Lytec Tables:

Patient

· List of all patients

· 'Chart Number' uniquely identifies patients

· Optional 'Primary Code' is the code of the primary insurance and must be found on the insurance table.

· Optional 'Secondary Code' is the code of the secondary insurance and must be found on the insurance table.

· Optional 'provider' is the code of the provider and must be found on the provider table.

· Optional 'primary insured - patient' must be found on the patient table itself. It is the person who holds the insurance for the patient, and is another patient.

· Optional 'primary insured - guarantor' must be found on the guarantor table. It is the person who holds the insurance for the patient, and is not a patient.

· Optional 'fee schedule type' must be found on the fee schedule header table, and it connects to the non-unique 'type' in that table.

· Optional 'patient code' must exist on the patient code table

Guarantor

· List of all people who hold insurance but are not patients

· 'Code' uniquely identifies guarantors

Transaction Code

· List of all types of transactions.

· Code uniquely identifies

Billing Detail

· Every billing detail has one transaction code

· 'Billing' must exist on the billing header

· 'Unique ID' identifies the billing detail

· 'Provider Code' must be found on the provider table

· Mandatory Item - main line number on the bill, starting at 0. These can be charges or payments, but all would not be associated to another main line number.

· Mandatory sub-item - sub number within the line, with payments and adjustments at the line level being sub-items.

· Charge - amount the patient is charged for a procedure, or the amount paid. This is always positive.

· Extended - amount the patient is charged for a procedure * the quantity. If this is a payment or negative adjustment, the amount is negative.

· Patient portion - the copay amount on each line. This only appears on charges and is just for documentation. It is not added to the charge. It defaults from the fee schedule.

· Detail note - check number on a payment transaction.

· Allowed - allowed amount originally coming from the fee schedule but able to be changed. This should be an extended allowed amount, so if you have a quantity of 2, it should show double the allowed amount.

· CPT code - the cpt code on each line. This only appears on charges and defaults from the fee schedule.

Billing Header

· Every billing header has one patient

· Billing uniquely identifies the bill header

· (Note: the patient has a fee schedule, but the bill header does not.)

· (Note: many other fields default from the patient, but the bill header overrides)

· Optional 'Primary Code' is the code of the primary insurance and must be found on the insurance table.

· Optional 'Secondary Code' is the code of the secondary insurance and must be found on the insurance table.

· Optional 'provider' is the code of the provider and must be found on the provider table.

· Optional 'primary insured - patient' must be found on the patient table itself. It is the person who holds the insurance for the patient, and is another patient.

· Optional 'primary insured - guarantor' must be found on the guarantor table. It is the person who holds the insurance for the patient, and is not a patient.

· Optional Location code

Patient Code

· Lists all patient codes (which is a type of patient to group patients)

· Provider

· Lists all providers

· Code uniquely identifies

Insurance

· Lists all insurance companies

· 'Code' uniquely identifies

· Optional 'fee schedule type' must be found on the fee schedule header table, and it connects to the non-unique 'type' in that table. Lytec will use the fee schedule of the insurance if both the patient and insurance have a fee schedule.

Fee schedule header

· Lists all fee schedules with their activity dates.

· 'Code' uniquely identifies, but normally you want each type to only have one record per date range.

Fee schedule detail

· 'Code' + 'transaction code' + locality + carrier id + uniquely identifies

· 'Code' must exist on the fee schedule header.

· Code indicates fee schedule description and activity dates

· 'transaction code' must be on the transaction code table.

Lytec uses fee schedules to find the following fields:

· Cpt code - which it defaults into the billing detail table (overrides tran code value and can be overridden on the bill)

· Type of service - which it stamps into the billing detail table (overrides tran code value and can be overridden on the bill)

· Place of service - which it stamps into the billing detail table (overrides tran code value and can be overridden on the bill)

· Facility Allowed & non-facility allowed - which it stamps into the billing detail table in its allowed field (should choose a value based on whether a facility code is filled, but may always choose non-facility). (overrides tran code value, and can be overridden on the bill entry).

· Modifier 1-4 - which it uses as a default when creating the billing detail modifier codes, but the user can change on bill entry.

· Charge - which it uses as a default when creating the billing detail but user can change on bill entry

· Co-pay - which it uses as a default when creating the billing detail's patient portion field but the user can change on the bill

· Co-pay type - which it uses to decide whether the co-pay is a percentage or flat amount. If percentage, bill entry will calculate instead of using co-pay amount.

Location Table

· Code uniquely identifies

· Its locality and carrier ID cross reference to the fee schedule

· It is used on a bill. Each bill can have one location code.