Update Insurance Window

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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.

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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.

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.

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.

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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.

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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.

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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

 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.

  If you use Connect Front Office to schedule appointments, you can change this value each time an appointment is completed and the patient status is changed to Checked Out. The value entered will be displayed in the Coverage Information on the New Appointment and Update Appointment windows.

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.

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.

1. Click the Create icon. The Create window opens.
2. Enter the relevant data for the new object being created.
3. Click Save.

1. Click the Update icon. The Update window opens.
2. Modify the relevant date for the object being updated.
3. Click Save.