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Documentation Index

Fetch the complete documentation index at: https://docs.stratapt.com/llms.txt

Use this file to discover all available pages before exploring further.

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Why This Matters

Front desk staff and clinicians are often the first people a patient asks about their out-of-pocket costs. Knowing the difference between a copay, co-insurance, and deductible — and where each one lives in StrataEMR — lets you answer confidently, collect the right amount, and avoid billing surprises later.

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The Three Cost-Sharing Types

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Copay

A copay is a flat dollar amount the patient pays for a specific type of visit, regardless of what the visit costs. It is defined on the patient’s insurance policy and is the same every time.
  • Example: $35 per physical therapy visit
  • When it applies: At every visit, usually regardless of whether the deductible is met
  • In StrataEMR: The copay appears in the patient’s policy details and drives the recommended amount shown at time of service

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Co-Insurance

Co-insurance is a percentage of the allowed amount the patient owes after their deductible is met. Unlike a copay, co-insurance varies based on what the visit costs and what the payer allows.
  • Example: Patient owes 20% of the allowed amount after their deductible is met
  • When it applies: After the patient has paid their full deductible for the year
  • In StrataEMR: Co-insurance is reflected in the benefit verification data and affects the amount shown in the Clarity Panel once the claim is adjudicated
Note: Co-insurance cannot be calculated exactly at time of service because it depends on the payer’s allowed amount, which is not confirmed until the claim is adjudicated. The recommended amount provides an estimate, not a guaranteed figure.

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Deductible

A deductible is the total amount the patient must pay out of pocket before their insurance begins sharing in the cost of care. Until the deductible is met, the patient typically pays the full allowed amount for each visit.
  • Example: A $1,000 annual deductible means the patient pays the first $1,000 of covered services each year before insurance kicks in
  • When it applies: At the start of every plan year — usually January 1 — until the deductible is met
  • In StrataEMR: The remaining deductible is tracked in the patient’s benefit verification data and factors into the collection suggestion
Note: Deductibles reset annually. Re-verify patient benefits at the start of each new plan year to ensure StrataEMR has the correct deductible remaining.

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How These Can Appear Together

Some patients have more than one type of cost-sharing active at the same time. Common combinations: Copay only: The patient pays a flat amount per visit. No deductible or co-insurance applies. Collect the flat copay amount every visit. Deductible, then co-insurance: The patient has an annual deductible and a co-insurance percentage. For early-year visits, they pay the full allowed amount toward their deductible. Once the deductible is met, they pay their co-insurance percentage per visit. Copay plus co-insurance: Some plans charge a copay at every visit and also apply co-insurance to specific services billed within that visit. Both amounts may appear in the Clarity Panel after adjudication. Copay plus deductible: Less common. The patient pays a copay each visit and also has a deductible that applies to certain services billed.

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How Much Should You Collect at Time of Service?

The recommended amount in StrataEMR is your starting point. It is calculated from the patient’s verified benefits and gives the most accurate estimate available before the claim is adjudicated. As a general guide:
  • If the patient has a copay, collect the flat copay amount shown in their policy. This is the most reliable figure.
  • If StrataEMR has calculated a recommended amount based on the patient’s payer history, collect the amount shown for the visit (the recommended amount) and let the Clarity Panel settle the final balance after adjudication.
  • If the patient has an outstanding patient responsibility, collect the amount shown on the task on the patient’s case.
Warning: Do not collect from patients whose secondary insurance is Medicaid. Medicaid is a payer of last resort and covers the patient’s share. Collecting from a Medicaid secondary patient when not permitted may violate your payer agreement.