These 'radio buttons' control how patient and payor fees are apportioned for services.

Fee Schedule Methods

Description of Use

Payor sets both the service fees and the payor’s portion

Each service is manually set to indicate the patient and payor charges to be used.

Payor sets just the payor’s portion

For each service the amount the payor (scheme) will cover is entered. The patient fee will be calculated as the normal private fee less the amount covered by the payor.

Payor sets the payor’s portion and the patient discount

Allows the patient to be charged the normal private fee less a percentage discount. If the payor amount in the Payor Fee Schedule is not set to zero, this will be deducted from the private fee before the discount is calculated, and the final patient fee determined.

If you need to use more than one discount rate, use the Combination Payor below, which allows the discount % to be set for individual items.

Combination

Allows the use of all the above Fee Schedule types. In the fee schedule window each service is manually set to indicate which method is to be used.

This box determines whether the ‘cost’ noted for a given service item is added on to the fee for the patient to pay (ticked) or assumed to be built into the fee (unticked).

Enter the payor’s phone number for following up on claims.

Enter the payor’s fax number for faxing any materials in support of claims.

Once the new payor is active, the current balance owed by them on outstanding claims, will be displayed in this area of the payor file.

The default Payor Type is ‘Others’. If the payor relates to a government claiming scheme supported by EXACT there will be an option for this Scheme in the drop-down list. Selecting one of these payors will trigger other features within EXACT necessary to fully support the scheme, such as giving access to the Bands Setup window, activating buttons on the Payor File window, and prompting for claiming information at the end of treatment.

Click this button to select optional services to be charted as part of a course of treatment by the current payor. If the courses selected are missing when the course of treatment is charged, the user will be prompted to either add or ignore them. In addition, you can set up optional services to be automatically charted when a course of treatment is created for that payor, in a similar way to Quickplans.

The ‘Fee Schedule’ button opens a window in which to import and edit fees for services, for the selected Payor.

Clicking this button will open the “Increase Payor Fees” window, to enable you to adjust the payor fees, as at a specified date

The ‘Claim’ button is used to bundle claims to be submitted to the Payor, or for printing claim reports. See: Transmitting NHS England Claims

The 'Bands Setup' button is only active if the current payor is set up as a capitation payor. Set or Update Services NHS Banding & NHS Band Fee Updates England & Wales