Accept Assignment Protocol

There are multiple fields throughout the system that control the Accept Assignment setting on a charge in the Procedure Entry function.   

The Ins Carrier Assignment Default field controls the default value for the Assignment Default field for the insurance carrier when you create new insurance carriers in the Maintain Insurance Carriers function.

 

If the Assignment Default field for an insurance carrier code is set to Yes, then when an insurance carrier code is added to a patient’s account, the Accept Assignment field in the policy will default to Yes.

 

If you want to always accept assignment for a procedure code, the Accept Assignment check box should be selected.

 
 

Hierarchy of defaults for Procedure Entry

The following logic is used to determine how the Accept Assignment field will default in Procedure Entry. As soon as one of the conditions is met, the value in the Accept Assignment field will be set.

 

    1.  If the Accept Assignment field is set to Yes for the primary insurance carrier for the patient, the Accept Assignment field in procedure entry will default to Yes.

 

    2.  If the Accept Assignment field is set to No for the primary insurance carrier for the patient:

 

a.  If the patient account has the Medicare Patient check box selected (Patient > Change Patient Data > Billing), the Accept Assignment field in Procedure Entry will default to the Accept Assignment setting for the procedure code.

 

b.  If the patient account does not have the Medicare Patient check box selected (Patient > Change Patient Data > Billing), the Accept Assignment field in Procedure Entry will default to the Accept Assignment setting for the primary insurance carrier for the patient.

 
 
Possible Scenarios:
 
Scenario Status of Accept Assignment Setting as it Processes through the Steps
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to Yes.
  • The patient account has the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to Yes.

Step 1: Accept Assignment = Yes

      and the matching process stops
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to Yes.
  • The patient account has the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to No.

Step 1: Accept Assignment = Yes

      and the matching process stops
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to Yes.
  • The patient account does not have the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to Yes.

Step 1: Accept Assignment = Yes

      and the matching process stops
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to Yes.
  • The patient account does not have the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to No.

Step 1: Accept Assignment = Yes

      and the matching process stops
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to No.
  • The patient account has the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to Yes.

Step 1: Accept Assignment = No

Step 2: Accept Assignment = No

Step 2a: Accept Assignment = Yes

      and the matching process stops
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to No.
  • The patient account has the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to No.

Step 1: Accept Assignment = No

Step 2: Accept Assignment = No

Step 2a: Accept Assignment = No

      and the matching process stops
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to No.
  • The patient account does not have the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to Yes.

Step 1: Accept Assignment = No

Step 2: Accept Assignment = No

Step 2a: Accept Assignment = No

Step 2b: Accept Assignment = No
  • The Accept Assignment setting for the Patient’s primary insurance carrier is set to No.
  • The patient account does not have the Medicare Patient check box selected.
  • The Accept Assignment setting for the Procedure Code is set to No.

Step 1: Accept Assignment = No

Step 2: Accept Assignment = No

Step 2a: Accept Assignment = No

Step 2b: Accept Assignment = No
 
The final Accept Assignment setting of Y (Yes) or N (No) will be placed in the A (Accept Assignment) column on the Procedure Entry Detail screen. You can always change this setting if needed, regardless of the other Accept Assignment settings throughout CGM webPRACTICE.