice writes-off for the Insurance company a fixed amount of $ 24.80 for the following Inventory Item: Exam-Comprehensive, Estab. Patient.
5. Rule type: Practice write-off
Example Rule name: Exam write-off
Example Rule: Practice writes-off for the Insurance Company the Balance for the following Category: Exam.
6. Rule type: Patient Pays
Example Rule name: Frame up to $115
Example Rule: Patient Pays 55% of the retail price up to $ 115.00 for the following Inventory Type: Frames.
7. Rule type: Patient Pays
Example Rule name: Frame over $115
Example Rule: Patient Pays a fixed amount of $ 70.00 plus 80% of the retail price over $ 115.00 for the following Inventory Type: Frames.
8. Rule type: Policy Pays
Example Rule name: Frame payment
Example Rule: Policy Pays a fixed amount of $ 86.14 for the following Inventory Type: Frames.
9. Rule type: Policy Pays
Example Rule name: Single Vision
Example Rule: Policy Pays a fixed amount of $ 36.48 for the following Inventory Group: Single Vision.
10. Rule type: Practice write-off
Example Rule name: SV write-off
Example Rule: Practice writes-off for the Insurance company the Balance for the following Inventory Group: Single Vision.
11. Rule type: Patient Pays
Example Rule name: Progressives
Example Rule: Patient Pays a fixed amount of $ 94.00 of the wholesale price for the following Inventory Group: Progressives.
12. Rule type: Policy Pays
Example Rule name: Progressive payment
Example Rule: Policy Pays a fixed amount of $ 70.45 for the following Inventory Group: Progressives.
13. Rule type: Patient Pays
Example Rule name: Materials Co-pay
Example Rule: Patient Pays a fixed amount of $ 15.00 of wholesale price for the following Category: Materials.
14. Rule type: Policy pays a flat fee for an Invoice
Example Rule name: Flat $ 225.00
Example Rule: The Insurance Policy Pays 0% of the amount of the Invoice, up to a maximum amount of $ 225.00
15. Rule type: Policy Pays for a group of Items
Example Rule name: 80% to $ 160
Example Rule: The Insurance Policy Pays 80% up to a maximum amount of $ 160.00 for the following group of Inventory Types:
Hard Contact Lens
Soft Contact Lens
Frames
Ophthalmic Lens
Service
16. Rule type: Patient Pays
Example Rule name: 15% CL Service disc
Example Rule: Patient Pays a 85% of the retail price for the following Category: Contact Lens Services.
17. Rule type: Practice write-off
Example Rule name: 15% CL Service disc write-off
Example Rule: Practice writes-off for the Insurance Company 15% of the retail price for the following Category: Contact Lens Services.
18. Rule type: Alert Rule
Example Rule name: Contacts
Example Rule: $ 105 towards Contacts and Contact Lens Services (15% disc)
- Show at Invoice time
- Show at Exam time
Message for the following Inventory Type: Soft Contact Lens
