• The Primary, Secondary, and Tertiary Insurances are on one Insurance Profile.
• When the Insurance changes, a new Insurance Profile should be created.

Insurance Management

• Insurance Management is located on the Patient and Encounter Dashboards in the Active Policies panel and on the Add/Modify Appointment screen. 
• Responsibility is established by the order that the Insurances are added in the Profile.

• Primary Insurance > Secondary Insurance > Tertiary Insurance > Patient
• The Primary Insurance is initially responsible.
• If the Patient has a Secondary and/or Tertiary Insurance, they become responsible in that order after the Primary adjudicates the Claim.
• After adjudication of the Insurance(s), the balance becomes the Patient's Responsibility.

Example: The Patient has Medicare as Primary and AARP as Secondary.

• The Claim is sent to Medicare and Payment is received and posted.
• The Claim is forwarded to AARP by Medicare, and AARP applies the balance to the Patient's deductible.
• The balance is now the Patient's Responsibility.

Insurance Profiles

• Add a New Insurance Profile: When a Patient has NEW Insurance, you always add a new Profile.

• Example:

• If the Patient had Aetna for the previous year, but they now have CIGNA for the current year, a new Profile should be created.

• See documentation and examples below for adding Secondary or Tertiary.

• Profile Statuses

• Default: The Default Profile is listed first.
• Active: Active Profiles below the Default.
• Collections: Profiles in Collections are also listed
• Inactive: You have the option to show Active Profiles only or to Include Inactive Profiles.

• A Profile should remain Active when there exist Active Encounters on that Profile.
• A DME and Workers Comp Profile can be listed as Active policies instead of Default.

• Primary, Secondary, and Tertiary Insurances are on one Insurance Profile.
• Make changes to Profiles by selecting Default or Active.
• Move Encounters from one profile to another and queue for re-billing.
• Hover-over Insurance to see Insurance Details.

• The Payer ID can be used to verify the Insurance against the Patient's Insurance card.

Add a Secondary or Tertiary Insurance

If you have already added the Primary Insurance and discover later that the Patient also has a Secondary Insurance, consider the following before adding the additional Insurance.

• Have you billed Encounters that were paid with the current Profile?

• Did the Patient have the Secondary/Tertiary Payer on the Encounter Dates of Service where the Primary Payer has already been paid?

• Should the Encounters that are attached to the Primary Profile also be billed to the Secondary/Tertiary Payer that you are adding?

• How long has it been since the Primary was added as an Insurance Profile?

Example 1: You added Medicare as the Primary Payer six months ago, and Encounter Payments have been posted during that six-month period. The Patient now (6 months later) presents a Medicare and Medicaid card.

• Question: Did the Patient have Medicaid as a Secondary six months ago?

• If not, DO NOT add to the current Medicare Profile.

• Create a NEW Insurance Profile with Medicare as Primary and Medicaid as Secondary.
• If Medicaid is added to the current Profile, the System will bill the previous Encounters to Medicaid when the Patient did not actually have Medicaid during that time.

Example 2: You added Medicare as Primary recently, and discover when the Remit is received that the Patient also has Medicaid for that DOS.

• If you verify that the Patient had Medicaid for the DOS of the Encounter, the Secondary can be added to the current Medicare Profile.

Learn More

Insurance Profile Overview

Insurance Policies

Default and Active Insurance Profiles

Add/Modify Insurance Profiles on an Existing Patient

Modify the Policy Holder Information

Move Existing Encounters to a New Insurance Profile

Delete an Insurance Profile

Expire an Insurance

Policies Not Part of an Insurance Profile

Medicare Secondary Payer Reason (MSP)

Use Plan and Product

Add an Alternate Address to an Existing Insurance

Default and Active

Workman's Compensation Policy Profile