Product Enhancements and New Features:

Allowance Table Enhancements (US Only)

Allowance table functionality has been enhanced, making it easier define the coverage rules for an insurance plan and improve estimation. You can now import values from any active procedure list / fee schedule, enabling you to use an existing procedure list's fees as the defined allowed amounts for an allowance table.
Note: You can still import values from any procedure list / fee schedule or existing allowance table (for another plan) when creating or editing an allowance table.

When importing values for a plan that already has coverage details defined, you can decide whether to overwrite the existing values, or to use the import functionality to fill in only undefined (blank) values.

Importing Coverage Values

To import values into an allowance table:

1. Select Administration > Insurance > Plans. Insurance plans are displayed based on the selected filters.
   Note: The Coverage column displays View if an allowance table is defined for the plan or Add if no coverage is defined.
   
2. Find the plan you want to update, and then click View or Add.
   - Click View to display the Allowance Table Summary for the plan. Then click Edit Allowance Table Details for this Plan.
   The Allowance Table is displayed.
   - Click Add if no coverage is defined. The Allowance Table is displayed.
3. Under Actions, select Import Values. The Import Allowance Table Values window is displayed.
   

4. Choose the source of the values:
   -- Select Office Fee Schedule, and then use the Procedure List / Fee Schedule field to select the list/schedule to import.
   Note: Only active lists are selectable.
   -- Select Existing Allowance Table and use the Plan Search field to select a plan. When selecting an allowance table, specify whether you want to import All Coverage Rules or Only Allowed Amounts.
   Note: Only allowed amounts are available when importing values from a procedure list / fee schedule.

   

   Note: Selecting All Coverage Rules imports rules such as whether a procedure is covered, whether it applies to a deductible, defined copayment or allowed amounts, the covered percentage, limitations, and so forth.

5. Click Import Values. The table is populated with the selected values.

6. From the Allowance Table, you can click Save Changes, or you can adjust one or more items for this plan, and then save the table.

Importing Values to Fill in the Blanks

When you import values to a plan for which coverage values have already been defined, you are prompted with the option to overwrite all the existing values, or to populate only the values that are undefined (blank fields).

The Fill in Blanks option has been improved to give you more control when updating a table.

When prompted, select Fill in Blanks to import values that are not defined in the existing table with the values from the selected plan.

Exceptions:

• A value can be changed from Not Covered to Covered, but not from Covered to Not Covered. If a procedure is Covered in an existing table, a change to Not Covered must be done manually in the Allowance Table window.
• A $0.00 or 0% value can be updated, but a dollar or percentage amount value cannot be changed to a zero amount. This applies to all fees, allowed amounts, deductible and co-pay amounts, and covered percentages
• Limitations can be added via importation, but not changed to a no-value status.

For more information, see How to Add or Edit Coverage Details for an Insurance Plan.

Medical Billing Code Additions (US Only)

Sensei Cloud has added new Current Procedural Terminology (CPT®) codes for documenting the injection of drugs for medical billing.

Note: Only CPT-only and CPT cross-coded procedures are billable to medical plans.

To select a CPT code for a procedure:

1. Select Administration > Procedures & Fees > Procedure List and Fee Schedule.
2. Select a code to update or create a new procedure code.
3. In the Create/Update Procedure window, use the CPT Code field to search for and select a code to add to the procedure.

For more information, see How to Use CPT Codes for Medical Billing.

Service Location Enhancement to Address Claim Rejections (US Only)

In response to customers experiencing medical claim rejections after entering a service location that does not have a defined Place of Service code of 11 (in office), additional information is now included on insurance claims. When the service location is not “in office,” Sensei Cloud now includes the name of the facility in addition to the service location code.

You can manage service locations by selecting Administration > Locations > Service Locations.

For more information on setting up and using service locations, see How to Add Service Locations and visit CMS.gov.

Defects and Small Enhancements

12 additional defects were addressed, including:

• Fixed: Updated Location Schedule Hours not reflecting on Schedule.
• Fixed: Deposit total displaying the wrong amount on the Archived Daysheet List.
• Updated: What’s New in Sensei Cloud has a new URL and is also accessible from the What’s New link in the User Menu.