About volume discount calculation line items

Users modeling contracts can include multi-channel discount calculations to handle volume discount pricing on claim line items. The line item code Multi-Channel Discount calculation basis calculates claims against contract line items that are reimbursed based on volume tiers. This calculation basis is available in the Calc Basis menu for clauses and terms, as shown in the following example of the Edit Clause dialog:

This calculation basis pays a set amount based on the number of units found for a set of procedures on a claim.

Multi-Channel Discount line items use translation tables similar to the way Line Item ASC Ambulatory Surgery Center. A facility service specializing in outpatient procedures. does. Translation data consists of a column of line item codes and a Category column. The description does not need to be in the translation table because it automatically populates with the description in the Line Item Code Library.

The Rates dialog for this type of line item contains multiple lines for specifying categories, number of units, rates, and the effective range of those rates based on unit volume. You can enter rates manually or upload translation and rates tables. For more information, see Import rates for a clause or term and Import translation tables.

For each category, claims are paid based on a volume discount of tiered pricing. The following example shows items for categories 1 and 2. If an incoming claim fits Category 1 and has three units, the rate paid is $4.00 because the Effective Range is 3 <= Units < 4. If the claim has four units, the rate paid is $5.00 because the Effective Range is 4 <= Units < 5. Any claim with eight units or more is paid at the $11.00 rate.

For more information, see the following:

• Modeling clauses and terms
• Add a clause to a provision
• Add a term to a clause

Claim voucher reports display Volume Discount calc details

When reconciling a multi-channel discount payment calculation on a claim, you can use the voucher report to see which line items on the claim triggered a Line-Item Code Multi-Channel Discount calculation on the claim, and were paid based on that calculation logic. You can use this detail to track down under or over payments, and to justify proper payment from the payer.

In the following example, a claim voucher report displays the following details for a multi-channel discount calculation on a claim:

• The Line item Multi-Channel Discount codes on the claim that matched those on the clause
• The service date detail and the category
• Payment amount for each