Configuring Health Plan Event Settings
This article covers how to set scheduling rules — including session overlap, allowed days, time windows, and duration limits — at the health plan level for a specific payer. These settings help ensure your billing stays within each payer's requirements.
Who This Applies To
- Admins with access to Configuration settings
- Organizations that have at least one Payer and at least one Health Plan configured
- Admins setting up a new payer or updating plan-level session rules
Before You Begin
- You must have Admin-level access.
- The payer must already be added to your account (Configuration > Billing > Payers).
- At least one Health Plan must exist under the payer.
Step-by-Step Instructions
Step 1 — Navigate to the Payer
- From the Agency navigation menu, go to Configuration > Billing.
- Click Payers.
- Select the payer you want to configure (e.g., Aetna).
Step 2 — Open the Health Plan
- On the payer detail page, locate the health plan cards on the right side of the screen.
- Click the health plan card you intend to configure (e.g., Default).
- A modal window opens titled [Plan Name] | [Payer] | Health Plan.
Step 3 — Open the Event Configuration Tab
- Inside the health plan modal, click the event_configuration tab.
- A caution banner will appear — read it before making changes. These are advanced settings.
Step 4 — Configure the Fields
Update the fields as needed for the payer's plan requirements. See the field reference table below for a description of each setting.
|
Field |
Default |
What It Controls |
|
Allow overlapping (Client) |
No |
Whether a client can have two sessions scheduled at the same time under this plan. |
|
Allow overlapping (Provider) |
No |
Whether a provider can be scheduled for two sessions simultaneously under this plan. |
|
Allowed days |
No Restriction |
The day(s) of the week on which sessions may be scheduled. Select a specific day or leave as No Restriction to allow all days. |
|
Start time |
12:00 AM |
The earliest time a session can begin under this plan. |
|
End time |
11:59 PM |
The latest time a session can end under this plan. |
|
Max Duration per Day (Client) |
10 hours |
Maximum total session hours a client can receive in a single day. |
|
Max Duration per Day (Provider) |
10 hours |
Maximum total session hours a provider can deliver in a single day. |
|
Max Duration per Week (Client) |
40 hours |
Maximum total session hours a client can receive in a calendar week. |
|
Max Duration per Week (Provider) |
60 hours |
Maximum total session hours a provider can deliver in a calendar week. |
|
Max consecutive days (Client) |
30 days |
Maximum number of consecutive days a client can have sessions scheduled. |
|
Max consecutive days (Provider) |
30 days |
Maximum number of consecutive days a provider can deliver sessions. |
Step 5 — Save Your Changes
- After updating the fields, click Update.
- A green "Updated with success" notification will appear at the top of the screen confirming your changes were saved.
Managing an Existing Configuration
Use the Actions menu (top right of the Event configuration tab) to manage a saved configuration:
|
Action |
What It Does |
|
Reset event configuration |
Restores all fields to their default values. Your saved configuration is replaced with the system defaults. |
|
Remove event configuration |
Deletes the event configuration entirely. The tab will display a “+ Add event configuration” button so you can create a new one. |
Troubleshooting
|
Issue |
What to Do |
|
The Event configuration tab is not visible |
Confirm the health plan exists and is open. Tab visibility depends on having a valid plan record. |
|
The tab shows only an "+ Add event configuration" button |
The configuration was removed or not added. Click on it to create a new one. |
|
Changes aren't saving |
Make sure you click Update before closing the modal. Changes are not auto-saved. |
|
I set a field incorrectly and need to start over |
Use Actions > Reset event configuration to restore all fields to defaults. |