Start Setup:

• To create a new configuration: Click + Add new claim configuration on the right side of the screen.
• To edit an existing configuration: Select the insurance configuration from the dropdown menu, then click Edit.

Connect Health Plans: In the pop-up window, select the insurance plans you want to connect to this claim configuration.

• Add Details: Enter the Procedure Code, Title, and Description for the service.

Choose a Unit Type:

• Time-Based: The unit count depends on service duration (e.g., 1 unit = 30 minutes).
• Fixed Unit: The unit count stays fixed per visit regardless of duration (e.g., 1 unit = 1 service).
• Variable: The total charge amount varies per visit occurrence.

If you select Time-Based, complete the following fields:

• Unit Duration: Enter the number of minutes that equal one unit (e.g., 30).
• Maximum Units (Optional): Enter a maximum unit cap, or leave this field blank for no limit.
  • Note: If you set a cap, any duration exceeding the billable limit will remain marked as non-billable time and will not carry over to another code.
• Rounding: By default, Pear Suite will round up to the nearest unit if the duration of the encounter was more than half of the unit length.  If you'd like to customize your rounding rules so that no rounding up is enabled or if you need a different rounding threshold, check Enable Rounding Configuration to input your custom rounding rules.

Setting Up Time-Accumulation Billing (Billing Code Sequences)

Use time-accumulation billing if your services pool a member's eligible minutes over a billing period and distribute them down an ordered chain of codes.

Common Example: Medicare CHI services bill the first 60 minutes under G0019 and any subsequent 30-minute increments under G0022.

1. Create All Configurations First: Build every individual claim configuration needed for the sequence before setting up the chain.
2. Enable the Sequence: Check the option to enable the Billing Code Sequence.
3. Set the Spillover Cutoff: Enter the maximum time limit (in minutes) for the primary code.
   1. Example: For G0019, set the cutoff to 60. Minutes beyond 60 will spill over to the next code. If left blank, this configuration will consume all remaining time.
4. Select the Next Configuration: Choose the follow-up configuration from the dropdown list (e.g., G0022).
5. Set Maximum Limits: If the final spillover configuration has a overall unit cap, define that limit within the last claim configuration in the chain.

Note: Enabling a billing code sequence automatically applies the spillover logic to generated claims.

For example, if you log a single 90-minute activity under G0019, the resulting claim will automatically split into:

• 1 unit of G0019 (covering the first 60 minutes)
• 1 unit of G0022 (covering the remaining 30 minutes)

However, your internal activity logs and activity export reports will still reflect only the original selection (G0019).

Best Practice: To keep your activity tracking and reporting perfectly aligned with your claims, have your team manually log these as two separate activities, assigning the correct procedure code to each segment.