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Split Billing configurations

Split Billing configurations allow you to split charges between an account's Funder  and Person Responsible  automatically.  Split Billing configurations do not have any effect on what is actually charged.  They only determine how those charges are split between the Funder  and Person Responsible .  Panacea medical aid statements have separate columns for the Funder  and Person Responsible , so it is easy for recipients  of these statements to see what portion they must pay.

For a discussion on whether "Balance Billing" is legal and/or ethical please click here .

The Split Billing tab looks like this:

This field allows you to choose a suitable description for this configuration.

There are three available Split Billing types:

  • Flat Rate: The Person Responsible  pays a fixed Rand amount per invoice, e.g. R25 per treatment.
  • Percentage: The Person Responsible  pays a percentage of each transaction, e.g. 20% of all charges.
  • Dual Pricelist: The Funder's  portion is determined by a pricelist.

Person responsible is liable for
Depending on the type selected above, this field specifies either the Rand amount or percentage that will be apportioned to the Person Responsible .

This determines what amounts are charged on eClaims:

  • Claim full amount charged: the full amount charged is sent in the eClaim
  • Claim only the funder's portion: Some medical aids (e.g. Discovery) will pay the member (instead of you) if you claim amounts that are higher than their tariff schedule.  You can avoid this by claiming amounts that match their schedule.  This option is usually used when the Type is set to Dual Pricelist and you have configured a pricelist that matches the Funder's  tariff schedule.  Please note, however, that this setting may be considered unethical.

Pricelists for funder's portion
When the Type is set to Dual Pricelist these two fields determine the pricelists that are used to determine the funder's portion.

Dual Pricelist example

In this example let us imagine that your practice charges the NHRPL + 15%.  This is higher than the rate paid by medical aids, so you want to split the charges between the Person Responsible  and the Funder  in such a way that the Funder  will pay according to their own tariff schedule and the Person Responsible  will pay in the difference.

In 2011 Datamax created over 70 custom pricelists according to the published rates for each medical aid.  This makes it easy to determine the Funder's  portion.

Let us imagine that you have a patient that is on hypothetical medical aid XYZ.  Datamax has created a pricelist for XYZ called the "XYZ Rate".  You have also created a custom pricelist called NHRPL + 15% and have configured it accordingly.

The Split Billing configuration would be set up as follows:

To complete the implementation of this scenario you will need to configure the following:

To test your configuration simply capture an invoice  then go to the account  and click on Transactions .  Check the Show transaction details checkbox  and Panacea will display columns showing how the charges were split.  Note that you can even adjust these portions manually by right-clicking on them.

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