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Patient Chart: Insurance

Version 14.19

About Patient Chart: Insurance

Path: Clinical, Practice Management, or Billing tab > Patient Chart button > Insurance

The Patient Chart includes the patient’s account. Some of the main functions that can be performed on a patient’s account include:

  • Enter a copay
  • Post a charge manually
  • Enter hospital charges
  • Verify claim accuracy
  • Post a patient payment
  • Issue a patient refund
  • Write an account note
  • View claim history
  • Print a CMS-1500
  • Print a statement

The Insurance window displays the patient's insurance information.

Patient Chart: Insurance Map

Number
SectionDescription

1

Insurance button

The Insurance button displays the insurance information in the Patient Chart.

2

Insurance Information function buttonsThe Insurance Information function buttons add, remove, edit and save insurance record information.
3
Patient Responsibility Guarantor / Statement Method
  • Patient Responsibility Guarantor: links the guarantor to the patient account. This is the patient or patient's contact (when the patient is a minor) who is responsible for the medical bills. 
  • Statement Method: the method in which the guarantor will receive statements (mail, portal, credit card on file, hold).
4
Insurance Record ListThe Insurance Record List displays the active, inactive, pending, and invalid insurance(s) that are added to the patient’s record.
5
Copy From buttonThe Copy From button copies a sibling's insurance record and attaches it to the patient’s insurance record. (see Copying Insurance Information From a Family Member).
6
Print buttonThe Print button opens the Patient Register Information Report window.  This window prints the patient’s demographics from within the patient registration. Be certain to select the items to appear on the report before clicking the Print button.
7
Self-Pay buttonThe Self-Pay button clears the primary insurance and marks the default payer as self-pay.
8
Validate buttonThe Validate button validates the selected insurance.
9
Insurance Information PanelThe Insurance Information panel contains the insurance information from the selected insurance record in the Insurance Record list. Once an insurance policy has been attached to a claim, it cannot be modified. The Insurance Information panel contains the following tabs:
  • Edit Insurance Record (or Adding New Insurance Record): This tab contains the insurance policy status, subscriber (patient name), subscriber ID,  group number, group name, VFC eligibility, and patient responsibility information.
  • Address/Employer: The Address/Employer tab contains the subscribers address returned from the insurance carrier via validation.  It also is where you can enter the subscriber's employer or school address.
  • Medical Benefits: The Medical Benefits tab is populated when insurance is validated using the Validation Feature. It displays benefit-specific information such as the office and lab capitation monthly amounts, PCP on file with the insurance payer, and assignment to Managed Care Organizations. All of this information is dependent upon the information that is made available by the clearinghouse/payer combination.
  • Pharmacy Benefits: The Pharmacy Benefits tab contains the pharmacy insurance information including patient's name, date of birth, gender, PBM name, policy number, group number and plan name.
Version 14.10

About Patient Account: Insurance Tab

Path: Smart Toolbar > Account button > Insurance tab

The Patient Account window maintains a patient’s account.  Some of the main functions that can be performed on a patient’s account include:

  • Enter a copay
  • Post a charge manually
  • Enter hospital charges
  • Verify claim accuracy
  • Post a patient payment
  • Issue a patient refund
  • Write an account note
  • View claim history
  • Print a CMS-1500
  • Print a statement

The insurance tab is a copy of the information that is captured on the Patient Register. New fields were added to help your billing and front staff better understand patient responsibility.

Patient Account: Insurance Tab Map

Number
SectionDescription

1

Patient Account tabs

The Patient Account contains the following tabs:

2

ScopeThe Scope field narrows the parameters for the displayed information in the patient’s account.  Information can be displayed by patient or family.
3
Insurance Information function buttonsThe Insurance Information function buttons add, removed, edit and save insurance record information.
4
GuarantorThe Guarantor field links the guarantor to the patient account.  The Guarantor is the patient or patient's contact (when the patient is a minor) who is the responsible party for the medical bills and insurance coverage.  You can set the method that the guarantor will receive the medical statements in this field (mail, portal, credit card on file, hold).
5
Insurance Record ListThe Insurance Record List displays the active, inactive, pending, and invalid insurance that are linked to the patient’s record.
6
Copy Insurance Information buttonThe Copy Insurance Information button copies a sibling's insurance record and attaches it to the patient’s insurance record. (see Copying Insurance Information From a Family Member).
7
Print Report buttonThe Print button opens the Patient Register Information Report window.  This window prints the patient’s demographics from within the patient registration.  Be certain to select the items to appear on the report before clicking the Print button.
8
Self-Pay buttonThe Self-Pay button clears the primary insurance and marks the default payer as self-pay.
9
Activate Card ReaderThe Activate Card Reader button marks the card reader as active.
10
Insurance Information PanelThe Insurance Information panel contains the insurance information from the selected insurance record in the Insurance Record list. Once an insurance policy has been attached to a claim, it cannot be modified.  The Insurance Information panel contains the following tabs:
  • Edit Insurance Record: The Edit Insurance Record contains the insurance policy status, subscriber (patient name), subscriber ID,  group number, group name, VFC eligibility, and patient responsibility information.
  • Address/Employer: The Address/Employer tab contains the subscribers address returned from the insurance carrier via validation.  It also is where you can enter the subscriber's employer or school address.
  • Medical Benefits: The Medical Benefits tab dIsplays the office and lab capitation monthly amounts.
  • Pharmacy Benefits: The Pharmacy Benefits tab contains the pharmacy insurance information including patients name, birthdate, gender, PBM name, policy number, group number and plan name.