When a new Insurance or Self Pay Profile is added, you may need to move some of the existing Encounters to the new Profile.

• This most often occurs when a claim is denied for not being covered, and a new Insurance Profile needs to be added and existing Encounters moved to the new Profile.

Move Encounter(s) to a New Insurance Profile

1. From the Patient Dashboard, select Insurance Management in the Active Policies panel.

2. Select the Profile line that contains the Encounters you want to move. (The line will be highlighted.)

• Select the Include Inactive Profiles button to view all Profiles.

3. From the list at the bottom of the screen, select the checkbox beside each Encounter number that needs to be moved.
4. Select Change Profile/Rebill.

5. From Current Profile - To New Profile: These usually default correctly, but check to make sure the Encounters are being moved to the New Profile you created.
6. Transfer Balance From Patient To:

• If the Encounter Balance is in Insurance Responsibility, this field will not display. Skip to the next numbered step.
• The field only displays if the Balance is Patient Responsibility and is being transferred to an Insurance.

• It will default to the Primary Insurance, which is not always correct.
• From the dropdown menu, select the Insurance to bill.

• See Examples of adding a Secondary Insurance.

7. Rebill: Leave checked. This will automatically set the Claim Status to Ready for Submission for the Encounters that are moved to the New Profile.
8. Reset Dunning: When changing from one Insurance to another, the Reset Dunning Count is auto checked.

• The Dunning Count will be reset to zero if left checked.

9. Enter a Claim History Note (optional).

• Save as a Billing Note if you want to see this note on the Encounter Dashboard.
• This is an internal note only.

10. Encounters with Fee Changes: When changing Insurances sometimes the Fees may be different.

• If you want to Update the Fees for the new Insurance, leave the box checked.

11. Select Save [F2].

The Encounters will now be on the New Profile, and the Claim Status is auto-set to Ready for Submission.

Add a Secondary Insurance when the Balance is Patient Responsibility

The Primary Insurance was billed and paid, and the Encounter Balance dropped to Patient Responsibility.

• The Patient had a secondary Insurance that was not part of the Insurance Profile at the time the Primary was billed

Example 1: Create a New Insurance Profile

• A new Insurance Profile is added with the primary and secondary Insurances.
• The Encounter is transferred to the new Insurance Profile.
• Transfer Balance From Patient To: Only the secondary Insurance needs to be billed, therefore select the secondary from the dropdown menu.

• After saving the new Insurance Profile, the Secondary Insurance will be set to Ready for Submission.

Example 2: Add to Existing Profile

• The secondary Insurance is added to the existing Insurance Profile.
• Select the checkbox: For all Encounters with a PATIENT balance, transfer to newly added policy and bill.

• The Secondary Insurance will be set to Ready for Submission.

• Select Save [F2].

Display all Profiles and Encounters

There may be some Profiles and Encounters that are not displayed because the Profile has been marked as Inactive or the Encounter Balance is a credit or is zero. 

To include these:

Include Inactive Profiles

• Select the radio button on the top right of the Insurance/Employer Management screen.

Include Encounters with Credit or Zero Balance

• Select the radio button on the right side of the screen above the listed Encounters.

The Encounter Check Box is Grayed Out

When moving an Encounter to a new Insurance, it cannot be moved because the Insurance check box is grayed out.

• Hover over the gray check box to see the reason the Encounter cannot be moved.
• In the example below, the Encounter Balance is out to multiple Payers.

Self Pay Profile

The Guarantor is the Responsible Party for all balances that are in the status of Patient Responsibility. The System defaults to Self Pay when there is no Insurance Profile.

Two Types of Patient Responsibility

• Self Pay: Patient does not have Insurance. The system assigns Self Pay automatically if no Insurance is chosen on Patient Registration. A Self Pay Charge does not have a Claim Status because it will never go to an Insurance.

• Self Pay after Insurance: The remaining Balance drops to the Patient after Insurance has paid.

If Self Pay is not on Insurance Management, you can choose Add Self Pay Profile to add the Profile.

• If Self Pay has been chosen on Patient Registration or on the Encounter, the Self Pay Profile is automatically added to Insurance Management.
• The Add Self Pay Profile button will no longer be available if Self Pay is already a profile.

Move an Encounter to a Self Pay Profile from an Insurance Profile

In an Open Period

The ability to move an Encounter from a Profile with Insurance to a Self Pay Profile in an Open Period can be done on the Modify Charge screen.

• If there is not a Self Pay Profile in the dropdown in the Insurance field, it will need to be added using the Insurance Management link.
• If there is a Self Pay Profile or after the Self Pay Profile is added, select Self Pay from the dropdown on the Modify Charge screen.
• You may get a Validation Warning that the Fee will change.
• Save the screen.

In a Closed Period

If the Encounter is in a Closed Period, the Insurance field on the Modify Charge screen will be grayed out.

• When the Profile is changed to Self Pay, the Encounter is reversed.

• A positive charge Encounter and negative charge Encounter will be created.
• The original Encounter number remains the same and changes can be made to it.

Move the Closed Period Encounter to Self Pay

1. Select Insurance Management on the Encounter Dashboard or on the Modify Charge screen.
2. Use the Add Self Pay Profile button to create the Self Pay Profile if there is not one.
3. Select the Profile line that contains the Encounters you want to move. (The line will be highlighted.)
4. From the list at the bottom of the screen, select the checkbox beside each Encounter number that needs to be moved to Self Pay.
5. Select Change Profile/Rebill.
6. From Current Profile - To New Profile: Select Self Pay.
7. Rebill: Leave checked. This will automatically set the Encounter to be billed to the Patient.
8. Select Save [F2].

Learn More

Self Pay Validation Warning

Insurance Management

Insurance Profiles Overview