Add/Edit Insurance

  • Updated

You can add or update the patient's primary, secondary, and tertiary insurance information from the related treatment episode. If the patient is private pay, you can add a Private Pay effective date using the following steps, click here to learn more.

Add Primary Insurance

Use the following steps to add the patient's primary insurance or set the patient to private pay.

  1. Navigate to Patients and click on the Patient Name.mceclip2.png
  2. Click on the Intake Quick Link for the treatment episode (this automatically navigates you to the Treatment Episode > Intake tab).
  3. Open the Insurance tab. mceclip2.png
  4. Click Create Insurance Set. mceclip3.png
    • Insurance Plan Changes: If the patient’s insurance plan expires or changes during their stay, create a new insurance set with the new effective date and insurance information. Claims will be submitted to the correct payer based on matching the dates of service to the insurance sets effective dates.
    • Private Pay/Loss of Coverage: If the patient is Private Pay or loses coverage during the treatment episode, use the Set to Private Pay button and set the effective date.
  5. Enter the Effective Date and click Create.
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    • Note: If the exact effective date is unknown, ensure that the date entered is on or before the patient’s admit date. Attendance (charges) can only be recorded when the patient has an active insurance policy or is set to private pay for the specified date.
  6. Click [Create] under Primary.
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  7. Select the patient’s primary insurance carrier from the drop-down and click Select.
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    • If you can't locate the payer on in the Practice Payers list, click Add New Payer and follow the linked instructions to add an electronic payer or a paper payer
  8. Upon selection, the Primary insurance information section will automatically open.
  9. In the Payer tab, verify that the Home, Medical, and Behavioral Payer selections are correct.
    1. If there is a Medical or Behavioral carveout noted in the policy, and those claims need to be submitted to a different payer, click on the Change link.
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    2. Select the appropriate carveout payer, then click Select. mceclip11.png
    3. The selections made here determine where claims are submitted. In the example chosen here, the patient has Cigna as their Home and Medical payer and a Behavioral carveout to Beacon Health Options. 
    4. Important: Almost all BCBS claims must be submitted to the practice’s local plan, instead of the patient’s home plan. If there is not a carveout, ensure that the local is selected for both the behavioral and medical payer fields.
  10. Click Edit to add Payer Phone and Address information. mceclip13.png
    1. An address is required for claims that will go out on paper. If the address information is not entered in Practice Admin > Payers or a different address or phone number is needed, toggle off Use Practice Payer Address and complete the address information.mceclip15.png
    2. Note: Filling out address information will not automatically send claims as paper. 
    3. Click Save
  11. Next, click on the Policy Holder tab and click Edit.mceclip16.png
  12. Enter subscriber information and store a copy of the insurance card in the Policy Holder tab. At a minimum, please include Insurance ID, Group Number, and Patient Relationship to Insured.mceclip0.png
    • If the subscriber relationship is not set to "Self", please ensure the Subscriber's First Name, Last Name, Date of Birth, Gender, Address, City, State, Zip, and Phone fields are completed for accurate billing.
    • If the patient has a carveout, please make sure you document both sets of Insurance IDs and Group Numbers.
    • The Benefits Assignment drop-down indicates which entity should receive reimbursement from the payer. Filling this out does not guarantee the payer will pay to the assignee.mceclip20.png
  13. To automatically run a quick Eligibility Check, toggle on Verify Eligibility on Save.mceclip19.png
    • Note: If the toggle isn't present, the payer doesn't support electronic eligibility checks. 
  14. Document the patient's prescription insurance details on the Rx tab. Click Edit to complete the Rx details.
  15. Click Save.

If you are in the process of creating a new treatment episode for the patient, please ensure you add Diagnoses Codes once you've completed adding their insurance policy information. 

Secondary and Tertiary Policies

You can record secondary and tertiary policies using the same steps described above. The policies must be added in order, meaning the Primary must be added before the Secondary which must be added before the Tertiary.

  1. From the Insurance tab, click [Create] under Secondary. mceclip22.png
  2. The option for [Create] under Tertiary will only appear once a secondary policy is added.

Termination Dates

If you add a new Insurance Set or Set to Private Pay, the Termination Date for the previous set will automatically update to the day before the new Effective Dates. You can also manually add a Termination Date if needed by clicking [Add].

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The system will warn you if the patient has an authorization plan whose dates extend past the termination date. You will still be allowed to add treatments for authorized dates even after the insurance is termed.

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Remove Termination Date

To remove a termination date, click on the Edit icon. mceclip0.png

Delete the Termination Date field values, then click Save.
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