Billing Third Parties and Funding Bodies

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Halaxy allows you to send invoices to third-party organisations instead of the listed patient, such as an employer or health fund. The organisation that is billed is determined by the patient's claim details under the relevant funder.

You can streamline this process by:

  1. ensuring that the funder type is set to a third-party type (such as "Workers Compensation", "Employee Assistance Program (EAP)", or "Third-party body");

  2. creating specific third-party fees linked to the third-party funder and using them for appointments where the third party pays

  3. setting up a patient's claim under the funder in their Funding tab with the paying organisation listed in the claim

  4. ensuring that the paying organisation's details are correct

Setting up these four elements means all you have to do is manage your calendar as usual, and the invoice will be automatically billed to the appropriate third party. 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 also the best way to troubleshoot issues with third-party billing.

You can also choose to anonymise a patient's name on third-party invoices by editing the patient's claim details.

Using Funders for Third Party Billing - Example

Mary performs treatment services for various schools around her area. Her patients are various students at the different schools, and the service is wholly paid for by the student's particular school.

To manage this in Halaxy, Mary sets up a funder called "School Services" and sets the funder type to "Third-party body". Because the school pays, she sets the default payer to "Organisation" instead of "Patient", but because the paying organisation is different for each student, she does not set a default paying organisation.

She then creates a $75 fee under this funder. Because the school pays for the full amount, she also sets the rebate amount to $75.

When Mary makes an appointment with a student using this fee, the student's claim under the funder "School Services" is automatically created in their Halaxy patient profile. For each student, she edits their individual claim information and sets the paying organisation to the student's school.

Now whenever Mary makes an appointment for a student, the invoice is automatically billed to the student's school.

Setting Up Third-Party Billing

1. Third-party funders

2. Third-party fees

A third-party fee is simply a fee that is set up under a third-party funder.

You can create a third-party fee the same way that you create any other fee:

  1. Click Finances > Fees.

  2. Click New Fee.

  3. In the Funder field, enter the name of the funder.

  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. You can now set the payer for the invoice to the organisation.

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:

360049079534-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.

To add claim information:

  1. Navigate to the patient's profile and 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 payer you set 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 > Organisations. Find the organisation in the list to view the organisation's profile page:

360049963373-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.

  2. Click Add Card to add payment information for the organisation. This is required for electronic payments processing through Halaxy.

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

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