Plan / Anesthesia Tab

Overview

The Plan: New and Plan: [name] pages are comprised of twelve tabs:

The Anesthesia tab collects information for anesthesia options for the plan.

Note: This tab is not accessible from the Plan: New page until the General tab has been populated and applied.

How to Get Here?

To open the Anesthesia tab for new plan:

From the Home Page:	From the Menus:	Via Shortcut Keys:
Click Payers & Plans from the Admin list Click Create Plan Populate the General tab Click Apply Click the Anesthesia tab	Open the Admin menu and select Payers & Plans Click Create Plan Populate the General tab Click Apply Click the Anesthesia tab	From the Payers & Plans page, press [Alt] + [P] Populate the General tab Click Apply Click the Anesthesia tab

To open the Anesthesia tab for existing plan:

From the Home Page:

From the Menus:

Via Shortcut Keys:

Click Payers & Plans from the Admin list
Select the plan to be modified
Click Update*
Click the Anesthesia tab

*Alternate Navigation: Double-click the plan from the list

Open the Admin menu and select Payers & Plans
Select the plan to be modified
Click Update*
Click the Anesthesia tab

*Alternate Navigation: Double-click the plan from the list

From the Payers & Plans page, select the plan to be modified
Press [Alt] + [U]
Click the Anesthesia tab

(Click an image below to enlarge.)

Plan: New Page / Anesthesia Tab

Plan: [name] Page / Anesthesia Tab

Field Definitions

Field	Type	Required	Description
Team Billing Section
Team Billing	Radio Selection	Yes	Determines whether claims include charges for a physician and a CRNA when involved on the same case that results in team billing. Claims can include charges for the physician only, the physician and CRNA, or the physician or CRNA. By default, this option is set to Bill Physician Only. If the plan uses a different billing method for team billing, select the option that applies: Bill Physician Only - The claim will only include charges for services rendered by a physician. Services rendered by a CRNA are not included on the claim. Bill Physician and CRNA on the same claim - The claim will include charges for services rendered by a physician and a CRNA, if applicable. Bill Physician and CRNA on separate claims - A separate claim will be generated for charges rendered by a physician and by a CRNA. Bill CRNA Only - The claim will only include charges for services rendered by the CRNA. If selected, the claim will reflect solo CRNA and solo CRNA modifiers based on the concurrency scheme. (This option is only used for certain scenarios when the seven steps of medical direction are not met and the CRNA's time needs to be submitted independently.)
Code Type Usage
Use ___ Codes in Claims	Drop Down	Yes	This option determines which procedure codes are used for claims and expected fee calculations. The options are: CPT ASA By default, general procedure (CPT) codes are used in claims and anesthesia (ASA) codes are used in expected fee calculations. If the plan uses different procedure codes than the default values, update the selection accordingly.
Custom Logic Section			Sets custom logic for cases in which MAC anesthesia is performed.
Use Georgia Medicaid MAC Logic (D9243)	Checkbox	No	Checking this option will populate the D9243 pseudo code in place of the ASA code if GA Medicaid is the payer and MAC anesthesia was performed on the case. D9243 possesses the following attributes: Description - IV sedation/analgesia - each add 15 min Short description - IV sedation analgesia - each add 15 min Base Unit value: 0 Supports time units No Relative Value Unit (RVU) value
Set Physical Status Modifiers to Second Position	Checkbox	No	Checking this option continues to utilize current modifier order logic when MAC anesthesia is performed on a case. (Modifier order is concurrency, physical status, method of anesthesia). Unchecking this option places the physical status modifiers in the third position after the method of anesthesia modifiers. (Modifier order is concurrency, method of anesthesia, physical status).
Use labor DOS From for C-Section procedures	Checkbox	No	Checking this option ensures the labor and C-Section procedure codes have the same date of service. Some insurance plans require these dates to be the same, even if the labor starts on one date and the C-section begins the next day (after midnight).
Generate one claim per provider	Checkbox	No	Checking this option ensures a new claim is generated for each rendering provider on the case.
Group procedures by provider on claim	Checkbox	No	Checking this option modifies the procedure sort order within an electronic claim to group and sort procedures by provider, and procedure type. Logic groups procedures by provider, and then lists anesthesia procedures followed by non-anesthesia procedures.
Enable Deductible Monitoring	Checkbox	No	Checking this option initiates generation of an outbound deductible monitoring file with claims tied to the insurance plan. The outbound file is sent to PayorLogic, which, in turn, sends a return inbound file with reasons to release or hold the claims: Deductible Met (Release) Pending Deductible (Hold) Threshold Met (Release) Deductible Not Available (Release) Aged (Release) Your practice must be enrolled with PayorLogic in order to utilize this service.
Payer ID	Free Text	Yes	The identification number for the Payer sent in the outbound deductible monitoring file to PayorLogic. If the Enable Deductible Monitoring checkbox is selected, the Payer ID field is enabled and required.
Concurrency Scheme Section
Concurrency Scheme	Drop Down	Yes	The option that assigns the concurrency scheme to the plan. You can specify to use either the default concurrency scheme (designated on the Concurrency Schemes tab) or one unique to the plan. By default, this option is set to the (Use Default).
Use Primary's Concurrency Scheme for Non-Primary Electronic Claims	Checkbox	No	If checked, the primary payer's concurrency scheme (including provider concurrency modifiers) is used on electronic claims if this plan is the secondary payer on the case.

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Overview

Field Definitions

Field

Type

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Description

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