Plan Benefit - Definition:
The Plan Benefit is the total amount payable under the terms of the agreement with the payor. It includes amounts that are to be paid by the payor, as well as amounts that are to be paid by the patient, such as deductibles and co-insurance. 

The AnalyTXs AllPayor system employs a unique "tool box" which allows all contract terms to be modeled and the Plan Benefit to be calculated. For example: carve-outs based on diagnosis codes and/or procedure codes with ceiling limits or limits based on per-unit values are easily accommodated. Some of the tools in the "tool box" are stop-loss, rehabilitation, skilled nursing, newborns, neonatal, laparoscopic procedures, CT scans, MRIs, trauma team activation, open heart, high cost drugs, implants, outpatient fee schedules, ASC tables, etc. New tools are easily created and deployed in a matter of hours for any of the unique contract terms which might not fit into already established "tools". The sum of the calculated amounts due under the specific terms of the contract is the Plan Benefit.