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Manage patient coverages

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 or patient refresh uses PointClickCare coverage information to identify payors. It does not create patient coverage records. Add the patient's coverages in RehabAlpha using the steps below.

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.

Use coverage information from PointClickCare​

PointClickCare refreshes can match payors already set up in RehabAlpha, but they do not import patient coverage dates, benefits, authorizations, or coverage order. Confirm those details with the appropriate source and enter them in the patient's Coverages.

Setting up a coverage does not select an admission's primary payor or create a billing episode. Continue with Set up a billing episode when you are ready to configure billing for the admission.

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.