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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

  1. Search for and open the member record if you aren't already in a member session.
  2. Click Add button.
  3. Select the Accumulator from the list.
    • To copy patient based accumulators information, select the check box next to the accumulator to copy and then click .
  4. Select the Fund from the list.
  5. Select the Illness from the list.
  6. Enter the Procedure Code.
  7. Enter the Effective From Date. Click and select a date or enter a date in MM/DD/YYYY format.
  8. Enter the Effective Through Date, Accumulator Amount, and Max Applied Amount.
  9. Click to apply your changes. The information you entered displays in the Admission Tracking table.
  10. Click Save icon to save.

Update a patient based accumulator

  1. Search for and open the member record if you aren't already in a member session.
  2. Click the accumulator row to update. The fields below the table update.
  3. Update the necessary fields.
  4. Click to apply your changes. The information that you entered displays in the Admission Tracking table.
  5. Click Save icon to save.

Any field with an asterisk * next to it or a red border around it must be completed before you can continue.

Patient based accumulators field descriptions

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

The beginning effective date for the accumulator amount.

Effective Through Date

The last day the accumulator amount is effective.
Fund The fundClosed A plan's asset pool held in trust for the benefit of union members and their families. The fund is the foundation of the basys system. Fund type examples include, welfare, pension, annuity and political action. ID associated with the contribution or payment.

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 scheduleClosed Defines parameters for Apps, contracts, status', pay, benefits, rules, etc.. associated with the accumulator.

Delete a patient based accumulator

  1. Search for and open the member record if you aren't already in a member session.
  2. Click the row in the Patient Based Accumulators table to delete.
  3. Click to remove the accumulator from the table.
  4. Click Save icon to save.

  1. Click the Details tab.

  2. Select the necessary Accumulator from the list.
  3. Click Add button and then select a schedule code from the list. You can type the first few characters of the code to search for a valid scheduleClosed Defines parameters for Apps, contracts, status', pay, benefits, rules, etc...
  4. Click to apply your changes.
  5. Click Save icon to save.
  6. To add a benefit code, click Add button 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 click to open the Benefit Code Lookup window and select a valid code.
  7. Click to apply your changes.
  8. Click Save icon to save.

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