Guide to third party billing

If a patient's treatment is paid for by an organization (such as an employer or a funding body) instead of the listed patient, you can set up third party billing so your invoices are automatically billed correctly.

Tip

Patient names can be anonymized on third party invoices. This can be enabled in the individual patient's claim details.

Overview

A third party is an organization who pays for a patient's treatment instead of the patient themselves.

By setting up third party billing, you can automate your invoicing while maintaining flexibility over differing paying organizations.

GIF: 1) Practitioner treats the patient, 2) Practitioner invoices the third party, 3) The third party pays for the patient's treatment

There are four elements to set up in Halaxy for third party billing:

Funder: When you create a third party funder, you must select the correct funder type because this determines the default settings for who is billed, how claims work for the funder, how information appears on invoices.
Fees: You must set up specific third party fees linked to the funder to use in appointments.
Patient's claim information: You must have the patient's correct claim information under this funder in the Funding tab of their profile.
Paying organization: You must ensure that the paying organization's details are correct.

When you have set up these four elements, you can simply manage your calendar as usual and the invoices are automatically billed to the appropriate third party.

Set up third party billing

To demonstrate how to set up third party billing, we are using the following example.

Example: Alex is a sports physician who treats student athletes at different universities. The treatments are fully paid for by the students' respective universities. In this example, the university is the paying organization (third party). Because the students come from different universities, the paying organization is not always the same in the invoice. With Halaxy, Alex can use third party billing so her invoices automatically bill the correct universities for each student without needing to manually enter information in every invoice.

Select the tabs below for complete step-by-step instructions.

Step 1: Set up the third party funder
1. Click Finances > Fees, then click the Funders tab.
2. In the top right, click Add Funder.
3. In the New Funder screen, first configure the funder:
  - Name: Enter the name of the funder. If it already exists in Halaxy's database, you can select its name to import it. For this example, the funder is University Services. Because the paying organization changes, the funder's name can be a general label.
  - Funder Type: Select what kind of funder this is. This determines how billing and claim information are used in invoices. For this example, select Third-party body. (Note: This must be set to a third party funder type, such as Workers Compensation, Employee Assistance Program (EAP) or Third-party body.)
  - Description (optional): Enter a brief description about this funder.
  - Identification/s: Enter the label for any identification/s to appear on the third party invoice that are required for claiming with the paying organization. For this example, the primary identification is Provider Number. A university may assign you an external contractor ID, which can be added as a secondary identification. (Note: Do not type the actual provider number. This is just a label. The actual number must be added in your Identifications page.)
  - Create default patient claim (optional): Tick this checkbox to automatically create a claim for this funder using these details whenever you create a new patient profile. If unticked, claims will only be automatically created when the patient has an appointment using a fee under this funder.
4. Configure the payment details, which are the default settings on how and when the invoice is billed:
  - Payer: Select who will be the default payer for fees booked under this funder. (If you need to make a one-off change, you can still change the payer on the invoice.)
    
    Organization (new invoice): The organization pays for the invoice. A new invoice is created each time you use a fee associated with this funder.
    
    Organization (existing invoice, same patient): The organization pays for the invoice. All fees associated with this funder for this patient are grouped into a single invoice. The invoice fees are collated according to the Invoice Schedule you set.
    
    Organization (existing invoice, any patient): The organization pays for the invoice. All fees associated with this funder for all patients are grouped into a single invoice. The invoice fees are collated according to the Invoice Schedule you set.
  - Invoice Merging: Select your preference for which fees under this funder are allowed to be merged into an invoice.
    
    Same practitioner / same clinic: Allow merging only for fees by the same practitioner from the same location (default)
    
    Same practitioner / any clinic: Allow merging only for fees by the same practitioner from any location in your practice group
    
    Any practitioner / same clinic: Allow merging only for fees by any practitioner but from the same location
    
    Any practitioner / any clinic: Allow merging for fees by any practitioner from any location in your practice group
  - Paying organization: The default organization that is billed and receives the invoice. If the paying organization constantly changes, you can leave this field blank.
  - Invoice Schedule: The frequency of invoice collation. This schedule is followed when Payer is set to Organization (existing invoice, same patient) or Organization (existing invoice, any patient). See related article: Set up an invoice schedule.
5. Click Save.
You have successfully set up the funder. Now you must create the fees to use for appointments specifically for this funder.
Step 2: Set up fees for the third party funder
1. Click Finances > Fees.
2. On the top right, click New Fee.
3. In the New Fee screen, configure the following. (For more details on setting up fees, see related article: Add fees and services)
  - Funder: Enter the name of the funder added in Step 1 and select it. (For this example, the funder is University Services.)
  - Fee Name: Enter the name of the service provided. (For this example, the fee name is Student athlete consultation.
  - Item Number (optional): Enter the item number used to identify the fee, if required.
  - Duration (optional): Enter the number of minutes for each appointment using this fee.
  - Amount / Rebate: If the third party is fully paying for the service, Amount and Rebate have the same value (and must be above 0.00). If the patient is paying a partial gap amount, Amount must be higher than Rebate, with the difference being what the patient pays.
4. Click Save Fee.
Whenever you use this fee for an appointment, the generated invoice and financial reports automatically link to the third party funder and its settings (from Step 1).

Note

If a patient pays a gap amount (i.e. the Amount and Rebate values are different), Halaxy automatically generates two invoices - one billed to the paying organization to pay the rebate and one billed to the patient to pay the gap amount.
Step 3: Set up patient claim information

Every patient receiving treatment under third party billing must have the appropriate claim information in their Funding page. Individual patient settings override the default funder settings, which means each patient can be assigned their own paying organization.
1. Open the patient profile and click the Funding tab.
2. At the top right, click New Claim.
3. For Funder, enter the name of the funder added in Step 1 and select it. (For this example, the funder is University Services.)
4. In the form, configure the following:
  - Paying Organization: Enter the name of the third party that is billed and receives the invoice. If it is a new organization, select to add it to your organizations list. For this example, the paying organization is the student's university.
  - Invoice Schedule / Payer: You have the option customize these fields for every patient, which overrides the default funder settings.
  - Reference Number (optional): Enter a reference number to identify this patient as eligible for the third party billing. For this example, the reference number is the patient's Student ID at their university.
  - Anonymize patient details on invoice (optional): Tick the checkbox to hide the patient's name on the invoice to appear in the format HK 123456.
5. Click Next.
Whenever you book this patient for an appointment with the third-party fee (from Step 2) associated with the funder (from Step 1), the paying organization in the patient's claim for this funder (from Step 3) is automatically billed.
Step 4: Set up the paying organization details

The last step is to add the paying organization's information so their details appear on the invoice. If provided, you can also add the paying organization's payment details for automatic payment processing.
1. Click Contacts > Organizations.
2. In the list, click the name of the paying organization to open their profile.
3. To edit the organization's details, click Edit, enter the required information, then click Save. (Tip: To ensure successful billing, it's recommended to add the organization's Vat Reg. TIN and address.)
4. (Optional) To add card payment details (if provided), click Add Card. In the pop-up, enter the card details then click Save.
The paying organization's details automatically appear on invoices billed to them, ready to be emailed or processed for payment.

From this organization page, you can also view their invoices and current fee balance.
Application

After setting up all four steps, you simply create appointments as you normally do, and the invoices are automatically created with the correct information for you.
1. Open the calendar.
2. Create an appointment for the patient you entered claim information for in Step 3.
3. In the appointment panel, add the third party fee you created in Step 2 then click Save.
  
  Image: By booking this patient, their claim details for the added fee's funder are automatically displayed in the appointment.
4. Click Invoice to open the appointment invoice.
5. The invoice is automatically billed to the paying organization specified in the patient's claim details for the fee's funder.