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Overview

The Scenarios feature allows you to model different billing approaches and compare potential revenue outcomes before submitting claims.

Accessing Scenarios

Click Scenarios in the sidebar navigation.

What Are Scenarios?

A scenario is a “what-if” calculation that shows how different billing codes or configurations would affect your revenue. Use scenarios to:
  • Compare billing code options
  • Evaluate premium code eligibility
  • Optimize billing strategies

Creating a Scenario

1

Start New Scenario

Click New Scenario or clone an existing one
2

Add Services

Enter the services you want to model:
  • Billing codes
  • Quantities
  • Time factors (if applicable)
3

Configure Options

Adjust settings like:
  • Premium eligibility
  • Facility type
  • Time of service
4

Calculate

Click Calculate to see the projected revenue

Comparing Scenarios

Create multiple scenarios with different configurations to compare:
ScenarioBilling CodesProjected Revenue
Option AA001A, A002A$150.00
Option BA001A, A003A$175.00
Option CA004A$125.00

Sharing Scenarios

Share scenarios with colleagues:
  1. Click Share
  2. Copy the generated URL
  3. Recipients can view (but not modify) your scenario
Scenario URLs include all configuration in the parameters, so they work without requiring login.

Cloning Scenarios

Duplicate a scenario to create variations:
  1. Open the scenario
  2. Click Clone
  3. Modify the copy as needed
  4. Save as a new scenario

Use Cases

Comparing Time-Based Billing

Model different time durations to see how they affect fees for time-based codes.

Premium Code Analysis

Determine if premium codes apply and calculate the additional revenue.

New Service Planning

Before offering a new service, model the expected revenue based on OHIP fees.

Limitations

  • Scenarios are estimates based on current fee schedules
  • Actual payments may vary based on OHIP processing
  • Scenarios don’t account for rejection risks