Set up outpatient per diem billing in Ease Health, match a charge rule to the level of care, and compare the generated dates and units in Claim Preview.
Ease Health can generate level-of-care events for per diem billing while IOP and PHP stay classified as outpatient. Open Configuration > Level of Care > Configuration Editor, find the program in Outpatient LOC, and select Bills per diem. Pair the setting with a matching Charge Code Rule, then verify the proposed service dates and units in Claim Preview.
This walkthrough uses a fictional day program that already bills its intensive outpatient program (IOP) by the day. Use the same sequence for a partial hospitalization program (PHP) whose billing terms use a daily unit. Have the billing lead bring the applicable service and contract terms into the test so the team has an expected result before opening the software.
Set up IOP and PHP per diem billing
- Map the level of care. In Configuration Editor, select the catalog level the organization offers and put it in Outpatient LOC. If the program is already mapped there, use its existing row.
- Check the site. Open the Locations tab and review the locations at which staff can assign that level. In a sample chart, choose the program site in Assign and confirm that the expected level appears.
- Select Bills per diem. Return to Configuration Editor and select the checkbox on the outpatient row. The selection saves immediately. Confirm it stays selected when the list reloads. A configuration editor can make the change, while a staff member with view access can check the setting.
- Check the sample admission. Open the patient's Level of Care tab and confirm the program, location and dates. Review the admission record with the person who entered it before investigating a charge.
The location selection controls where staff can choose a level in the chart. Bills per diem controls whether a stay at that outpatient level produces a level-of-care event. Check both when a new site starts offering the program. Configure levels of care by location
Match the event to a Charge Code Rule
Open Charge Code Rules and check the rule your billing team uses for the daily service. Its Level of Care condition can match the level-of-care event produced by the stay. Compare the level on the rule with the level on the sample admission. Then check any location, payer and effective-date conditions used by your rule. Have the rule owner explain which source supplies each detail and show the result on the sample.
Use the code, units and applicable conditions your billing team has verified for the service. Some programs bill by a daily unit and others by time or encounter. The setting controls the source of a proposed charge in Ease Health. Your contract and the applicable billing instructions determine the unit you expect to see. Substance use billing guide
For a program that previously generated individual encounter charges, review both sources in the same test period. Ask the biller to identify each proposed line, explain how it was generated and confirm whether separate services are expected. Record the expected result for the specific program and payer before changing the setup used across sites.
Find the stay in Claimable Events
Open Claimable Events after the billing data refresh. Filter by the sample patient and service dates, then look for LOC under Event Type. A level-of-care event starts from the admission. The per diem rule uses the qualifying days in that stay to generate the proposed charges.
Compare the range on the worklist with the chart. If a patient moved between programs, look for the correct receiving level, location and start date in the chart. Check the original stay and the new stay separately, especially around the transfer date. Use the facility and professional claim matrix to record which team owns each line when the program and a clinician both provide services. IOP and PHP claim responsibility matrix
Review the dates and units in Claim Preview
Select the sample event and open Preview Claim. Compare the service dates, procedure or revenue code, and units against the expected result you wrote down before the demo. Check the payer, location and providers that appear in the preview. Ask billing to explain the source of any value that differs from the chart or the team's expectation.
In a fictional two-day IOP test, give the reviewer one qualifying day and a second day that needs a decision. Record what the billing team expects on both dates before it looks at the preview. Ask the reviewer to point to the source record and the matching rule for each line. For a review-only demo, finish at the preview. Claim generation walkthrough
Investigate a missing day or charge
| What you see | Check first | Who can confirm the result |
|---|---|---|
| IOP is missing from the chart picker | Check the catalog mapping and the chosen location | Configuration editor |
| The stay is in the chart but no LOC event appears | Check Bills per diem, the patient and date filters, and the billing data refresh | Configuration editor and biller |
| The event shows No charge rule | Check the Level of Care condition and other rule criteria for that sample | Charge rule owner |
| Only some dates are available | Compare the stay, dates and the reason on each affected row | Biller and program staff |
| A preview line has different units than expected | Compare the matching rule and its output with the reviewed billing terms | Billing lead |
When the default list is empty, keep the sample patient's date range and expand the Billable filter to see events that need follow-up. Read the reason on the row before changing the chart or the rule. A charge setup issue and a documentation issue belong with different staff. Troubleshoot a missing claimable event
Record the test before extending the setup
Keep the test record for the program location, the mapped level of care, the date range, the matching rule and the expected claim lines. Have a program staff member confirm the source admission and a billing staff member confirm the preview. Include an exception such as a date outside the expected period or a second location that uses a different rule. That gives the next site a worked example and a clear check for where its setup differs.
If the program moves patients from PHP to IOP, repeat the same review for the receiving program and its first date of service. The two-site demo follows the chart, schedule, documentation and claim review across that handoff. Two-site IOP and PHP demo
Related reading:
Frequently Asked Questions
Can IOP and PHP stay outpatient when they bill per diem?
Yes. In Ease Health, select Bills per diem on the Outpatient LOC row. The program stays in the outpatient list and its stays can produce level-of-care events for per diem billing.
Does Bills per diem generate the charge by itself?
The setting supplies the level-of-care event. A matching Charge Code Rule determines the proposed charge. In Claim Preview, compare the dates, code and units with the billing terms for the service.
When does a new per diem event appear?
The setting saves when you select the checkbox. Look for the event after the next billing data refresh. If it is still missing, check the patient stay, the service dates, the LOC filter and any billing status filters.
How can I review a per diem claim before submission?
Open the level-of-care event in Claimable Events and choose Preview Claim. Compare the claim lines with your source records and billing terms. Leave the example in preview for a review-only test.
