How to Add Insurance to a Patient’s file
In your software you can add in an Insurance policy where the Patient (self), Another Patient, a Non-Patient or a Company is the policy holder.
If you would like to select a Fee Schedule when applying insurance to a patient's file, you will need to make sure the payer is set up in Admin > Payers and your Fee Schedule has been created in Admin > Fee Schedules.
Please keep in mind: Fee Schedules are not required for billing. They are just extremely helpful if you are aware of an insurance payer’s allowed amounts and would like your software to do automatic write-offs for the difference between what you charge in the office (listed in Price List) and that payer’s allowed amounts (listed in the Fee Schedule).
Before we get started:
*If you are creating a policy where the Patient is the policy holder (self), please go straight to ‘Adding the Policy to the Patient’s File Step 1’.
*If you are needing to create a policy when Another Patient is the policy holder, make sure the policy holding patient has their insurance snapshot as (self), set up before adding the additional family members.
*If you are creating a policy where a Non- Patient is the policy holder, you will need to follow the steps HERE before adding insurance into the patient's file.
*If you are creating a policy where a Company is the policy holder, you will need to follow the steps HERE before adding insurance into the patient's file.
ADDING THE POLICY TO THE PATIENT’S FILE
Go to the Patient Rolodex, by selecting Patients in your main toolbar on the bottom left of the screen
Select Patient Name
Go to the patient's Insurance Tab and Select ADD/EDIT button
Select Create New Policy, Click Next
Select New Primary, Next
- Self - if the patient is a policyholder. (Skip to step 4)
- Another Patient - if another patient is the policyholder.
- Non- Patient - if a person is the policy holder and not a patient in the office.
- Company - if a patient’s company is the policyholder.
*If you select Another Patient
(Select this option if a different patient is the policy holder)
Select the Patient's name who holds the Policy, Next
Select the Policy attached to that patient and select Next
*If you selected Non-Patient
(Select this option if you added the policy holder in as a Non Patient)
Select Non-Patient that was added to the system, Next
Select Policy, Next
*If you selected Company
(Select this option if you added in the Company in Rolodex, as the policy holder)
Select Company added into your software, Next
Select Policy attached to the Company, Next
Step 4: Entering Policy Information
This area is designed to keep your Patient's ledger as accurate as possible so, its best to be as detailed as you can be. However if you do not know some of the info for this page, it will allow you to go ahead and save and you can come back later to add it in.
Let’s breakdown the areas further
You will need to enter the Patient's Insurance ID into box 1a and select Relationship to insured in box 6. Relationship options in the dropdown are: Self, Spouse, Child, Other and Leave blank.
If the Patient has a co-pay, you will enter that into “Patient flat co-pay amount”. The software by default will apply the co-pay towards a deductible, if you DO NOT want the co-pay applied to the deductible, you will have to select the box provided under the co-pay amount that states “Do not apply co-pay to deductible”.
Then you will enter the percentage that insurance covers in the “Insurance percentage of covered charges” location.
If you are just placing in a policy as a courtesy or the patient’s insurance policy does not cover services, you will uncheck the provided ‘Co-Pay Amount’ and ‘Insurance Percentage’ boxes, which will make the patient to be 100% responsible for charges.
In my scenario, my patient has a 25.00 co-pay and then insurance covers 100% of the charges after the co-pay.
If you enter a co-pay amount into the provided location but the insurance percentage is left at 0%, all responsibility after the co-pay amount will be placed on the patient as well.
If a patient does not have a copay and patient has an 80/20 policy. Place 80% into insurance percentage area and the system will place 20% on patient and 80% as payer/insurance responsibility to pay.
In this area you can enter:
- Policy Reset Date
- Indicate if this policy is a Capitation plan
- Enter the Deductible amount
- Enter the Yearly Visit/Dollar Max
- Enter how much money has been used at the time the policy is being added to the patient's account
- Policy Reset Date: The date everything resets, and the counter starts over. A new insurance snapshot will be created automatically on this date.
- Yearly Max Visit: This is the maximum number of visits allowed for services in your office, during the patient’s policy year.
- Number of visits used to date: This number tells the system how many visits have been used in another location so, the software knows where to start counting. Once they hit their Max visit amount, the system will place 100% of the responsibility on the patient to pay for services rendered until the policy reset date.
- Yearly Max Dollar amount: This is the maximum dollar amount allowed for services in your office, during the patient’s policy year.
- Dollar Amount used to date: This number tells the system how much money has been used in another location so the software knows where to start counting. Once they hit their Max Dollar amount, the system will place 100% of the responsibility on the patient to pay for services rendered until the policy reset date.
- Deductible amount: This is where you tell the system how much the patient’s full deductible is.
- Deductible to be met: Of the patient’s deductible, how much is the patient still responsible to pay. When a patient owes an amount towards their deductible, the software will place 100% of the responsibility on the patient to pay. The system will also monitor EOBs received into the office and once the office receives payment on services rendered, the deductible count will be stopped and any NEW charges to a patient’s appointment, from that moment forward, will be allocated based on the policy limits, co-pays and insurance percentage placed into your software.
- This is a capitation plan: You will only check the box provided if this is a capitation plan. A Capitation plan is a plan where a payment arrangement for health care service providers such as physicians, physician assistants or nurse practitioners. It pays a physician or group of physicians a set amount for each enrolled person assigned to them per period, whether that person seeks care or not.
Please keep in mind: the software Does not communicate with any other software or insurance payer database. The software can only account for info placed into it. If the patient has sought treatment at another location, the counts may be slightly off.
This area allows you to connect a Fee Schedule to a Patient and Exhaust Benefits until the reset date, for your Primary policy only.
The Reset date is selected in the prior section.
Fee Schedules are created in Admin > Fee Schedules. If you are entering in a policy for a payer, where a fee schedule has been created, you can select that fee schedule in the drop-down provided.
If you choose to Exhaust benefits in an insurance policy, you are provided two options: You can make the patient 100% responsible for the Price List amount (amount you charge for a service in your office) or the Fee Schedule amount (allowed amounts set forth by the insurance payer) while the benefits are exhausted.
Once the restart date comes up, the policy will go back to the original settings.
In this area, you will be focusing on info placed into the HCFA CMS 1500 form.
- Hold HCFA: If you select the hold HCFA box, HCFAs will not generate for ANY charges within the patient's dates of service until removed. This box does not go off policy start date but, starts the moment the box is pressed.
- Box 13 authorization of Benefits: This box must be checked if the Insured or Responsible party authorizes payment for treatment described on the HCFA generated.
- Box 11 Insured’s Policy Group or FECA number: This is where you would place the Insured’s Group number or FECA number to be presented on a HCFA form.
- 11b Employer’s Name or School Name: This is where you would place the Employer’s name or school name to be presented on a HCFA form.
- 11c Insurance plan name or program name: This is where you would place the Insurance Plan name or program name to be presented on a HCFA form.
- 11d Is there another health benefit plan: This location you must select Yes, No or Leave Blank. Select Yes if there is another health benefit plan such as a Secondary or Tertiary. Select No if the patient has a Primary insurance policy only and select Leave Blank if you were instructed to do so.
- 27 Accept Assignment: Select this box if payment will be sent to the clinic. Do Not select if the patient is to receive reimbursement.
Box 9s Area:
This location is used when there is another health benefit plan. It is separated by Primary, Secondary and Tertiary tabs. You will place the corresponding info onto the correct tab.
For Example: If a Patient has a Secondary, the Secondary’s information will be placed in the box 9s area under the Primary tab. This way the Secondary info is printed on the Primary’s HCFA and provides the Primary the information on who to forward claims to. Tertiary insurance would be placed under the Secondary tab and so forth.
At the very bottom, there is a location for Adjuster information. This info is not placed on a HCFA. In the event you have an Adjusters information, it can be placed here for record and viewed in the patient's Insurance tab, Primary sub-tab.
Once finished making all selections, Select Next
*If your patient has a Secondary, you will select Create New Policy > New Secondary and follow the steps to enter the Secondaries info and repeat these steps if your patient has a Tertiary insurance Policy.
When you are finished entering your patient’s policy information and they do not have any other policies to enter, you will select finished, Next.
Add in the Start Date for the Policy.
Make sure it is BEFORE the first Date of Service the policy is covering, Next
Select OK on the pop up, to confirm the new policy entered
You are all set!!!
Insurance Start Dates cannot be edited once placed in. If you need to change the start date you will need to delete the policy and then add it back in with the correct start date, and the ledger will recalculate.
If your patient requires an authorization before they can use benefits, please click HERE for information on applying an authorization code.
- Support Information -
If you have any questions or need assistance with this process please contact Support by:
Live chat: Click the 'Support Portal' button in your main toolbar (on left-hand side) within your software, click the green 'Support' box in bottom right of screen.***This has the fastest response time***