The system shall track and manage benefit limits, H deductibles, co-pays, and covered and non-covered services for each plan. H The system shall capture and maintain details on multiple payers for a client. H The system support multiple fee schedules by payer with specific billing/adjust rules for each program and/or payer. The system shall manage multiple reimbursement H methods including fee for service, case rates, per diem, capitation and grant-in-aid H The system assign and maintain a unique identifier for each program. H The system shall support per program fees. H The system shall support per session fees. The system shall support drug testing fees. H H The system shall support miscellaneous fees. The system shall permit adjustments to Client H accounts at any point in the billing process. Specifications PRI MU RESP Included Add'l No Comments Cost Entering and Maintaining Payer, Program, Plan Information: (continued) H The system shall capture, track and link services delivered to a managed care client by out-of-network providers. The system shall define, capture, and track D information on any programs from which a client is receiving service to include: - Adult Protective Services (APS) - - Child Welfare Services (CW) - - Probation
The system shall track and manage benefit limits, deductibles, co-pays, and covered and non-covered services for each plan. H The system shall capture and maintain details on multiple payers for a client. H The system support multiple fee schedules by payer with specific billing/adjust rules for each program and/or payer. H The system shall manage multiple reimbursement methods including fee for service, case rates, per diem, capitation and grant-in-aid H The system assign and maintain a unique identifier for each program. H The system shall support per program fees. H The system shall support per session fees. H The system shall support drug testing fees. H The system shall support miscellaneous fees. H The system shall permit adjustments to Client accounts at any point in the billing process. H Specifications PRI MU RESP Included Add'l Cost No Comments Entering and Maintaining Payer, Program, Plan Information: (continued) The system shall capture, track and link services delivered to a managed care client by out-of-network providers. H The system shall define, capture, and track information on any programs from which a client is receiving service to include: - Adult Protective Services (APS) - - Child Welfare Services (CW) - - Probation D
SAMPLE-EHR-Requirements-Template-Nov-2012.docx