Access to Add/Modify Insurance Policy is controlled by User Permissions.

Policy Breakdown Panel (Encounter Specific)

Insurance / Employer Management

• Using this link a new Insurance Profile can be added or changes can be made to an existing Insurance Profile.
• All active and inactive profiles can be viewed.
• Encounters can be moved from one Profile to another.
• Policies can be added that are not part of a Profile

• Example: The Patient has a Medicare Advantage Plan. The Medicare card is entered in the Policies Not Part of a Profile for information purposes only. This card will not show for use to bill Claims.

• If the Patient drops the Medicare Advantage plan, the Medicare card info can be moved to the Active Profiles

• Claim History: View Claim Status changes and Claim Submission History

• Filter Criteria
• Timely Filing
• Add to Worklist
• ANSI Submission History
• Most Recent Claims Batch number

Insurance and Patient Responsibility Information (Encounter Specific)

• Insurance/Employer: Name of the Responsible Party (Payer, Employer of Patient Name)

• Hover-over shows Payer information
• Select the Payer Name Link to go to the Add/Modify Policy screen where Policy information can be edited.

• Card Scanned: *This is a Premium Add-On Feature.
• Policy: Policy Number
• Group: Group Number/Name
• Status | Last Checked: Status of the Claim when it was last checked.

• Common Statuses:

• Ready for Submission/Resubmission: If the Reference Batch is closed the claim will be in the next Claims Batch.
• Hold Coordination of Benefits: Holding for current Responsible Party to pay.

• This status will automatically change when the payment is posted for the current Responsible Party.

• Payer Accepted: The Claim has been accepted by the Payer, but this does not mean that the Claim is going to be adjudicated.

• Responsibility Date: The date that this payer became responsible.
• Days that this payer has been responsible
• Bill Date: The days since the Claim was last billed.

• If the Responsible Party is a Collections Agency, the Bill Date will reflect the date that the Encounter was sent to Collections.
• If the Responsible Party is an Employer (Invoice Billing), the Bill Date will reflect the Mailed Date.

• Days: Days since the claim was last billed
• Eligibility / Verified | DOS

• Use the Verify link to run an Eligibility Check.

• If the dates do not have a link, Eligibility was checked manually.

• The first date shows the last date that Eligibility was requested.
• The second Date shows the last Date of Service for the request.
• The Check Mark, X, or Question Mark shows the Status.
• If there is not a date, Eligibility has not been checked on the Encounter Level.

• Balance: Shows the Balance that is in the Responsible Party's amount owed.

Learn More

Encounter Dashboard Overview

Actions Panel

Charge Panel

Encounter Balance Panel

Procedure Panel

Encounter Notes Panel

Other Encounter Panels