Billing Funding Bodies and Third Parties

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Third-party billing occurs when you invoice someone other than the patient who received treatment (such as a private funding body or private health insurance). For example, you may invoice a school for treatment that you provide to a student, or invoice a workers compensation program for treatment provided to an injured worker.

Halaxy allows you to send invoices to funding bodies or other third-parties instead of the listed patient. You can streamline this process by creating third-party fees and setting up your patients' funding information; invoices can then be manually sent to the third party or automatically sent according to a schedule.

Patient names can be anonymised on third-party invoices if required.

Setting Up Third-Party Billing

To streamline third-party billing for a hassle-free experience, you should set up four things:

  1. the funder with an appropriate funding type (such as "Workers Compensation", "Employee Assistance Program (EAP)", or "Third-party body");
  2. a third-party fee with an appropriate rebate; 
  3. the patient's claim and paying organisation (which will override the default paying organisation assigned to the funder, if applicable); and
  4. the paying organisation's details (which will appear on the invoice).

Setting up these four elements means all you have to do is manage your calendar as usual. If you have set up automatic payments processing, third-party invoices will be automatically processed.

Ensuring that these four elements are correctly set up is the best way to troubleshoot issues with third-party billing.

1. Third-party funders

To add a third-party funder:

  1. Under Finances, click Fees, then click the Funders tab.
  2. Click Add Funder and import the funder from Halaxy's database, or type the name of the Funder and add it as a new funder. If you are adding a new funder, ensure the Funder Type is set to to an appropriate setting, such as "Worker's Compensation" or "Third-party body".
  3. Under Identification (Primary), type the label used by the funding body to determine eligible practitioners (e.g., if the funding body uses provider numbers, type the words "Provider Number". Do NOT type your actual provider number; this is just a label).
  4. Under Payment Details, choose from the following options:
    • Payer:
      • Patient: the patient pays for the invoice
      • Organisation (new invoice): each fee associated with this funder will be sent as a new invoice to the paying organisation
      • Organisation (existing invoice, same patient): all fees for this patient associated with this funder will be sent as a single collated invoice to the paying organisation
      • Organisation (existing invoice, any patient): all fees for all patients associated with this funder will be sent as a single collated invoice to the paying organisation
    • Paying organisation: the default organisation that will be billed (can be the same as the funder or a different organisation). If you do not want to set a default organisation, leave this field blank - this is useful if the paying organisation changes (for example, NDIS claims where different organisations may pay for the patient, or if you provide the same service to different schools, whereby you may put "School Services" as the funder name and invoice different paying organisations each time)
    • Invoice Schedule: how often invoices are sent when the payer is set to "Organisation (existing invoice, same patient)" or "Organisation (Existing invoice, any patient)". For example, you could choose to send collated daily invoices, weekly invoices or monthly invoices.
    • (Optional) Tick the "Anonymise patient details on invoice" checkbox to anonymise the patient details. If ticked, the patient will appear as an anonymised ID such as "HK 123456".
  5. Click Save.

NOTE: The Halaxy database features a generic third-party funder named "Third party". You can import this funder and use it for third-party billing where you do not require any further information such as identifications or specific fees.

2. Third-party fees

To streamline third-party billing, it is best to add fees specific to third-party billing to your fees list so you can set a rebate amount. You can create a third-party fee the same way that you create any other fee:

  1. Under Finances, click Fees.
  2. Click New Fee.
  3. In the Funder field, enter the name of the funding body or select "Third party" ("Third party" is a generic third-party funder set up in Halaxy's database).
  4. If the funding body requires an item number, enter the item number in the Item Number field (this is the number that the funding body uses to identify the fee). 
  5. Set the fee amount and rebate. The rebate is the amount paid by the third party; it should be above $0 for all third-party fees. If the patient does not pay anything above what the third party pays, the amount and rebate should be the same. if the patient pays a gap amount (the difference between the total fee and what the funding body pays), the amount should be higher than the rebate.
  6. Click Save.

RESULT: Whenever you use this fee, the third-party body and its associated settings will automatically be linked to the invoice and your financial reports, including the patient's claim details for the funder.

NOTE: Where the fee amount and rebate amount are different - for example, the total is $120 and the rebate is $70, so the gap amount the patient pays is $50 - Halaxy creates an invoice for the full fee, with the rebate amount billed to the third party. This can result in the patient invoice appearing as partially paid when the invoice is created due to the third-party also being invoiced, even if no payment has yet been added. On the patient invoice, you will see a linked invoice for the third party in the Payments section:

Invoice_Third_Party_Partial_Payment.png

3. Patient claim and funding information

Patients will need to have the appropriate claim information in their Funding page in order to use third-party billing. Settings for the patient will override the default settings for the funder, which means each patient can be assigned their own paying organisation.

  1. From the patient's profile, click the Funding tab.
  2. To create a new claim, click New Claim and add the name of the funder, then click Next. To edit an existing claim, click the Expand (+) icon next to the claim and click the Edit (pencil) icon next to the claim details.
  3. In the Paying Organisation field, type the name of the organisation that will pay the rebate amount for this patient. If you click to add the organisation as a new organisation, it will be added to your organisations list (under Contacts > Organisations).
  4. Under Payment Details, choose from the following options:
    • Payer:
      • Patient: the patient pays for the invoice
      • Organisation (new invoice): each fee associated with this funder will be sent as a new invoice to the paying organisation
      • Organisation (existing invoice, same patient): all fees for this patient associated with this funder will be sent as a single collated invoice to the paying organisation
      • Organisation (existing invoice, any patient): all fees for all patients associated with this funder will be sent as a single collated invoice to the paying organisation
    • Paying organisation: the organisation that will be billed. This is set at the patient level and will override the default settings for the funder.
    • Invoice Schedule: how often invoices are sent when the payer is set to "Organisation (existing invoice, same patient)" or "Organisation (Existing invoice, any patient)". For example, you could choose to send collated daily invoices, weekly invoices or monthly invoices.
    • (Optional) Tick the "Anonymise patient details on invoice" checkbox to anonymise the patient details. If ticked, the patient will appear as an anonymised ID such as "HK 123456".
  5. Click Next.

RESULT: Whenever you create an invoice for the patient using the third-party fee associated with the funder, the paying organisation listed in the patient's Funding page will be billed. If none is set, the default paying organisation for the funder is billed instead.

4. Paying organisation details

Whenever you add a paying organisation, it is added to your organisations list. You should ensure the organisation has up-to-date information so it can appear on the invoice.

To access your organisations list, click Contacts, then Organisations. Find the organisation in the list to view the organisation's profile page:

Organisations_Profile.png

You can view invoices and the current fee balance for the organisation on this page.

To ensure that automatic third-party billing is successful:

  1. Click Edit to edit the Organisation's details, including Address and ABN number.
  2. Click Add Card to add payment information for the organisation. This is required for payments processing through Halaxy. 

RESULT: The organisation's details will appear on the invoice, and payments can be automatically processed.

Changing the Payer for a Single Invoice and Creating a Copy for the Paying Organisation

To change the paying organisation for a single invoice, click the cogwheel icon in the top-right of the invoice, then choose whether to bill the patient or the organisation in the Payer field:

Invoices_ChangePayer.gif

If the patient does not have a paying organisation set up for the funder in their Funding page, you will need to set one.

Alternatively, If the invoice has the Payer set to the patient, you can click Invoice Funder to switch the payer to the paying organisation, or to retain the invoice and create a separate copy billed to the paying organisation.

Invoice_InvoiceFunder.png

If you opt to create a separate copy, the paying organisation's copy will be linked in the patient's copy, and the patient's copy will show as Paid in Full when the paying organisation's copy is paid.

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