Description
The Insurance Verification pop-up provides a way to view the patient's demographic and insurance information that is sent and received for an insurance verification request. The left side of the pop-up shows the information that was submitted and the right side shows the information that was returned.
Access
AdminCenter > Insurance > Insurance Verification > Status link
TaskCenter > Patient Info > Insurance > Insurance Verification button > Status link
You must have the necessary security permissions to access the Insurance Verification pop-up. See the Roles Guide.
Technical Manual
Header Information
The top of the Insurance Verification pop-up displays the patient's demographics such as first and last name, MRN, date of birth, age, and gender. All this information is from the patient record in the system. The top of the pop-up also displays provider information such as provider name and NPI; this information comes from the order that triggered the verification request.
Response Additional Information
The Response Additional Information section displays a list of system messages from the payor that require attention. This section only appears during the Pending Review state when the system receives messages from the payor. If there are no messages, this section will not appear.
Insurance Information
Primary, Secondary, and Tertiary tabs display the details of each type of insurance that the patient has. As part of the insurance verification feature, the system requires you to include at least one of the insurance payers in the request. If secondary or tertiary insurances exist, include those in the verification as well.
Submitted
The left side of the pop-up displays the information that was sent to the third party for insurance verification.
| Patient Information | |
|---|---|
| First Name | Displays the patient's first name. |
Last Name | Displays the patient's last name. |
| Sex | Displays the patient's gender. |
| Date of Birth | Displays the patient's birth date. |
| Provider Information | |
| Name | Displays the name of the patient's provider. |
| NPI | Displays the provider's national provider identifier number. |
| Insurance Information | |
| Company Name | Displays the name of the insurance company. |
| Subscriber ID | Displays the identification number of the person carrying the insurance plan. |
| Effective Start Date | Displays the date the insurance plan was effective. |
| Effective End Date | Displays the date the insurance plan expires. |
| Group Name | Displays the name of the group (usually an employer) that provides the insurance plan to the subscriber and patient. |
| Group Number | Displays the number identifying the group that provides the insurance plan to the subscriber and patient. |
| Plan Information | |
| Plan Name | Displays the name of the insurance plan. |
| Insured Patient Information | |
| Insured Last Name | Displays the last name of the individual who holds the insurance policy. |
| Insured First Name | Displays the first name of the individual who holds the insurance policy. |
| Insured Sex | Displays the gender of the individual who holds the insurance policy. |
| Insured Date of Birth | Displays the birth date of the individual who holds the insurance policy. |
Response
The right side of the pop-up displays the same fields as the Submitted section shown above, but displays the response from the third party insurance verification in each of the fields. The following fields are only in the Response section, however.
When the system receives a response from the third party that is different from the correlating input value, the field turns red, providing an indicator that a correction was made. A warning icon will appear on the Primary, Secondary, or Tertiary insurance tabs on the left side. If an error was made (misspelling of a patient's name, date of birth, sex, or policy number), the third party will return the corrected data in the response, and the corrected information will overwrite the existing patient data or the corrected data is presented to a user as part of a workflow allowing them to decide how to update the patient's record.
| Insurance Information | |
|---|---|
| Coverage Level | Displays the patient/subscriber's insurance coverage level. |
| Plan Information | |
| In Plan Network | Displays the name of the in plan network. |
| Network ID | Displays the identification for the network. |
| Network Description | Displays a brief description of the network. |
| Out of Pocket | |
| Limit | Displays the out-of-pocket limit for the patient/subscriber for this insurance plan. |
| Year-to-Date | Displays how much the patient/subscriber has spent year to date on out of pocket costs for this insurance plan. |
| Remaining | Displays how much the patient/subscriber still needs to spend to reach the out-of-pocket limit for this insurance plan. |
| Coinsurance & Copay | |
| Coinsurance | Displays the coinsurance for this plan. |
| Copay | Displays the copay for this plan. |
| Deductible | |
| Limit | Displays the patient/subscriber's deductible limit for this insurance plan. |
| Year-to-date | Displays how much the patient/subscriber has spent year to date toward the deductible for this insurance plan. |
| Remaining | Displays how much the patient/subscriber still needs to spend to reach the deductible for this insurance plan. |
Complete the Request
| Acknowledge & Update | Select the button to apply the updates to the patient information and mark the request complete. |
|---|---|
| Acknowledge | Select the button to mark the request as acknowledged. When you select this button, the system does not apply updates; you must manually update the patient information, if needed. |
| Cancel | Select the button to close the Insurance Verification pop-up without saving any changes. |
