• It 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.

• This means that the Patient has NEW Insurance.

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

• This may not apply to adding a Secondary or Tertiary.

• See Examples below for adding Secondary or Tertiary later.

• 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.

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

Example 1: You added Medicare as the Primary Payer six months ago, and Encounters 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.