Patient Insurance Information
The Insurance Tab is used to enter or edit any of the insurance information.
To input a patient's insurance, type in the Sequence Number (example: 1 is primary, 2 is secondary).
If known, Carrier Code can be typed in. If it is not known, F4 will pull up a lookup table for carriers. Locate carrier by code or by name, and hit the Enter key to select it.
The Insurance Carrier Maintenance Screen can be accessed from this screen; there is a "New" button at the bottom left hand corner. The "New" Button will open the insurance carrier maintenance screen; this will allow user to add a new carrier or view an existing carrier's information.
ID Nums and Coverage Tab: After the carrier is located/entered, enter the appropriate numbers in the boxes for ID#, Group#, etc. Also, fill in the Deductible, Co-Pay, and Cover %. Cover % drives a report called Patient Responsibility Estimate. Restriction Notes and General Notes are not entered from this section; these notes are created from the insurance carrier maintenance screen.
Insured Person If Not Guarantor Tab: This screen is to be used when the insured person is not the same as the guarantor for this registration.
To save the carrier information, press the F2 key or click in the next empty line directly under the Insurance Tab. If there is an additional carrier, put a 2 in the Seq# field and repeat the rest of the steps to select an insurance carrier.
Some key factors to remember when setting up a new carrier are:
Form Required - Enter UNIV90 for a 1500 form.
ID# Names - These refers to the ID# Labels; what does the carrier use to refer to the ID#?...Member #, Policy #, etc. Social Security number can be defaulted to appear in this field. After the Label for ID# Names is entered in # 1, hit Enter. The cursor will move to a single space in front of #2, and the following message will appear: "Use Soc Sec# as Default? [Y/Blank]." Enter a Y to default to Social Security Number as the ID Number.
(M)edicare or (B)lue Cross Michigan - This field is for electronic billing. If this carrier is Medicare and claims are to be processed electronically, an M has to be in this field.
Print patient balance statement before insurance pays? - If answered yes, the patient/guarantor will always receive a statement, even if an insurance carrier is responsible. If answered no, the patient/guarantor will only receive a statement when he/she is responsible.
Terms - Some contracts require that the invoices are paid within a certain amount of time and this field is only used for reference purposes.