Configure Procedure Billing Behaviors with iBar Files
When you post charges in PCC, a series of custom configurations decide how different procedures will pend to the payer, which procedures will be linked to the copay, and whether or not charges are capitated (written off at time of service).
Many of these options are controlled with a Special Information File, also called an i-bar file, assigned to the insurance plan. You can edit these i-bar files to control billing options.
PCC Support Will Do This For You: The options and tools described in this help article are for the hands-on biller who wishes to take direct control of these billing functions on their system. PCC Support sets up I-bar files for your insurance plans for you, and in most situations you will not need to make changes. Additionally, your Client Advocate is always ready to help you adjust your configuration. Give us a call!
Contents
- 1 Introduction: What Can I Do With an I-Bar File?
- 2 Quickstart: Run ibar and Work With I-Bar Files
- 3 Make Procedures Pend or Not Pend the Insurance Payer
- 4 Make Procedures Appear or Not Appear on Claims
- 5 Change Expected Copay Amounts for Procedures
- 6 Change Base Fees for Procedures
- 7 Change Write-Off or Capitation Behavior for Procedures
- 8 Other ibar Program Tools and Options
Introduction: What Can I Do With an I-Bar File?
A Special Information File, sometimes called an I-bar file, controls how each procedure will be treated for an insurance company when charges are posted. Some insurance companies require different copay amounts for different types of visits. You may have special procedures that should only pend to certain insurance companies. Maybe you use different fee schedules for a medicaid insurance plan and VFC immunizations. All of these needs and more can be met with a custom I-bar file.
An I-bar file answers the following questions for every procedure:
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Should this procedure pend to the insurance company?
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Should this procedure appear on the insurance claim?
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Should this procedure require a copay?
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What fee schedule should this procedure utilize?
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How much of this procedure should be written off (or capitated) at the time of service?
Quickstart: Run ibar and Work With I-Bar Files
The following procedure will help you get started with the ibar program and help to ensure you make effective changes to your I-bar files.
Review Procedure Groups
Before working with I-bar files, review how your procedures are grouped in the Procedure Table. The ibar program allows you to manipulate groups of procedures, so proper grouping will help you quickly set up your I-bar file.
Run the program byproc to verify your procedures are grouped properly. You can find byproc in the Partner Configuration window or run it from a command prompt. If you spot problems with the groups, regroup them as necessary in the Procedure Table in ted before proceeding.
Optional: Fill Out inscows Worksheet
You may want to print out an insurance company worksheet to help organize the configuration you are about to set up. The inscows command will generate an insurance company worksheet.
Identify I-bar File For Editing
Run the Table Editor (ted) and find the insurance plan or plans you wish to update. If necessary, add a new plan using the instructions in the section above.
Once you know which insurance plan(s) to edit, check the “Special Information File” field for the plan. Write down that name.
Note: Many insurance plans may be using the same Special Information File. You can review which plans use a particular I-bar file in the ibar program.
Run the Special Information File Editor (ibar)
While viewing an insurance plan in ted, press F6 – Edit Config to run the ibar program. The I-bar file for the plan you were viewing will be automatically selected.
Alternately, you can run the ibar program from a command prompt or from the insconfig program in the Partner Configuration window. When starting ibar in this way, you will need to select an I-bar file with which you wish to work, or create a new file. Use an asterisk (*) to see a list of existing files and the option to create a new one.
List Plans that Use this I-bar File
Before you make any changes to an I-bar file, you should find out which plans use it. All plans using the same I-bar file will be affected by your changes. Press F7 – Which Inscos to see a list of all insurance plans that share this I-bar file.
If Necessary, Create New I-bar File
If you determine that you need a new, unique I-bar file for your insurance plan, you can create one. Use the asterisk (*) to show the list of existing I-bar files and select the “Create New I_File” option. As soon as you start making changes, you will be asked to name the file. Choose a simple, specific name.
Change the Pending Status, Batching Status, Copay, Fee Schedule, or Capitation For Any Procedure or Group of Procedures
Once you are confident you have selected the appropriate I-bar file and that you will not inadvertently affect other insurance plans by mistake, follow the steps in the next set of instructions to alter how procedures will behave for insurance plans using this I-bar file.
Make Procedures Pend or Not Pend the Insurance Payer
From the main ibar screen, press F2 – Change Pending to change the default pending status for all procedures or a group of procedures. You might want to do this if certain insurance companies do not cover a procedure and you wish that procedure to be a personal charge.
After pressing F2, you will see a list of your procedures. You can fill out the “Pend Insurance” box with a “Yes” or “No”, or use the features of ibar to select a group of procedures and duplicate the template line.
Example: Suppose you were just informed that an insurance company is now fee-for-service for all physicals. You need to change the appropriate I-bar file so that all “Well Child” procedures pend the insurance plan automatically. Follow this procedure:
Select the ibar File and Press F2
After selecting the appropriate I-bar file, press F2 – Change Pending to change the pending status of some procedures.
Check Template Line
Make sure the TEMPLATE line at the top is set to “Yes.”
Press F7 to Select a Group of Procedures
Press F7 – Select By Group to mark just a single procedure group.
Select Groups that Need to Pend
Use an X to check off the group you wish to change. In this case, the “Well Child Care” group, or whatever group contains your physicals. Press F1 – Save and Quit to return to the normal list.
Press F8 to Copy the “Yes” from Template to Each of the Chosen Procedures
You will be shown a warning screen telling you to press F1 – Generate to continue.
In the example above, you learned how to use the TEMPLATE function of ibar and the F8 – Select By Group key to change whether or not Well Child procedures are pended to an insurance plan. These same tools can be used for changing HCFA status, copay information, base fees, and capitation information for all procedures.
Make Procedures Appear or Not Appear on Claims
While using ibar to edit procedure behaviors, press F3 – Change Batching to configure which procedures will print, or not print, on your claim forms. The list of procedures allows you to set how the procedure will batch. This option also controls behavior for electronic claims.
Change Pending, or Batching?: Whether or not a procedure pends an insurance company and whether or not it appears on a claim are two different options. If a procedure pends an insurance company but is never batched, it will never be billed! Please contact PCC if you have any questions about this or other features of ibar.
You can identify which batch each procedure should print to simply by changing the “HCFA Batch” field on each line. The system will automatically fill in “Default” as the HCFA batch that the insurance should print to. If you leave this as “Default” the system will print to the HCFA batch that is indicated on the individual insurance company. If a procedure should never print on any HCFA form, choose “Never” as the batch.
The ibar program can even accommodate carriers who want office visits printed on a standard 1500 form and hospital charges printed on some other form. Use the Change Batching screen to send hospital procedures to the hospital batch while all others go to the “Default” or some other batch.
Note: Procedures can only be assigned to existing HCFA batches. If you need help adding a new HCFA batch, please contact our Customer Care Team.
The full list of possible HCFA settings include:
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Default — Use the default HCFA batch assigned to this plan (this can be found in
ted). If the procedure should be batching, you generally want to use this setting. -
Never — Never print this procedure on a HCFA form in any batch.
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[Batch name] — You can choose to send certain procedures to specific batches which may be different than the one used as a default in
ted. For example, perhaps hospital charges need to go on a separate form. If so, you could send the hospital procedures to a special batch while all others go to the regular batch.
Change Expected Copay Amounts for Procedures
While editing an I-bar file in ibar, press F4 – Change Copay to configure certain procedures to expect, or not expect, a copay. Press this key to bring up the copay screen, which lists all of your procedures and tells you how much each one expects for a copay. You can enter a specific dollar amount, a percentage of the charge, or both as the copay amount.
If a procedure should never get a copay, simply choose “Never” and leave the copay amount fields at 0.
Possible settings are:
| Never | Never allow this procedure to expect a copay |
| Group/See Ted | Expect one copay for the group of charges and use the default copay amount listed for this Insurance Plan in ted |
| Group/Set Amt | Expect one copay for the group of charges and calculate the copay amount based on information on this screen |
| Per Proc/See Ted | Expect one copay just for this procedure, and use the default copay amount listed for this Insurance Plan in ted |
| Per Proc/Set Amt | Expect one copay just for this procedure, and calculate the copay amount based on information on this screen |
| Not Specified | Each procedure should have something specified for the expected copay, even if there is no. If you see “Not Specified” set for any procedure (except in the top Template section), you should fix it. |
Change Base Fees for Procedures
While editing an I-bar file in ibar, press F5 – Change Base Fee to specify special charge amounts for selected procedures. You can select which of Partner’s ten different available fee schedules a procedure should use for this insurance plan, or you can set a specific charge amount.
Possible settings are:
| Use Sched X Price | Uses the price found in Schedule X (A, B, C, etc) in ted |
| Use Special Fee | Enter a dollar amount to be charged for this procedure |
Change Write-Off or Capitation Behavior for Procedures
While editing an I-bar file in the ibar program, press F6 – Change WriteOff to configure items that should automatically be adjusted off at the time of posting. For capitated plans, configure the I-bar to adjust off any procedure covered by capitation. Other than writing off the charge completely, you can also enter a specific dollar amount, a percentage of the charge, or both as the default write-off.
Possible settings are:
| Adj Off Everything | Adjusts off the entire charge amount for the procedure |
| Adj Off Nothing | Makes no adjustments to the charge amount for the procedure |
| Adj To Sched X | Adjusts off just enough so that the price comes down to the price found in Schedule X (A, B, C, etc) in ted |
| Adj To WriteOff | Adjusts off just enough so that the price comes down to the price found in the WriteOff field on this screen |
| Adj WriteOff Amt | Adjusts off the amount found in the WriteOff field on this screen |
Other ibar Program Tools and Options
While using the ibar, you can take advantage of some other special features:
Change Settings for One Procedure
Press F8 – Change All in ibar to change all the policy behaviors for one procedure at a time.
You can use this function when you have recently added a new procedure into the procedure table and would like to update its settings for an individual I-bar file.
After you press F8 and select the desired procedure, you will be able to set pending status, HCFA batching status, Expected Copay status, Base Fee, and Write-Off behavior.