Services

A Service is an instance of care, set up for future use, completed, and then billed for.

Each Service has a configuration that details the type of care to be delivered, affecting Service Eligibility.

It houses the Provider’s Notes, and the lifecycle of insurance claims.

All updates to a Service (status change, estimate change, etc.,) will be broadcast as an Event and pushed through webhooks.

Estimates

When a Service is created, the Patient’s currently-active Insurance is evaluated to find the Policy that best suits. Given that, Bridge will fetch real-time information on the patient’s progress towards their deductibles/out-of-pocket limits, and create a “Service Estimate”. This can be presented to the Patient, and used to collect any copays/coinsurance.

Notes

Services require a signed Note to be attached before billing. Bridge will coordinate the format of these, and Providers should be aware of how they should be tailored for successful claims. Use the Service Notes API to submit these before moving into Billing.

Billing

The lifecycle of a Service tracks its progress through the billing process. This is initiated by a call to the Bill Service API.

Bridge handles the claims process, but Providers must submit their signed Notes before claims can be submitted.

Payments are tracked against specific Services, these include both patient responsibility (which you may collect, and register as an “external payment”, or Bridge can collect directly), and insurance reimbursements.

When claims are processed, the finalized insurance payment allows Bridge to determine the actual patient responsibility. In most cases, the Service Estimate should be accurate, and the patient responsibility (in the form of copay) should have already been collected. Otherwise, those can be handled in the “SETTLING” phase.

Settling

If the Patient responsibility was collected accurately, and there is no outstanding balance, the Service immediately moves through to the COMPLETE status.

If the Patient responsibility was not charged, undercharged, or overcharged, the Service will remain in the SETTLING state. Webhooks will notify your system of the outstanding balance.

Register payments and refunds using the [Create Payment] API, when the outstanding balance reaches zero the Service moves into COMPLETE.

Triage

During the claims process, Bridge may need to contact you, or require information from the Provider. Services will move into the TRIAGE state, and will move out when a claim is resubmit or if a denial is accepted.

While in the TRIAGE status, inspect the tasks property of the Service to determine what actions to take. See the Get Service API for the list of task types. The catch-all TRIAGE task type will have a memo attached explaining the issue.