The process of billing NIB Type C procedures, to accommodate the SDEX item, has been simplified in FYDO.

To accommodate the easier workflow, development work has been completed to restructure how FYDO processes these claims, ensuring they can continue to be transmitted electronically and paid successfully via ECLIPSE.

As part of this update:
– It will no longer be necessary to manually add SDEX as an item number to each claim
– FYDO will automatically populate and transmit the required information in the correct segments in line with NIB’s updated requirements

Please see the updated requirements below for billing NIB procedures with a Type C Certificate:

1. Settings > Health Fund Fees > Fund: NIB > Other Settings tab.
   Review the two options below to ensure the setting aligns with your NIB contract stipulations:
   – When Type C – Charge Theatre fees is to be selected if your contract allows theatre fees for the Type C item number.
   – When Type C – ignore Type C accom fee is to be selected if the contract allows for the regular accommodation band (1 to 4) to be billed, instead of the specific Type C Accommodate Fee.

2. The Type C Accommodation Fee must be configured, as it will be used and reported within the Single Value Benefit (Casebase Fee) segment. This can be found in the Same Day Fees tab.

3. NIB Type C procedures are now required to be billed on a per diem basis. When using the Create Invoice screen, please ensure that the billing type is set to Default or Per Diem. FYDO will convert the per diem Type C bed fee into the required Single Value Benefit (Casebase Fee) segment, applying the appropriate mapping code.

If you require any further clarification, please don’t hesitate to reach out.