Patient Account: Insurance

Version 14.8

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
Section
Description

1

Patient Account tabs

The Patient Account contains the following tabs:

2

Scope
The 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 buttons
The Insurance Information function buttons add, removed, edit and save insurance record information.
4
Guarantor
The 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 List
The Insurance Record List displays the active, inactive, pending, and invalid insurance that are linked to the patient’s record.
6
Copy Insurance Information button
The 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 button
The 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 button
The Self-Pay button clears the primary insurance and marks the default payer as self-pay.
9
Activate Card Reader
The Activate Card Reader button marks the card reader as active.
10
Insurance Information Panel
The 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.