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Validate Insurance

Version 14.19
Path: Clinical, Practice Management, or Billing tab > Schedule button

Overview

To use the validation feature in Office Practicum, offices will need to:

  1. Enroll for Full HIPAA transactions with Office Practicum.
  2. Enroll with an integrated clearinghouse.
  3. Set up the Insurance Payer Table to use the Validation Feature.
This feature will work contingent on the proper set up of the Insurance Record, accurate Patient Information entered into the patient record, and whether the payer is supported by the clearinghouse for Real-Time Eligibility.

You can use the validation feature to: 

  • Verify an individual patient's insurance in the Add/Edit Appointment window.
  • Verify an individual patient's insurance in the Tracking tab of the Schedule.
  • Verify insurance coverage for every patient (based on parameters set) on the schedule for a particular day. 

Verify Insurance for an Individual Patient from the Appointment

  1. Select the Calendar view from the Schedule.
  2. Navigate to the patient whose insurance you would like to validate.
  3. Double-click on the patient's appointment. This will open the Add/Edit Appointment window.
  4. Click the Validate button located in the Primary Insurance section of the window.

Validation will process for the patient.

Verify Insurance for an Individual Patient from the Tracking Tab

  1. From the Schedule, select the Tracking radio button 

There are two columns that you will use to perform insurance validation.

  • Insurance Validation column : this column populates with the color key result after validation has been performed.
  • Verify Insurance column:  this column populates with a Verify Insurance button on each individual patient's line in the Tracking window and is used to validate insurance for that patient.

Note: If you do not see the Ins. Valid or Verify Insurance columns in your window, it is likely the columns have been removed from view. To learn how to add columns to your view, click here.
  1. Click the Line for the patient whose insurance you would like to verify. The Verify Insurance button is displayed.
  2. Click the Verify Insurance button. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If the result is nothing or the field is White, ask the patient for updated insurance information or call the payer for further information.
  • If the result is Dark Green, the validation check has returned a valid insurance status.
  • If the result is Yellow, retry your validation attempt. There could have been connectivity issues at the time of validation attempt.
  • If the result is Light Green, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If the result is Pink, then the insurance on file is invalid.

Verify Insurance for All Patients on Schedule

  1. Follow steps 1 and 2 above
  2. At the top of the Tracking window, click the Validate button  

3. In the Insurance Validation box, select your criteria and click the Begin button to start validating

  1. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If the result is nothing or the field is White, ask the patient for updated insurance information or call the payer for further information.
  • If the result is Dark Green, the validation check has returned a valid insurance status.
  • If the result is Yellow, retry your validation attempt. There could have been connectivity issues at the time of validation attempt.
  • If the result is Light Green, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If the result is Pink, then the insurance on file is invalid.

Version 14.10
Path: Smart Toolbar > Schedule button > Tracking tab

Overview

To use the validation feature in Office Practicum, offices will need to:

  1. Enroll for Full HIPAA transactions with Office Practicum.
  2. Enroll with an integrated clearinghouse.
  3. Set up the Insurance Payer Table to use the Validation Feature.
This feature will work contingent on the proper set up of the Insurance Record, accurate Patient Information entered into the patient record, and whether the payer is supported by the clearinghouse for Real-Time Eligibility.

You can use the validation feature to: 

  • Verify an individual patient's insurance in the Add/Edit Appointment window.
  • Verify an individual patient's insurance in the Tracking tab of the Schedule and Practice Workflow window .
  • Verify insurance coverage for every patient (based on parameters set) on the schedule for a particular day. 

Verify Insurance for an Individual Patient from the Appointment

  1. Click the Sched button
  2. Navigate to the patient whose insurance you would like to validate
  3. Within the Add/Edit Appointment window, double-click the patient's appointment
  4. In the Primary Insurance section, click the Validate button 

Validation will process for the patient.

Verify Insurance for an Individual Patient from the Tracking Tab

  1. Click the Schedule button
  2. Click the Tracking tab

There are two columns that you will use to perform insurance validation.

  • Insurance Validation column : this column will populate with the color key result after validation has been performed.
  • Verify Insurance column:  this column will populate with a Verify Insurance button on each individual patient's line in the Tracking window and will be used to validate insurance for that patient.

Note: If you do not see the Ins. Valid or Verify Insurance columns in your window, it is likely the columns have been removed from view. To learn how to add columns to your view, click here.
  1. Click the Line for the patient whose insurance you would like to verify. The Verify Insurance button is displayed.
  2. Click the Verify Insurance button. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If the result is nothing or the field is White, ask the patient for updated insurance information or call the payer for further information.
  • If the result is Dark Green, the validation check has returned a valid insurance status.
  • If the result is Yellow, retry your validation attempt. There could have been connectivity issues at the time of validation attempt.
  • If the result is Light Green, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If the result is Pink, then the insurance on file is invalid.

Verify Insurance for All Patients on Schedule

  1. Follow steps 1-3 above
  2. At the top of the Tracking window, click on the Validate button

  1. In the Insurance Validation box, select your criteria and click the Begin button to start validating

  1. Validation will process and return a result in the Ins. Valid column based on the color key.
  • If nothing comes back into the system or the field is White in color, ask the patient for updated insurance information or call the payer for further information.
  • If a Dark Green color comes back into the system, the validation check has returned a valid insurance status.
  • If a Yellow color comes back into the system, retry your validation attempt.  There could have been connectivity issues at the time of validation attempt.
  • If a Light Green color comes back into the system, then there is no insurance policy to validate on file. The patient is either listed as Self Pay or the insurance was not ranked.
  • If a Pink color comes back into the system, then the insurance on file is invalid.