Change an Insurance Policy

  • Updated

During the patient's treatment episode, you may need to make updates to their insurance details. This article reviews the process for adding a new policy, managing effective dates and termination dates, and removing secondary/tertiary payers.

Add a New Policy

If the patient’s current policy terms and another policy becomes effective, add the new policy to the patient's treatment episode so claims are submitted to the correct payer.

  1. Navigate to Patients and click on the Patient Name.mceclip0.png
  2. Click on the Intake quick link for the correct treatment episode (this automatically navigates you to the Treatment Episode > Intake tab). mceclip1.png
  3. Open the Insurance tab. mceclip3.png
  4. Click [Add] in the Termination Date column. mceclip4.png
  5. Select the Termination Date and click Save.mceclip5.png
  6.  Next, click Create Insurance Set. mceclip6.png
  7. Enter the new policy's Effective Date, then click Create. It's important that the new Effective Date and the previous policy's Termination Date don't overlap, so the system understands which policy to bill for each date of service.
  8. Add the insurance using these instructions. mceclip8.png
  9. Once the policy is configured, new claims with dates of service on or after the new policy's Effective Date will be submitted to the new insurance set. Corrections will prompt to send new claims to the updated payer for all previously submitted claims with dates of service on or after the new policy effective date. So in our example, any claims with dates of service 2/2/2023 or later will be sent to Cigna, any claims for dates of service 2/1/2023 or prior will be sent to Aetna.

Changing the Effective Date

If the patient’s policy was recorded with the incorrect effective date or another policy should have been active, you can edit the Insurance Set's Effective Date and Termination Date.

  1. Navigate to the patient’s Treatment Episode > Intake > Insurance tab.
  2. Review the current policy Effective Dates. Claims will be submitted to the policy that was effective during the claim date of service.mceclip9.png
  3. Click the Effective Date to the left of the policy requiring edits.mceclip10.png
  4. Update the Effective Date and click Save.
  5. If needed, you can update the Termination Date by clicking on the [Edit] or [Add] link.mceclip12.png
  6. Update the Termination Date and click Save.

Use Effective and Termination Dates rather than Deleting Insurance Sets: Rather than deleting an insurance set that has been used to bill claims for the client, We recommend backdating the effective date of the policy to before another policy’s effective date. When an insurance set is deleted the system will prompt claim corrections for any claims previously submitted to the deleted payer. 

Removing a Secondary

If primary claims were submitted showing a secondary payer, but submissions do not need to go to the secondary, you must send a correction to the primary payer before those claims can be closed. 

  1. Navigate to the patient’s Treatment Episode > Intake > Insurance tab.mceclip0.png
  2. Click on the Secondary payer name.mceclip1.png
  3. Click Delete under the Payer tab. mceclip2.png
  4. Confirm the deletion.
  5. If primary claims were submitted while a secondary payer was entered, open the patient's Insurance Billing tab in the Treatment Episode.mceclip4.png
  6. Open the Review Corrections tab.mceclip5.png
  7. Click Check for Corrections.mceclip8.png
  8. Click Submit to confirm.
  9. When corrections populate, click Compare. The Current Value column should show that the secondary payer information is being removed from the claim.mceclip5.png
  10. Click Resolve and proceed with the process to finish correcting and submitting the claim.

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