Insurance Global Configurations

1. What does this feature do? (High-Level Overview)

This feature lets authorized users configure insurer-level defaults that affect billing and note behavior across the system. It centralizes global insurance settings so operational rules stay consistent regardless of location.

2. Who is this for? (Roles & Permissions)

• Users with manage_insurances (commonly Admin/Owner in default role setups): Can create and edit insurer global settings.
• Clinical and billing users who create or process notes: Do not configure these options, but are directly impacted by their enforcement (for example, provider selection and time-limit validation).

3. Business Rules & Enforcements

• Rule 1: Required insurer form fields are name, street, city, zip, state, payer_id, and daily_limit_hours.
• Rule 2: daily_limit_hours is validated between 0.25 and 24 hours, with a default value of 10.00.
• Rule 3: Daily time-limit validation for notes uses the patient’s primary insurer daily_limit_hours, combining BCBA and RBT minutes for the same day.
• Rule 4: Weekly note time is also limited to 40 hours. Both daily and weekly checks are skipped only for users allowed to ignore time limits (for example, Superadmin / ignore_time_limits capability).
• Rule 5: If Uses Supervisor as Provider is enabled and the actual provider is RBT, billing/modifier logic and claim rendering-provider selection use the supervisor as the effective provider.
• Rule 6: Determines telehealth apart from POS (uses_is_telehealth) enables BCBA telehealth capture; when is_telehealth=true, telehealth is forced, and otherwise logic falls back to POS telehealth codes (02, 10).
• Rule 7: These are global insurance-level settings. Location-specific setup (for example, Insurance Services and CPT Code limit by Location) is configured in separate tabs and should be documented separately.

4. UI Placement

1. Sidebar > Insurance > Insurance List (/insurance/list): Open an insurer record.
2. Add Insurance (/insurance/register) and Edit Insurance (/insurance/list/edit/:id): Main forms for global insurer fields.
3. Insurance Detail form (top section): Contains Uses Supervisor as Provider, Determines telehealth apart from POS, and Daily Limit Hours.

5. How-To Guide (Step-by-Step)

Scenario A: Configure a new insurer with global defaults

1. Open Insurance > Insurance List.
2. Click + to open Add Insurance.
3. Complete required identity fields (name, payer_id, address fields).
4. Set Daily Limit Hours based on policy.
5. Toggle Uses Supervisor as Provider and Determines telehealth apart from POS as needed.
6. Click Save.

Scenario B: Update an existing insurer’s global behavior

1. Open Insurance > Insurance List.
2. Click the insurer name to open Edit Insurance.
3. Adjust Daily Limit Hours and option toggles in the top configuration area.
4. Save changes and confirm downstream workflows (notes/claims) with the updated insurer configuration.

6. What happens if…? (Edge Cases / FAQ)

• Q: If Determines telehealth apart from POS is disabled, how is telehealth classified?
  A: The system falls back to POS logic (02/10 treated as telehealth).
• Q: If Daily Limit Hours changes today, are previously saved notes rewritten?
  A: No. The limit is enforced during note validation on create/update; existing historical notes are not retroactively rewritten.
• Q: Are these settings location-specific?
  A: No. These are insurer-level global settings. Location-specific constraints are managed in dedicated tabs (for example, CPT limits by location).