Encounter Policy Breakdown Panel
Encounter Breakdown Policy Panel
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.