Patients are allowed to have unlimited insurance coverage records. This way you never have to delete a record and lose connection to that record for past invoices. Before adding patient coverage records it is best that you enter your most common insurance carriers in the Insurance Module.
The other implication of this is that you never need to create a separate patient record for workman's compensation and another for regular medical. At the invoice level you will be able select from any insurance which one to use on that invoice and which ones to remove!
A new record is started by clicking the Add Patient Insurance button in the Patients Module and confirming your action.
Insurance Names and Numbers
- If you know it, enter the
insurance carrier’s code from the Ins Code field. If you do not
know the insurance code, click the Pick List button located
just above the right of the Ins Code field. This shows you a
special dialog used to select an insurance. You can click one of the ABC
buttons, or enter up to eight letters of the insurance
company’s name in the search field and then click Search. This finds
all
insurance that start with that letter or string of letters. You can
then sort the list by clicking one of the underlined column
names, like City. Then you can scroll the list to search
for the company.
- To use an insurance from the list just click on its name, which then appears in the Current Insurance field. When done click Return.
- If you still cannot find
the carrier, you can click on the Insurance
Module button and go there to either find the record again or
create a new one to use for this patient! When you try to leave the
Insurances module it will ask if you want to use the current insurance
for this Coverage record!
- Enter the ID and Group if available. Many times the patient's (or subscriber's) SSN is the ID number (if you want to use the SSN click the green arrow pointing towards the ID field). Do not to use any dashes or spaces, especially with any patient whose claim could be sent electronic, when entering in numbers.
- If you know it, enter the Group Name.
- Select the appropriate Relationship
between the patient and the insured from the pop-up list. If you
do NOT select “Self”
you must enter the subscriber’s First and Last name. If
you
do not the software will remind you! In addition, if the patient's age
warrants
it, you may be asked to change the relationship to "child".
- The Insurance Type field may already have data in it based on the insurance Code selected. If not, or if the code selected does NOT pertain to this insurance record, make a selection from the pop-up list. The field is required. For example, MP means Medicare Primary. Most insurances are GP for Group Policy.
- Enter the Start and End date of the current policy if known. These fields are NOT required.
- If you know the Eligibility Phone enter it here. The same goes for the Adjustor name and Claim Number. These last two fields are specific for accident or injury claims.
- Billing Priority is a required field. It labels this policy as the patient’s primary (1), secondary (2) or tertiary (3) carrier. If a carrier is no longer active select 99. Never delete an insurance record unless it is wrong before it is used!
- Check Pays Deductible as Yes or No if this insurance is a Medicare patient’s secondary insurance and you know its pays for deductibles.
Confirm Eligibility
PracticeMaker® is able to check the insurance eligibility on most Medicare patients. If you want to check this Medicare patient's eligibility the next time you create an "eligibility file" select "Yes". This function only works with Medicare patients at present.
Patient's Insurance List
This list shows of the patient's coverage records, including the one you are working on. Use this list to change the Billing Order or Priority of the insurance. You should have only one primary, secondary and tertiary insurance. There can as many "99" records as you want!
Subscriber
Information
If needed, complete the Subscriber’s Information fields. Subscriber's Information only needs to be completed if the patient is NOT the owner (or subscriber in insurance lingo) of the insurance policy. In this case fill in as much information as you believe is needed to collect from this insurance. If the Relationship is anything but "Self" and you leave the subscriber blank, you will get the dialog below! If you leave the first name or Sex fields empty, similar dialogs remind you!
The information is Subscriber's Employment Information is not needed in most insurance billing.
If you believe the subscriber you want to you for this record is already in the database, click the Find A Subscriber button. The dialog below guides you through the search. If any records match you will get a list to select from!
If needed, complete the Subscriber’s Information fields. Subscriber's Information only needs to be completed if the patient is NOT the owner (or subscriber in insurance lingo) of the insurance policy. In this case fill in as much information as you believe is needed to collect from this insurance. If the Relationship is anything but "Self" and you leave the subscriber blank, you will get the dialog below! If you leave the first name or Sex fields empty, similar dialogs remind you!
The information is Subscriber's Employment Information is not needed in most insurance billing.
If you believe the subscriber you want to you for this record is already in the database, click the Find A Subscriber button. The dialog below guides you through the search. If any records match you will get a list to select from!
When selecting a patient's insurance in the Coverages module, be sure to select the correct carrier. After all, there could be dozens (as seen here!!).