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Manage patient coverages

warning

RehabAlpha is still under active development. It is not yet HIPAA compliant and should only be used with dummy data.

Coverage records describe who may be responsible for paying for a patient's therapy services during a specific time period.

Coverage can include payor, dates, deductible, copay, coinsurance, out-of-pocket maximum, authorizations, tags, and notes.

For a connected PointClickCare patient, a facility refresh or patient refresh also imports supported coverages. Review those coverages before adding the same coverage manually.

Before you start​

Confirm that the payor already exists in your organization's payor list. If it does not, add the payor first.

Add a coverage​

  1. Open the patient.
  2. Click Coverages.
  3. Click New coverage.
  4. Select the payor.
  5. Enter the coverage start date.
  6. Enter an end date if the coverage has a known end date.
  7. Add deductible, copay, coinsurance, out-of-pocket maximum, or authorization details when needed.
  8. Click Save.

For each authorization, use HCPCS codes to select up to 20 distinct approved codes. This single list includes the supported Level I codes and G0283, offering codes valid at some point during the authorization dates. Selected codes stay visible when those dates change.

Update a coverage​

  1. Open the patient.
  2. Click Coverages.
  3. Open the coverage.
  4. Click Edit.
  5. Update benefits, dates, authorizations, tags, or notes.
  6. Click Save.

Review coverages imported from PointClickCare​

Refresh imports non-informational Medicare Part A, Medicare Part B, Medicaid, and Private Pay coverages from the patient's current PCC coverage tree. It uses that tree's effective dates and leaves the end date blank when PCC supplies no end date. PCC rank is read-only and shows the order supplied by PCC; it does not select an admission's primary payor or create a billing episode.

Later refreshes update the linked coverage's payor, effective dates, time zone, and PCC rank. Manual changes to the payor, dates, or time zone can be replaced. Authorizations, deductible, copay, coinsurance, out-of-pocket maximum, tags, and notes remain as entered in RehabAlpha. New imported coverages have no authorizations, and their financial details start as unknown.

Medicare Part D and informational entries are excluded. Managed care, outpatient, other, and unrecognized types are skipped with a coverage issue for review. Invalid dates or ranks, unresolved payors, and overlaps with an existing coverage can also prevent a coverage from importing. Other valid coverages and the patient's details can still import.

Refresh reads the current PCC tree, not the patient's complete coverage history. If PCC changes the tree or omits a previously imported coverage that still appears active, RehabAlpha preserves the existing coverage and reports any conflict for review. It does not guess an end date or remove that coverage. Deleting an imported coverage removes its PCC link and cancels an active refresh; a later refresh may recreate it if PCC still supplies it.

Why coverage dates matter​

Coverage dates help RehabAlpha decide which policy period applies to a charge. This matters when benefits, deductibles, copays, authorizations, or payor responsibility change over time.