Insurance Management

Insurance Management is used to manage a Patient's Insurance Profiles.

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, a new Profile must always be added.

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

To make changes to the Profile or Policy, use the Modify Icon

Default: The Default Profile is listed first.
Active: Active Profiles are listed after the Default.

Active Encounters should exist on Active Profiles

Inactive: You have the option to show Active Profiles only or to Include Inactive Profiles.
Expired: Expired Profiles are listed after the Default

If a Profile is Expired, the Status and Expiration date will appear red.

Primary, Secondary, and Tertiary Insurances are on one Insurance Profile.

Move Encounters from one profile to another and queue for re-billing.

Hover over a Policy to see Insurance Details.

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

COLLECTIONS Profiles appear in the Patient column.
Select the History link to show any changes that have been made to the Profile.
To delete a Profile, select the trash icon in the Delete column.

A Profile cannot be deleted if the Profile is associated with any Encounter.

To remove a Profile from view, select the checkbox in the Active column to deactivate a Profile.

Profiles should only be deleted if they were entered in error.

Add a Secondary or Tertiary Insurance

To add a Secondary or Tertiary insurance policy, select the Add button and input the Insurance information.

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.

Primary and Secondary are the Same Insurance

For HSA and HRA Payment, select this link: Post an HSA/HRA Payment

If the Primary and Secondary Insurances are the same, you will get a warning if you try to add the secondary As New.

Add the secondary as From Existing.

Select the same Insurance.

Select Save [F2].

Insurance Management

Insurance Management