Payor Plans

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Billing

The definition of 'Plan' in EMR-Bear is a specific "benefit plan" offered by the Payor that a given client might be associated with. Most Payors offer several benefit plans, and each of them might have a different set of benefits for different clients enrolled in that plan (i.e., some plans may cover certain procedures, others might not, or reimbursements may differ from plan to plan).

Many times the billing address that receives claims for a given plan is different from that of another plan for the same Payor. For these reasons, one Payor may have several plans associated with them. EMR-Bear provides a transparent way to define your client's insurance companies to the correct Payor and (benefit) Plan under that Payor.

Viewing Payor Plans

From the Payors list (see Payors), click View Benefit Plans.

Payor plan 1.png


This shows all of the plans (if any) associated with the Payor. (NOTE: The bottom part of this screen is used in rare cases when it is necessary to link the Payor to an existing plan.)

Payor plan 2.png
Click Capture pencil.PNG to edit an existing plan.
Click Capture delete icon.PNGto delete an existing plan.
Click Capture magnifying glass icon.PNG to show details about the plan.

Creating Payor Plans

Clicking on the "Create New plan" button takes you to the New Benefit Plan form:

Payor plan 3.png
  • Name: the name for this plan (required)
  • Fee Schedule: the Fee Schedule associated with this plan.
  • Effective since and Effective until will be pre-populated, however, if these plans reflect a specific contract term, you can use these fields to keep track of the contract's end date.
  • Allowed Amount: applies to specific contracts in which service amounts are capped and can be used to help you track the balance remaining to be used for a given contract/plan.