🎯 Billing Mode Selection

📋 Patient & Insurance Information

Provider Codes Reference:

MB - 155 834 6098 | AF - 167 906 1196 | HK - 106 391 6138

🤱 Pregnancy Information

💼 Insurance Details

Insurance Options:

📅 Next Year Insurance Information

These values are used when EDD or specific procedures fall in the next calendar year

Payment Method Selection:

Note: Enable both options for plans that use copay for office visits and coinsurance for testing/procedures. When Office Visit copay is enabled and copay amount is entered, office visits will use copay. When disabled or no copay amount, office visits will use coinsurance like other services.

Billing Options:

Note: Enable for patients with 100% coverage on certain procedures. When enabled, covered services will show $0 patient responsibility and insurance will be billed first instead of collecting upfront payment.

💼 Insurance Allowable Rates

Note: These rates auto-populate based on your insurance selection but can be manually edited if needed.

📅 Deductible Year Info

💰 Calculated Results

Remaining Deductible
$0.00
Remaining Out-of-Pocket
$0.00
Confirmation Visit
$0.00
FTS (First Trimester Screen)
$0.00
Separate charge if selected
20 Week Ultrasound
$0.00
Separate charge if selected
Estimated Patient Responsibility
$0.00
Global + ($350 Circumcision)

Payment Schedule

Enter 28-week date to calculate payment schedule

This is an estimate. Final billing depends on actual services and insurance processing.