Patient based accumulators (PBA)
Patient Based Accumulators are special accumulators that have been approved on a case-by-case basis. For example, a patient might be approved for a motorized wheelchair for a certain amount of time. You can add, update, and delete Patient Based Accumulator information on the Patient Based Accumulators
subtab. On the Details
subtab, you can associate a schedule or benefit code with an accumulator.
When you enter Patient Based Accumulator information, it also displays on the Member Patient Based Accumulators
tab.
Home > Members > Claims > Patient Based Accumulators
OR open the Patient Based Accumulators in a member session:
Add a patient based accumulator
- Search for and open the member record if you aren't already in a member session.
- Click
.
- Select the
Accumulator
from the list. - Select the
Fund
from the list. - Select the
Illness
from the list. - Enter the
Procedure Code
. - Enter the
Effective From Date
. Clickand select a date or enter a date in
MM/DD/YYYY
format. - Enter the
Effective Through Date, Accumulator Amount
, andMax Applied Amount
. - Click
to apply your changes. The information you entered displays in the
Admission Tracking
table. - Click
to save.
Update a patient based accumulator
- Search for and open the member record if you aren't already in a member session.
- Click the accumulator row to update. The fields below the table update.
- Update the necessary fields.
- Click
to apply your changes. The information that you entered displays in the
Admission Tracking
table. - Click
to save.
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Any field with an asterisk * next to it or a red border around it must be completed before you can continue.
Field | Description |
---|---|
Patient Based Accumulators tab | |
Accumulator | All deductibles, maximums, and reversions that can be based on a specific benefit, procedure, or diagnosis code. |
Accumulator Amount |
The amount of the accumulator that will be applied to the
individual between the Effective From Date and the Effective Through Date . |
Effective From Date |
|
Effective Through Date |
The last day the accumulator amount is effective. |
Fund | The fund![]() |
Illness |
The Illness code associated with the accumulator. |
Max Applied Amount | Indicates a maximum limit for individual amounts applied to the family accumulator. Only used for maximums and reversions. |
Procedure Code |
A code that identifies a specific service performed by a service provider. |
Details tab | |
Accumulator | All deductibles, maximums, and reversions that can be based on a specific benefit, procedure, or diagnosis code. |
Benefit Code |
The benefit code representing a benefit or service covered in the Summary Plan Description document (e.g. eye exam, emergency outpatient care, or an office medical visit). See BCode field behavior and messages. |
Schedule | The schedule![]() |
Delete a patient based accumulator
- Search for and open the member record if you aren't already in a member session.
- Click the row in the Patient Based Accumulators table to delete.
- Click
to remove the accumulator from the table.
- Click
to save.
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-
Click the
Details
tab. - Select the necessary
Accumulator
from the list. - Click
and then select a schedule code from the list. You can type the first few characters of the code to search for a valid schedule
Defines parameters for Apps, contracts, status', pay, benefits, rules, etc...
- Click
to apply your changes.
- Click
to save.
- To add a benefit code, click
below the benefit code table and then type the
Benefit Code
in the box. If you don't know the benefit code, type a character and clickto open the
Benefit Code Lookup
window and select a valid code. - Click
to apply your changes.
- Click
to save.