Repasse aos profissionais

Every clinic calculates, every month, how much of what it received belongs to the professional who provided the care — and almost always does it in a spreadsheet. Here the calculation comes out ready: the month's claims, received base, each person's percentage and the payable generated at closing.

The base for the payout is the billed amount of the claims minus the LOST disallowances. This is where the spreadsheet gets it wrong: paying out on the billed amount pays the professional part of a disallowance the clinic never received, and the difference comes out of the clinic's pocket, every month, without anyone seeing where it disappears. A disallowance under APPEAL does not reduce it — while it's being disputed, the money can still come back, and subtracting it in advance would be the symmetrical error.

You can register a general percentage per professional and a specific one per health plan. The health plan one prevails, because the plan that pays less usually has a different payout. The effective date lets you renegotiate the percentage without rewriting the past: March's closing keeps showing March's percentage.

The closing is unique per professional and period — clicking again does not pay twice, which is the most expensive possible mistake here. What has already been closed is recorded with the base and the percentage of that moment; to correct it, generate the payable only when the calculation is right, or post the adjustment in finance with the reason written down.