Benefit Maxima Percentage Rule

Article author
Ryan
  • Updated

Define the percentage of the cost the company will pay for each service, the remaining percentage is billed to the patient. The options for benefit maxima percentage rules are:

  • Name - Set the name of the rule
  • Benefit Maxima Apply When…
    • Primary Doctor is - Rule only applies if a specific doctor is attending
    • Site is - Rule only applies if the appointment is at a specific site
    • Location is - Rule only applies if the appointment is in a specific location
    • Tag is - Rule only applies if the ‘Billing Tag’ for a session is equal to the text field
  • Benefit Maxima - Define the benefit maxima percentage for each service