The CHR uses explicit and implicit modifiers in conjunction with the fee code to determine the amount payable. Explicit modifiers need to be manually applied to a fee code while implicit modifiers are automatically applied when the criteria are met.

The types of implicit modifiers available in the CHR are based on:

  • the age of the patient,

  • consecutive hospital days (level),

  • the providers specialty (skill),

  • the facility type (tray fee),

  • the number of calls,

  • the provider's role.

Steps

1. Start a bill from an encounter, from the Visits dashboard or from the patient's chart. If you're editing a bill, open the bill from the Billing dashboard.

2. Add a fee item to the bill (see Adding billing items to provincial bills).

3. To search for the service code:

  • by code, in the first search field, start typing the code.

  • by description, in the second search field, start typing the description.

4. In the list of results, select the code you want. As soon as the code is selected, the implicit fee modifiers are applied.

You can see the applied modifier codes in the New Insured Payment window.

⚠️ Important: If you modify the patient's date of birth, the service date or the provider's skill after adding your billing items, implicit modifiers may not be applied properly. You need to make another change to the bill for the amount to be recalculated.

Note that AHCIP will pay the right amount either way, but the bill may come back with the Adjusted status since the amount billed and the amount paid don't match.

5. To apply explicit fee modifiers, select them from the modifier lists. You can apply up to 3 explicit modifiers to the same fee code.

📌 Note: Only modifiers that can be used with the selected fee code are available in the list. For this reason, always enter the fee code before you select a modifier.

6. To add a modifier more than once, if applicable, enter the number of Units.

7. To add or remove the tray fee implicit modifier, select the Show Advanced Fields checkbox.

  • If the facility is a hospital, by default, no tray fee is applied. Select Override Tray Fee to apply a tray fee.

  • If the facility is an office, the tray fee is applied by default. Select Override Tray Fee to remove the tray fee.

8. To see the calculation and the total billed amount, hover over the EQ icon.

Updated September 22, 2022

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