Maintain Insurance Plan Code Conversion Amounts

By using Insurance Plan Code Conversion Amounts, you can automatically calculate the allowed amounts for procedure codes based on the Total Relative Value Units set up in an RVS schedule. For CGM webPRACTICE to calculate the procedure's allowed amount, the RVS Schedule pricing algorithm is used.

RVS Schedule Pricing Algorithm
Multiply the Total RVS Unit Value entered for a procedure by the Conversion Factor entered for the Insurance Plan Code.

See RVS Setup Process for additional information.

Since the conversion factors are established by the insurance carriers, they are stored within the Insurance Plan Codes.

Upon accessing this function, the Maintain Ins Plan Code Conversion Amts screen displays containing blank data fields.

Data Field Information
Prompt Response Req Len
Plan Code Type the code you want or select from the Plan Code list.   3
Effective Date Type the date you want or click the calendar icon to select a date. This field defaults to the most current effective date for the selected Plan Code.   15
Procedure Code Type the procedure code or range of procedure codes that this conversion factor applies to. Since some plans may pay one conversion factor for surgery procedures, another for office visits, and another for lab procedures, you can select a range of codes. To select a range, type the first procedure code in the range, a dash '-', and then the last procedure code. For example, '99213-99299'.   12
Conversion Factor Type the conversion factor in currency format. This field allows four decimal places. If the insurance carrier provides you with a number with more than four decimal places, round the number up or down, as applicable. For example, the conversion factor provided is '5.34239' so you would round it to '5.3424'.   10
Rate Schedule A $ Type the conversion factor if it applies to the Dr Rate Schedule 'A'.   10
Rate Schedule B $ Type the conversion factor if it applies to the Dr Rate Schedule 'B'.   10
Rate Schedule C $ Type the conversion factor if it applies to the Dr Rate Schedule 'C'.   10
Rate Schedule D $ Type the conversion factor if it applies to the Dr Rate Schedule 'D'.   10
Rate Schedule E $ Type the conversion factor if it applies to the Dr Rate Schedule 'E'.   10