Based on your settings for the various levels of billing, Copia assigns the appropriate lab account number during order entry so that the charges for the order are credited to the correct entity.

For more help, click one of the following links:

• Accessing this Feature
• Definition of Billing Levels
• Assigning Lab Account Numbers to Orders

Internal Billing Settings

• Define billing status rules in the Billing Status Rules administration page.
• Assign billing status rules to hosts or insurance companies (for all hosts or for specific hosts) or insurance plans (for all hosts or for specific hosts) in the Hosts or Insurance administration pages.
• Assign internal billing account numbers in the Hosts administration pages.
• Determine whether Copia displays internal or external billing information on the Order Patient Samples page using a setting on the Locations administration page.
• Determine whether Copia displays internal or external billing on requisitions and manifests and/or in HL7 messages using a setting on the Hosts administration page.

External Billing Settings

• Adjust the user-level (or ordering provider-level) billing settings in the Lab Accounts page (accessed from the User page in the My Preferences section of the program or from the Users administration page) or in the Account Numbers page during order entry.
• Adjust the location-level billing settings in the Location Lab Accounts page in the This Location section of the program.
• Only a system administrator may adjust practice-level billing settings in the Practices administration page.

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Definition of Billing Levels

There are two types of billing in Copia: "internal billing" and "external billing." Copia considers the billing relationship between the business entity using Copia and the laboratories performing the testing for that business entity to be "internal billing," while the billing status/account number settings for users, locations, and practices is "external billing."

Once you define one or more billing status rules for internal billing, you may do the following:

• Assign the billing status rule to the host, insurance company (for all hosts or for specific hosts), or insurance plan (for all hosts or for specific hosts) it applies to. See the Admin: Hosts or Admin: Insurance topics.
• Define on the Hosts administration page the internal account number for the billing status, as well as define the billing status (internal or external) that appears on the host's requisition and the billing status that is sent to the host via an HL7 message. See the Admin: Hosts topic.
• Configure on the Locations administration page which billing status appears on the Order Patient Samples page based on the user's signed-in location. See the Admin: Locations topic.

The hierarchy for defining internal billing status rules is:

1. Host-specific insurance plan: These rules apply to specific hosts for the insurance plan.
2. Insurance plan: These rules apply to all hosts that use this plan.
3. Host-specific insurance company: These rules apply to specific hosts for the insurance company.
4. Insurance company: These rules apply to all hosts that use this company.
5. Testing host: These rules apply to the selected host if it is the testing location.

For orders where there are no internal billing rules, there are three levels of external billing settings:

1. User-level (Ordering Provider-level) settings: These settings are used for orders placed by specific providers. Non-provider users will not have these settings. Adjust the user-level billing settings in the Lab Accounts page or in the Account Numbers page during order entry. See the Lab Accounts or Account Numbers topics.
2. Location-level settings: These settings are used for orders sent to specific locations. Adjust the location-level billing settings in the Location Lab Accounts page. See the Location Lab Accounts topic.
3. Practice-level settings: These settings are used for orders when no location-level or user-level settings are available, or when the Orchard Copia Administrator has set up a practice-level lab account to override the location-level and user-level settings. See the Admin: Practices topic.

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Assigning Lab Account Numbers to Orders

1. Copia assigns lab account numbers when you place an order.
2. When you reach the Order Patient Samples page during order entry, Copia automatically assigns the lab account number for billing based on the check it performs.
3. As Copia checks your billing settings to assign the lab account number, it first looks to see whether to display the internal or external billing account information. This setting is located on the Locations administration page.
   • Internal Billing: When displaying internal billing information based on billing status rules, Copia displays the account number from the Hosts administration page.
   • External Billing: When displaying external billing information, Copia reviews your billing settings in the following order: User, Location, and then Practice.
   • If Copia finds a lab account number for the user (ordering provider), then Copia will assign that number.
   • If Copia cannot find a user-level lab account number, or if you have set up a location-level lab account to override the user-level settings, then Copia will assign the location-level lab account number.
   • If Copia cannot find user-level or location-level lab account numbers or if the Orchard Copia Administrator has set up a practice-level lab account to override the location-level and user-level settings, then Copia will assign the practice-level lab account number.
4. You may manually make some modifications to the automatically assigned lab account number in the Account Numbers page. See the Account Numbers topic.
5. The displayed billing status (client bill or direct bill) for each order choice is also based on whether Copia is displaying internal or external billing information.
   • Internal Billing: Copia displays the billing status from either the Hosts or Insurance administration pages, depending on the level at which the billing status rule is set.
   • External Billing: Copia factors in the Allow Client Bill insurance company setting that allows practices or providers to bill the client for testing, as well as the Allow Client Bill for Medicare for this practice setting (which supersedes the Allow Client Bill setting, if enabled) for the practice the user is associated with. So, if the Medicare type insurance company/plan allows client bill, users can select client bill for order choices, as long as the ordering practice allows Medicare type insurance to use client bill. If the Medicare insurance is set to allow client bill, but the practice is set to not allow client bill for Medicare, then Copia will not allow client bill
• If one of these settings is enabled, Copia applies the client bill/direct bill setting for the user, location, or practice, as appropriate (see above).
• If one of these settings is not enabled, Copia applies the status of direct bill to any insurance not marked as client bill that is used as the payor for the order.
• The billing status is sent and received through the insurance segment of the HL7 message. The client bill status is sent as "Client," and the direct bill status is sent as "Insurance."

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