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Payors

warning

Satxuma is still under active development. It is not yet HIPAA compliant and should only be used with dummy data.

A payor is the person or company responsible for reimbursing therapy services. In other words, a payor is the entity that pays for all or part of a patient’s care.

Data model​

Satxuma stores payors under an organization:

Payor types​

Every payor must have a payor type. Payor type must be one of

  • Commercial Insurance
  • Managed Care Part A
  • Managed Care Part B
  • Medicaid
  • Medicare Part A
  • Medicare Part B
  • Private Pay
  • Workers' Compensation

Payor type can used to design a contract with a facility. Additionally, Satxuma uses the payor type to enforce some rules. For example, if a payor with type Medicare A exists in a billing period, it must be the ONLY payor in that billing period.

Properties​

A Payor has the following properties:

  • id (string)
    A unique identifier for the payor.
  • name (string)
    The name of the payor. Must be a non-empty string.
  • type (PayorType)
    The type of payor. Types include:
    • Commercial Insurance
    • Managed Care Part A
    • Managed Care Part B
    • Medicaid
    • Medicare Part A
    • Medicare Part B
    • Private Pay
    • Workers' Compensation
  • notes (string, optional)
    Optional free-text notes about the payor, such as plan details or restrictions.

Examples​

Example 1: Medicare Part A​

{
  "id": "123",
  "name": "Medicare Part A",
  "type": "Medicare Part A",
  "notes": ""
}

Example 2: Managed Care Plan​

{
  "id": "123",
  "name": "Aetna Rehab Plan",
  "type": "Managed Care",
  "notes": "Covers up to 20 therapy visits per month"
}

Example 3: Private Pay​

{
  "id": "123",
  "name": "Joe Blow",
  "type": "Private Pay",
  "notes": ""
}

Example 4: Medicaid​

{
  "name": "Healthy Families Medicaid",
  "type": "Medicaid"
}