Patient Insurance Setup

Mary Jane -

 

* Updated (2018/12/13) - Coverage Reset, No Expiration *

 

SYSTEM SETUP

 

1. System Settings Insurance Default

Settings>General>System>Patients>Insurance Section>Default Coverage Percentage.

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Typically clinics set this system default to 100% coverage. Telus will automatically send claims through Juvonno at 100%. 

You can override this in each patient profile under each individual insurance company record.

 

2. Visible Insurance Field:

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".

 

3. Insurance Forms:

If you want the system to create insurance forms that you can manually give to the patient or manually send to the insurance company, you must first go to Settings>Forms.  Select the check boxes beside the insurance forms you will need to create for a patient. 

 

4. Set up the Insurance Companies you will be using.

Before you can create an insurance record in the patient profile create the insurance company under Settings>Third Party Companies>New Third Party. These records you create you will be able to select in the insurance record insurance field.  

 

5. Patient Set up

Go to Patients Profile>Insurance>New Insurance.

 

POLICY DETAILS SECTION

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Descriptor field: You can turn this field on and off under Settings>General>System>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: is only applicable to BC Teleplan.

 

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.

 

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.

 

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.

 

Relationship to Policy Holder:  Select from the drop-down options.  When you select the Insurer as Self the patient's DOB will auto-populate. 

 

ADJUSTERS SECTION

Enter Adjustor information if it applies. This information will populate to batch invoices.

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DEDUCTIBLE SECTION

Enter the Deductible details. (Not required for Telus insurance companies)

 

POLICY RULES

 

Coverage Type

From the drop-down options select:

a. Default system settings

When you have set this under Settings>General>System>Patients>Insurance Section>Default Coverage Percentage it will automatically appear in this field. 

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You are able to enter a percentage and override the default.  For example, you entered 100% in the system default you can override this in the patient profile, insurance tab, insurance record by entering 80%, 50% or whatever applies as per the patient insurance coverage.

 

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Coverage Type - per Category

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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, 100% for Massage, 50% for orthotics.

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 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.)

 

Block Fee

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You can enter a start and end date and amount.  These policy rules will be visible in the appointment booking popup.

The total Amount will count down as it's being used.

 

Coverage Reset

Select the when the patient's insurance expires. You are also able to select a No Expiry option.

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OTHER SECTION

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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.

 

Keep in mind you do not have to use these calculations for Telus insurers.

 

 

 

 

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