Insurance

Description

Use the Insurance page to view, create, or edit patient insurance information, as well as access patient demographic and order information. You must first select a patient using the search feature before you can perform any of these tasks.

The Insurance Summary tab, which is selected by default, displays an overview for the currently selected insurance set for the patient. The system will use the selected insurance set when evaluating medical necessity and determining billing for the patient's orders. You may establish multiple insurance sets for a patient, with each set containing up to three insurance plans: primary, secondary, and tertiary, and you may assign a guarantor to each insurance set.

If you attempt to change the primary insurance plan for an insurance set that has been used in an order, the system creates a new insurance set for the patient with the current primary, secondary, tertiary, and guarantor information after you select a different insurance. Depending on your system default settings, the system may prevent you from creating patient insurance sets that contain non-validated insurance.

Note

You cannot add inactive insurance companies or plans to an insurance set. Also, if an insurance set contains an inactive insurance company or plan, the system will not allow you to assign that insurance set to the patient until you have removed or activated the inactive insurance company or plan. This restriction also applies to patient insurance sets that use practice-specific insurance plans that are mapped to inactive system plans.

Access

Select the Patient Info menu button, and then select the Insurance submenu link.
Select the Insurance link below the Find Patient search field on the Demographics, Order History, Collect Samples, or Order Patient Samples pages. If the Use pop-ups for patient Demographics and Insurance on Order Patient samples and Collect Samples pages option is enabled on the Application page or the Users page, then the Insurance page appears as a pop-up from the Order Patient Samples or Collect Samples pages.
Select the name of the desired patient, and then select Insurance in the pop-up list on the Find Patient or Order page or the Lab Orders page.

Technical Manual

Navigating this Page

As with any program or web page displayed in an Internet browser, you may always use your mouse to select buttons or to make fields active (ready to accept input).

You may also press the Tab key on your keyboard to move through the available elements (fields or buttons) and change which element is currently active. Some users find this method faster than using a mouse. The system allows administrators to set the tabbing order for this page (based on location or system default settings), so that the fields become active in the order most useful to the facility. When setting the tabbing order, administrators may also set one or more elements of the page so that the system skips them when determining what field or button receives the cursor focus. Upon entering the page, the system places the cursor at the first element not set to skip or the first unpopulated element if all the preceding elements are populated. See the Tabbing Order topic.

Even if a tabbing order is set, you may still use your mouse to access the desired page elements, including those skipped in the tabbing order.

Viewing or Selecting Patient Insurance Sets

The system displays the selected patient's name, age, sex, and Patient ID at the top of the Insurance page once the patient is selected. You may modify demographic and insurance information; review the patient's order history; or place an order, collect samples or create a blank requisition for the patient by selecting the links listed below.

For existing, new, or modified insurance plans, modify insurance set details on the Primary, Secondary, or Tertiary tabs, and add or modify guarantor information on the Guarantor tab. See "Adding or Modifying Insurance Plans" or "Adding or Modifying Guarantor Information" below.

Insurance Verification	Select to open a pop-up that displays the insurance verification records for the patient. See Insurance Verification Pop-up.
Find Patient	Use the search feature to select the patient whose insurance information you wish to view. See the Selecting a Patient topic. If you selected a patient in another page before opening this one, then that patient's insurance is shown. If you did not find the correct patient in your search, you may need to create a new patient record. See the Demographics topic.
Demographics	Select this link (or press the Alt+U hotkey) to view or modify the patient's demographic information. See the Demographics topic.
Insurance	Select this link (or press the Alt+I hotkey) to refresh the current page.
Order History	Select this link (or press the Alt+O hotkey) to view the patient's order history or edit an order. See the Order History topic.
Options	Select this link to open a pop-up list of actions. Select the action you wish to take for the selected patient.
New Order	Select to place an order for the patient in the Order Patient Samples page.
Collect Samples	Select to collect samples for all orders for the patient that are ready for collection.
Blank Patient Requisition	Select to view or print a blank requisition from the View PDF page. When creating blank requisitions, the system will attempt to use the format selected for your signed-in location, if available. If not, the system uses the system default format. If the location's format is set to use the system default.
Patient Labels	Select to print the system default patient type labels.
Change Log	Select to view the change log for the selected patient on the Change Log administration page.
None	Select to disable access to create blank requisitions.
Rearrange	Select the up or down arrows in the column to change the hierarchy of the primary, secondary, and tertiary insurance defined within the insurance set.
Save	Select to make your changes take effect. If the insurance set you modify has been referenced from an order that has not been cancelled and you modify the primary insurance hierarchy, then the system automatically creates a new insurance set to represent the rearranged insurance set instead of modifying an insurance record that has been used previously.
Select Different Insurance	Select to select a different, existing insurance set in the Patient Insurance Sets page. See the Patient Insurance Sets topic.
Create New Insurance	Select to create or modify insurance plans and/or companies. See "Adding or Modifying Insurance Plans" below.
Add Primary Insurance	Select to add insurance for the patient. See "Adding or Modifying Insurance Plans" below. If you select a different set or create a new insurance plan, the system ultimately displays the new insurance set in the patient's Insurance page.
Close Window	Select to close the page and return to the preceding page.
X	Select to close the page and return to the preceding page.
?	Select to view the help for the Insurance page. If you use the help hotkey from the pop-up, it will open the help for the Order Patient Samples page.

Adding or Modifying Insurance Plans

The system allows you to enter up to three insurance plans for each insurance set. Select Primary, Secondary, or Tertiary tabs at the top of the page to enter the insurance plan information. The Tertiary tab is not available until there is a secondary insurance plan, and that the system alerts you to inactivated insurance companies or plans at the top of the page. Depending on the settings on the System Defaults or Insurance administration pages, one or more of the insurance fields may be required. Required fields are indicated with asterisks. A system administrator may assign a security right to one or more roles to disregard required fields, if appropriate.

Insurance Company	Enter one or more characters in the search field.
Insurance Plan	Enter one or more characters in the search field.
Search	Select to locate the patient's insurance company or plan in the Insurance Search page or press the Enter key to select a patient's insurance company or plan.
Insurance Type	Select an option from the drop-down list to select the type of insurance for the patient. The drop-down list defaults to All, which does not filter by insurance type. See "Viewing or Selecting Patient Insurance Sets" above. Note This search allows you to verify that the insurance company or plan you wish to create does not already exist before creating a new plan. If you attempt to change the primary insurance plan for an insurance set that has been used in an order, the system creates a new insurance set for the patient with the current primary, secondary, tertiary, and guarantor information after you select a different insurance.
All	Displays all insurance types.
Copy from Previous	Enter one or more characters in the search field to search for the patient's previous primary, secondary, and/or tertiary insurance plans. Upon selecting a previous plan, that plan's information will be copied into the current patient's insurance set's primary, secondary, and/or tertiary insurance plan.
Select	Once you have selected or created an insurance company or plan, the system displays the selected plan information, if available, in the Insurance Plan page. Use this page to view, create, or edit company or plan information. Select Select to continue. See the Insurance Plan topic.
Update and Select	Once you have selected or created an insurance company or plan, the system displays the selected plan information, if available, in the Insurance Plan page. Use this page to view, create, or edit company or plan information. Select Update and Select to update and continue. See the Insurance Plan topic.
Policy	Enter the policy number for the patient's insurance.
Group	Enter the name of the group to which the employer belongs.
Group #	Enter the identification number for the group to which the employer belongs.
Relationship to Insured	Select the option that describes the relationship of the insured individual to the selected patient. This field is required.
Self	Select to automatically fill in the patient's demographic information. If you select one of the other options, the system asks if it should automatically fill in the patient's phone and address information.
OK	Select to have the patient's information entered automatically.
Cancel	Select to manually enter the information.
First Name/Middle Name/Last Name	Enter the name of the individual who carries the insurance policy. The Last Name field is required.
Subscriber ID	Enter an identification number used by the selected insurance set.
Sex	Select the sex of the insured individual from the drop-down list. When creating a new patient record and the Sex field is not required, the system populates the field with the undeclared value, but if it is a required field, the system displays a blank until you select the appropriate option.
Date of Birth	Enter the birth date for the insured individual in the format of MM/DD/YYYY. If this field is required, you may have the security right to enter zeros in place of a date of birth to indicate that the date of birth is not known or required. The field will appear in red if it is empty or the value is invalid, until you correct the entry.
Phone #1/Phone #2	Enter the telephone contact information for the insured individual.
Address 1/Address 2/ZIP Code/City/State/Country	Enter the full address for the insured individual, including any apartment or suite numbers. If ZIP code checking is enabled in the System Defaults administration page, then, when you enter a ZIP code that exists in the database, the system automatically fills in the city and state associated with the ZIP code, and if the ZIP code update option is enabled, then the system also updates the corresponding city and state data, if appropriate.
Employment Status	Enter the employment status for the insured individual.
Insured SSN	Enter the Social Security Number for the insured individual. Depending on the system default, location, or insurance administration settings, the system may consider one or more of the insurance fields required and/or require certain numeric/alphanumeric patterns for policy numbers, groups, and group numbers. See the System Defaults, Locations, or Insurance topics.
Employer	Enter the name of the employer providing the insurance.
Employer ID	Enter the identification number for the employer providing the insurance.
Employer Plan Code	Enter the employer's insurance plan code.
Employer Phone #	Enter the employer's phone number.
Address 1/Address 2/ZIP Code/City/State/Country	Enter the full address for the insured individual's employer, including any suite numbers. If ZIP code checking is enabled in the System Defaults administration page, then, when you enter a ZIP code that exists in the database, the system automatically fills in the city and state associated with the ZIP code, and if the ZIP code update option is enabled, then the system also updates the corresponding city and state data, if appropriate.
Load Image	Select to add a picture to the patient's file for the selected insurance plan. See "Adding, Updating, or Deleting Photos" below. If you have already added a photo, the system displays a thumbnail-sized version of it next to the Load Image button. Select the image to see the full-sized version.
Close	Select to close the image.
X	Select to close the pop-up.
Remove	Select to remove the currently viewed insurance (primary, secondary, or tertiary) from the currently selected set and to shift lower insurance one position to the left. For example, if you remove the secondary insurance, the tertiary insurance becomes the new secondary insurance.
Save	Select to record the changes.
Self	Depending on the system default administration settings, the system may automatically fill in patients' guarantor information with their current demographic information when you select Self as the relationship to insured for the patients' primary insurance without entering other guarantor information. See the System Defaults topic.
Discard Changes	Select to clear any changes made to the insurance plan.

Adding, Updating, or Deleting Photos

In order to use the insurance photo feature, a System Administrator must enable it in the System Defaults administration page. See the System Defaults topic.

Load Image

Select to open the patient image page, where you may add, update, or delete patient images. See the Images topic. Once the insurance photo feature is enabled, the Load Image button is available for patients on the Primary, Secondary, or Tertiary tabs.

Save

Select to save the image in the patient's file. If you do not save the image this way, the system will not retain the image in the file.

Once you have loaded the image, the system displays the photo on this page, as well as on reports or other printed documents that include the insurance photo in the layout template. See the Layout Templates topic.

Adding or Modifying Guarantor Information

Self	Select to automatically fill in the patient's demographic information. If you select one of the other options, the system asks if it should automatically fill in the patient's phone and address information.
Relationship to Insured	Select an option from the drop-down list that describes the relationship of the selected patient to the insured individual.
OK	Select to have the system enter the patient's information automatically.
Cancel	Select to manually enter the information.
First Name/Middle Name/Last Name	Enter the name of the guarantor.
SSN	Enter the Social Security Number of the guarantor.
Sex	Select the sex of the guarantor from the drop-down list.
Date of Birth	Enter the birth date for the guarantor in the format of MM/DD/YYYY.
Phone #1/Phone #2	Enter the telephone contact information for the insured individual.
Address 1/Address 2/ZIP Code/City/State/Country	Enter the full address for the insured individual, including any apartment or suite numbers. If ZIP code checking is enabled in the System Defaults administration page, then, when you enter a ZIP code that exists in the database, the system automatically fills in the city and state associated with the ZIP code.
Discard Changes	Select to clear any changes made to the guarantor information. This action only clears any changes you have made to fields since the last time you saved the guarantor information.
Save	Select to record the changes.

Page tree