Overview

The Update Insurance window is used to modify insurance information.

How to Get Here?

To open the Update Insurance window:

From the Menus:
Via Shortcut Keys: 
  1. Select the insurance to be modified in the Active Insurance section.
  2. Click Edit. Note: Click Update on the Patient, Guarantor & Insurance tab.


The Insurance section is available from the following pages/tabs:

  1. Select the insurance to be modified in the Active Insurance section.
  2. Press [Alt] + [E]. Note: Press [Alt] + [U] on the Patient, Guarantor & Insurance tab.

 

The Insurance section is available from the following pages/tabs:

 

 


Field Definitions

Field

Type

Required 

Description

Payer 

Drop Down

Yes

The company that provides insurance coverage for the patient. Payers can be insurance companies or a government agency, for example, Medicare or Medicaid.

The list of payers is maintained in Admin > Payers & Plans.

Insurance Plan 

Drop Down

Yes

The name of the plan that provides the insurance coverage for the patient. Plans belong to payers, which are insurance companies or government agencies, for example, Medicare or Medicaid. The list of plans is maintained in Admin > Payers & Plans.

If the plan selected has been designated as a Miscellaneous Plan - Always ask for updated plan name and address (via Plan page > Claims tab), the Plan Address window opens after tabbing out of the Plan field.

You must enter a name and address for the plan before any new information entered can be saved.

Subscriber TypeDrop DownYes

The person who is insured. The available options include:

  • Patient

  • Some Other Person

  • Organization

If you select Some Other Person or Organization, the Subscriber Name option becomes available. You must specify the name of the person or company who has financial responsibility for the patient.

Subscriber NameDrop Down Yes

The person or organization who is financially responsible for the patient. 

If the person or organization is not listed, use the search criteria (as shown) to find the person or organization.

 

You can enter last name, first name, social security number, date of birth, or account number as the search criteria. Only the names that match the search criteria will be listed on the Select a Person window that opens with search results.

You can enter a partial name by typing one or more letters of the last name or first name. The search will be done on the information entered. Press [Tab] to advance to each option.

You can enter name or phone as the search criteria. Only the records that match the search criteria will be listed on the Find Organization window that opens with search results.

Subscriber ID 

Free Text

Yes

The person who owns the insurance coverage.

The unique number issued by the payer to the employee who participates in a group plan. This number identifies the employee and can be the same as the Member ID, based on whether the insurance company issues separate numbers to identify its participants.

Member ID 

Free Text

Yes

The unique number issues by the payer to identify the patient who participates in a group plan.

Member IDs and Subscriber IDs can be the same or a different number based on whether the insurance company issues separate number to identify its participants. The member identification number is used by some payers to differentiate between the employee and the participating dependents, for example 00 might identify the employee and 01 might identify the spouse of the employee.

Group ID 

Free Text

NoThe unique number issued by the payer to the owner of the insurance policy.
Patient Relationship to Subscriber Drop Down Yes

The relationship to the participating subscriber of the insurance plan. The drop down list becomes available only when the Subscriber Type is set to Some Other Person.

Click the appropriate value from the list:

  • Self

  • Spouse

  • Child

  • Employee

  • Other Relationship

  • Cadaver Donor

  • Life Partner

  • Unknown

Coverage ConfirmedCheckboxNo If selected, the insurance coverage has been verified as current and valid.
Effective DateCalendar DateNoDate field used to designate the insurance effective date.
Expiration DateCalendar DateNoDate field used to designate the insurance expiration date.
Referral Numbers TableNo

 The table is used to add and track referral numbers:

  • Referral Number - Number issued by the primary or referring physician for a specific treatment or treatment series. Based on the type of treatment,  the referral may also limit the number of treatments and have an expiration date. Payment for services rendered may rely on whether a referral number is associated with a case.

    If a referral number is entered, the referring physician must be specified on the General Case Information tab.

    If a referral number is entered and the referring physician has not been specified, the following message is displayed: Referring Physician is required if a referral number is supplied for the case. 

    After entering the referral number, the referral number must be specified in the Referral # column in the insurance area on the Patient, Guarantor, & Insurance tab.

  • Effective - Date indicates when the patient can begin treatments.
  • Expiration - Date the referral period expires and treatments can no longer be rendered.
  • Allowed Visits - Number of visits allowed for the treatment from a referral.

  • Used Visits - Number of visits used for the treatment series established by the referral. This information is tracked manually.

Button/Icon Descriptions

Button

Shortcut

Description

Step by Step Guides

Add[Alt] + [A]To add a referral number to the insurance.
  1. From the Referral Numbers table, click Add. A new line item is added to the table.
  2. Enter the referral number in the Referral Number field for a specific treatment or series of treatments.
  3. Open the Effective drop down and select the effective date for the referral from the calendar.
  4. Open the Expiration drop down and select the expiration date for the referral from the calendar.
  5. Enter the number of Allowed Visits authorized for the referral treatment.
  6. Enter the number of Used Visits (completed) for the referral treatment.
 
[CTRL] + [F] Opens the appropriate search window to locate the relevant object (e.g., payer).
  1. Click the Find icon. The Search window opens.
  2. Enter search criteria in relevant fields.
  3. Click OK. The search results are displayed.
  4. Select the relevant record being searched.
 
[CTRL] + [C]  Open the appropriate create window to create the relevant object (e.g., Create Subscriber window).
  1. Click the Create icon. The Create window opens.
  2. Enter the relevant data for the new object being created.
  3. Click Save.
 
[CTRL] + [U]  Opens the appropriate edit window to modify the relevant object (e.g., insurance plan name/address, Update Person window).
  1. Click the Update icon. The Update window opens.
  2. Modify the relevant date for the object being updated.
  3. Click Save.


 

Related Topics

New > [Object]

Create Account / Insurance Tab

Create Person / Insurance Tab

Create Insurance Window

Creating Accounts

Creating Person

Adding Insurance

Editing Insurance

Expiring Insurance

Reactivating Inactive Insurance

People

People Page



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