Payor - Restriction on the BC selection option based on the comments section within that payor
Revenue Cycle Transformation
- Capability status
- To be confirmed with PRN
- Transformation phase
- To be confirmed with PRN
- Effort
- To be confirmed with PRN
Current State / What We Learned
Observed today, as captured in the corrected assessment.
This is an option currently for P payors that we can add <BC:P> within the comments to limit the selection for that payor record to only the billcode of P.
Desired Future State
The target way of working PRN and Raintree are aiming for.
To help prevent mistaken selections the team would like the option for other payors to be able to indicate that the billcode can NOT be a P payor.
Requirement / Gap
Currently there is not an option and we are not prevented from adding a payor as a P billcode if the comment reads as <BC:<>P> which would be read as the Billcode is greater or less than (meaning not equal to) P.
Raintree Recommended Path
This would be an option to limit payors like the <BC:P> comment that would only allow a payor to be selected as a P, but instead would be something like does not equal a P. Currently this would be a custom request or a suggestion for a future enhancement.
Dependencies / Considerations
N/A as this would be an added safety precaution
Outstanding Questions / Decisions
N/A - The concern is that users may mistakenly select an insurance and place it in the P payor position mistakenly.
Evidence

Supporting screenshots from the corrected Detailed Transformation Assessment.
Source
Detailed Transformation Assessment (Corrected)Related opportunities
Related by workstream and subject matter. These are not stated dependencies unless the assessment says so.

