Note: If you have not already set up your insurance settings, click here to review the guide.
Adding a New Insurance
Navigate to Patients Profile>Insurance>New Insurance.
Policy Details Section
Descriptor field: If you do not see this field in the Patient Insurance record popup you have to enable it by going to:
Settings>General>System>Patients>Insurance Section>Name Patient Insurance Records.
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.
Biller field: is only applicable to BC Teleplan.
Insurance Company: Select the insurance company from the drop-down options (these are insurers you previously set up).
Policy Holder DOB: When you select the Insurer as Self the patients DOB will auto-populate. Otherwise, enter the correct DOB for the policyholder.
Relationship to Policy Holder: Select from the drop-down options. When you select the Insurer as Self the patient's DOB will auto-populate.
Policy #'s: Enter Policy Holder information, claim #'s, policy #'s etc. related to the information provided by the patient.
Provider: Only required for BC and Teleplan.
Enter Adjustor information if it applies. This information will populate to batch invoices.
Enter the Deductible details. (Not required when direct billing to Telus)
Coverage Type: Default
This would have been set up Settings>General>System>Patients>Insurance Section>Default Coverage Percentage (as stated above) it will automatically appear in this field.
You are able to enter a percentage and override the default.
For example, you entered 100% in the system default you can override this by entering 80%, 50% or whatever it is based on the patient insurance coverage.
Telus: The default must be 100%.
Private Insurance: This field will be set to whatever percentage the patients has.
Coverage Type - Per Category
You will use this option for insurance companies that are not submitted directly through Telus.
These categories are based on those you set up under the Setting>Product & Services Categories.
Some insurance companies cover different percentages based on the modality for example 80% for Chiro, 50% for Massage etc.
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 based on the category.
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 would be Physio Initial Assessment.
b. Department is Service / Category would be 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.)
Coverage Type: Block Fee
Enter a start date, an end date* and total amount allowed.
These policy rules will be visible in the appointment booking popup.
The total Amount will count down as it's being used.
* Note: If you do not set an End Date, this Block Fee will not correctly function with the maximum amount set and if the invoice amount is more than the amount allowed, it will leave the insurance with a negative amount without splitting the difference towards the patient.
Coverage Type: Telus Health eClaims
Coverage Type: Telus Health eClaims - Category Coverage
You can use the Coverage Type option to manually set up the individual percentages covered by insurance. However, the invoice will still be submitted through Telus at 100%.
Select when the patient's insurance expires or select No Expiry if applicable.
Default: When you book an appointment on the schedule the insurance field will automatically populate this insurance company name if you select the Default to Yes.
Status: When this insurance is exhausted or is no longer active Deactivate it.
Notes: Add any notes pertaining to the patient.
Example: A patient comes in in the middle of the year and their total yearly insurance coverage is $1,500.00 however they only have $500.00 left for the remainder of the year. You can add a note in this section indicating these details so you know in the new year their total coverage needs to be updated to $1,500.00.