Patient Insurance Setup

Mary Jane -

TIP: You can edit the visible fields located in the Patients Insurance tab by going to Settings>General>System>Patients>Insurance section. If you edit this page, scroll to the bottom of the page and "Save".

After you have selected the Forms you will be using for patients under Settings>Forms & Letters section - Forms and created the insurance contacts under Settings>Companies & Contacts section - Third Party Companies you're ready to create insurance records for patients.

1. Go to Patients Profile>Insurance>New Insurance.

2. Descriptor field: Use this field to define if you have, for example, 1 client (husband and wife) with 2 insurance companies. You can enter a descriptor as Great West Life Primary and Great West Life Secondary.  This will allow you to select the correct insurance company when booking the appointment and billing the primary and secondary companies correctly.

3. Insurance field: Select the insurance company from the drop down options (these are insurers you previously set up).

4. Enter Policy Holder information, claim #'s, policy #'s etc.

5. Enter Adjustor information if necessary.

6. Enter the Deductible details.

7. Most important: Enter the policy rules.

8. In the "Coverage Type" field you can enter a percentage or select "Default". The default setting reflects the percentage you entered under Settings>System & Company Settings section - General>System>Insurance section - Default Coverage Percentage.  You can enter a percentage and override the default.

Example: Default insurance is 100%, you can override that by entering 80%.

CATEGORY COVERAGE

If your clinic has multiple modalities set the Policy Rules Coverage Type to "Per Category".  The menu will expand  where you can further define each service and amount of coverage.

You must first set up your Product & Service Categories to reflect different modalities in order to use this section.

Here is an Example of several modalities with different maximum totals covered by insurance based on the type of appointment.

a. Create separate Product & Service Categories as follows: Chiropractor, Massage Therapist and Physio Therapist etc.

If the total amount of coverage paid for each type of service, example, Initial Assessment is different total maximum than a follow up you will set up 2 Product & Service Categories.  Example, Physio Initial Assessment and Physio Treatment.

1. Product & Service set up:

    a. Department is Service / Category is Physio Initial Assessment.

    b. Department is Service / Category is Physio Treatment.

2. Patient Insurance set up for these 2 examples based on a total of $500 maximum for the year:

    Go to Patient Profile>Insurance Tab>Policy Rules Section>Coverage type: Per Category.

    a. Physio Initial Assessment / % - 80% / Max. Year $75.00 / Max. Visit $75.00

        (Max per year and visit for this example would be the same because the patient would typically only be

         having 1 of this type of appointment.)

    b. Physio Follow Up / % - 80% / Max. Year $425.00 / Max Visit $50.00

       (The maximum per year at $500 - $75.00 for the initial assessment leaves $425.00 balance for follow

        ups.)

 

 

 

 

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